Experts at Mediclinic Welcare Hospital shine light on the different pelvic issues women face...
18 June 2019| Last updated on 19 June 2019
Every woman who has gone through pregnancy and childbirth, and especially if she is over the age of 40, may have experienced some problems with her pelvic floor.
These problems could vary from feeling different in the vagina and vulva area during sexual intercourse to urine or bowel incontinence and feeling a lump.
In this article we briefly mention some of the most common problems and the treatments that can be offered.
Urinary incontinence presents in several types including:
- Stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh
- Urge incontinence – when urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards
- Overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking
- Total incontinence – when your bladder can't store any urine at all, which causes you to pass urine constantly or have frequent leaking
Urinary incontinence is a common problem and you should not feel embarrassed to talk about it to your doctor. It can happen due to child birth, obesity, family history or getting older. It is not normal to leak urine and you should not have to deal with these problems.
If you have any symptoms, you need assessment of your pelvic floor by an Expert Consultant Gynaecologist to give you the required management plan.
Assessment of Pelvic Floor
First, we need to examine and make sure you don’t have prolapse of bladder, bowel or the uterus. Then we would check your urine for infection and other problems and give you a bladder diary to fill for three days to assess the bladder function.
If you experience more symptoms of urgency and frequently urinating, you have an overactive bladder. There are several medications that can help, however the first step is to avoid drinking or eating any food that irritates your bladder, such as coffee, tea, green tea and citrus juice. If these measures are not helpful, a course of medication and then injection of Botox into the bladder will reduce the symptoms significantly.
If you leak with coughing, sneezing, running or lifting heavy objects, you have a weak bladder neck and stress incontinence. You can undertake a course of physiotherapy first to reinforce your pelvic floor muscles. If you still have the symptoms we can offer injection of some bulking agents (Hyaloronic acids) around the bladder neck to prevent leaking or perform a sling procedure to support the bladder neck.
Prior to the surgery you need an urodynamic test to evaluate the bladder pressures and confirm the diagnosis. Each of these procedures are very effective to relieve your symptoms and side effects are very rare. We will discuss all benefits and risks with you in detail prior to the surgery and will respect your decisions.
If you have over flow incontinence and retention of urine, you are at risk of recurrent urinary tract infection and incontinence. This is more common in elderly women and those who have a large bladder prolapse. After examination if there is a prolapse, it can be treated by non-surgical methods (such as insertion of vaginal pessary) or pelvic floor surgery.
These procedures are performed internally and you will not have any external cuts. The recovery for vaginal surgeries is usually much quicker than abdominal procedures.
If you want to avoid surgery we can guide you and teach you to empty your bladder by some special methods to avoid overflow leaking and infections.
If you suffer from difficulty to completely empty your bowel or have occasional accidents with your bowel movement, you may have a bowel prolapse (rectocele) or an anal sphincter defect due to pelvic floor damage during childbirth. You need to avoid constipation by eating a high fibre diet, drinking enough water, taking laxatives and doing sufficient exercise. There are many effective non-surgical and surgical treatments that can be done by your consultant urogynaecologist.
After childbirth and menopause the vaginal sensitivity and shape can change. This is due to a lack of the oestrogen hormone and vaginal wall laxity. Most women complain of lack of sensation during sexual intercourse and lack of orgasm.
You need to be assessed by a Consultant Urogynaecologist who can offer a range of treatments including replacement of oestrogen deficiency, pelvic floor exercises and pelvic reconstruction procedures. Treatment options such as laser vaginal tightening or surgical procedures to reinforce the vagina and correct the defects are very effective and give satisfying results to most women.
Some women have specific dissatisfaction and worry about the appearance and shape of the external genitalia and also the vagina, especially after a traumatic childbirth. It is important to seek help and advice by an Expert Urogynaecologist Consultant with experience in aesthetic gynaecology to evaluate the situation. In most cases reassurance and non-surgical methods will help. However, if required, there are several surgical methods that can be offered to help you.
Authored by Dr. Maryam Pezeshki, Consultant Urogynaecologist, Laparoscopic surgeon and Aesthetic Gynaecologist, at Mediclinic Welcare Hospital and Mediclinic Deira
Authored by Dr. Maryam Pezeshki
Consultant Urogynaecologist, Laparoscopic surgeon and Aesthetic Gynaecologist
Mediclinic Welcare Hospital and Mediclinic Deira