Women’s Urology & Health Care

Urine Leak (Urinary Incontinence)

Types of Incontinence

Stress urinary incontinence involves urine loss with physical exertion due to poor urethral support. Urge incontinence features sudden urgency from bladder overactivity, often with frequent urination. Mixed incontinence combines both, while rarer forms include overflow or functional types.

Causes

Common triggers include pregnancy and vaginal delivery weakening pelvic muscles, menopause-related hormonal shifts, obesity increasing bladder pressure, and conditions like UTIs or diabetes. Neurological issues or chronic constipation can also contribute.

Conservative Treatments

Pelvic floor muscle training (Kegels) strengthens muscles and improves symptoms in mild to moderate cases. Lifestyle changes such as weight loss, fluid management, bladder training, and avoiding caffeine help manage symptoms. Pessaries or physical therapy with biofeedback provide non-invasive support.

Medical and Surgical Options

Medications like anticholinergics or mirabegron relax the bladder for urge types, while topical estrogen aids postmenopausal women. Advanced options include Botox injections, nerve stimulation, or surgery like mid-urethral slings for stress incontinence with cure rates over 80% in suitable candidates. Consult a specialist for personalized evaluation

Recurrent urinary tract infections (UTIs) in females

They are defined as two or more episodes of UTI within six months or three or more within a year. They affect 20-30% of women after an initial UTI, primarily due to bacterial reinfection from gut flora like E. coli. Proper diagnosis via mid-stream urine culture is essential to rule out mimics like interstitial cystitis or prolapse.

Causes

Sexual activity facilitates bacterial entry into the urethra, while spermicides disrupt vaginal flora. Postmenopausal estrogen decline causes vaginal atrophy, thinning tissues and altering protective bacteria. Other factors include poor bladder emptying from prolapse, stones, or anatomical issues.

Risk Factors

Younger women face higher risks from frequent intercourse, diaphragm use, or childhood UTI history. Postmenopausal women are prone due to atrophic vaginitis and prolapse impairing urine flow. Reinfection often stems from persistent rectal uropathogens or quiescent intracellular reservoirs in the bladder.

Management Options

Continuous low-dose antibiotics, post-coital prophylaxis, or self-start therapy reduce recurrences. Non-antibiotic approaches include vaginal estrogen for atrophy or behavioral changes like post-void wiping. Investigate with imaging or cystoscopy if structural issues are suspected

Pelvic Organ Prolapse

Genital prolapse in females, also known as pelvic organ prolapse, occurs when pelvic organs like the uterus, bladder, or rectum bulge into or outside the vagina due to weakened support structures. It affects many women, particularly after childbirth or with aging.

Symptoms

Common signs include a feeling of heaviness or pressure in the pelvis, a bulge or lump at the vaginal opening, and lower back pain that improves when lying down. Other issues involve urinary problems like frequent infections or incontinence, bowel emptying difficulties, and pain during sex.

Causes and Risk Factors

Weakened pelvic floor muscles and ligaments cause prolapse, often from vaginal childbirth, multiple pregnancies, or menopause-related estrogen loss. Additional risks include obesity, chronic constipation, heavy lifting, chronic cough, hysterectomy, and genetic factors.

Stages

Prolapse severity ranges from stage 1 (mild, prolapse >1 cm above vaginal opening) to stage 4 (complete eversion). Stages 1-2 are often moderate and asymptomatic, while 3-4 cause significant symptoms requiring intervention.

Diagnosis

Urologist diagnose this problem via pelvic exam, often using a speculum, with the patient bearing down or standing to assess prolapse extent. The Pelvic Organ Prolapse Quantification (POP-Q) system standardizes staging.

Treatment Options

Nonsurgical approaches suit mild cases: pelvic floor exercises strengthen muscles, pessaries provide vaginal support, and hormone creams alleviate symptoms. Surgery for severe prolapse includes vaginal repairs (anterior/posterior colporrhaphy), suspensions (sacrospinous or uterosacral), or sacrocolpopexy, sometimes with mesh. Treatment choice depends on symptoms, age, and health status of the individual.

Urinary Fistulas In Females

Vaginal fistulas in females are abnormal openings between the vagina and nearby organs like the bladder or ureter, often causing urine leakage. Common types include vesicovaginal, Utero-vaginal and ureterovaginal fistulas.

Types

Vesicovaginal fistulas connect the vagina to the bladder, leading to continuous urinary incontinence. Ureterovaginal fistulas involve the ureter and cause similar urinary issues.

Causes

Fistulas often arise from obstetric trauma during prolonged labor, surgical complications like hysterectomy, radiation therapy or cancer. In developing regions, childbirth injuries remain a primary cause.

Symptoms

Patients typically experience persistent vaginal leakage of urine , foul odour, recurrent infections, skin irritation, and social distress. Diagnosis involves dye tests, cystoscopy, or imaging.

Treatment

Small fistulas may heal with conservative measures like catheter drainage, antibiotics, or stents for 4-8 weeks. Most require surgery, such as vaginal layered closure, tissue flaps, grafts, or minimally invasive laparoscopic/robotic approaches, with high success rates over 90% for simple cases.

Prognosis

Surgical repairs succeed in most patients, restoring continence and quality of life, though complex cases (e.g., post-radiation) may need advanced flaps or multiple procedures. Follow-up prevents recurrence.