Urodynamic Stress Incontinence (USI)
This diagnosis is present in around 70% of women coming for assessment.
This diagnosis implies urinary incontinence (involuntary leakage or loss of urine) due to weakness of the muscles and ligaments around the bladder neck and urethra (passage from bladder to outside) that normally keep women dry. Recent research by Professor Haylen has demonstrated clearly that the mechanism of stress incontinence is an open bladder neck.
The diagnosis of USI should be distinguished from the symptom of stress incontinence which, as mentioned previously, is the involuntary loss of urine with coughing, sneezing, running, jumping.
Uterine and/ or Vaginal Prolapse
Abnormal descent down the vagina of the uterus, the bladder (cystocele or anterior [front] vaginal wall prolapse), the rectum (rectocele or posterior [back] vaginal wall prolapse) or vaginal vault (enterocoele).
Some aspect of prolapse is present in around 65% of women coming for assessment. In Professor Haylen’s series of 560 consecutive women coming for assessment, these were the following prevalences: Uterine prolapse (15% overall), Cystocoele (57% overall), Rectocoele (41% overall) Enterocoele (8% overall).
Detrusor Overactivity (DO)
This diagnosis is present in around 25% of women coming for assessment.
This diagnosis is made when there are abnormal contractions of the detrusor (bladder) muscles. These contractions, seen during the cystometry part of the urodynamics testing (part 3 assessment), are associated with a compelling desire to void which is difficult to defer.
The symptoms (history part of the assessment) that are commonly associated with the condition are frequency (over 7 voids per day), nocturia (interruption of sleep more than once per night because of the need to void), urgency, urge incontinence and enuresis (bed-wetting).
Example of a cystometry trace showing detrusor overactivity (abnormal rises in the bladder and detrusor pressures representing contractions).
This diagnosis is present in up to 39% of women coming for assessment.
This diagnosis implies abnormally slow and/ or incomplete bladder emptying (voiding). In the voiding study section of the urodynamic studies, there is an abnormally slow urine flow (under the 10th centile of the Liverpool [Haylen] monograms) and/ or a high post-void residual (over 30mls – if measured by ultrasound within 60 seconds of voiding).
Recurrent Urinary Tract Infections
At least 3 medically documented urinary tract infections in the last 12 months have been experienced.
Where there is a much-increased sensation in the bladder during filling at the time of cytometry, as well as the limitation of the capacity of the bladder to under 400mls (normal capacity is around 500mls). Often some component of inflammation may be present with this diagnosis.
It is common for women to have more than one of the above diagnoses with the most common combination being urodynamic stress incontinence (USI) and uterine and/or vaginal prolapse.
Other Gynaecological Diagnoses
Around 1 in 12 women coming for assessment will have some other diagnosis found in and around the pelvis. These may be lumps (tumours) around the uterus (fibroids) or ovary, as well as other changes to the anatomy of the bladder or urethra.
These are muscle lumps in different parts of the uterus, almost always benign, causing enlargement of the uterus. They can however cause pelvic discomfort or be associated with heavy periods. Treatment of the fibroids may be necessary for these symptoms or if the fibroid uterus is causing excess pressure on the bladder.
Heavy and/or prolonged periods, which are disabling and may cause lethargy and tiredness, with blood loss causing anaemia.