01. What is Urogynecology?
Urogynecology is a new subspecialty that deals with pelvic floor problems in women. Pelvic floor problems include Urinary Incontinence, Prolapse, Faecal Incontinence, Sexual Dysfunction and Pelvic pain.
02. Who is a Urogynecologist?
Urogynecologists are fellowship trained doctors Urologists/Gynecologists/Surgeons who spend a good number of years training in treating pelvic floor problems in women. These subspecialists/superspecialists train doing the same procedures over and over again till they can do it better than anyone else.
03. How common is urinary incontinence among women?
Urinary incontinence is a chronic condition with little tendency to go away without treatment. A staggering 25-70% of women suffer from urinary incontinence and this is data from the west. It is estimated that women have an estimated 11% lifetime risk of undergoing surgery for incontinence.
04. What causes urinary incontinence?
Urinary Incontinence in women arises out of damage to the pelvic floor. A variety of conditions like vaginal delivery, removal of the uterus, previous surgery in the pelvis, chronic constipation, asthma, nerve problems may be responsible for weakening the floor and may result in incontinence.
05. What is interstitial cystitis? What kind of treatment is there for interstitial cystitis?
Interstitial cystitis (IC) is a condition that causes discomfort or pain in the bladder and the surrounding pelvic region. Patients may have Pain, frequency, urgency or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. There may be pain during vaginal intercourse. IC is usually a differential diagnosis to chronic pain syndromes that presents with severe urinary symptoms. IC is not an easy condition to treat. A combination of treatments from bladder distension, injections into the bladder, drugs are available.
06. What treatment options are available?
Interstitial cystitis (IC) is a condition that causes discomfort or pain in the bladder and the surrounding pelvic region. Patients may have Pain, frequency, urgency or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. There may be pain during vaginal intercourse. IC is usually a differential diagnosis to chronic pain syndromes that presents with severe urinary symptoms. IC is not an easy condition to treat. A combination of treatments from bladder distension, injections into the bladder, drugs are available.
07. I’ve heard that surgery doesn’t work for very long. Is that true? How can I prevent this problem?
That’s not true. The minimally invasive slings for urinary incontinence have success rates that range from 80-90% over a period of 13yrs. Some basic donts would be to refrain from activities that increase intra-abdominal pressure like weightlifting, constipating and to do regular pelvic floor exercises.
08. What does “prolapse” mean? What symptoms are caused by my prolapse?
The word “prolapse” in Latin means to “fall”. In Prolapse, the pelvic organs like the uterus, the bladder and bowel fall from their original position. Women with Prolapse may complain of heaviness, a dragging sensation between the thighs, difficulty in emptying bladder or bowel, and urinary/faecal incontinence.
09. Why did this happen to me? Did I do something to cause this problem?
You are not alone in thinking that. UI affects 40% of women who have had a vaginal delivery and hence pelvic floor dysfunction is almost ubiquitous. If you are an asthmatic, obese, or had undergone surgery in the pelvis or suffer from constipation there is an increased risk. Old age and menopause also predispose.
10. Do I need to have surgery for my prolapse? If I choose to use a pessary, won’t that give me an infection?
Mild to moderate prolapse can be treated by conservative measures like pelvic floor muscle exercises. Severe prolapse usually requires surgery. However, in women who cannot undergo surgery immediately due to several limiting factors, a pessary might be the best bet. A properly maintained pessary will not lead to infection.
11. What will happen if I just ignore this problem? Will it get worse?
Prolapse or urinary incontinence usually worsen with time if the risk factors are not corrected.
12. If I decide to have surgery, what can I expect during the recovery period?
Most surgeries at our institute are done on a day care basis. Hence the pain and discomfort in the postoperative period is usually kept to a minimum. A catheter with a urinary bag is usually left in place for the first 24 hrs and then removed.
13. I have prolapse, but I don’t leak urine. Do I still need bladder testing?
As the pelvic floor is a common denominator for the bladder, bowel and the uterus any problem affecting the bladder will affect the bowel and the uterus as well. Hence about 50% of patients who have prolapse will have incontinence. Sometimes when the prolpase is huge it might kink the urine tube and mask the incontinence. Hence it is important for patients with prolpase to get checked for incontinence.
