Bladder problems

Introduction to Urogynaecology

Many women find difficulties in holding their water and suffer the embarrassment and discomfort of urinary leakage. A proportion of these women are too embarrassed to seek help and a proportion frightened by tales of strange surgical procedures which are suggested to help. Other women find their bladders force them to go to the toilet very frequently or in a great rush and others find their sleep disturbed by the need to go to the loo. There are many reasons for these problems and at times, the skill of the doctor can be severely tested in trying to discover the root cause. I shall try to tread a simple path through this complex subject.

Like all tissues in the body, the bladder is conditioned by hormones but the moment to moment control is largely under the influence of nerves. There can therefore be hormonal, emotional or neurological reasons for bladder problems. In our Clinic, our Continence Advisor and Physiotherapist as well as the doctors can be very helpful in curing the problems arising from this sort of thing but in some cases it may need the attention of clinicians in other specialties.

In the Urogynaecology Clinic, we deal mainly with women with conditions where either the bladder is overactive with frequent visits to the toilet (leading to Urge Incontinence) or problems where the mechanism for holding water in the bladder (the continence mechanism) is overcome by squeezing the bladder with a cough or sneeze or other activity (called Stress Incontinence).

If you have problems like this and wish to consult one of our specialists, please ring  0845 686 1540  to arrange an appointment.

Download here the Input/Output pdf form

Investigation

We will normally ask you to keep an “input/output chart”, recording each drink that you take and the volume and nature of that drink and also each time that you empty your bladder and the quantity of urine passed. This, in conjunction with a careful history can point toward an over-active bladder or a defective continence mechanism. An Ultrasound scan of the pelvis may be used to exclude the presence of ovarian cysts or other masses. If there is a suggestion of cystitis, we will usually ask for a “mid stream sample” of urine (MSU) for the laboratory to culture any germs.

We will also ask you to complete a questionnaire about how your problem affects your life.

A Urodynamic Assessment will be arranged and an appointment for you to return to the Urogynaecology Clinic when the result will be available.

Urodynamic Assessment

This is a simple test in which we measure the pressure exerted by the muscle coating of the bladder. In our clinic one of our experienced Sisters performs the test as we can appreciate that some women find it extremely embarrassing. There is no cutting or pain involved. Fine plastic tubes are inserted through the natural passages into the bladder and into the back passage. The pressures are measured by electronic transducers and the patterns of pressure recorded on a computer enabling the doctors to come and assess the bladder function later

How is this test performed?

When you arrive, you will be asked to empty your bladder on a special commode. We appreciate that in this unusual situation, you may find it difficult and a little delay is to be expected. Just relax and let the natural process occur. After that, you are asked to lie down and the tubes are gently inserted. We then measure the pressure along the length of the urethra (the tube from the bladder to the outside) by gently withdrawing the tube at a steady rate. The catheter is then reinserted and your bladder slowly filled with water from a bag, measuring the pressure exerted by the bladder muscle. You will be asked to tell Sister when you first feel your bladder is full enough to go to the toilet. At this point she will probably ask you to cough and measure the pressure that that produces. She will then fill the bladder a bit more until you have a strong desire to void. Lastly, you will again be asked to empty your bladder, this time with tubes in place to measure pressures. An appointment will be made to return to the Urogynaecology Clinic for one of the doctors to discuss these test findings and arrange any appropriate treatment.

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