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Pelvic Floor and Bladder Health (Urogynaecology)

  • What is Urogynaecology?

    Pelvic floor

    The pelvic floor is the combination or muscles, connective tissue, ligaments and nerves that function to support and control the uterus, vagina, bladder, and rectum. Occasionally, repeated heavy lifting, chronic disease, surgery, or childbirth may damage the pelvic floor. Pelvic floor dysfunction affects women of all ages, and encompasses a variety of conditions such as urinary tract infection, pelvic organ prolapse, or lower bowel problems.

    Urogynaecology is a subspecialty combining urology and gynaecology to help women treat pelvic floor dysfunction. In this page, we explore the common pelvic floor dysfunctions affecting women and the treatment options available.

  • Urinary Tract Infections (UTIs)

    Woman with lower abdomen pain

    Urinary tract infections (UTIs) occur when the urinary tract becomes infected, usually caused by bacteria that enters the urinary tract via the urethra. UTIs affect women more than men, with more than 50% of women experiencing at least one UTI in their lifetime. Though most of these infections are treatable with medication, UTI may recur within six months after the initial episode, usually due to infection by a different bacteria or due to the suppressing effect of treatment wearing off.

    It is important to be aware of the signs and symptoms of UTI. If left untreated, UTI may lead to infection of the kidneys or even more severe health complications. In this section, we look at the signs and symptoms, the risk factors, as well as treatment options available.

    References:

    Griebling TL. Urinary tract infection in women. In: Litwin MS, Saigal CS, eds. Urologic Diseases in America. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, D.C.: GPO; 2007. NIH publication 07–5512:587–619.

    Signs & Symptoms

    Infections of the urethra or the bladder are known as lower UTIs. Symptoms of lower UTI include:

    • Pain or burning during urination
    • Feeling of inability to empty bladder fully
    • Needing to pee more often than usual
    • Sudden urges to pee
    • Pain in lower part of belly
    • Cloudy or blood within urine
    • Pain during sexual intercourse

    If lower UTI is not treated promptly, it may lead to infections of the ureters or kidneys, known as upper UTI. Symptoms of upper UTI include:

    • Pain in back or side area
    • Fever or chills
    • Malaise

    UTI should not be taken lightly and you should seek prompt medical attention. Talk to your urogynaecologist to find out more.

    Risk Factors

    Certain factors increase the risk of having urinary tract infection (UTI). These include:

    • Multiple sexual partners
    • Frequent or intense intercourse
    • Diabetes
    • Usage of birth control pills
    • Blockage in urinary tract
    • Incontinence
    • Having a history of UTIs

    Talk to your urogynaecologists to find out if you are at risk of contracting urinary tract infection, and the prevention methods one should take.

    Diagnosis & Treatment

    Your urogynaecologist will perform a medical history and physical examination to check if there are any changes to your abdomen or kidneys. Certain tests such as urine tests may be prescribed.

    Treatment depends on severity of the infection and may include medication of lifestyle changes. Talk to your urogynaecologist to understand more.

  • Urinary Incontinence & Voiding Dysfunction in Females

    Woman with lower abdomen pain

    The bladder and urethra is located at the lower urinary tract, and functions to store and expel urine in a timely manner. Urinary incontinence is when there is poor coordination between the bladder muscle and the urethra, usually leading to urine leakage with activities such as laughing, coughing, or exercising. This could be due to nerve disorder, an overactive bladder, or imbalance between bladder contraction and urethral resistance.

    Voiding dysfunction may lead to a complete loss of bladder control, depending on the extent to which bladder control is affected. In this section, we look at the common signs and symptoms, and the treatment options available.

    Signs & Symptoms

    Common symptoms of urinary incontinence include, but are not limited to:

    • Frequent urination
    • Weak stream when urinating
    • Needing to urinate at night (nocturia)
    • Difficulty initiating urination
    • Feeling of incomplete emptying of bladder

    Depending on the extent to which bladder control is infected, urinary incontinence may lead to total loss of bladder control. If you experience any of the above symptoms, talk to your urogynaecologist. Prompt diagnosis will help in preventing any potential health complications.

    Diagnosis & Treatment

    Your urogynaecologist will look into your medical history and conduct a physical examination. At times, tests may be prescribed including:

    • Blood tests
    • Urinalysis
    • Cytoscopy
    • Bladder scan
    • Radiology imaging, such as ultrasound, CT scan, or MRI

    Depending on your medical assessment and condition, your urogynaecologist may recommend treatment in the form of rehabilitation, medication, or surgical intervention. Consult your urogynaecologist to find out more.

    References:

    Robinson D, Staskin D, Laterza RM, Koebl H. Defining female voiding dysfunction: ICI-RS 2011. Neurourology and urodynamics. Mar 2012;31(3):313-316.

  • Pelvic Organ Prolapse

    Woman with low backache

    The pelvic organs consist of the uterus, bladder, and rectum, which are held in place by pelvic tissues and pelvic floor muscles. Due to childbirth, weakening muscles, heavy lifting, chronic coughing, or surgery, there are times when a pelvic organ such as the bladder drops from its normal place and pushes against the wall of the vagina. This is known as pelvic organ prolapse, and may cause discomfort or pain. More than one organ may prolapse at the same time, which include the bladder, urethra, uterus, vaginal, small bowel, or rectum.

    Signs & Symptoms

    Early onset of pelvic organ prolapse may not bring about any symptoms. When a prolapse is further down, common symptoms include:

    • Pain during sexual intercourse
    • Weak or intermittent urine stream
    • Reoccurring urinary tract infections (UTIs)
    • Heavy sensation felt in the vagina
    • Bulging lump in the vagina or at vaginal entrance
    • Feeling of incomplete bladder emptying
    • Frequent urination
    • Dull backache

    If you experience any of the above symptoms, seek medical attention promptly. It is important to consult with a urogynaecologist to understand the treatment and management of the condition.

    Diagnosis & Treatment

    Your urogynaecologist will take your medical history and perform a physical examination. Further tests may also be recommended for a full investigation.

    Treatment depends on the type of prolapse, the woman's age, childbirth plans, as well as severity of the condition. In certain cases, lifestyle changes and pelvic floor exercises may be recommended. If non-surgical treatment does not provide sufficient relief from symptoms, surgical intervention may be required. With the advancement of medical technology, minimally invasive surgical techniques are now available which offers minimal scarring and faster recovery time. Talk to your urogynaecologist to find out more.

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