Urogynaecology

Urogynaecology is a subspecialty of gynaecology that focuses on the diagnosis and treatment of urinary incontinence and female pelvic floor disorders.

It includes the assessment, investigation, and treatment of women with urinary and faecal incontinence, female pelvic floor disorders, uterine prolapse, recurrent urinary tract infections, and bladder pain.

The main pelvic health conditions you would seek urogynaecology services include:

• Urinary incontinence – urine leakage when you cough, laugh or sneeze.
• Overactive bladder – urine leakage as well as frequent, intense urges to urinate.
• Bowel control disorders – includes constipation, bowel leakage or faecal incontinence.
• Pelvic organ prolapse – is when pelvic organs (bladder, vagina, and uterus) drop due to a loss of support.

A urogynaecologist is a specialist who has completed training extra training in both gynaecology and urology. As they have training in both specialties, they are particularly skilled to help women with conditions that affect their pelvic floor and continence.

A urogynaecology service sees women who are experiencing pelvic floor problems. These can include leakage of urine, problems relating to an overactive bladder, painful bladder syndrome, pelvic organ prolapse (bladder, vagina, and uterus), and recurrent urinary tract disorders.

A pelvic floor is a group of muscles that support the bladder, bowel, and uterus in women. These muscles help support the spine, maintain bladder and bowel control, prevent prolapse and play an important role in sexual function. The pelvic floor can be weakened by pregnancy, childbirth, obesity, lifting and exercise that overload the pelvic muscles, menopause, ageing, chronic coughing, and the straining of chronic constipation.

A urogynaecology service can include the evaluation, diagnosis, treatment, and management of pelvic floor conditions.

Urogynaecology investigative and diagnostic tests include cystoscopy, uroflowmetry, and urodynamics.

Treatment for pelvic floor conditions include:

• Behavioural therapy—relaxation techniques, pelvic floor muscle training with specialist physiotherapists, and dietary changes can help manage symptoms.
• Vaginal pessaries— are soft, flexible devices placed in the vagina to help support the bladder, vagina, uterus, and/or rectum.
• Medications—drugs and topical medications may be a treatment option.
• Surgery—ranges from minimally invasive and laparoscopic procedures to reconstructive surgery, depending on the woman’s condition. Surgery can rebuild pelvic floor support, repair prolapse, insert vaginal tape and mesh for urinary leakage, repair damaged anal or sphincter muscles, and may remove the uterus (hysterectomy).

The occurrence of pelvic disorders is high. Yet many women endure these painful, embarrassing, or life-restricting symptoms that are too often passed off as being 'normal' features of ageing and childbirth.

Urogynaecology is important as its primary focus is on quality of life and supporting women with pelvic floor muscle problems. It is also important as it provides unique expertise in obstetrics, urology, and gynaecology and a vital link with obstetrics, urology, and colorectal services.

There are classic symptoms of a prolapsed bladder, also known as a cystocele or a dropped bladder.

These include:

• Feeling or seeing a bulge through your vaginal opening. This is the most common symptom.
• Problems passing urine – such as a slow stream, a feeling of not fully emptying your bladder, needing to urinate more often, and leaking urine when you cough, sneeze or exercise (stress incontinence).
• Frequent urinary tract infections.
• Feeling of fullness, heaviness, or pain in your pelvic area or lower back, that may get worse with standing, lifting, coughing, or as the day goes on.
• Uncomfortable or painful sex.
• Problems inserting tampons or applicators.

The costs of a urogynaecology will depend on the investigative tests required, the condition you are diagnosed with, the exact surgery required, and your Ramsay hospital of choice.

You will receive a formal quotation price after your consultation with one of our expert urogynaecologists. This formal quote for your procedure will be valid for 60 days. You can rest assured that it includes unlimited aftercare.

We have a number of finance options if you are paying for your tests or treatments yourself. These include:

• Interest-free finance - no deposit required and the option to make monthly instalments at 0% interest.
• All-inclusive Total Care - a one-off payment for all the treatment you need at a pre-agreed price.
• Pay as you go – a flexible funding option if your treatment costs are difficult to assess or you want to pay for your treatment costs as and when they arise.
• Urogynaecology is covered by most medical insurance policies. We advise that you obtain written confirmation from your insurance company before having your procedure.

The recovery process of a urogynaecology procedure will depend on your health condition and the procedure you are having done.

If you have a flexible cystoscopy, you can go home shortly afterward and return to your normal activities including work and exercise as soon as you feel able to.

A vaginal pessary is fitted by a urogynaecologist or nurse and women don’t usually require recovery or experience pain.

Recovery from anal sphincterotomy takes roughly six weeks to fully heal. Patients return to work within a couple of weeks. Painkillers can help with pain and this should ease after a few days. Patients may worry about bowel movements which can initially cause some pain.

Pelvic organ prolapse surgery performed using open surgery can take up to six weeks to recover. If you have keyhole surgery, your recovery may be reduced to one to two weeks.

You will be invited for a follow-up appointment to check your recovery after surgery.