Urogynaecology focuses on pelvic floor disorders.
Pelvic floor function, anatomy, and function are all affected by the pelvic floor in women. The pelvic floor supports organs such as uterus, bladder, rectum, and vagina.
Most women are at risk for developing pelvic floor problems at various stages of their lives when their pelvic floor is weakened and damaged by pregnancy, childbirth, ageing, and menopause. The health effects of pelvic floor disorders if left untreated can be quite significant.
It is important to note that many women can suffer from different types of pelvic floor disorders at different stages of their lives, or more than 1 type of pelvic floor disorders at any 1 time. A urogynecologist is a more qualified specialist who has specific expertise in diagnosis, investigation, and treatment of women’s pelvic floor disorders than a general gynecologist.
Common pelvic floor disorders include:
Pelvic organ prolapse (POP)
It refers to a drooping of the uterus, the bladder, or the rectum into and beyond the vaginal opening. The condition affects one in three women who have had children. It is more common in older women. One in 10 women will require surgery in their lifetimes.
It is primarily caused by weakened pelvic floor muscles caused by damage sustained during pregnancy and childbirth, as well as by aging and menopause. Chronic strain on pelvic floor muscles can also cause POP, as can obesity, coughing, constipation, and jobs that require heavy lifting or long hours. POP is characterized by feeling a lump in the vagina, or a heavy dragging sensation, bleeding after menopause, urinary issues, constipation, or painful sex.
POP can be treated non-surgically or surgically. You can perform Kegel exercises to strengthen weak pelvic floor muscles, make lifestyle changes, and use vaginal pessaries (which are soft, removable devices that are inserted into your vagina to support your prolapsed organs) as non-surgical alternatives. An urogynaecologist will perform surgery for pelvic organ prolapse based on the severity of the condition, your age, general health, medical conditions, surgical history and sexual activity.
Urinary incontinence
Under various circumstances, one leaks urine involuntarily. The urge to go to the toilet may arise when you are physically exerting yourself e.g. laughing, coughing, sneezing, running, jumping, or when you feel the urge but are unable to make it there in time. The problem can occur at any age, including in young women, during pregnancy and after childbirth, all the way up to women going through menopause.
Incontinence is caused by weakened pelvic floor muscles (damage sustained during pregnancy and childbirth, weakening from aging and menopause, obesity), weakened bladder muscles (from aging and nerve damage), and medications. Coffee, certain illnesses, and smoking make urinary incontinence worse.
Often, treating urinary incontinence involves conservative lifestyle changes such as managing weight, eating a healthy diet, adjusting fluid intake, cutting back on caffeine, doing bladder exercises, taking scheduled bathroom breaks, avoiding constipation, and Kegel exercises. Your urogynecologist may recommend surgery in certain cases.
Overactive bladder (OAB)
It happens when you feel the urge to urinate and need to visit the toilet frequently. This occurs at night while you are sleeping, and is known as nocturia. You may find that your life revolves around the toilet as this can be disruptive to your work and social life.
OAB is caused by the bladder muscles trying to empty urine that isn’t there. An infection of the urinary tract (UTI) can often cause this. Alternatively, it may result from nerve damage caused by old age, diabetes, stroke, dementia, etc. Medications and caffeine may also contribute.
Changing one’s lifestyle is the first-line treatment for OAB, like treating urinary incontinence. It is usually necessary to prescribe medications for OAB in addition to the lifestyle changes mentioned above. By relaxing your bladder muscles, you can increase the time between passing urine. Additionally, Botox injections into the bladder (which are done under general or local anesthesia) and nerve stimulation are 2nd line invasive options. They are only given to women who have not improved after trying all other measures, and usually need to be repeated six months later.