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Urogynaecology

Overview

What is Urogynaecology?

Urogynaecology is a focused subspecialty sitting at the intersection of gynaecology and urology, which deals specifically with pelvic floor disorders in women. These are conditions that affect the muscles, ligaments and connective tissues which are holding the pelvic organs in their correct positions. These organs are the bladder, uterus, vagina and rectum. This support system can weaken, and when this happens, problems like urinary leakage, a feeling of a vaginal bulge or difficulty emptying the bladder can arise.

Many women live with these issues for years. They often feel too embarrassed to mention them during a routine check-up. It is not uncommon in fact, for someone to wait half a decade before seeking professional help. With advanced training in diagnosing and managing these sensitive problems, a urogynaecology specialist offers solutions that range from simple lifestyle advice to minimally invasive surgery. Restoring comfort, confidence and quality of life are the main goals.

Types of Pelvic Floor Disorders

Pelvic floor dysfunction takes several forms, of which a person may experience more than one at the same time. Urinary incontinence is the most common condition seen in urogynecology clinics, which itself has different patterns. Stress incontinence involves leaking urine when pressure increases on the bladder. This happens mainly during activities like coughing, sneezing, laughing or exercise. Urgency incontinence is a sudden, intense urge to pass urine, which is followed by leakage before reaching a toilet. This is often part of an overactive bladder.

Another major category is pelvic organ prolapse. This is where the bladder, uterus or bowel drops from its normal position and pushes against the walls of the vagina. This manifests as the feeling of sitting on a small ball or causing a visible bulge. Other conditions treated include recurrent urinary tract infections, painful bladder syndrome, known as interstitial cystitis, urinary fistulas, which are abnormal connections between the bladder and vagina. Complications from previous mesh surgeries can also contribute.

Mistakenly, many women believe that urine leakage or a vaginal bulge is a normal part of ageing or childbirth, although it is not. These are medical conditions and can be treated effectively. When any form of urine leakage occurs, a consultation with a specialist is recommended. Even if this happens in small amounts, and most importantly, if it happens unexpectedly or interferes with daily life.

There are many other reasons to seek help. This includes constantly feeling the need to rush to the toilet, waking up more than twice during the night to pass urine or experiencing repeated episodes of cystitis. Investigations should be booked for a sensation of heaviness, pressure or a lump in the vagina. A lump that is especially more noticeable at the end of the day or after standing for long periods is a red flag. Further signs are having difficulty emptying the bladder completely, as well as needing to change position to pass urine. All women deserve a proper assessment, and no woman should accept these symptoms as inevitable.

Prior to diagnosis, a detailed conversation takes place, mainly covering symptoms. Specialists assess their timing and how they affect everyday activities. A thorough physical examination is then performed, which includes a pelvic exam to assess for prolapse and to check the strength of the pelvic floor muscles. A cough stress test may be done to see if leakage occurs with increased abdominal pressure.

In urogynecology, one of the most valuable diagnostics is urodynamic testing. This set of procedures is used to measure how well the bladder and urethra store and release urine. It typically involves passing small, soft catheters to fill the bladder with sterile fluid, all while recording pressure readings. This test helps distinguish between multiple factors. These are stress incontinence, urgency incontinence and mixed patterns, which are critical for choosing the right treatment. Other investigations may include a bladder diary, urine tests, ultrasound to check for residual urine after voiding. A cystoscopy is used to look inside the bladder.

  • Stress urinary incontinence
  • Urgency incontinence and overactive bladder
  • Mixed urinary incontinence
  • Pelvic organ prolapse
  • Recurrent urinary tract infections
  • Painful bladder syndrome / interstitial cystitis
  • Urethral diverticulum
  • Urinary fistulae
  • Complications from previous mesh surgery
  • Voiding dysfunction and urinary retention

Treatment for pelvic floor disorders follows a stepwise path at NMC, where we always start with the least invasive options. Conservative measures have proven to bring significant improvement for many women. Pelvic floor muscle training, which is guided by a specialist physiotherapist, can help strengthen weakened support structures. We use bladder retraining techniques to teach the bladder to hold urine for longer periods. We offer lifestyle advice on fluid intake, diet and managing constipation as these play a vital role in healing.

A range of medical and procedural options is available when conservative measures are not enough. Medications are available that relax the bladder muscle for an overactive bladder. Botox injections into the bladder wall have proven to sometimes be highly effective in more resistant cases. Another non-surgical option is posterior tibial nerve stimulation, which is when a small needle is inserted near the ankle and delivers gentle electrical pulses to the nerves that control the bladder.

Surgery offers excellent outcomes, especially for stress incontinence or prolapse that has not responded to other treatments. The best urogynecology doctors at NMC are skilled in certain procedures. They perform synthetic or autologous slings, which use the patient's own tissue. They are also experts at colposuspension and sacrocolpopexy, which is used for vault prolapse. Expert removal of synthetic mesh is performed, where previous mesh surgery has caused pain or erosion. All surgical decisions are made jointly. Clear explanations of expected benefits and potential risks are provided in detail.

The best urogynecology doctors at NMC are consultant gynaecologists possessing fellowship training in pelvic floor disorders. Specialist nurses, physiotherapists and urologists work to support them, all ensuring holistic care. Appointments are conducted in a private, respectful environment. This allows for sensitive topics to be discussed without embarrassment.

The team brings international expertise and compassion that's genuine to every case they work on. This helps all patients, whether the search is for initial advice or a second opinion on a complex problem. Consistent, high-quality urogynecology care is always accessible across the NMC network across Abu Dhabi, Dubai, Sharjah, Ajman, Ras Al Khaimah and Al Ain.

FAQs

Find the Answer to Your Medical Questions

Frequently Asked Questions

No. Childbirth is known to sometimes weaken pelvic floor muscles, but ongoing leakage is not a normal aftereffect. If appropriate treatment is sought, it can almost always be improved or cured.
A urologist treats bladder and urinary tract conditions in both men and women, while a urogynaecologist is a gynaecologist with extra training. This training covers bladder problems and prolapse specific to women and takes a broader view of the entire pelvic floor.
Slings and other continence procedures have success rates of 80 to 90 per cent in carefully selected patients. Most women notice a dramatic improvement or complete resolution of leakage.
Not at all. Many women with mild or moderate prolapse manage well with pelvic floor exercises, a vaginal pessary (a removable device inserted to support the pelvic organs) or lifestyle changes. Surgery is reserved for those with symptoms that remain bothersome despite having taken these measures.
Allergen immunotherapy, also known as desensitisation, is safe for children over five years with severe hay fever, dust mite allergy or venom allergy. It is administered in a clinic equipped for emergency care. Sublingual (under the tongue) immunotherapy for grass and dust mites has a very low risk of severe reactions. It can be given at home after the first dose is observed by a doctor.
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