Urogynaecology
Urinary incontinence and bladder problems not only affect elderly women but bladder and pelvic floor health issues are also common among younger, more active women as well. Many women in their 20's and 30's have experienced some form of incontinence.Many women feel too embarrassed to seek treatment, suffering in silence but rest assured that this is a common issue for women and getting treatment can be life changing. For women affected by urinary incontinence, daily tasks may become more difficult, since coughing, laughing or sneezing may trigger an accident. Simple solutions and enhanced treatments available for these disorders can correct this and give you your confidence back.
What are Bladder and Pelvic Floor Disorders?
Bladder and pelvic floor disorders, also known as urogynecologic disorders, include any pain or dysfunction in the area of the uterus, cervix, vagina, bladder or rectum. The primary types of bladder and pelvic floor disorders are:
Urinary incontinence - two main types of urinary incontinence are:
Stress Incontinence - Tiny leaks that occur when motion stresses the bladder. These motions may include coughing, sneezing or laughing.- Urge Incontinence - Also called "overactive bladder," this is the urgent need to go to the bathroom followed by an involuntary loss of urine.
- Pelvic organ prolapse - described as a fallen bladder, uterus, vagina or rectum
- Fistulas - vesicovaginal or rectovaginal - an opening between the wall of the vagina and the wall of the bladder or rectum which can lead to urine leakage
- Complex benign conditions of the vagina and urethra such as vaginal cysts, absence of vagina, and urethral diverticulums
- Other problems with urination or pelvic floor
Urogynecologic problems can affect women of any age but the condition is most common in women who are post-menopausal and those who have given birth. Pregnancy and childbirth can damage the tissues supporting the pelvic organs, while bladder support naturally weakens as we get older. These factors can lead to weakened supportive tissue and damage to the nerves that control bladder function.
Diagnosis and Evaluation
Diagnostic and therapeutic options are tailored to your needs. You can rest assured that your evaluation will be in a comfortable and friendly environment to put you at ease.
Your evaluation may include:
- History and physical examination - The first visit consists of an interview and consultation followed by a physical exam and pelvic exam. Following the exam, specialised testing may be recommended.
- Urine examination - A urine analysis and culture are performed to detect infection, inflammation, blood or other underlying kidney problems.
- Cystoscopy - This test enables a view directly inside the bladder through a small camera inserted through the urethra. It is a common test used to detect inflammation, stones or tumors.
- Multi-channel urodynamics - Urodynamic testing evaluates the bladder's function. These tests are particularly useful for women with urinary incontinence or urinary frequency.
- Electrodiagnostic testing (EMG) of the pelvic floor - This testing evaluates nerve function of the pelvic floor. EMG determines the pelvic floor's muscle response to a series of small electrical impulses.
Behavioural Therapy
Behavioural therapy is safe, easy to learn, and does not have side effects. Examples of behavioural therapy are:
- Pelvic Muscle Training - Regularly practicing pelvic muscle (Kegel) exercises to help muscle control and manage leakage
- Bladder Training - Lengthening the time between trips to the bathroom to train the bladder to help women with urge incontinence
- Relaxation Exercises - Breathing slowly and deeply when the urge strikes
- Fluid and dietary modification - For example, decreasing daily caffeine intake to help reduce or eliminate urine leakage
Pessaries and other devices can be used to treat some conditions as a safe alternative to surgery. Medications are available to treat a variety of urogynecologic problems.
Surgery
In some cases surgical treatment may be the recommended option for treatment. vaginal surgery and abdominal surgery is usually minimally invasive with quick recovery times.
- Minimally invasive surgery for stress incontinence - This surgery includes transvaginal slings ("tapes"), fascial slings and collagen injections.
- Minimally invasive surgery for urge incontinence: This technique electrically stimulates the sacral nerves that influence the behaviour of the bladder, urinary sphincter and pelvic floor. It is an outpatient procedure, performed in two stages and is highly effective, safe and well tolerated.
- Laparoscopic surgery - A surgery performed via small incisions using specially designed surgical instruments and viewed through a laparoscope, or surgical telescope. This surgery can be used to treat a prolapsed uterus.
- Pelvic reconstructive surgery - If your condition permits, urinary incontinence or pelvic organ prolapse can be repaired through the vagina with no visible abdominal incisions. For advanced conditions, abdominal surgery may be recommended.