Common Urogynaecology Conditions
The conditions that we commonly treat include:
This is the leakage of urine with some form of exertion eg. coughing, sneezing, laughing, bending, running, jumping. Usually caused by pregnancy, childbirth, chronic cough, obesity and it often worsens with time.
Treatment for most women should begin with pelvic floor exercises, which ideally should be commenced during a woman's first pregnancy. Not everyone finds it easy to contract these muscles, especially when they have been weakened by vaginal births. You can read the information leaflet about pelvic floor exercises. We strongly advise that you have a simple examination by a doctor/ nurse / physiotherapist to check that you are performing these exercises correctly. Women whose pelvic floor strength is very poor are likely to benefit from the help of a physiotherapist. Various devices exist that can help a woman perform the exercises correctly.
Despite performing these exercises, many women with troublesome stress incontinence will eventually consider having an operation. The most commonly performed operation is the Tension-free Vaginal Tape (TVT) procedure. This minimally invasive operation has revolutionised the treatment of stress incontinence over the past 15 years. This operation is usually performed as a day case procedure and most women can return to work after 2 weeks. Other treatments for stress incontinence include urethral bulking agents and Colposuspension. Please see our leaflets.
This is a common condition which becomes more common with advancing age but can also affect children. Sufferers usually have a varying combination of frequency (passage of urine 8 or more per day), nocturia (waking due to the desire to pass urine more than once per night), and urgency (sudden strong desire to pass urine). Leakage, often heavy, accompanied by urgency is called urgency incontinence. It is important to exclude cystitis in women with these symptoms. Treatment involves a sensible control of fluid intake, avoidance of caffeine and other fluids which can irritate the bladder, bladder retraining and drug therapy. If these treatments fail we can then offer Botox to the bladder or neuromodulation.
A prolapse is due to a weakness in the pelvic floor tissues which causes a bulge in the vagina. The feeling of a lump at the entrance to the vagina is the most common symptom. The symptoms of prolapse are worse when a woman has been on her feet for some time, especially with lifting and after physical exercise. A prolapse can interfere with the bladder, bowel and with sexual intercourse, and may involve the womb (uterus) alone, the vaginal walls, or both the womb and the vaginal walls. There are different types of vaginal prolapse: cystocele, rectocele, enterocele, uterine and vaginal vault prolapse.
NICE recommends first line treatments including supervised pelvic floor exercises for twelve weeks with a physiotherapists. Other conservative options include vaginal ring pessaries to provide support for a prolapse. If these treatments are not successful in alleviating symptoms, surgery may be considered.
The surgery that is performed will depend on the type and severity of prolapse.
Please see the leaflets regarding these
Bladder Pain Syndrome
This is a troublesome condition and symptoms include cystitis, dysuria, frequency, urgency, blood in the urine and fever. A significant number of women will develop cystitis at some point during their lifetime but frequent episodes warrant investigation. Cystitis occurs more frequently in women, during pregnancy, in diabetics and in women who have a catheter inserted into their bladder. Many women may benefit from a prolonged course of low dose antibiotics. Bladder pain syndrome is a poorly understood condition where women complain of pain in the region of their bladder, which worsens as their bladder fills up. Affected women pass urine frequently, their bladder only holding small volumes. Diagnosis is made on the basis of symptoms and cystoscopy findings. It can be treated with tablets and / or bladder instillations. Further information can be found from the Bowel and Bladder Foundation.
Getting up at night to pass urine has several
causes. Most people pass less than a third of their total 24 hour output of
urine during the night (the urine sample produced on waking in the morning must
be included with the night time volume). People who produce excessive urine
overnight usually do so because of ankle oedema (swelling). This fluid moves from the ankles when lying down, returns to the bloodstream and is excreted by
the kidneys/bladder. The treatment of nocturia in this situation is the
treatment of the ankle oedema.
Women who produce small volumes of urine when they wake may have overactive bladder, urinary infection or chronic urinary retention. Women who sleep poorly will often go to the toilet when they wake out of habit - this is different from being woken by the need to pass urine.
Difficulty Passing Urine
This may be experienced as difficulty starting the flow of urine, a slow stream, a sensation of incomplete bladder emptying or a desire to return to the toilet soon after passing urine. Women in whom the bladder does not empty completely may develop cystitis symptoms. Incontinence can also result. Causes include prolapse of the bladder (cystocele), previous surgery for stress incontinence or prolapse and an underactive bladder (detrusor hypotonia). Cystocele can be treated with a pessary device or surgery. Women with an underactive bladder may need to consider performing intermittent self-catheterisation. For many women this technique is easy to learn and may need to perform it two or three times per day. The Specialist Nurses will give full instruction and support.