By Dr.Karthik Gunasekaran, Consultant Urogynecologist
In a country with an estimated population of 10 billion people, approximately 45% of them women, there is a dire need for subspecialists catering to women’s health. Women, on account of pregnancy and delivery are subjected to certain stressors which are very unique to them.
Though childbirth is a profound experience and one of the highlights in a woman’s life, this experience can be impacted by changes in a woman’s body, particularly bowel or bladder control. Unfortunately, these changes are rarely discussed among women.
In order to analyse the problems that crop up following traumatic labour, one needs to understand the basic anatomy of the pelvic floor. The pelvic floor in a woman consists of the structures between the pelvic bones and the backbone at the hip. This would include the muscles, nerves and blood vessels which offer support to important organs like the uterus(womb), the bladder, the vagina(birth canal) and the rectum(bowel).
When these support structures get damaged or injured during vaginal childbirth or during instrumental delivery(forceps) or due to other factors such as weight lifting, chronic cough (asthmatics), obesity, smoking and menopause, pelvic floor dysfunction develops.
There are many ways in which pelvic floor dysfunction can manifest. Uncontrolled leakage of urine which is a social or hygienic problem is urinary incontinence. This can be either related to an increase in intra-abdominal pressure such as during coughing and sneezing (stress urinary incontinence) or urgency related (urge incontinence).
Prolapse (descent of organs like uterus, vagina, bladder and rectum from their normal position) is again due to injury to the pelvic floor. Chronic pain in the region of the pelvis, sexual dysfunction and uncontrolled loss of motion (faecal incontinence) are some of the manifestations of pelvic floor dysfunction.
The important question, however, is who is to handle these problems. Traditionally gynaecologists deal with the uterus and vagina, urologists with the bladder and the surgeons with the rectum. However, when pelvic floor dysfunction manifests, all these organs are typically affected at the same time requiring a confluence of different specialities. Thus was born the subspecialty of urogynecology. Sir Turner-Warwick, an eminent urologist from the UK described the Urogynecologist as “Neither a Urologist nor a Gynaecologist, but someone with speciality training in treating pelvic floor problems in women”. When the rectum also got included as a pelvic organ, colorectal surgeons came into play and the concept of reconstructive pelvic surgery was born.
25_70% of women suffer from urinary incontinence and related pelvic floor problems. Urinary incontinence is a social problem and many women suffer in silence as they feel ashamed to discuss this with family members or friends.