Pelvic floor

Gynecological conditions are often present in urology as well. These are called urogynecological conditions, or syndromes: inability to hold urine, prolapse of the bladder, and other syndromes and symptoms. In such cases, patients can turn not only to a gynecologist but also to a urologist.

In other words, urinary incontinence and pelvic organ prolapse sit where two specialties meet. A urological evaluation looks at the bladder and the urethra; when necessary, the decision is made together with a gynecologist.

In overactive bladder syndrome, the patient constantly feels the need to go to the toilet. The condition is common in both women and men and can negatively affect social life, daily plans, sleep and sex life.

In older men, overactive bladder syndrome can develop along with enlargement of the prostate gland. That is why a prostate examination is important for older men who complain of frequent urination.

Treatment can be conservative (medication) or surgical; a specialist decides which is appropriate after an examination. The same approach is not right for every patient.

If frequent urination comes with burning, fever or blood in the urine, infection and other causes must be ruled out first — overactive bladder is diagnosed only after an examination.

Medications widely used in urology for urinary incontinence and for the prostate can cause adverse effects when taken together with certain other drugs — steroids, heart medications and antiarrhythmics. In older patients, it must always be checked which drug groups these medications can be used together with.

Anticholinergic medications given for urinary incontinence carry a risk of harming memory and cognitive function in older patients. In patients with glaucoma (especially narrow-angle glaucoma), this group of drugs may be contraindicated — be sure to tell your doctor if you have been diagnosed with glaucoma.

When the bladder is sensitive, medication from this group is often prescribed. If it causes a dry mouth, that is a side effect: dry mouth is one of the expected side effects of this group of drugs.

Do not stop a prescribed medication or change its dose without consulting the doctor who is treating you; report any concerns about the medication and any side effects to your doctor.

In stress urinary incontinence, this method places a synthetic tape (sling) that supports the urethra. It is a short procedure performed through small incisions, and patients usually return to normal life quickly.

The method is intended for incontinence that occurs when laughing, sneezing or coughing — stress incontinence. No incision is made on the abdomen; the tape is passed through small incisions and positioned beneath the urethra. A long hospital stay is usually not required, and most patients return to their daily routine within a short time.

A sling procedure is only for stress incontinence; urge incontinence (overactive bladder) requires different treatment. For this reason, the type of incontinence must be determined precisely before surgery — as with any surgical procedure, there are risks, and the method is not suitable for every patient.

How long the procedure takes and its outcome vary from person to person; like any surgical procedure, sling surgery carries risks, and the method is chosen individually, only after an examination.

As a general recommendation, heavy lifting, activities that increase pressure inside the abdomen (such as hard straining) and sports are not recommended for about 1 month after surgery, and sexual intercourse for about 1.5 months. These time frames are a general guide; the doctor may adjust them individually based on the patient’s condition and how the operation went.

Injury to the bladder is a rare but possible complication. If you develop difficulty urinating, increasing pain or a fever after surgery, tell your doctor without waiting.

In neurogenic bladder dysfunction, neither MRI, CT nor ultrasound will make the diagnosis. In such cases, a urodynamic study is needed.

When the nerve control of the bladder is disrupted, imaging may show the structure of the organ, but not how it works. For this reason, every condition has its own specific test, each patient is approached individually, and a specific test is chosen to match the complaint — there is no need to put every patient through every test.

Imaging tests (ultrasound, CT, MRI) can be useful for assessing the structure of the urinary tract; a urodynamic study does not replace them but complements them. The doctor decides which test is needed based on the complaint.

Acute conditions and acute syndromes can be treated in a short time. Chronic conditions, however, sometimes require several courses. Urinary incontinence in children is one example: sometimes one course of treatment is enough for it to go away, while in other cases several courses, or even an extensive course of treatment, may be needed.

In such cases, patience is needed — without it, the treatment will not be effective either.

The course and outcome of treatment differ from patient to patient; complaints that have lasted for many years may require several courses. In children with urinary incontinence, the parents’ patience and consistent adherence to the treatment are especially important.

Do not stop a course of treatment on your own before the period agreed with your doctor is over; if you are not seeing results, the next step is decided together with the doctor.

Frequent urination, passing only small amounts of urine despite the urge, burning or pain when urinating, lower abdominal pain, fever and fatigue are signs of a urinary tract infection and can be mistaken for an overactive bladder. Sometimes the infection itself is the cause of the incontinence.

A chronic infection can last for years and may require long-term treatment. To confirm the diagnosis, cystoscopy and multiphase CT imaging may be used when necessary. If surgery is planned, any existing urinary tract infection must be treated first.

Visible blood in the urine (dark or red urine) can be a sign of infection, but it should not simply be explained away as one: even without pain, even if it happens only once, it always requires an examination. Even if the ultrasound is normal, cystoscopy and imaging of the upper urinary tract may be needed.