Providing women with the care they need
UROGYNAECOLOGY is a branch of gynaecology that deals with pelvic floor dysfunctions in women.
Dr Nor Azhana Mohamad, consultant obstetrician and gynaecologist (with special interest in urogynaecology) at Avisena Specialist Hospital, explains, “The pelvic floor is a structure that consists of muscles, ligaments, soft tissue and bony components that supports pelvic organs such as the bladder, uterus and rectum.
“Pelvic floor dysfunction causes conditions such as pelvic organ prolapse, overactive bladder, urinary or bowel incontinence, recurring urinary tract infections, urogenital atrophy and dyspareunia (difficult or painful sexual intercourse).”
According to her, risk factors for urogynaecological conditions include ageing, menopause, pregnancy and vaginal delivery, obesity, constipation, chronic coughing, smoking, manual labour that involves heavy lifting and genetic predisposition.
Women with urogynaecological conditions commonly present with:
Sudden and intense urge to urinate that cannot be put off even when the bladder is not full, sometimes leading to leakage.
Frequent urination, to the point of restricting daily activity.
Urinary leakage that occurs during physical activity such as laughing, coughing or changing body posture.
A dragging sensation or heaviness over the vagina that indicates the presence of pelvic organ prolapse. In severe cases, patients may feel or see a lump at the vaginal opening or experience severe backache.
According to Dr Nor Azhana, “Urogynaecological conditions are not life-threatening, but their symptoms can be debilitating. Many women with these conditions have low self-esteem and isolate themselves socially. Some may end up with psychiatric disorders such as depression.
“Other than psychosocial implications, long-standing and untreated urogynaecological conditions may lead to complications such as skin excoriation from prolonged usage of sanitary pads or diapers, vaginal infection, bleeding and urinary obstruction (which may lead to renal failure).”
Seeking treatment
Urogynaecology is a relatively new field in Malaysia. Lack of awareness among our women causes them to suffer in silence.
Dr Nor Azhana says, “Women acknowledge the problem but treat it as part of the ageing process and neglect to seek treatment. Fear of surgery is another reason older women choose to live with these conditions.”
Although surgery may be strongly advised to treat pelvic organ prolapse and stress urinary incontinence, there are other treatment options available for pelvic floor dysfunction. Conservative approaches are listed below.
Behavioural – Making lifestyle changes, including reducing weight, adjusting your nature of work and avoiding caffeine, carbonated drinks, fruit juices and alcohol. Dr Nor Azhana advises that you keep a bladder diary to identify your urinary patterns. Subsequently, training the bladder under the supervision of your urogynaecologist can help alleviate symptoms of overactive bladder.
Pelvic floor exercise –DrNor Azhana suggests doing pelvic floor exercises to prevent urogynaecological conditions. Intensive pelvic floor exercise under the guidance of a trained physiotherapist is an effective firstline treatment for stress urinary incontinence.
Medication – This option can control symptoms of overactive bladder, but there are side effects. Hence, good counselling by a urogynaecologist is crucial to improve the outcome of treatment.
Non-surgical prolapse treatment – Available in the form of ring pessaries. They reduce the protrusion of pelvic structures into the vagina. They are meant for lifelong use and require monitoring for possible complications such as infection and ulceration.
With advancements in medical science, the population of elderly women is on the rise. Dr Nor Azhana shares, “Women nowadays are productive even beyond their 50s, significantly contributing to the society and economy. Many enjoy outdoor activities and remain sexually active. We do not want these treatable conditions to deprive women from living their lives to the fullest. She highlights that the number of urogynaecologists in the country is increasing and advises Malaysian women to make use of the services available and seek appropriate care when needed. For more information, call 03-5515 1888.