Alicia J Palmieri, DO, on care prior to a urogynecologist referral for pelvic floor, SUI

At the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting, Contemporary OB/GYN spoke with Alicia J Palmieri, DO, urogynecologist, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, to highlight her perspective on when to refer to a specialist for pelvic floor conditions and clinical insight to stress urinary incontinence management.

Contemporary OB/GYN:

Many patients referred to urogynecologists with pelvic floor conditions often have yet to receive treatment. What would you like to see referring clinicians initiate before that referral?

Alicia J Palmieri, DO:

Many patients that are referred to urogynecologists, although the conditions are often properly diagnosed, often many of those patients have not started on any treatment options. It would be very beneficial for patient care for patients to be started on some of the more conservative treatment options, such as pelvic floor physical therapy or behavioral modifications.

By initiating this prior to a consultation with the urogynecologist, it allows urogynecologists to start more invasive or advanced treatment options, and oftentimes, a lot of patients are adequately treated with these more conservative options. So, I would hope that more generalists would start and feel more comfortable starting these initial conservative options, with often a concurrent referral to a urogynecologist.

Contemporary OB/GYN:

How has the management of stress urinary incontinence evolved, and where does surgical intervention fit relative to the conservative pharmacologic options in the treatment landscape?

Palmieri:

Stress urinary incontinence is a condition that's very common among women, and it's very bothersome to their quality of life, it has a very negative impact on their quality of life. Something I like to tell my patients is that I want them to have all of the options, have autonomy, and have the confidence to make a decision.

Oftentimes, a lot of patients think that the only treatment option for stress urinary incontinence is surgical intervention or more invasive treatment options that have long recovery times and require surgery in the hospital, when nowadays that's actually pretty inconsistent with the treatment options that we have to offer.

I counsel all of my patients on more conservative treatment options, like pelvic floor physical therapy. There are other options that we can do in the office, like continence pessaries, and there's even a newer treatment option called intraurethral bulking with a specific bulking agent that was released in the last 10 years on the American market, and that treatment option can actually be done as a same-day procedure in the office, so patients can come to the office and drive themselves home with no recovery time following that.

There are surgical, more invasive surgical options, but a lot of times patients like to start with those least invasive options, and a lot of them, before they come to my office, aren't even aware that there are these options available.