What is Urogynaecology?

Urogynaecology is the branch of Gynaecology, which deals with the problems of structure and function of the following organs: uterus, cervix, vagina, urinary bladder, bowel and pelvic floor.

1.Structural problems:

  • Pelvic Organ Prolapse (POP) also known as weakness of the pelvic floor is a common condition found in women. In this medical condition, the muscles and tissues of the pelvis of a woman becomes weak and cannot support or hold the pelvic organs (uterus, cervix, vagina, urinary bladder, rectum) in their normal positions. As a result the pelvic floor drops down, dragging these pelvic structures with it.

2.Functional Problems:

  • Problems of the urinary bladder
  • Problems of the rectum/back passage
  • Problems of sexual function
Causes of Pelvic Organ Prolapse

There are many causes of the weakness/damage of the pelvic floor muscles and tissues. The most common are listed below:

  • Weak tissues by nature/heredity
  • Pregnancy
  • Child birth/delivery
  • Increased weight
  • Increasing age
  • Chronic constipation/chronic cough/ lifting heavy objects over many months or years
  • Nerve abnormalities
  • Trauma/accident or nerve damage

Pelvic Organ Prolapse affects

  • 50% of women who give birth by normal delivery or by caesarean section
  • 60% of women between the ages of 50 and 80 years
  • 1 in 10 women will need some surgery for prolapse before the age of 50 and of these 35% will need more than one procedure
  • A sensation of vaginal fullness or pressure
    • Typically the women will complain of feeling or seeing a ‘bulge’ or ‘lump’ in the vagina.
    • Another common way of expression is the sensation of ‘something coming down’.
  • Lower back pain with standing or walking, usually at the end of the day
  • Lower abdominal discomfort/pain
  • In severe cases, vaginal spotting/bleeding from ulceration of the protruding prolapsed cervix or vaginal walls
  • Urinary problems
    • Urge Incontinence: Inability to hold even small amounts of urine
    • Stress Incontinence: Leakage of urine with laughing /sneezing/ walking/ climbing stairs/exercise/sexual intercourse etc
    • Frequently passing urine during the day and waking up many times in the night to pass urine
    • Double Voiding: Inability to empty the urinary bladder completely
    • Pain before, during and after passing urine
    • Frequent urinary tract infections
  • Bowel problems
    • Urgency to pass stool
    • Leakage of stool
    • Inability to hold wind
    • Constipation
    • Inability to empty the bowel completely
    • Pain with passing stools
  • Problems/difficulty with sexual intercourse
    • Pain during and after intercourse
    • Inability to experience orgasm
    • Leaking urine or stool or wind with intercourse
    • Vaginal flatus
Effect on your life

With any of the above problems, women experience symptoms that have a significant negative impact on their normal daily activities, sexual function and exercise.

Having a pelvic floor prolapse or bowel/bladder problem, can have a deeply damaging effect on women’s body image, personality and sexuality, as well as her physical, psychological and emotional well-being.

Women with pelvic organ prolapse often feel alone, isolated and depressed. They may feel embarrassed by this condition, and because the condition is generally not discussed, they do not seek treatment and the condition gets even worse.

Experience and Skill of Dr (Mrs) Salma Kayani

Dr Salma Kayani has been formally trained and has vast skill and experience in dealing with the medical and surgical treatments of all the above conditions.

Dr Salma Kayani has the experience and the expertise of treating these problems surgically in three different ways:

  • 1. Laparoscopically/key hole surgery
  • 2. Vaginal surgery
  • 3. Combination of laparoscopic and vaginal surgery

A further unique service provided by Dr (Mrs) Salma Kayani is that some problems of urine leakage only require a minor procedure (15-20 minutes), which can be undertaken in the outpatient clinic. This means that the woman with this problem can just walk in to the clinic with the problem and walk out of the clinic completely cured.

These different treatment modalities, give Dr (Mrs) Salma Kayani the flexibility of providing the best possible method of surgical treatment, tailoring it to the precise requirement of the individual patient’s problem, which results in complete surgical treatment of the problem and guaranteed 100% patient satisfaction.

Very few Gynaecologists in the world are able to offer this comprehensive range of medical and surgical service.

Member of International Panel of Experts

Dr (Mrs) Salma Kayani is member of these prestigious international organisations for the last 10 years:

  • British Society for Urogynaecology (BSUG)
  • International Continence Society (ICS)
  • International Urogynaecology Association (IUGA)

Dr (Mrs) Salma Kayani is the member of international select panel of experts in the following societies /organisations

  • International Continence Society (ICS)
    In the International Continence Society (ICS) Dr Salma is the member of the Standardization Steering Committee, which is responsible for setting and establishing standards, terminology and methodology of clinical management and research of continence/urinary bladder care of International Continence Care Societies of the world.
  • International Uro-Gynaecological Association (IUGA)
    In the International Uro-Gynaecological Association (IUGA) Dr (Mrs) Salma Kayani is member of the Specialist Committee for Advanced Laparoscopic Surgery – Sacrocolpopexy. The surgical techniques approved by this specialist committee for Laparoscopic Sacrocolpopexy (gold standard technique) are followed and practised by all internationally recognised Laparoscopic Gynaecological Surgeons

In addition, Dr (Mrs) Salma Kayani is also the member of the exclusive 4-member panel, which is developing training programmes for urologists and urogynaecologists all over the world on how to assess bladder and bowel problems of spinal cord injury patients.

She chairs many international interactive seminars for the training of the Gold Standard technique of Laparoscopic Sacrocolpopexy as well as scientific meetings on this subject.

Being member of these exclusive international panels provides Dr (Mrs) Salma Kayani with the unique benefit that her technique and skills are supported by up-to-date evidence; her clinical and surgical practice is recognized and professionally acknowledged worldwide.

Advantages to Dr Salma Kayani’s Patients:
Being member of these prestigious select panels of these internationally recognised societies/organisations, Dr (Mrs) Salma Kayani’s patients can have the confidence that:

  • Dr Salma Kayani’s clinical and surgical practice is in accordance with the latest medical standards and surgical techniques available internationally.
  • The care her patients receive is evidence-based, up-to-date, internationally recognised and has the support of these prestigious international organisations and select panels.
Surgical Treatments

Dr Salma is qualified and experienced to undertake the following highly skilled advanced laparoscopic and vaginal procedures:

  • Gold Standard Procedures: (Advanced Laparoscopic and Advanced Vaginal Surgery)
    • Laparoscopic Sacrocolpopexy
    • Laparoscopic Sacro Hysteropexy
    • Laparoscopic Colposuspension
    • Vaginal Sacro Spinous Fixation
  • Surgery for Urinary incontinence (Vaginal)
    • TVT
    • TVTO
    • Bulking agents
  • Surgery for Anal incontinence (Vaginal and Anal)
    • Anal sphincter surgery
  • Surgery for Prolapse (Advanced Laparoscopic and Advanced Vaginal Surgery)
    • Repair of the prolapsed urinary bladder
    • Repair of the prolapsed rectum and anal canal.
    • Repair of prolapsed uterus or vaginal vault
  • Special Message for Muslim Women:

    Having problems with sensation of urgency to pass urine/bowel or uncontrolled leakage of urine/bowel or inability to hold wind, has a great impact on your ability to say prayers with need for repeated Wudu/ablution. This is not only a great embarrassment but also a great hindrance in religious supplication –Salat/Saum/Tasbeeh/Tilawat of the Holy Quraan.
    This problem becomes an even bigger issue at the time of pilgrimage – Hajj/Umra or any other religious Ziarats/Pilgrimages. These occasions are sometimes only once-in-a-lifetime opportunities, which need to be performed with complete focus and dedication.
    The medical and surgical treatments described above which are provided by Dr (Mrs) Salma Kayani will InshaAllah result in complete treatment resulting in mental peace and physical ease, so that you will be able to completely focus on your religious supplications.

Frequently Asked Questions

What is the Pelvic Floor?

The pelvic floor is composed of muscles and ligaments that form a sling across the opening of the pelvis. Muscles and ligaments work together in the pelvis of women to support pelvic organs such as the vagina, uterus, urinary bladder and bowel. Pelvic floor disorders are caused by weakening support of the muscles, ligaments and connective tissue in the pelvis.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is the bulging or dropping of the uterus, rectum or bladder into the vagina. There are several different types of pelvic organ prolapse and it is common to have more than one type at the same time. While prolapse is not considered a life threatening condition, it may cause a great deal of discomfort and distress. The various types are:

  • Cystocoele - when the bladder falls down into the vagina
  • Uterine prolapse - when the womb drops down into the vagina
  • Vaginal vault prolapse - when the vagina itself falls down
  • Enterocoele - when the small bowel pushes against the vagina causing a bulge
  • Rectocoele - when the rectal support becomes weak and bulges into the vagina

What is incontinence?

Incontinence occurs when women have trouble controlling their urine (urinary incontinence) or their bowels (fecal incontinence).
There are many possible causes of incontinence. The two most common forms of urinary incontinence are stress incontinence and urge incontinence. Others are Overflow incontinence and Mixed incontinence.

Stress incontinence happens when something you do – such as coughing, laughing, sneezing, jumping, lifting or exercising – increases the pressure in your abdomen enough that it pushes urine past the urethra. In other words, some external force pushes on the bladder and urine squirts out.

Urge incontinence happens when women are not able to wait until they empty their bladder. Women experiencing this problem say, that, "When I have to go, I have to go." This occurs because the normal ability of the nerves to give the message to the bladder to wait until it is the right time to pass urine is weakened. With urge incontinence, when a woman feels the need to empty her bladder, the message sent by the nerves to the bladder, to wait, simply doesn't work anymore. In this case either they have to immediately find a toilet or suffer from the extreme embarrassment of urinary leakage.

Overflow incontinence happens when the bladder gets overfilled and over flows. This can occur with medical conditions that desensitize the bladder sensory system. This may also occur when certain prolapses prevent complete emptying of the bladder.

Mixed Incontinence is a combination of one or more of the above.

What is urodynamic testing?

Urodynamic testing is a series of bladder tests that are done in order to observe how your lower urinary tract reacts under certain conditions. It is usually done to see if you have problems with loss of urine (urinary incontinence) or to figure out what type of incontinence you may have. Testing usually consists of filling your bladder with sterile water, then observing the pressure and how your bladder reacts under these increasing pressure conditions. When the test begins, the physician inserts a small soft catheter in your bladder and a tube is hooked up to a bag of sterile water. Your bladder is then filled to around 250 cc (approximately one cup), which most women can hold without needing to urinate. A second catheter, which is connected to a machine or computer, also is inserted. This catheter measures the pressures within your bladder. Once the bladder is filled, you will be asked to cough and strain in order to see how much urine you leak.

What is Interstitial Cystitis?

Interstitial Cystitis (IC) is a chronic condition of the bladder often causing symptoms of frequency, urgency, painful urination, painful intercourse and chronic pelvic pain. A common theory of Interstitial Cystitis is that it is a defect in the lining of the bladder (like an ulcer in the stomach). Treatment options include the bladder diet, medications, bladder lavage treatment and neuromodulation.

What treatment options are available for urinary incontinence?

Treatment options include habit training, prompted voiding, pelvic muscle rehabilitation (Kegel exercises), pessaries, medications and surgery. Surgery is the only permanent treatment for prolapse and stress incontinence.

If I Do Nothing Will It Get Worse?

It may not happen quickly but, if left untreated, over time the condition often worsens. In rare instances, prolapse can cause urinary retention that may lead to kidney infection or permanent kidney damage. In these cases, treatment is necessary. Otherwise, the decision to treat the prolapse should be based on your signs and symptoms.

What is Anal Incontinence?

Anal incontinence is the involuntary leakage of gas, liquid stool or solid stool.

What causes Anal Incontinence?

Like other pelvic floor disorders, anal incontinence usually occurs because of childbirth. Even easy normal vaginal deliveries can result in direct injury to the anal sphincter muscle or to the innervations of the rectum and sphincter. About 15% of the time anal incontinence occurs because of direct injury to the anal sphincter. This may or may not be caused during childbirth. After childbirth you can often compensate for this problem. However as you grow older, the weakness of these muscles becomes more apparent. There are conditions that can lead to this disorder. Some of the more common ones include: Haemorrhoids or Haemorrhoid surgery, Radiation Enteritis, Spinal Cord Injuries, Inflammatory Bowel Disease, Multiple Sclerosis, Parkinson’s Disease, Stroke, Dementia, Diabetic Neuropathy, Rectal Prolapse and Descending Perineum Syndrome.

What Can Be Done To Treat Anal Incontinence?

There are different approaches to treating anal incontinence. The treatment depends upon the condition causing it. A complete history and physical examination will help identify the potential problems. Anal manometry, transanal ultrasound and pudendal nerve latency studies are diagnostic tests that are helpful in evaluation. Treatment options include dietary modifications, weight loss, bowel management, biofeedback, physical therapy and surgical options including anal sphincter repair, rectocele repair and sacral nerve neuromodulation.

When should I contact a doctor?

  • If you have any concern at all about any condition with your body
  • If you feel a bulge or lump inside or outside of your vagina
  • If you have lower back pain or increased pelvic pressure that interferes with your daily activities
  • If you have irregular vaginal spotting or bleeding
  • If you experience frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the symptoms listed here that interfere with your daily routine
  • If you are experiencing any problems with your bowels mentioned above.
  • If sexual intercourse is painful or difficult

How will I be evaluated?

When you see your doctor, you will have a detailed health history taken in order to get a thorough explanation of your symptoms. A pelvic examination is necessary to diagnose pelvic organ prolapse. If a prolapse is identified, your urogynaecologist will determine which organs are involved and the degree of the prolapse. Other test may be ordered based on the findings during history and examination.

Will treatment for prolapse affect my sex life?

If you choose to have surgery, you are asked to wait to have intercourse for a period of time (maximum 6 weeks), after which women report an improved sex life.

What can I expect at my first visit?

  • The doctor will take a thorough history of your symptoms
  • Pelvic examination
  • Evaluation of pelvic support
  • Evaluation of loss of urine or stool
  • Neurological examination
  • Evaluation of pelvic muscles
  • Some blood tests
  • You may be asked to fill a bladder diary and make follow up appointment
  • Schedule surgery