Urogynaecology

What is Uterine and Pelvic Floor Prolapse?

Uterine and pelvic floor prolapse occurs when the muscles and ligaments supporting the pelvic organs weaken. This can cause the uterus, bladder, or rectum to slip out of place and press into the vagina. Prolapse is common and can affect women of all ages, particularly those who have had multiple childbirths, are postmenopausal, or have a history of heavy lifting.

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Types of Prolapse:

• Uterine Prolapse: The uterus descends into the vaginal canal.

• Cystocele (Bladder Prolapse): The bladder bulges into the front wall of the vagina.

• Rectocele (Rectal Prolapse): The rectum pushes against the back wall of the vagina.

• Enterocele: The small intestine presses against the upper part of the vaginal wall.

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Symptoms:

• A feeling of heaviness or pressure in the pelvis

• A bulge in the vagina that may be felt or seen

• Discomfort or pain during intercourse

• Difficulty emptying the bladder or bowel

• Lower back pain

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Causes:

• Childbirth (especially vaginal delivery)

• Aging and menopause (due to decreased estrogen)

• Chronic coughing or straining (e.g., from constipation)

• Obesity

• Previous pelvic surgery

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Diagnosis:

Diagnosis is made through a physical examination and may include imaging tests such as ultrasound or MRI.

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Treatment Options:

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• Lifestyle Changes: Weight loss, avoiding heavy lifting, and managing constipation.

• Pelvic Floor Exercises (Kegels): Strengthen the muscles supporting the pelvic organs.

• Pessaries: A device inserted into the vagina to support the organs.

• Surgery: Options include vaginal repair procedures or a hysterectomy, depending on the severity.

 

When to See a Doctor:

If you notice symptoms like a bulge in your vagina, pelvic pressure, or discomfort, it is important to seek medical advice.

What is Female Urinary Incontinence?

Female urinary incontinence is the involuntary leakage of urine, which can range from a small amount to a significant volume. It is a common condition that can affect a woman's daily life and emotional well-being.

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Types of Urinary Incontinence

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• Stress Incontinence: Leakage of urine during physical activities that put pressure on the bladder, such as coughing, sneezing, laughing, or exercise.

• Urge Incontinence: A sudden, intense urge to urinate followed by involuntary leakage. It is often associated with overactive bladder.

• Mixed Incontinence: A combination of stress and urge incontinence.

• Overflow Incontinence: Leakage due to a bladder that does not empty completely, often resulting in dribbling of urine.

• Functional Incontinence: When physical or cognitive impairments prevent a person from reaching the toilet in time.

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Symptoms

Symptoms of urinary incontinence may include:

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• Involuntary leakage of urine

• Frequent or urgent need to urinate

• Difficulty starting or maintaining a steady stream of urine

• Feeling of incomplete bladder emptying

• Nighttime urination (nocturia)

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Possible Causes

Urinary incontinence can be caused by various factors, including:

• Pregnancy and Childbirth: Weakened pelvic floor muscles and tissues.

• Hormonal Changes: Changes during menopause can affect bladder control.

• Aging: Natural aging process can weaken the bladder and pelvic floor muscles.

• Obesity: Excess weight can put pressure on the bladder.

• Chronic Coughing: Conditions like chronic bronchitis or smoking-related cough can contribute to stress incontinence.

• Neurological Conditions: Conditions such as multiple sclerosis or stroke can affect bladder function.

• Medications: Some medications can cause or worsen incontinence.

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Diagnosis

To diagnose urinary incontinence, your gynaecologist may perform:

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• Medical History and Physical Examination: Discussing your symptoms and conducting a physical exam.

• Urinalysis: To check for infections or other abnormalities.

• Bladder Diary: Recording your urinary patterns and fluid intake.

• Urodynamic Testing: To assess how well the bladder and urethra are functioning.

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Treatment Options

Treatment for urinary incontinence depends on the type and severity and may include:

• Lifestyle Modifications: Weight management, fluid management, and avoiding bladder irritants.

• Pelvic Floor Exercises: Strengthening exercises, such as Kegel exercises, to improve muscle control.

• Medications: Drugs that help manage symptoms or improve bladder control.

• Bladder Training: Techniques to increase the time between urinations and improve bladder control.

• Devices: Pessaries or other devices to support the bladder and urethra.

• Surgery: Surgical options may be considered if other treatments are ineffective. Procedures may include sling procedures or bladder neck suspension.

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Living with Urinary Incontinence

Managing urinary incontinence often involves a combination of lifestyle changes, medical treatments, and coping strategies. Regular follow-up with your healthcare provider is important to monitor symptoms and adjust treatment plans as needed.

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When to See a Doctor

Consult your gynaecologist if you experience urinary incontinence symptoms that affect your quality of life. Early evaluation and treatment can help improve symptoms and prevent complications.

 

For more information, please contact our office.