Urogynaecology Services | Advanced Women’s Pelvic Health Care in Penang

What is Urogynaecology?

Urogynaecology is a subspecialty of Obstetrics and Gynaecology focused on women’s pelvic floor, bladder, vaginal, bowel and pelvic support problems.

These conditions are common, but often hidden because women feel embarrassed, ashamed, or believe symptoms are “normal after childbirth” or “part of ageing.” They are not. Leakage, vaginal bulge, urgency, pelvic pain, painful sex and recurrent bladder symptoms can often be improved with the right diagnosis and a personalised treatment plan.

At Gleneagles Hospital Penang, urogynaecology care focuses on restoring comfort, confidence, dignity, sexual wellbeing and quality of life.

Conditions We Treat

1. Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the uterus, bladder, vaginal walls or bowel descend due to weakened pelvic support.

Common symptoms include:

• A bulge or lump at the vagina
• Heaviness or dragging sensation
• Difficulty passing urine
• Recurrent urinary tract infections
• Difficulty opening bowels
• Sexual discomfort
• Symptoms that worsen after standing, lifting or walking

Treatment may include pelvic floor therapy, pessary support, vaginal surgery, uterine-sparing surgery, vault suspension, colpocleisis or personalised reconstructive procedures.

2. Urinary Incontinence

Urinary leakage is treatable. The key is identifying the type.

Stress urinary incontinence: Leakage during coughing, sneezing, laughing, exercise or lifting.

Urgency urinary incontinence: Sudden strong urge to pass urine, sometimes with leakage before reaching the toilet.

Mixed urinary incontinence: A combination of stress and urgency leakage.

Treatment may include bladder training, pelvic floor rehabilitation, medication, pessary support, bulking agents, sling surgery, botulinum toxin treatment or advanced bladder investigations.

3. Overactive Bladder

Overactive bladder causes urgency, frequency and nocturia.

Symptoms include:

• Rushing to the toilet
• Passing urine too often
• Waking at night to urinate
• Fear of travel, meetings or social events
• Avoiding fluids because of bladder anxiety

Treatment is tailored and may include bladder retraining, lifestyle changes, medication, tibial nerve stimulation, botulinum toxin treatment and advanced evaluation when symptoms do not respond.

4. Recurrent Urinary Tract Infection

Recurrent UTI can affect sleep, work, intimacy and emotional wellbeing.

Assessment may include urine culture, bladder emptying assessment, pelvic examination, ultrasound, cystoscopy where needed and evaluation for menopause-related vaginal changes.

Treatment may include targeted antibiotics, prevention strategies, vaginal oestrogen where appropriate, bladder health counselling and investigation for underlying causes.

5. Bladder Pain Syndrome

Bladder pain syndrome can cause pelvic pain, urinary frequency, urgency and discomfort when the bladder fills.

Care focuses on careful diagnosis, avoiding unnecessary repeated antibiotics, identifying pain triggers and building a long-term management plan.

6. Genitopelvic Pain and Painful Sex

Pain during intercourse, vaginal tightness, burning, pelvic floor spasm and penetration difficulty may be related to pelvic floor muscle dysfunction, hormonal changes, trauma, infection, menopause, bladder pain or nerve sensitivity.

Treatment may include pelvic floor assessment, myofascial release, vaginal oestrogen when suitable, pain mapping, physiotherapy, counselling support and a stepwise recovery plan.

7. Postpartum Pelvic Floor Problems

Pregnancy and childbirth can affect the pelvic floor.

We assess and treat:

• Postnatal urinary leakage
• Vaginal heaviness
• Perineal pain
• Painful intercourse
• Birth-related pelvic floor trauma
• Anal sphincter injury concerns
• Return-to-exercise problems

Early assessment can prevent years of silent suffering.

8. Menopause and Pelvic Health

Menopause can affect the bladder, vagina, sexual function and pelvic floor.

Symptoms may include:

• Vaginal dryness
• Burning
• Painful sex
• Recurrent UTI
• Urgency
• Leakage
• Pelvic discomfort

Treatment may include local hormone therapy, pelvic floor care, sexual pain management and personalised menopause-related pelvic health support.

Diagnosis and Assessment

A urogynaecology consultation may include:

1. Detailed symptom assessment Understanding leakage, urgency, prolapse, bowel symptoms, pain, sexual function and quality-of-life impact.

2. Pelvic examination Assessment of prolapse, vaginal tissue health, pelvic floor muscle tone, scars, pain points and support defects.

3. Urine tests and urine culture To detect infection, blood, inflammation or recurrent infection patterns.

4. Bladder diary A simple but powerful tool to understand frequency, fluid intake, urgency and nocturia.

5. Ultrasound assessment May include pelvic, bladder or transperineal ultrasound to evaluate pelvic floor movement, bladder emptying and support.

6. Urodynamic testing Used when symptoms are complex, surgery is being considered, or diagnosis is uncertain.

7. Cystoscopy A camera examination of the bladder when blood in urine, recurrent UTI, bladder pain or suspicious symptoms require further evaluation.

Treatment Options

Treatment is never one-size-fits-all. The goal is to match treatment to the woman’s symptoms, lifestyle, anatomy, age, sexual function, future plans and quality of life.

Conservative Treatment

• Pelvic floor muscle training
• Bladder training
• Lifestyle and fluid advice
• Weight optimisation
• Bowel management
• Vaginal oestrogen where appropriate
• Pelvic floor physiotherapy
• Pessary fitting for prolapse or leakage

Medical Treatment

• Overactive bladder medication
• Vaginal hormone therapy
• Pain-modulating treatment where suitable
• Recurrent UTI prevention plans
• Bladder pain management

Office-Based and Minimally Invasive Treatments

• Pessary care
• Bladder instillation where appropriate
• Botulinum toxin injection for refractory overactive bladder
• Urethral bulking for selected stress urinary incontinence
• Pelvic floor trigger point management

Surgical Treatment

• Vaginal prolapse repair
• Uterine-sparing prolapse surgery
• Vaginal hysterectomy for prolapse where appropriate
• Vault suspension
• Uterosacral ligament suspension
• Stress urinary incontinence surgery
• Colpocleisis for selected women who no longer desire vaginal intercourse
• Repair of complex recurrent prolapse
• Bladder and Rectal fistula via transvaginal approach