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Introduction
The female bladder stores and passes urine at the appropriate time and place. When there are problems with bladder function, the patient will need to visit the toilet often, may be unable to pass urine, or may even leak urine. On the other hand, prolapse of the pelvic organs such as the urinary bladder (urine “bag”), womb, and rectum (back-passage) is very common and occurs in more than 10 per cent of women.
Urinary frequency and urgency
Urinary frequency is the need to pass urine for more than seven times during the day or less than every two hours.
Urgency is a strong and sudden desire to void which, if not relieved immediately, may lead to urge incontinence.
Urge Incontinence is an involuntary leakage of urine, usually preceded by urgency.
What are the common causes of frequency and urgency?
What to do if you have urinary frequency and urgency?
You should visit your family doctor who will ask you questions on your medical history and urinary habits. After a physical examination, the doctor may perform a few simple tests such as collecting your urine specimen for analysis to exclude urinary tract infection. Depending on the cause of your condition, the doctor may start you on medication or refer you to a specialist for further management.
Urinary incontinence
Urinary incontinence refers to an involuntary loss of urine. Types of incontinence include:
• Stress urinary incontinence — involuntary loss of urine associated with coughing, sneezing, carrying heavy things and even running or jumping.
• Urge incontinence — involuntary loss of urine preceded by a sudden strong desire to pass urine and voiding before the ability to reach the toilet.
• Overflow incontinence — involuntary loss of urine due to an inability to empty the bladder well.
What should you do if you have urinary incontinence?
Mild urinary incontinence may not be troublesome but moderate to severe urinary incontinence can have a drastic effect on a woman's quality of life. It can also cause social and hygiene problems.
These women should seek help from their doctor. Management depends on the type of incontinence and the severity of the condition.
 Management of urinary incontinence
Regular pelvic floor exercises can be performed to improve the incontinence in mild cases. In severe cases of stress urinary incontinence, surgical correction by your gynaecologist should be considered (Table 52.1).
Urinary tract infection (UTI)
UTI is due to the presence of bacteria in the urine. UTI can be divided into either upper tract infection (kidney) or lower tract infection (bladder).
Pyelonephritis is the acute bacterial infection of the kidneys. Patients have severe back pain and high fever and may have frequency and urgency of urine as well. Cystitis is the infection of the urinary bladder and patients complain of frequency, urgency and dysuria (pain on passing urine).
What should you do if you have a urinary tract infection (UTI)?
General measures for simple cystitis include taking more fluids — more than two litres a day — to encourage more urine formation to flush out the bacteria.
You would need to consult a doctor if the symptoms persist or if you have a fever. Oral antibiotics prescribed by the doctor would eradicate 90 per cent of infection in a normal person. The doctor may order some investigations relevant to your condition if necessary.
Patients with severe UTI associated with fever and kidney infection may require intravenous antibiotics and hospitalisation.
Uterovaginal prolapse
What is uterovaginal prolapse (UVP)?
This is the protrusion of the pelvic organs (bladder, uterus and rectum) down into or out of the vagina. Patients usually complain of feeling something heavy in the vagina or a sensation of a lump protruding out of the introitus. There are different degrees of severity as shown in the diagram below (Figures 52.2, 52.3 and 52.4).
What are the causes of uterovaginal prolapse (UVP)?
• Vaginal delivery of baby
• Pregnancy
• Heavy lifting
• Chronic constipation
• Menopause
How can I prevent uterovaginal prolapse (UVP)?
The risks of UVP may be reduced by
• Pelvic floor exercises during pregnancy and after vaginal delivery
• Avoiding carrying heavy objects
• Treating chronic constipation
• Maintaining body weight in the healthy range
Management of uterovaginal prolapse (UVP)
The patient complains of a lump at the introitus. She will not be able to ascertain whether the protruding organ is the bladder (cystocele), womb or rectum (rectocele). The doctor needs to perform a pelvic examination to determine the site and degree of the prolapse.
Conservative measures include using a ring pessary and local hormone therapy. However, the use of the ring pessary may be associated with vaginal infection or ulceration of the vagina leading to vaginal discharge or bleeding.
Surgery is presently the treatment of choice for pelvic organ prolapse unless the patient is not fit for surgery.
Conservation of the uterus is possible if the patient chooses to keep her womb.
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