Urogynaecology

• Cystocele: Prolapse of the front wall of the vagina.
• Rectocele: Prolapse of the back wall of the vagina.
• Uterus: Prolapse of the womb.
• Vault: Prolapse of the top of the vagina after a hysterectomy.

Find out more about more about Pelvic organ prolapse - NHS https://www.nhs.uk

The British Society of Urogynaecology (BSUG) and the Pelvic organ prolapse NHS website have further information about treatment offered.

The urogynaecology team works closely with a variety of specialised teams to ensure comprehensive care throughout your journey. As part of your treatment plan, you may be referred to a pelvic health physiotherapist for targeted exercises, the bladder and bowel team for symptom management and support, the colorectal team for addressing related concerns and the urology team for specialised expertise in urinary tract issues. This multidisciplinary approach is designed to provide holistic and tailored care, addressing all aspects of pelvic health.

Physiotherapy can be helpful in many ways. If your prolapse can be managed without the need for a pessary or surgery, you may be referred to a physiotherapist in order to strengthen the pelvic floor muscles.

If you do have any other treatments, you will still need to complete the physiotherapy sessions prior to any surgical intervention as it can help by improving control over bladder and bowel function, improving existing prolapse or reducing the risk of prolapse, and improved recovery from childbirth and surgery.

• getUBetter App
• PH Physio Self Referral Form 2026
• Pelvic Floor Exercises

The Bladder and Bowel health service are a team specialising in the care of patients with bladder and bowel symptoms. Offering an open referral system we offer assessment, management and advice on many aspects of bladder and bowel care. Within Cwm Taf Morgannwg the bladder and bowel team offer Nurse led clinics (for lower urinary tract symptoms – LUTS and Pelvic Floor exercises) and Urinary Catheterisation – held at HCHP, DSH, YCC & RGH. Education – multidisciplinary & multiagency (Urinary Catheterisation, Bowel Care & Continence Assessment & Management – all can be accessed via SharePoint). Residual urine ultrasound scans, Flow studies, Assessment and fitting of urinary appliances and symptom management/coping strategies.

• Bladder Diary
• Bladder Training
• Squeezy

Urogynaecology and colorectal teams work closely together to provide coordinated care for patients with complex pelvic floor disorders that affect both the urinary and bowel systems. The teams combine their expertise to ensure accurate diagnosis and comprehensive management. This collaborative approach allows for integrated surgical and non-surgical treatments and ensures that patient care is holistic, efficient, and centred on improving overall pelvic floor function and quality of life.

Treatments
Urogynaecology offer several treatments to women with pelvic organ prolapse, incontinence, as well as bladder pain syndrome, please see below all treatments our service offers.

Vaginal pessaries are used to alleviate symptoms of pelvic prolapse and support the vaginal walls. Pessaries come in all different shapes and sizes used on a trial-and-error basis to find the patients correct fit depending on their prolapse and lifestyle. Pessaries are either PVC or silicone and are placed into the vagina. This device should be comfortable and help improve quality of life.

Vaginal estrogen is offered during pessary management to keep vaginal tissues well moisturised.

• Vaginal Pessary for Pelvic Organ Prolapse
• Low-Dose Vaginal Estrogen Therapy

At the start of the urodynamic investigation, a fine sensor, catheter tube/wire (sterile) will be put into your bladder through the urethra (the tube through which urine is passed). Another sensor will be placed into the rectum (back passage) or vagina (used occasionally for women). Placing these tubes/wires should not be painful as a lubrication gel is used to reduce any discomfort. Some patients may find this part of the investigation slightly uncomfortable or a little embarrassing. The nurse specialist will try to reduce this as much as possible. When the sensor tubes/wires are in place, they are attached to a computer and your bladder activity will be measured as it fills and empties.

Your bladder will be filled with sterile saline (salt water) through the fine tube until you feel the need to pass urine. You will be asked to cough at various stages during the investigation; this is to show if the sensors are recording correctly. The nurse specialist will try to reproduce the bladder symptoms that you are currently having by getting you to cough, laugh or listen to running water. You will also be asked a series of questions such as your first desire to pass urine or whether you experience any urgency. When the nurse specialist feels that enough information has been collected, you will be allowed to empty your bladder into the specially adapted urodynamic toilet (in private). This toilet will measure the flow rate and volume of urine passed. Once this is done, the sensor tubes/wires will be gently taken out and you will be offered some wet wipes and dry wipes so you can have a wash and make yourself comfortable and get dressed in privacy.

• Urodynamics

There are several different surgical treatments for pelvic organ prolapse. This can include surgical repair, hysterectomy or closing the vagina.

Surgical repairs are usually done by making cuts in the wall of the vagina under general anaesthetic. Anterior wall repair is where the bladder bulges into the vagina from the front wall of the vagina. Posterior wall repair is where the bowel bulges forward into the back wall of the vagina.

These operations can involve lifting and supporting the pelvic organs. This could be by stitching them into place or supporting the existing tissues to make them stronger.

• Pelvic Organ Prolapse | RCOG
• Sacrohysteropexy for Uterine Prolapse - Patient Information Leaflet
• Sacrospinous Fixation (SSF) - Patient Information Leaflet
• Patient Decision Aid on Surgery for Uterine Prolapse
• Operations to Treat Prolapse of the Uterus - Patient Information Leaflet
• Anterior Vaginal Wall Repair - Patient Information Leaflet
• Posterior Vaginal Wall Repair - Patient Information Leaflet

For women with a prolapsed womb who have been through the menopause or do not wish to have any more children, a doctor may recommend surgery to remove the womb (hysterectomy). It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.

• Vaginal Hysterectomy for Uterine Prolapse
• Vaginal Hysterectomy for Pelvic Organ Prolapse

Occasionally, an operation that closes part or all the vagina may be an option. This treatment is only offered to women who have advanced prolapse, when other treatments have not worked and they're sure they do not want to have sex again in the future. This operation can be a good option for frail women who would not be able to have more complex surgery.

• Colpocleisis - Patient Information Leaflet

Urinary incontinence is when the normal process of storing and passing urine is disrupted causing involuntary leakage of urine.

This can happen for several reasons such as:

Weakened muscles such as your pelvic floor and urethral sphincter; problems with these muscles may be caused by damage during childbirth, increased pressure on tummy (pregnant or obese), certain medicines, damage to the bladder or nearby area during surgery, connective tissue disorders or other neurological conditions.

• Surgery for Stress Urinary Incontinence Patient Decision Aid
• Autologous Fascial Sling
• Urethral Bulking to treat Stress Urinary Incontinence
• Colposuspension for Stress Urinary Incontinence

Bulkamid is a urethral bulking agent that is used to treat SUI. It is a smooth, water-based gel which remains in the body over time without causing reactions in the surrounding tissue. The Bulkamid procedure consists of 3-4 injections into the wall of the urethra (this is the tube that allows urine to leave the bladder). By adding additional volume to the wall of the urethra, it helps prevent urine from leaking out of the bladder during normal daily activities.

• Urethral Bulking

If non-surgical treatments for urinary incontinence are unsuccessful or unsuitable, surgery or other procedures may be recommended. Colposuspension involves making a cut in your lower abdomen, lifting the neck of your bladder, and stitching it in this lifted position. Sling surgery involves making a cut in your lower tummy (abdomen) and vagina so a sling can be placed around the neck of the bladder to support it and prevent urine leaking. Urethral bulking agent is a substance that's injected into the walls of the urethra in people with stress incontinence who have a vagina. This increases the size of the urethral walls and allows the urethra to stay closed with more force.

• Colposuspension

Cystoscopy Is a test where a cystoscope is passed into the bladder by a healthcare professional to have a look into the bladder to again confirm or determine whether there is any under lying conditions causing urinary symptoms. During cystoscopy, injections into the bladder may be offered to help relax the bladder wall. This can then reduce urinary urgency and frequency, reducing urinary incontinence. Improvements are usually noticed three to four days after treatment. This is an outpatient procedure.

• Botox Injections to Treat Overactive Bladder
• Cystoscopy

Percutaneous tibial nerve stimulation (PTNS), also referred to as posterior tibial nerve stimulation, is the least invasive form of neuromodulation used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency, urinary frequency and urge incontinence.

• Percutaneous Tibial Nerve Stimulation

Bladder training combined with pelvic floor muscle training can be helpful with incontinence symptoms. It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine.

• Bladder Training

Some surgical interventions for prolapse and urinary incontinence can affect bladder function, meaning that a small number of patients may have difficulty emptying their bladder fully after surgery. Procedures such as prolapse repair or incontinence surgery can alter bladder support or urethral dynamics, occasionally leading to urinary retention or incomplete bladder emptying. In these cases, patients may need to learn intermittent self-catheterisation as a temporary or, less commonly, long-term measure to safely empty the bladder. This technique helps prevent complications such as urinary tract infections or bladder over-distension and allows patients to maintain independence while bladder function recovers or is managed appropriately.

• Information from The British Association of Urological Surgeons (BAUS) about self-catheterisation
• Intermittent Self Catheterization (ISC) - Your Pelvic Floor