Urogynecology

Our Services

• Our expertise includes evaluating, diagnosing, managing, and treating female pelvic floor disorders.
• We specialize in clinically assessing women with lower urinary tract dysfunction.
• Proficient in conducting and interpreting various laboratory, radiographic, and interventional studies, including cystoscopy, urodynamic testing, anorectal manometry, and endoanal ultrasound.
• We create personalized plans integrating medical, behavioral, and surgical options.
• Our commitment extends to promoting women’s pelvic floor health through research and education.

What We Do 

• Range of investigations: urine analysis, multichannel urodynamic studies, perineal ultrasound, cysto-urethroscopy and bladder biopsy
• Non-invasive management of urinary incontinence, addressing both stress incontinence and overactive bladder.
• Non-surgical approaches for pelvic organ prolapse, including uterine, bladder, and vaginal prolapse.
• Implementing bladder training techniques.
• Utilizing therapies such as physiotherapy, Pelvic Floor Therapy, Biofeedback, Neuromuscular Electrical Stimulation, and conducting Patient Education Classes.
• Specialized clinics for perineal care.
• Dedicated clinics for the fitting and care of pessaries.
• Providing guidance on catheter care, including training for intermittent self-catheterization.
• Offering bladder instillation clinics tailored for painful bladder syndrome.
• Administering drug therapies.
• Implementing Percutaneous Tibial Nerve Stimulation.
• Utilizing Sacral Nerve Stimulation techniques.
• Performing surgeries for incontinence and prolapse.

Your Condition and Treatment

Urinary Problems

Women of all ages may face urinary issues, ranging from leakage during activities to overactive bladder symptoms and chronic complaints like bladder pain. Stress incontinence, often triggered by factors such as childbirth or chronic straining, involves involuntary urine loss. Overactive bladder manifests as frequent urination, nocturnal urination, urgency, and urge incontinence.

Our clinic offers various treatments to enhance bladder control, eliminate leakage, and improve overall quality of life. Treatment options include lifestyle adjustments, medical interventions, and surgical procedures tailored to the severity of incontinence.

Specific treatment options include:

• Pelvic floor physiotherapy
• Pessary fitting
• Peri-urethral bulking agents
• Urethral sling surgery
• Posterior tibial nerve stimulation
• Intravesical Botox injection
• Sacral nerve stimulation

Pelvic organ prolapse

Pelvic floor prolapse, a prevalent gynecological issue, occurs when the supportive network of muscles, fibrous tissue, and ligaments weakens, leading to the descent of pelvic organs (vagina, cervix, womb, bladder, urethra, rectum) akin to a hammock. Symptoms include a noticeable bulge or lump, often felt as bearing down or visibly present, with some experiencing difficulty squeezing pelvic floor/vaginal muscles.

Treatment decisions hinge on symptom impact on quality of life; not all cases require intervention. Non-surgical options, such as vaginal pessaries and specialized pelvic floor exercises, are available. Surgical and non-surgical treatments at Danat Al Emarat Hospital cater to individual factors like prolapse severity, associated symptoms, medical history, and personal preference.

Nonsurgical interventions, including lifestyle adjustments, exercises, and pessary use, can alleviate discomfort and pressure from pelvic organ prolapse.

Surgical interventions to address various types of pelvic organ prolapse include:

• Repair of the bladder (cystocele) or urethra (urethrocele)
• Removal of the uterus (hysterectomy)
• Repair of the Repair of the vaginal wall (vaginal vault suspension)
• Closure of the vagina (vaginal obliteration)
• Ectum (rectocele) or small bowel (enterocele)

Accidental Bowel Leakage (Fecal Incontinence)

Hydration Guidelines – To ensure optimal kidney function, avoid restricting fluid intake. Aim to consume at least six drinks daily (equivalent to 1½ to 2 liters), with a preference for still water. If nighttime bathroom trips are disruptive, consider having your last drink at least 2 hours before bedtime.

Bladder Irritation Management – If experiencing bladder irritation, gradually reduce caffeine-containing drinks and substitute them with options like decaffeinated tea, decaffeinated coffee, herbal teas, and water. Note that green tea also contains caffeine, and many fizzy drinks may have caffeine content. Limiting alcohol intake and being cautious with sweeteners is advised, as they can affect the bladder.

Bladder Training – Frequent bathroom visits can train the bladder to hold less urine. Bladder training helps reduce urgency and frequency, teaching how to control urges and minimize rushed trips to the toilet. The goal is to normalize bladder function, with recommended intervals of passing urine every 3 to 4 hours, voiding 6-8 times a day, and not more than once during the night. With time, the bladder should become less overactive, granting better control.

Pelvic Floor Muscle Training – Understanding the location and function of pelvic floor muscles is essential for women. These muscles support the abdominal contents and regulate the bladder and bowel. Training sessions teach how to effectively exercise these muscles. When performed correctly, these exercises strengthen the muscles, providing support to the bladder and aiding in closing the bladder outlet. This can lead to a reduction in leakage and urgency.

*There may be useful apps you may download to assist and track with Kegal Exercises

In-Clinic Assessments

Our clinic is equipped with state-of-the-art equipment to evaluate patients with pelvic floor disorders.

Various testing can be done in the clinic including:

Cystoscopy – A small procedure in-office procedure, done with minimal pain. It involves using a specialized camera called a cystoscope to examine the urethra and bladder. The test is typically performed for various reasons, including:

Bladder control issues like urinary incontinence or overactive bladder

Previous surgeries near or involving the bladder

Presence of blood in the urine

Detection of abnormal cells in a urine sample under the microscope

Recurrent urinary tract or bladder infections

Experience of pain in the bladder, urethral, or pelvic areas

Multichannel Urodynamic Studies – Urodynamic assessments are a series of tests designed to evaluate the functionality of your bladder, urinary sphincter, and urethra. These tests specifically assess how effectively the bladder fills and empties. Typically, this test is recommended if you experience

• Urine leakage
• Frequent urination
• Sudden, strong urge to urinate
• Problem starting a urine stream
• Problems emptying your bladder.

The test aims to assess the pressure inside your bladder during the filling and emptying of urine processes, as well as evaluate the strength of your pelvic floor muscles. To facilitate this evaluation, please complete the Bladder Diary, noting your fluid intake and urinary output accurately. Bring the with you to your appointment.

Instructions to follow before your test – It is important to stop taking any tablets or patches you have been prescribed for your bladder symptoms for 5 days prior to your test. This does not include antibiotics or diuretic tablets (water tablets).

What will happen before the test?

You will be asked details about your bladder problem and will be given the opportunity to discuss any worries or concerns you have about the test.

What does the test involve?

When you arrive at the clinic with a comfortably full bladder you will be asked to pass urine into a special toilet which you will do in private.

The next stage involves applying a local anaesthetic lubricant to numb the area. A small tube will be inserted into your bladder and a small pressure sensor into the back passage or the vagina. Your bladder will be refilled and pressure measurements taken until your bladder feels full.

At this point you will be asked to pass urine into the special toilet again until you feel your bladder is empty.

The tubes will then be removed and you will be able to have a wash and get dressed.

What will happen after the test?

The appointment takes 30-60 minutes. In some cases it may have been arranged for you to be seen by the doctor or nurse immediately following the test to discuss the results, and this may take longer. Alternatively, you may be sent a follow up appointment to see the doctor at a later date.

After your test we recommend that you increase your fluid intake over the next 24 hours to prevent any irritation after the procedure.

Intermittent self-catheterisation – Intermittent self-catheterisation (ISC) is simply a term to describe the process of regular catheterisation which you carry out yourself to remove urine from the bladder.

A catheter is a thin plastic device specifically designed to empty your bladder artificially.

There are many reasons why some people cannot urinate without help from catheters. It may be caused by damaged to the nerve supply to your bladder, the result of back problems, an operation or a condition you were born with.

Whatever the reason urine must not be left in the bladder for too long as it becomes stale and may lead to infection in the bladder and this could result in kidney damage.

Transperineal Pelvic Floor Ultrasound

What is a transperineal pelvic floor ultrasound scan? This is a scan of the pelvic floor using a hand-held probe or ‘transducer’ which is placed on the perineum (the area between the vagina and the anus). This enables images to be taken of the bladder, urethra (what urine flows through), vagina, cervix, uterus (womb), perineum, anal canal, and pelvic floor muscles.

Is there any special preparation before the scan? You may be asked to empty your bladder just before the scan. For best results, it is better if you have also had a recent bowel movement.

What should I expect during the scan?

The urogynecologist performs the scan after you undress from the waist down. While lying on the examination chair, the lights are dimmed for clearer visualization. Gel is applied to a gloved transducer on the perineum, and you may feel slight pressure but minimal discomfort. Squeezing and bearing down may be requested for precise information. The operator will guide you through the process, occasionally requiring a standing position.

What information does the scan provide?

The scan reveals pelvic floor issues like bladder, uterus, rectum, and bowel prolapse, along with potential damage to pelvic floor muscles and the anal canal from childbirth. It can also detect the presence of ‘mesh implants’ or slings. Additional findings include incomplete bladder emptying, pelvic floor muscle function during contraction, and complex problems in the back passage such as rectocele or rectal intussusception. These findings aid in planning suitable treatment options for your doctor.

How long will the scan take?

The scan usually takes about 10-15 minutes.

Are there any risks involved?

Ultrasound scans are considered to be safe, and there are no known risks of performing transperineal scans.

What happens with the results of the scan?

The findings will be forwarded to your doctor, who will then discuss the findings with you.

Anal Manometry – a specialized test assessing the function of your anal and rectal muscles, crucial for controlling bowel movements. If you’re experiencing challenges with bowel movements, it may be linked to the functioning of these muscles. This test measures muscle contractions to assess their activation and coordination. Typically ordered for chronic constipation, fecal incontinence, pain during defecation, and obstructive defecation evaluations.

Meet the team

The Urogynecology and Pelvic Floor Disorders Clinic at Danat Al Emarat Hospital consists of a team of consultant physicians and surgeons, clinical nurse specialists, specialist women’s health physiotherapists, registered and practical nurses and healthcare assistants offering a holistic approach for your care. Our patients are individuals with simple and complex clinical problems of:

• Urinary incontinence
• Dysfunctional bladder control
• Bladder pain disorders
• Recurrent urinary tract infections
• Congenital anomalies of the pelvic floor
• Fecal incontinence and defecatory dysfunction
• Pelvic organ prolapse
• Vesico-vaginal and Recto-vaginal fistulae
• Complications of pelvic floor surgeries
• Urethral diverticula
• Mesh complications – either in the vagina or bladder
• Voiding dysfunction
• Neurogenic bladder