Female Urology

Female urology

Female urology looks at the health of a woman’s bladder and pelvic floor. Urological problems are very common after pregnancy and may continue throughout life.

Incontinence, pelvic pain, and urinary tract infections can affect the quality of a woman’s life. Women do not need to learn to live with these conditions.

Here at Fitzwilliam Hospital we have qualified and experience consultant urologists who can offer diagnosis, advice and education and, effective treatment options for these issues. The Braithwaite day unit is used for minor operations and endoscopies and, our fully equipped ultra clean air theatre suite supports more complex surgeries.

We have a women’s health physiotherapy specialist who uses the latest physiotherapy techniques including biofeedback and can offer advice on exercises to help improve women’s urology problems including vaginal prolapse, incontinence, lower urinary tract disorders and, rectal prolapse.

If you are concerned about your bladder or pelvic floor then please book an appointment with one of our urologists by calling 01733 842304 or contact us.

Urology conditions we treat

Bladder prolapse

A bladder prolapse happens when the muscles and ligaments in your vagina weaken causing the bladder, bowel or uterus they support to drop into your vagina.

Bladder prolapse is often seen in women who have had multiple vaginal deliveries and those who have had their uterus removed in a hysterectomy. Hormonal changes during the menopause, chronic coughing, constipation or, previous pelvic surgery may also lead to a bladder prolapse.

How to treat a bladder prolapse will be based on the extent of the prolapse. You may be advised to do exercises to strengthen your pelvic floor muscles and avoid heavy lifting or straining. You may be prescribed hormones to maintain your pelvic muscle strength. A device, called a pessary may be inserted into your vagina to keep your bladder in place. Sometimes pelvic floor repair surgery may be required.

Incontinence

Incontinence is the accidental release of urine. This common yet frustrating and embarrassing bladder control problem can vary in its severity from being an occasional leak through to an inability to hold any urine at all.

There are three main types of female urinary incontinence:

  • stress incontinence – incontinence happens when you do something that puts pressure on your bladder such as sneezing, laughing or jogging.
  • urge incontinence – incontinence happens when you have a sudden need to urinate but you can’t get to the toilet in time.
  • overflow incontinence - constant dribbling of urine due to an inability to completely empty your bladder.

There are several treatment options available for urinary incontinence that are based on its cause. Medications, creams, pelvic floor exercises, biofeedback and electrical stimulation, bladder training, pessary insertion and surgery are some of the treatments we may recommend for you.

Surgical options for incontinence include:

  • tape procedures to hold your urethra up in the correct position.
  • colposuspension to lift and stitch the neck of your bladder into position.
  • a sling to support your bladder neck.
  • anterior vaginal repair of an anterior vaginal wall prolapse, when your bladder bulges into your vagina.
  • collagen injections to increases the size of your urethral walls and keep your urethra closed with more force.
  • nerve stimulation to improve the way signals are sent between your brain and the muscles you use when you urinate.
  • Interstitial cystitis (IC)

    Interstitial cystitis, also known as chronic pelvic pain, is an enduring inflammatory condition of your bladder wall. It causes long-term pain and a feeling of needing to urinate frequently that will not go away on its own.

    The symptoms of interstitial cystitis can have a number of causes and so doctors must first rule out other conditions to be able to diagnose interstitial cystitis. A cystoscopy is often used to evaluate patients with suspected IC and a biopsy of the bladder, in which a tissue sample is removed and analysed, may be performed.

    Unfortunately, there's currently no cure for interstitial cystitis. Treatment aims to relieve its symptoms with most people being helped by one or a combination of treatments. These include: lifestyle changes, medications, physiotherapy, bladder retraining to reduce urinary frequency, TENS unit for pain control and, surgery.

    Surgical options we offer include: cauterisation, bladder distension, botulinum toxin injections, nerve stimulation using neuromodulation and, bladder augmentation.

    Pelvic floor repair

    Your pelvic floor is a bowl of muscles that support your bladder, vagina and rectum. By contracting and relaxing these muscles, you control your bowel and bladder movements. They can become irritated, torn and weakened, especially after childbirth.

    Pelvic floor dysfunction can often be successfully treated without surgery by improving muscle coordination. Biofeedback is the most common type of non-surgical treatment. Medications and relaxation techniques can also work. Surgery may be recommended if these conservative methods are not successful.

    There are several types of pelvic floor repair surgery and urology surgeons often carry out more than one of these repairs simultaneously.

    • An anterior repair corrects weak muscles in the front wall of your vagina and pushes your bladder and urethra back into place.
    • A posterior repair corrects the muscles in the back wall of your vagina and pushes your bowel back into place.
    • If your uterus is prolapsing, it may be removed by a hysterectomy.

    • Urinary tract infections (UTI)

      A urinary tract infection causes the inflammation of your bladder and/or urinary tract due to the presence of bacteria. It can cause pain or burning with urination, an urgency or increased frequency of urination, lower abdomen pain, increased incontinence and dark, foul smelling or cloudy urine. About 50% of women will develop a UTI during their lifetime.

      A UTI can cause serious medical problems if it spreads to your kidneys or into your bloodstream. It is important to properly diagnose and treat a UTI.

      UTIs may be investigated by lab analysis of your urine and urine culture, scans including ultrasound, CT scan or magnetic resonance imaging (MRI) and, cystoscopy.

      Antibiotics usually are the first line treatment for UTIs with the drug prescription being based on your health condition and the type of bacteria found in your urine.

      Kidney stones

      Kidney stones are a buildup of a substance that normally dissolves in your urine and instead it precipitates out to form a crystal and grows into a stone.

      Small kidney stones pass out of your body when urinating. Large kidney stones can become lodged in your kidney or ureter and block your normal flow of urine causing pain, infection, blood in your urine and sometimes kidney damage.

      Treatment for larger kidney stones depends on their size, location, whether you have a urinary infection, your medical profile, and the severity of the condition. It can include keyhole surgery to remove them or shock wave or laser lithotripsy to break them into smaller pieces so that they can move on, on their own.

      Ureteroscopy is an endoscopic procedure to remove or fragment stones located anywhere from your kidney down to your bladder.

      Vaginal prolapse surgery

      A vaginal prolapse is when the organs inside your pelvis fall, bulge, or protrude into your vaginal wall. It commonly occurs in women who have had a hysterectomy to remove their uterus. Child birth and the menopause are other common causes.

      Pelvic floor muscle training and lifestyle changes may help your vaginal prolapse. If these aren’t successful then vaginal prolapse surgery may be required. It is however not suitable or recommended if you are planning to get pregnant in the future. If there is significant prolapse of your uterus, a vaginal hysterectomy may also be recommended.

      The majority of prolapse surgeries are performed via the vagina. This means that there are no surgical incisions made on your abdomen.

      It can be performed as an anterior repair when the weak muscles in the front wall of your vagina are repaired and strengthened whilst pushing your bladder and urethra back into place.

      A posterior repair is an alternative operation that repairs the muscles in the back wall of your vagina and pushes your bowel back into place.

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