Urogynaecology focuses on pelvic floor disorders.
The pelvic floor in women is important as it helps the pelvic organs such as the uterus, bladder, rectum and vagina to be supported both in terms of anatomy and function.
It is typically weakened and damaged from pregnancy, childbirth, ageing and menopause – hence most women are vulnerable to developing problems associated with their pelvic floor in various stages of their life. Pelvic floor disorders, if left untreated, can reduce your quality of life and affect your relationships significantly.
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. If you suspect that you may be having a pelvic floor disorder, it is best to consult a urogynaecologist as opposed to a general gynaecologist, as he/she is a trained specialist with specific expertise in diagnosis, investigation and treatment of women’s pelvic floor disorders.
Common pelvic floor disorders include:
Pelvic organ prolapse (POP)
This refers to a drooping of the uterus, bladder or rectum into and beyond the vagina. It is more common in older women, affecting 1 in 3 women who have had children. 1 in 10 women will need surgery in their lifetime for POP.
The main cause of POP is weakened pelvic floor muscles from damage sustained during pregnancy and childbirth as well as weakening from ageing and menopause. Another major cause of POP involves chronic increased pressure on pelvic floor muscles e.g. obesity, chronic cough, chronic constipation, jobs that involve heavy lifting/straining. Symptoms of POP include feeling a lump in the vagina, or a heavy dragging sensation, bleeding after menopause, urinary issues, constipation or painful sex.
Treatment options for POP include non-surgical and surgical. Non-surgical options include Kegel exercises to strengthen the weakened pelvic floor muscle tone, lifestyle changes and vaginal pessaries (which are soft, removable devices that is inserted in your vagina to support your prolapsed pelvic organs). Surgery for POP is individualised and performed by a urogynaecologist who will advise you based on the severity of your pelvic organ prolapse, age, general health, medical conditions, surgical history and sexual activity.
Urinary incontinence
This is when one leaks urine involuntarily under various circumstances. This can include when you are physically exerting yourself e.g. laughing, coughing, sneezing, jogging, jumping, or when you feel the urge to go to the toilet but are unable to make it there in time. This can occur even in young women e.g. during pregnancy or shortly after childbirth, all the way to menopausal women.
The causes of urinary incontinence include weakened pelvic floor muscles (damage sustained during pregnancy and childbirth, weakening from ageing and menopause, obesity), weakened bladder muscles (from ageing and nerve damage), medications. Factors that worsen urinary incontinence include caffeine, certain medical conditions and smoking.
Treatment for urinary incontinence often involves conservative lifestyle changes including maintaining a healthy weight, adjusting diet or fluid intake, cutting down on caffeine, bladder training, taking scheduled toilet breaks, avoiding smoking and constipation, Kegel exercises. In certain cases, surgery may be recommended by your urogynaecologist.
Overactive bladder (OAB)
This is when you find yourself feeling the urge to urinate and needing to visit the toilet frequently. If this happens at night while you are sleeping, it is termed nocturia. This can be disruptive to your social activities and work as you may find your life revolving around the toilet.
The main cause of OAB is bladder muscles squeezing to try and empty urine out when you don’t intend to. Sometimes this can be caused by a urinary tract infection (UTI) that goes away after some time. In other cases, this can be caused by damage to the nervous system e.g. older age or medical conditions such as diabetes, stroke, dementia etc. Other causes include weakened pelvic floor muscles, medications and caffeine.
Treatment of OAB involves first-line lifestyle changes similar to that of urinary incontinence. Medications for OAB can usually prescribed in addition to the lifestyle changes above. These relax your bladder muscle and allow you to increase the intervals that you need to pass urine. Finally, 2nd line invasive options include Botox injection into the bladder (this is done through a scope into the bladder under local or general anaesthesia) and nerve stimulation. These are reserved for women who have failed to improve despite all measures and usually need to be repeated as their effects last for 6 months.
Dr Ng Kai Lyn [MBBS (Singapore), MMed O&G (Singapore), MRCOG (UK)] is an obstetrics and gynaecology specialist currently practicing at the Advanced Centre of Reproductive Medicine at Gleneagles Hospital. She is also the founder of https://GynaePatientInfo.com, a patient resource site for obstetrics and gynaecological issues.
Article by: Ng Kai Lyn June 11, 2021