Female Urology

The urology system relates to the parts of the body that deal with urination. Both men and women have the same anatomical parts however, there are some differences.

Women have shorter ureters which make them more prone to urinary tract infections.

The bladder in women is in a different location to men, sitting on top of the wall of the vagina. Due to childbirth, aging effects, excessive weight and anything that puts additional pressure on the muscles the bladder can move, sag or become loose where it is not supported causing problems such as prolapse.

What is Prolapse?

When ligaments, muscles and fascia around the pelvic organs are stretched those organs can become unsupported and move or drop down. The word prolapse literally means to ‘fall out of place’.

Different types of prolapse include:

  • Bladder Prolapse is also known as cystocele, fallen bladder or anterior prolapse this is a problem unique to female anatomy. This occurs when the supportive tissue between the woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina.
  • Vaginal Prolapse where vaginal walls become stretched and can bulge in the front or back affecting the bladder (front) or rectum (back)
  • Uterine or Cervical Prolapse which is where the uterus and cervix drop outside the vagina
  • Bowel Prolapse, Rectocele or Posterior Prolapse is when the wall of fibrous tissue the separates the rectum from the vagina weakens, allowing the vaginal wall to bulge.

Symptoms of Prolapse

  • Difficulty completely emptying the bladder (voiding) or the bowel when going to the toilet
  • History of difficulty voiding, hesitancy, slow flow, urgency, stress incontinence, bladder or bowel urgency or incontinence
  • Vaginal bulging – complaint of a bulge, swelling or ‘something coming down’, able to feel bulge by direct contact or able to see using a mirror.
  • Pelvic pressure – complaint of increased heaviness, pressure or dragging in the suprapubic, perineum or pelvic region.
  • Bleeding, discharge, infections related to ulceration of the prolapsed.
  • Splinting/digitations – the need to digitally replace the prolapsed or otherwise apply manual pressure to assist with voiding or defecation.
  • Discomfort during sexual intercourse.
  • Lower back ache.

Management of Prolapse

Pessaries:
A pessary is a removable device that is placed in your vagina to support the weakened and prolapsed walls of the vagina or uterus. A pessary helps to provide mechanical support to the prolapsed organs thus relieving your symptoms.

Pelvic floor exercises:
Pelvic floor exercises may be helpful in improving or preventing worsening of early stages of prolapsed. Pelvic floor exercises require times, motivation and proper technique.

Lifestyle management:
Changes to help reduce intra abdominal pressure which can exacerbate symptoms include weight loss, avoid heavy lifting, avoid constipation and try to manage chronic coughing.

Surgery:
For some women a surgical repair may be offered to restore your pelvic organs to their natural position whilst retaining sexual function. Surgery may be approached vaginally, abdominally or via laparoscopic or robotic. Your doctor will discuss the most appropriate surgical treatment for you.