The urogynaecological field concerns those pathologies that are on the borderline between gynaecological and urological competences.
Urogynaecology or “female gynaecology” takes care of problems of the urogenital area of women. It is therefore a field that can be interesting both for urologists and gynaecologists having specific competences in this sector.
At any age a woman can necessitate to go to the urogynaecologist: we can think about the high frequency of problems like cystitis, urinary incontinence, Hyperactive Bladder Syndrome and pelvic organs prolapse.
Very often female pelvic floor disorders create negative effects on the quality of life of the affected woman; for example, the involuntary leak of urine provokes embarrassment and peculiar situation of social, work and sexual distancing.
Urinary incontinence is ranked as follows:
- Stress urinary incontinence (50%)
- Urgency urinary incontinence (20%)
- Mixed urinary incontinence (30%)
The stress urinary incontinence
This disorder is provoked by an acquired anatomical defect, like the sphincter incompetence (“Sphincter deficiency for stress incontinence”) or urethral hypermobility, provoked by a deficiency of the urethral tissues of support. The stress urinary incontinence appears with the augmentation of the abdominal pressure on the bladder due to physical efforts (cough, sneeze, laugh and various movements). The involuntary leak of urine caused by efforts can be managed, in the simplest cases, with a rehabilitation of the pelvic floor muscles. These exercises can be learnt by the patient during outpatient sessions with the physiotherapist and then reproduced autonomously at the patient’s home.
The urgency urinary incontinence
This type of incontinence appears during the bladder hyperactivity; it occurs especially during hard contractions of the bladder muscle, the detrusor muscle, that cannot be voluntary controlled. The “bladder hyperactive syndrome” is featured by the presence of urgent urination, rise of urination frequency, with or without urinary incontinence. This form of deficiency can be managed, according to the level of incontinence, with medications that can be taken orally or, for more serious cases, injected in the bladder (botulinum toxin).
The mixed urinary incontinence
In the mixed urinary incontinence can be observe the coexistence of signs and symptoms of urgency and stress urinary incontinence.
The prolapse of the organs contained in the female pelvis (uterus, bladder, intestine) occurred when they lose their natural position and bulge in the vagina.
This is a very common condition: over 50% of women in menopause suffer of prolapses, even if just the 10-20 % of them claims having serious disorders:
- Chronic pelvis pains
- Sensation of encumbrance (foreign body) in the vagina
- Vaginal bleeding
- Troubles of urination: urinary incontinence or urinary retention.
Sometimes the prolapse can hide the urinary incontinence disorder, because it compresses the urethra stopping the involuntary leak of urine that can otherwise occurs after the correction of the prolapse.
Intestinal disorders (constipation)