Services › Urogynaecology — Incontinence and Prolapse
Urogynaecology — Incontinence and Prolapse
Urinary incontinence and prolapse of the uterus or bladder are common in women yet rarely spoken about. They are not an inevitable part of ageing, and the great majority can be treated.
Symptoms
- Leaking with coughing, sneezing, laughing or lifting
- Urgency and not reaching the toilet in time
- Getting up to pass urine at night
- Pelvic pressure or a sensation of something coming down
- Incomplete emptying of the bladder
- Discomfort during intercourse
Causes and contributing factors
- Number of births and a history of difficult delivery
- Loss of tissue support after the menopause
- Excess weight
- Chronic constipation and persistent cough
- Work involving heavy lifting
- Previous pelvic surgery
Assessment
Because the type of symptom — urgency or stress leakage — determines treatment, it is asked about in detail. Examination, urine testing and ultrasound assessment of bladder emptying follow; a bladder diary or further testing may be requested.
Treatment
The first step is usually not surgical: pelvic floor (Kegel) exercises, weight loss, treating constipation, bladder training and, in suitable patients, local oestrogen give clear benefit.
If symptoms persist, medication or surgery is considered. Sling procedures are used for stress incontinence and repair surgery for prolapse. Which method is appropriate depends on the type of symptom and the degree of prolapse.