Urogynaecology
Urogynaecology
Women are susceptible to specific health issues like incontinence, prolapse or pelvic pain that may be uncomfortable as well as embarrassing. These conditions may severely impact your life -affecting your ability to go to the toilet easily, have sex, or wear certain clothes. These conditions can sometimes be tricky to diagnose, treat and resolve. Our clinic provides specific care for all pelvic and gynaecological disorders, with state-of-the-art diagnostic tools and the advanced treatment options and technology. We provide the compassionate care that you deserve with confidentiality, comfort and respect.
Dr Ruchi Singh provides advice on:
- Pelvic floor dysfunction assessment and diagnosis
- Testings – urodynamic testing procedures and cystoscopy
- Stress urinary incontinence diagnosis and management
- Interstitial cystitis
- Overactive bladder: Urinary urgency and frequency
- Nocturia (frequent night-time urination)
- Urinary dysfunctions including urinary retention and post-birth urinary problems
- Managing recurrent urinary tract infections
- Prolapse assessment and management
- Pessary fittings for prolapse management
- Robotic endoscopy for pelvic floor dysfunction
- Surgical treatments for prolapse
- OASIS and perineal trauma after vaginal delivery
- Sexual dysfunction related to the pelvic floor
- Sexual dysfunction related to the genitourinary syndrome of menopause
Pelvic floor dysfunction
Pelvic floor dysfunction is when you are not able to effectively control the bladder or the bowel with laxity of the vagina and muscles in your pelvis. It is usually a dysfunction of the structural support system.
There are many different treatments available for pelvic floor dysfunction, including conservative and surgical treatments. Pelvic physiotherapy and exercises with strengthening the pelvic floor is the first step, however sometimes surgical interventions can be very successful.
Bladder and urinary conditions
Urinary incontinence
Urinary incontinence is the inability to control when you urinate and is not necessarily a normal part of ageing. This condition can often be improved and cured with treatment. It affects both men and women, and prevalence increases with age. Stress urinary incontinence occurs when there is a loss of urine when you laugh, cough or sneeze, but can also occur with an overactive bladder as well
Overactive bladder, urinary urgency and nocturia
An overactive bladder (OAB) occurs when the bladder muscle spasms or contracts resulting in the urgent need to urinate. OAB can interfere with daily routines, work and intimacy.
Nocturia is a term used to describe excessive urination at night. Those who have to wake up to urinate more than twice a night and are having their sleep interrupted may have nocturia. This can be caused by a range of lifestyle choices and can be a sign of other medical conditions.
Urinary incontinence management
Treatments for urinary incontinence will depend of your individual symptoms and causes, but some of the possible ways to manage and treat urinary incontinence include:
- Bladder training – delaying urination after you get the urge
- Double voiding – urinating then waiting a few minutes and trying again to learn to fully empty your bladder
- Pelvic floor muscle exercises – to strengthen the muscles
- Medication
- Incontinence surgery
- Intra vesical Botox
- Posterior Tibial Nerve Stimulation
- Sacral Nerve Modulation
Recurrent urinary tract infections
Urinary tract infections (UTIs) occur when bacteria get into the bladder, ureters or urethra (or all three), via the urethra, which causes irritation, the frequent urge to urinate and pain/burning while urinating. Besides bacteria from the colon entering the urethra, recurrent UTI’s can be caused by:
- Incomplete bladder emptying
- Foreign objects in the urinary tract
- Stones
- Urethral diverticulum – a pocket that forms next to the urethra that can fill with urine
A urine culture can confirm whether you have a UTI or not.
Pelvic pain/Bladder pain syndrome (interstitial cystitis)
There are many possible reasons why you may be experiencing ongoing pain in the genital and bladder area. The cause of the pain can greatly differ between people and can be difficult to identify as there are so many structures is the pelvic area that can be responsible.
Painful bladder syndrome or interstitial cystitis affects women of all ages, and generally feels like a UTI that won’t go away. Pain is often experienced in the mid to lower pelvic or vaginal area, and will increase as the bladder fills. There are many effective treatment options that can be trialled to determine which is best for you.
Voiding dysfunction
Urinary tract infections (UTIs) occur when bacteria get into the bladder, ureters or urethra (or all three), via the urethra, which causes irritation, the frequent urge to urinate and pain/burning while urinating. Besides bacteria from the colon entering the urethra, recurrent UTI’s can be caused by:
- Incomplete bladder emptying
- Foreign objects in the urinary tract
- Stones
- Urethral diverticulum – a pocket that forms next to the urethra that can fill with urine
A urine culture can confirm whether you have a UTI or not.
Prolapse
A prolapse is caused by a lack of support for the vaginal structure that results in a bulging of the organs into the vagina. This condition is usually painless and feels like pressure in the pelvic area.
Prolapse assessment and management
It is important to determine what parts of the vagina and what organs are involved in your prolapse. Some of the non-surgical ways to manage a prolapse include:
- A pessary – a silicone vaginal insert that holds the prolapse in place
- Pelvic floor exercises and physiotherapy – to strengthen the pelvic floor musculature to prevent or slow the progression of prolapse.
Vaginal pessaries
A vaginal pessary is a removable silicone device that is placed into the vagina to support areas of pelvic organ prolapse. There are a variety of different pessaries available, and your gynaecologist will be able to recommend the best type for you. The pessary will be fitted specifically to your body to hold your pelvic organs in position without causing any discomfort.
Surgical treatment of vaginal prolapse
Some of the possible surgical procedures used to treat a vaginal prolapse include:
- Reconstructive vaginal repair
- Vaginal vault suspension
- Robotic pelvic floor repair
- Vaginal repair with mesh
Sexual dysfunction
A sexual problem or dysfunction refers to a problem during any phase of the sexual response cycle that prevents an individual from experiencing satisfaction from sexual activity. This can be caused by a number of physical or psychological problems, including menopause and hormonal imbalance, depressive conditions, pelvic pathology or with systemic disorders like Diabetes.
Urodynamic testing
Urodynamics is a series of tests that are conducted that evaluates the function of the bladder and can determine if the bladder is having involuntary contractions.
Cystoscopy
A cystoscope is a thin tube with a light and camera on the end that is inserted through your urethra and into your bladder so the doctor can see the inside. This magnified image can allow your doctor to see any problems that may be occurring inside your bladder.