Urogynaecology
Overactive bladder, bladder weakness, bladder infection or organ dropping are common problems among women – however, very few women talk openly about them and do not trust their doctor, even though the above-mentioned symptoms can cause a high degree of suffering and impose significant restrictions on everyday life.
Urogynaecology services
The field of urogynaecology is an important branch of gynaecology. Urogynaecology deals with the different forms of urinary incontinence as well as dropping or prolapses of the rectum, uterus, vagina and urinary bladder. A urogynaecological consultation therefore focuses on problems of urinary incontinence – i.e. the involuntary release of urine in connection with physical exertion or when laughing, coughing, sneezing – and the dropping of the female genitals (e.g. the dropping or prolapse of the uterus and/or the vagina).
However, even during urogynaecological consultations, many of those affected do not have the courage to talk openly about their problem. On the contrary, they prefer to avoid certain situations or even give up their hobbies because of these issues. This is mainly due to the fact that most women feel that they are “not really ill,” and therefore cannot be helped. However, this is not true, as there are many effective therapies that can help women suffering from these medical problems – regardless of their age.
Urinary incontinence
The risk of urinary incontinence increases in women with age. However, urinary incontinence can also occur at a younger age, for example childbirth,surgery or an accident.
The following forms of urinary incontinence are known:
- Urge incontinence (known as an overactive bladder): women suffer from a permanent urge to urinate or unintentionally lose urine after a previous sensation of urgency, resulting in frequent toilet visits and a constant urge to urinate. This form of urinary incontinence is caused, among other things, by inflammatory changes, foreign bodies such as bladder stones, hormonal disorders, as a result of surgery or by various diseases such as diabetes or Parkinson’s disease
- Stress incontinence: the woman loses urine during physical exertion, i.e. when coughing, sneezing, laughing or lifting, for example. Stress incontinence is caused by the fact that the closure mechanism of the muscles that control urine flow is too weak after childbirth, after surgery, due to dropping of the bladder, weakness of the muscles or connective tissue or due to hormonal changes, especially during the menopause.
- Mixed incontinence = a combination of urge and stress incontinence
- Neurogenic bladder: this is an underlying neurological condition that results in a malfunction of the bladder
Treatments
There are various ways to treat urinary incontinence:
- Pelvic floor training for stress incontinence
- Electrotherapy (the pelvic floor muscles are trained passively using painless electrical impulses)
- Toilet or bladder training
- Biofeedback: the deliberate tensing of the muscles is registered by a probe and displayed as feedback.
- Hormone treatment: for urinary incontinence due to menopause, a local oestrogen preparation – for example in the form of an ointment – is prescribed
- Administration of antispasmodic drugs in case of urge incontinence
- Insertion of a tension-free vaginal tape (TVT), i.e. a small plastic tape which is not under tension placed around the urethra underneath the bladder in a minimally invasive procedure (with a small incision through the vagina). When coughing or sneezing, the urethra is pressed against this tape so that it closes up and no urine is leaked.
- Sealing of the urethra using intraurethral injection therapy to close the bladder neck, which is often wide open in stress-incontinent patients
Urogenital prolapse
Symptoms
The following symptoms indicate a lowering of the uterus, urinary bladder or rectum:
- Feeling of pressure in the vagina or impairment or heaviness in the area of the perineum
- Vaginal bulging
- Pain in the back and lower abdomen
- Circulatory disorders
- Urinary incontinence
- Frequent urge to urinate
- Irritation of the urinary tract
- Difficulty passing urine and the feeling of not having fully emptied your bladder
- Difficulty emptying your bowels
- Problems with emptying your bladder (also: micturition disorder)
- Increased occurrence of cysts
Causes
The main causes of urogenital prolapse are age, number of pregnancies, menopause, excess weight, chronic constipation, previous pelvic surgery, uterine fibromas, frequent carrying of excessively heavy loads
Treatments
In the event of a urogenital prolapse, various treatments are performed depending on the stage of the disease:
- Pessaries used to treat a urogenital prolapse are small discs, cubes or rings made of rubber or silicone, which are inserted into the vagina to support the organs. Physiotherapy may also be prescribed.
- Pelvic floor rehabilitation can also be helpful; this strengthens the muscles of the female perineum and thus slows down the development of the genital prolapse, alleviating bladder problems and reducing the feeling of heaviness in the vaginal area.
- If none of these treatment methods is effective, a surgical procedure may be considered. This is intended to restore the normal anatomy of the pelvic organs – i.e. bladder, uterus, vagina, rectum – which have sunk too deep into the lesser pelvis. Another advantage of this procedure is the possibility of treating stress incontinence at the same time.
FAQs
What is a pelvic floor dropping?
A dropping of the pelvic floor (medical term: descensus) is when a woman’s genitals – i.e. the uterus and vagina – have dropped into an abnormally downward position. If the uterus protrudes completely in front of the entrance to the vagina, this is called a (uterine) prolapse.
What can women do to prevent their pelvic floor from dropping?
Targeted pelvic floor training – preferably under expert guidance – with special exercises to strengthen the muscles can help to alleviate the symptoms. Weight reduction is also recommended for overweight women.
