UROGYNECOLOGY

Urogynecology is a specified branch of OBS/GYN which deals with the diagnosis and treatment of pelvic floor disorders in women.

This involves conditions that affect the vagina, uterus, rectum, urinary bladder and the pelvic floor, which is a structure made up of muscles, ligaments, nerves and connective tissues that supports pelvic organs and aids in the control of their functions.

Conditions Associated with Urogynecology

The most common conditions in urogynecology are caused due to weakened muscles in the pelvic floor, resulting in problems such as

• urinary incontinence - inability to control the passage of urine.
• fecal incontinence - inability to control fecal excretion.
• pain in the pelvic region or the vagina
• urinary retention - some amount of urine is retained in the bladder i.e. bladder is not emptied
• pelvic organ prolapse - the bladder or cervix drops below its normal position, and protrudes from the vagina.

Diagnosis

Problems of the uterus may be diagnosed either by using a laparoscope or imaging techniques such as CT scan, MRI, Ultrasound, etc.

A prolapse is usually visible, and treated accordingly

Treatment

Depending on the severity of the problem, the treatment may either be conservative and non-surgical, however in serious cases, a surgery is required.

Incontinence

Fecal incontinence is treated in the following ways

Non-surgical

• Anti-diarrheal medications
• Laxatives
• Change in diet
• Exercises to strengthen the vital muscles to control bowel movements
• Stool impaction treatment
• Pelvic floor muscle training

Surgery if the patient doesn’t respond to the other treatments

• Sphincteroplasty
• Treating rectal prolapsed
• Sphincter replacement

In case of urinary incontinence, following methods are used

The treatment depends on the cause and the type of incontinence.

• Change in diet- reducing caffeine intake, limited liquid intake, no alcohol
• To lose weight (if obese)
• Double voiding, in case of overflow incontinence
• Make Scheduled toilet trips

Other Treatments

• Pelvic floor muscle exercises
• Electrical stimulation
• Bladder training
• Medications
• Anticholinergics
• Mirabegron (Myrbetriq)
• Alpha blockers
• Topical estrogen

Surgery is performed if none of the above methods work.

Prolapse

The treatment for a prolapse is based on the severity of the symptoms.

Behavioral Treatment

• This initial treatment focuses on strengthening of the pelvic floor muscles, by doing Kegal exercises.
• Increasing fiber intake to prevent constipation
• Weight loss
• Avoid doing any work which creates a pressure on the pelvic organs

Mechanical treatment

• In this, a small plastic devise called pessary into the vagina to support the drooping organs.

Surgical treatment

• Removing or repairing the organ through surgery.

Pelvic Pain

Pelvic pain is usually a symptom of other problems, and the diagnosis should be done properly before commencing with any treatment.

"Authored By Dr.Niraj Mahajan"