Urogynaecology Leaflets

The leaflet is detailed below, or you can download the 'Care after Bladder Botox' leaflet in PDF.

What Happens Next?

• You have had your Botox treatment today. An appointment for a flow rate and bladder scan will be sent to you within the next 2-4 weeks.
• This is to check you are emptying your bladder fully.
• If you have a normal sensation to pass urine and are able to empty your bladder you do not need to do anything until this appointment.
• It is normal to feel the urge to empty the bladder every 3-4 hours.

How Will I Know If My Bladder Is Working Properly?

• Look out for symptoms such as:
  • lower abdominal bloating
  • passing small amounts of urine
  • unable to pass any urine at all
  • no urge to pass urine after 4 hours
• If you experience any of the above symptoms you will need to self-catheterise.

When Might These Symptoms Happen?

• Between 24 hours and 2 weeks following Botox.

How Do I Start Self-Catheterisation?

• Always try to pass urine normally first.
• Measure the amount passed normally in a jug.
• If you are unable to pass urine or only pass a small amount (50-100mls) then self-catheterise.
• Measure the amount of urine drained through the catheter. 

How Often Should I Self-Catheterise?

• This depends on the amount of urine drained through the catheter. The higher the volume of urine drained the more often you will need to catheterise.

 

0 – 100mls	no need to CISC
100 – 150mls	once a day
150 – 250mls	twice a day
250 – 350mls	three times a day

 

• It is common to require self-catheterisation first thing in the morning and before bed.
• We recommend you only use a catheter every 3-4 hours maximum and no more than 6 times per day. You may not need to catheterise every time you go to the toilet.
• If you drain less than 100mls from the catheter on three consecutive occasions you can stop self-catheterisation.
• Remember the effects of Botox are temporary and will eventually wear off. This means the frequency of catheter use may also reduce.

Should you experience symptoms of a urine infection, such as pain, burning, stinging or blood in the urine, please see your GP.

The leaflet is detailed below, or you can download the 'Urodynamic Investigations - Cystometry' leaflet in PDF.

What are Urodynamic Investigations?

• Urodynamic investigations or urodynamics are a series of tests to demonstrate how your bladder is working. It is important to discover the exact bladder problem in order that the best treatment can be offered to you.
• During all your tests a nurse will always be there to support you and answer any questions that you may have.
• When all the tests are completed you will see a doctor or the clinical nurse specialty who will discuss the results with you.
• We often have medical and nursing student’s observing the tests we perform. We will ask your permission if they can observe the test and you can request that they leave the room at any time.

What is a Cystometry (Bladder Pressure Test)

This test tells us how your bladder behaves when filling with fluid and on emptying. It takes approximately one hour to do.

• Before the test the nurse will ask you to empty your bladder. You may need to give a specimen of urine and the nurse will tell you if this is needed.
• The test is conducted in a quiet room with a doctor or clinical nurse specialty and nurse present.
• It does not require any needles or anaesthetic so you can carry out your activities as normal after the test.
• You will be asked to wear a hospital gown.
• To do the test the nurse will need to place two small tubes (catheters) into your bladder and one small tube in the back passage or vagina. You might feel a slight discomfort as these tubes are being inserted.
• When you are comfortable the test will begin. Your bladder is filled with sterile water through one of the catheters until you feel a strong desire to go to the toilet.
• One tube is removed from the bladder, you will be asked to stand up. You will be asked to do some coughing and gentle jumping. We also run the water as this can irritate your bladder. All of these may cause you to leak, if you do it is only sterile water that you lose but it is important as this will assess your bladder function.
• You will then be asked to empty your bladder on a specialty toilet with the tubes still in place. The doctor and nurse will leave the room to give you privacy. Once you have emptied your bladder the remaining two tubes will be removed.
• The results of the test will be discussed with you before you go home.
• If you have a vaginal wall prolapse you may have a vaginal pessary inserted for the test. You will be informed whether you need this.

What is a Pessary?

We occasionally use a ring pessary to assess patients who have a prolapse. A pessary is a ring of plastic, which gets inserted into the vagina by either a doctor or a nurse. It may feel uncomfortable whilst it is being inserted but once it’s in place you shouldn’t feel it in the vagina. The ring pessary is removed at the end of the test. However if you would prefer to keep it in till your operation, the nurse will give you some more information regarding the pessary. 

Why do I Need a Pessary?

The prolapse can kink the bladder pipe (urethra), which may hide stress incontinence – leaking with sneeze, cough, and exercise and laughing. Some women, who have surgery for their prolapse, may find that after surgery they develop leakage or find it difficult to empty their bladder. Sometimes these investigations are performed before your operation to decide what type of surgery you need or to see if this improves the emptying of your bladder.

The staff on the ward are always available to discuss this and any other issues with you in full, please do not hesitate to contact the Urodynamics Specialist Nurse / Continence Advisor on 0151 708 9988 Ext 4321 @ Liverpool Women's NHS Foundation Trust.

Some useful websites for further information are www.bladderandbowelfoundation.org

The leaflet is detailed below, or you can download the 'Vaginal Pessary' leaflet in PDF.

What is a Prolapse?

A prolapse means that your uterus, bladder or rectum is bulging or leaning into the vagina, because the muscular walls of the vagina have become weakened. This can sometimes be felt as a lump in the vagina. If the prolapse is large it may also cause difficulty when emptying the bladder or bowel. Up to 50% of women can experience a prolapse and it is possible for a woman to have more than one type of prolapse at the same time.

Patients with a prolapse can have varying symptoms which can include vaginal heaviness & discomfort, feeling a lump in the vagina, difficulty emptying your bladder or bowel and discomfort during sexual intercourse.

What is a Vaginal Pessary?

A pessary is a removable medical device that fits into your vagina to support the weakened vaginal walls or uterus. There are many different types of vaginal pessaries, some that can stay safely inside the vagina for several months and others that need to be removed daily.

Vaginal pessaries can be used to avoid or delay surgery and aim to improve your symptoms of the prolapse.

The type of vaginal pessary that has been chosen for you often depends on the type and severity of prolapse you have.

The success of a vaginal pessary can be measured by the improvement of your symptoms, the comfort of the pessary and that it stays in place.

What are the alternative treatments for prolapse?

Depending on your symptoms and the severity of your prolapse there are alternative treatments to vaginal pessaries, which include physiotherapy, conservative management or surgery.

What will happen after the initial fitting of my pessary?

As soon as the pessary is inserted the clinician will check with you that it feels comfortable before you leave the clinic.

You can carry on your daily activities as usual including exercise. You should avoid straining when having you bowels open as this could affect the position of the pessary inside, and cause the pessary to fall out.

You will be invited to a follow-up appointment by the clinician who has fitted the pessary to discuss if this treatment has worked well for you. If the pessary has not been successful then you can choose to try another type of pessary or one of the alternative treatments.

If you continue with the vaginal pessary you may want to learn how to remove and re-insert it yourself. This option is available to all patients and an appointment with one of the Urogynaecology Nurse Practioners can be arranged for you.

What are the risks or side effects of a Vaginal Pessary?

Expulsion (Pessary falling out)

In some women a vaginal pessary can come out; however this does tend to be more common following the first insertion. If your pessary falls out then you are advised to wait for your next appointment. However if you do experience difficulty passing urine when your prolapse is down you can contact us to arrange an earlier appointment (Contact numbers at the end of this leaflet)

Try to avoid straining to open your bowels as this force can push the pessary and contribute to it falling out.

Vaginal Discharge

Most women have a small vaginal discharge which can increase with a vaginal pessary. If the discharge becomes discoloured and unpleasant and is associated with feeling unwell, elevated temperature or lower abdominal discomfort it could mean you have an infection or ulceration. A vaginal swab can check for an infection and an examination can look for ulceration, your GP should be able to arrange these.

Pain or Discomfort

When a pessary is fitted, you should not be able to feel it inside. Pain or discomfort could be caused if the pessary is too big, small or has moved inside. You can contact the hospital for advice if you experience this. (Contact numbers at the end of the leaflet)

Bleeding / Ulceration to the vaginal wall

Depending on the size and type of vaginal pessary you have fitted can increase your risk of developing ulceration to the vaginal walls. This happens due to the increased pressure on the walls from the pessary. Ulceration is not dangerous and will heal itself simply by removing the pessary for a short time. Sometimes you may be prescribed a vaginal topical cream to use to reduce the risk if ulceration.

On occasions the skin on the vagina can bleed when a pessary is removed and can be caused from some minor trauma to the skin during the removal. If this happens it will normally settle down by itself. If you continue to bleed after 7 days you can contact the nursing staff for advice.  (Contact number at the end of the leaflet)

Are there any restrictions to my daily activity?

No, the pessary should not restrict any of your activities. In fact the pessary is a treatment to allow you to carry on with the normal activities of your life.

Can I have sex with a Vaginal Pessary?

If you have a ring or ring with support you can still have sex. All other pessaries would have to be removed before you or your partner had sex. You can be taught how to remove and reinsert your vaginal pessary. If this is what you would like to do then speak to your Doctor or Nurse and an appointment can be arranged for you to learn this.

Contact Numbers:-

To make or change an appointment in clinic – 0151 702 4328

For clinical advice from Urogynaecology Nurses -0151 702 4321

We have an answer phone service so please leave your name, hospital number or NHS number, a contact number and a brief message. We aim to answer all queries as soon as possible but sometimes this may not be on the same day that you have phoned.

For Emergencies Only

If you are in severe pain or you cannot pass urine at all then please contact the Gynaecology Emergency Department on 0151 708 9988 ext. 4120 or your GP for further advice or assistance.

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Bladder Instillation for Interstitial Cystitis/ Painful Bladder' leaflet in PDF.

What Is Bladder Pain Syndrome (Interstitial Cystitis)?

Bladder Pain Syndrome/Interstitial cystitis is a long term (chronic) inflammation of the bladder wall. It is a poorly understood condition. It is a chronic pelvic pain condition. It affects more women than men across all ages and ethnicities.

It can cause:-

• Lower abdominal pain
• Urinary frequency- passing urine more than 8 times a day
• Urinary urgency – strong urge to pass urine
• Pain or burning when passing urine
• Pelvic pain
• Pain when bladder is filling up
• Waking up at night to pass urine
• Pain with sexual intercourse

See interstitial cystitis leaflet for more details

What Is A Bladder Instillation?

This is a liquid solution that is introduced into the bladder through a catheter.

There are several different types of solution that can be inserted into your bladder; they can provide temporary relief from your bladder symptoms.

They work by coating your bladder with a protective layer to help reduce the symptoms of urgency, pain and frequency.

How Is The Treatment Given?

• You will be asked to pass a sample of urine to ensure that you do not have a urine infection and that your bladder is sufficiently empty prior to instillation.
• If you do have an infection- we are not able to give the instillation that day, but you will be given another appointment.

• A catheter is passed into your urethra and the solution is passed through the catheter into your bladder.
• You will need to keep the solution in your bladder for up to two hours. If you cannot tolerate this, the treatment may not be as effective. You can go home straight after the instillation.

Advice Pre and Post Treatment

Try not to drink a lot of fluid prior to and after your instillation to prevent dilution of the solution.

How Many Treatments Will I Have?

You will be given an instillation every week for 6 weeks and if there is some improvement you will then have monthly instillations until your symptoms resolve.

Do not be discouraged if your symptoms are not relieved straight away it can take 5 or 6 treatments before they improve.

Are There Any Side Effects?

There are no specific side effects if you have these instillations, however in some cases catheterisation can cause minor discomfort.

Are There Any Alternatives?

Please refer to the interstitial cystitis/painful bladder leaflet for further information. Alternative treatments would be discussed with your Consultant.

Will I Have A Follow Up Appointment?

You will remain under the care of the nurse specialists unless you wish to discuss alternative treatments or if you have any change in your condition.

You can contact the Urogynaecology Nurse Specialists at the Liverpool Women’s on 0151 702 4321

Useful websites for advice and support:-

www.bladderandbowelfoundation.org

www.ichelp.org

www.iuga.org

www.ic-network.com/

 

 

 

The leaflet is detailed below, or you can download the 'Bowel Incontinence' leaflet in PDF.

Bowel Incontinence.

This means not always being able to control your bowels.

There are 2 types, faecal incontinence and flatal incontinence.

What Is Faecal Incontinence?

Faecal Incontinence is when you are unable to stop yourself from passing a bowel motion (faeces, stools).It can vary from staining of underwear to passing a complete stool without control.

What Is Flatal Incontinence?

Flatal Incontinence – this is when you cannot stop yourself from passing wind (Flatus) from the back passage.

Who Does It Affect?

Anyone can be affected but certain groups of people are more likely to have bowel incontinence than others:

• Frail older people
• People with loose stools or diarrhoea
• Women who have recently given birth
• People who have injury to or disease of their nervous system or spinal cord.
• People with learning disabilities or memory problems.
• People with urinary incontinence.
• People who have a prolapse of their rectum or organs in the pelvis (This means that these organs have slipped down from their usual position in the body).
• People who have had an operation on their colon (Part of the bowel) or anus.
• People who have had radiotherapy to the pelvic area of their body.

Normal Bowel Emptying

Inside the anus (back passage) are two rings of muscle called the anal sphincters. The inner ring of muscle is called the internal sphincter and is kept closed. When the stool enters the rectum the internal anal sphincter relaxes and the top of the anal canal opens. The stool enters the anal canal where nerve cells can tell if the stool is very loose(Diarrhoea), if there is wind (Flatus) or if itis a normal formed stool.

The outer ring of muscle is called the external anal sphincter. This is the muscle you squeeze when you want to stop passing wind or having your bowels open. If you need to have a normal bowel movement but you are not near a toilet then you will squeeze the external anal sphincter muscle. This holds the stool in and it is pushed back up out of the anal canal until you are able to find a toilet. All this normally happens without really thinking about it.

Why Does Faecal Incontinence Occur?

Weakened Sphincter Muscles

If the sphincter muscles are weak then it is harder to control your bowels. They can be weakened by pregnancy and childbirth, especially if you had a tear to these sphincter muscles during the birth of your baby. This type of tear is called a Third Degree Tear or Fourth Degree Tear. As we get older the sphincter muscles naturally become weaker.

Nerve Injury

If the nerve supply to the anal sphincters is not working properly due to injury or damage, then bowel control can be affected. This can happen during childbirth, after some types of surgery or because of an injury to the spine. Other medical conditions such as a “stroke”, epilepsy and multiple sclerosis (MS) can also affect the nerves supply.

Diet

Some foods and drinks can make your stools loose. When stools are loose they are hard to hold in. Some drinks can make stools loose: Alcoholic drinks, “fizzy” drinks and drinks which contain caffeine (Tea and coffee).Foods which can affect your stool include chocolate, Liquorice, fatty foods or foods with a lot of fibre in e.g. some cereals. Some artificial sweeteners can make stools loose. Certain foods can give you lots of “wind”, e.g. beans, lentils, pulses, high fibre fruit and vegetables. This can also make any leakage of faeces worse.

Irritable Bowel Syndrome (IBS)

This is a disorder that affects how the large bowel works. Symptoms include pain or discomfort in the abdomen, bloating, an urgent need to empty the bowel and changes in bowel habit. IBS should be diagnosed by a doctor. Certain foods can make things worse so you may need special advice on your diet.

Constipation

When hard stools are built up in the bowel they are difficult to pass. Loose, watery faeces can leak around them. This sort of faecal incontinence is common with elderly people and children.

Medicines

Certain medicines can make your bowel motions loose. Ask your doctor or pharmacist if you think this may be the cause.

Diarrhoea

Loose stools are hard to control. Diarrhoea, very loose watery stools, can be caused by a “Bug” so see your GP if symptoms persist or if you are unwell.

Conservative Treatments

Diet Control

Regular meals are important. When you eat breakfast in the morning this makes a wave of pressure start in your bowel shortly afterwards. This gives you the feeling that you need to empty your bowel. If your stools are too loose, some foods can make them thicker: Rice, rice cakes, rice crackers, fresh pasta, bread, mashed potato, stewed apple, smooth peanut butter, marshmallows and jelly. Try drinking water or decaffeinated drinks instead of tea, coffee or fizzy drinks. Drink 8 to 10 cups of fluid a day, unless advised not to by your doctor.

Pelvic Floor Exercises

These are exercises which will help strengthen your pelvic floor muscles to help you have better control of your bowel. To help you do these exercises you may be referred to physiotherapists or nurses who are able to teach you how to do these.

Medicines

Loperamide

Loperamide is the most common treatment for faecal incontinence. It is an anti-motility drug .This means that it slows down the passage of stools. This will help give you more control of your bowel movements. Loperamide can be given as tablets or syrup. The dose can be adjusted to make your stools firm but not hard. It can be used long term in doses of 0.5 mg to 16mg per day as required. You should not be given Loperamide if you have acute diarrhoea without a diagnosed cause, if you have hard or infrequent stools or an acute attack of ulcerative colitis.

Codeine Phosphate

If Loperamide is not suitable for you, you may be prescribed Codeine Phosphate tablets to make your stools firmer. This is usually used as an Opioid Analgesic (Painkiller).Some people can become dependent on (Addicted to) these types of painkiller. This is not usual if you are taking the tablets under medical supervision but you should discuss this with your doctor.

Colpermin/Peppermint Oil.

If you have a lot of wind, you may be prescribed Colpermin capsules. These area form of peppermint oil and can help reduce wind. If you are prescribed a medicine and are unsure about anything, please tell your consultant, GP or pharmacist who can answer your questions.

Specialists.

You should be referred to a specialist e.g.Colo-rectal doctor, Continence Nurse or Specialist Physiotherapist by your GP. This is so you can have specialised advice, treatment or investigations.

Hygiene for Faecal Incontinence.

Faecal l incontinence can make your skin sore. When wiping yourself it is recommended that you use a soft toilet paper and avoid rubbing the skin too hard after having your bowels open. This is so you do not damage the skin which would make you feel sore and could cause infection. Women should always wipe from the front to the back .This is to reduce the transfer of bacteria from the bowel which could cause infections in the bladder. To wash the perineal area (area between the vagina and back passage) use warm water and a mild unscented soap.

If your Skin Is Sore.

Using a “Barrier cream” such as zinc and castor oil cream or Sudocrem can help protect your skin. Only apply a very thin layer of any cream that you may use. See your nurse or doctor if the skin is broken or doesn’t get better as you may have an infection which needs treatment.

If You Have a Problem with Faecal Incontinence

Faecal incontinence is embarrassing but do talk to your Doctor, Nurse, Midwife or Health Visitor so that they can offer advice and support.

References

NICE 2007, clinical guideline 49, Faecal Incontinence.

Useful websites www.bladderandbowelfoundation.org

 

Click here to download the 'Urodynamic Investigations – Flow Studies' leaflet (opens in a new window).

What are Urodynamic Investigations?

•  Urodynamic investigations are a series of tests to demonstrate how your bladder is working. It is important to discover the exact bladder problem in order that the best treatment can be offered to you.
• During all your tests a nurse or health care assistant will always be there to support you and answer any questions you may have.
• We often have Medical and Nursing students observing the tests we perform. We will ask your permission if they can observe the test and you can request, they leave the room at any time.

What are Flow Studies? 

This test tells us how much urine your bladder can hold and how well you empty your bladder. The time it takes to do this test will vary and depend on how long it takes your bladder to fill. The nurse’s in the urodynamic department will be able to advise you about this.

• If possible, try and attend for your appointment with a full bladder. Your test will be carried out as soon as possible after you arrive in the department.
• If your bladder is not full when you arrive you will be provided with some water or juice to drink. You will then be asked to wait until your bladder feels full and you need to go to the toilet.
• When you need to go to the toilet to pass urine you will be asked to use a special type of toilet called a Urodyn. The urodyn will measure the speed and amount of urine you pass.
• After you have emptied your bladder, an abdominal scan will be performed (near your bikini line) and this will measure the amount of urine left in your bladder.
• The results of this test will be discussed with you on the day you attend or at a review appointment which will be made for you.

If for any reason you feel that you would not be able to do any of the above tests do not hesitate to contact the Department or discuss with one of the nurses when you attend your appointment. 

The staff in the department are available to discuss this and any other issues with you in full, please do not hesitate to contact the Urodynamics Specialist Nurse/Continence Advisor on 0151 708 9988 Ext 4321 at Liverpool Women’s Hospital or at the Aintree site on 0151-529-2025.

Some useful websites for further information are:

www.bladderandbowelfoundation.org.uk  

 

The leaflet is detailed below, or you can download the 'Urogenital Atrophy' leaflet in PDF. 

What is Urogenital Atrophy?

Urogenital Atrophy is a condition which most often occurs during and after the menopause when the lack of the female hormone oestrogen affects the vagina, urethra & bladder trigone.

After the menopause the amount of oestrogen produced by the ovaries falls. The lack of oestrogen leads to a thinning of the tissues around the vaginal area and a reduction in the number of the small mucus producing glands. There is also a loss of fat around the genitals producing a different appearance than previously. As a result, the vagina can become shortened, less elastic and dryer with less lubricating mucus; the genital skin also looks paler. These changes usually take months or years and vary between women.

How common is Urogenital Atrophy? 

Vaginal dryness occurs in about 1 in 4 women leading up to the menopause, it becomes more common after the menopause when about 1 in 2 women are affected. About 7 in 10 women in their seventies have this problem. 

What signs & symptoms can occur?

The changes described above may occur but without causing any symptoms or discomfort. However, some of the following symptoms may occur in some women. All of the following symptoms can be caused by other medical conditions, but atrophic vaginitis is a common (and usually treatable) cause of these symptoms.

• Painful intercourse – as the vagina is smaller/shorter, drier and less likely to become lubricated during sex, intercourse can become painful. The skin around the vagina is more easily made sore and this aggravates the problem.
• Vaginal bleeding – as the vaginal and uterine tissue is thinner and more fragile it can occasionally lead to spotting and bleeding. If you notice any post-menopausal vaginal bleeding, you must always report it to your GP.
• Vulvo-vaginal Discomfort – if the vulva or vagina becomes tender and inflamed some women can experience constant discomfort.
• Infection and discharge – the vagina is less resistant to infection after the menopause and sometimes becomes infected. An offensive (smelly) unpleasant vaginal discharge may need treatment from your GP.
• Itch – the skin around the vulva is more sensitive and more likely to itch in some women. This produces a tendency to scratch which then makes the skin more likely to itch. An itch/scratch cycle follows which can be both difficult to break and quite distressing.
• Urinary problems (frequency/urgency to pass urine)– these may be due to thinning and weakening of the tissue around the neck of the bladder or around the urethra (the opening for urine). A prolapse or weakening of part of the vaginal wall may also cause urinary symptoms which may increase with age. There is no evidence that topical oestrogens/hormone replacement will prevent or help urinary symptoms. Urinary symptoms that may occur include one or more of the following:
• Passing water too often (frequency)
• Not being able to hold on (urgency)
• Pain when passing urine (dysuria)

What are the treatments for Urogenital Atrophy?

Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen it can be helped by replacing the oestrogen topically. This can be done in several ways:

• Hormone Replacement Therapy (HRT) – this means taking hormone drugs in the form of a tablet, gel, implant or patches. This may be the best treatment, but some women don’t like the idea that periods may return with this treatment, especially if it is many years since the menopause. You can discuss this more fully with your GP.
• Oestrogen creams or Vaginal Pessary – sometimes a cream or pessary containing oestrogen is prescribed. This replaces oestrogen to the vagina and surrounding tissues, usually the cream or pessary is used every night for 2 weeks and then twice a week for a further 4 weeks. This treatment is usually effective and can be repeated if the problem recurs.
• Non-hormonal Lubricants & Moisturisers – if vaginal dryness is the only problem or hormone creams are not recommended because of other medical problems, lubricating gels like KY jelly or moisturisers such as Replens, Regelle, SYLK or Hyalofemme may be obtained from the pharmacy or on prescription from your GP.

Useful websites

 

www.gpnotebook.co.uk/simplepage.cfm?ID=-771358705  – 17k

 

www.patient.co.uk/showdoc/40024656/  

 

www.replens.co.uk  

 

www.sylk.co.uk  

 

 

Liverpool Women’s is a smoke free site. Smoking is not allowed inside the hospital building, grounds, car parks or gardens. If you would like advice about stopping smoking please ask a member of staff.

 

The leaflet is detailed below, or you can download 'Postnatal Urinary Retention' leaflet in PDF. 

What is postnatal urine retention?

We want you to be able to pass urine spontaneously within 4 hours of your baby being born or 4 hours after you have had your catheter removed. If you are unable to do this, it may mean you have gone into postnatal urinary retention. Sometimes you may not be able to pass urine at all but sometimes you may be able to pass small volumes of urine with difficulty, but larger volumes still remain in your bladder. If this happens it is important to tell your midwife.

Why does urine retention happen?

1. This can happen because you feel sore underneath, especially if you have had stitches
2. There is usually some swelling in and around the vagina after having your baby, which can take time to settle and can make it harder for you to pass urine
3. An epidural or spinal anaesthetic can cause altered sensation in your lower body, which can affect your bladder temporarily
4. There may be injury to the pelvic nerves, which may have happened during the birth

You are more likely to have problems if:

• This is your first baby
• You have had an epidural or spinal anaesthesia
• You have had a prolonged labour
• You have had an instrumental delivery (forceps or ventouse)
• You have had a tear or stitches
• You have a urine infection
• You have had problems previously

What can I do to help me try to pass urine?

1. Analgesia – ask your midwife to give you painkillers if you feel sore
2. Getting up and walking about – movement really helps to reduce any swelling there may be
3. Privacy – If you feel nervous about using the toilet in the bay, use one of the toilets on the main corridor of the ward
4. Taking a warm bath or shower – this will help relax you and make you more comfortable

What happens if I cannot pass urine?

If you are unable to pass urine 4 hours after having your baby or your catheter removed, then a midwife or doctor will scan your bladder to check how much urine is there. It may be likely that the midwife will then need to empty your bladder using a catheter.

If you are in discomfort from a full bladder before this time or the midwife can feel a very full bladder, then you may have to have your bladder emptied earlier.

What is a catheter?

This is a thin, sterile tube, which is usually made of plastic. The catheter is passed into your urethra (the small opening through which urine is passed) and into your bladder. This allows the urine to drain out. Your midwife or doctor will ask for your consent to put a catheter in your bladder. If you decide you do not want this, then you will be encouraged to try to pass urine again yourself. You could be at risk of harming your bladder in the long term if you still cannot pass urine, especially if there is a large volume of urine there.

Having a catheter inserted can be a little uncomfortable but it is a quick, safe procedure. You should feel much more comfortable when your bladder is emptied. It may be necessary to leave the catheter in place for at least 24 hours, to let the bladder “rest”. If this happens, a leg drainage bag will be attached to the catheter to collect the urine. This will be strapped to your leg to allow you to continue to mobilise. Staff will show you how to empty your bag when it is getting full. Overnight, another larger catheter bag will be attached to the leg bag and kept on a stand at the side of the bed. This will allow more urine to drain without having to be emptied as frequently and therefore allow you to rest for longer periods.

You can still have showers and it is important to keep the perineal area (the area between the vagina and back passage) clean, especially after opening your bowels.

It is really important to stay hydrated. Aim to drink 2 litres of water or dilute juice per day, 3 litres if breast-feeding.

What happens when the catheter is removed?

You will be asked for permission to take your catheter out. A midwife or maternity assistant will remove it. This is a quick procedure, and you may experience some very slight discomfort.

It is important that when the catheter is removed, we monitor what you drink and how much urine you pass. This can tell us whether your bladder is working normally again. This is easy to do: you will be given a fluid chart and shown how to write down what you drink and how much urine you pass. To measure the urine you pass, your midwife or maternity assistant will provide you with a jug.

You may find that initially you are unable to tell when your bladder is full. This is usually a temporary problem. If this is happening, then it is recommended that you try to go to the toilet every 3-4 hours. This will prevent your bladder getting too full.

What happens if I cannot pass urine after the catheter is removed?

It may be necessary to put the catheter back in. This would be for around a week, and you would then be referred to the link Midwives in the Urogynaecology Department. This is situated on the ground floor of the hospital. The staff there are trained to provide specialist investigation, advice, and support for women with bladder problems. They will discuss the best form of management for your bladder problem.

In most cases, urine retention is a temporary problem, which may take a few weeks to resolve. If you have any ongoing voiding issues, we may teach you how to perform self-catheterisation (Clean Intermittent Self Catheterisation) as an interim measure until the issues resolves. The staff in the Urogynaecology department will provide support and advice during this time and will arrange any follow-up you may need.

Will bladder problems happen again in another pregnancy?

This is hard to say – there is a chance you may have a recurrence of these problems however we cannot predict if this would be the case for you. If you fall pregnant again, make sure you tell the midwife who is ‘booking’ you in that you have had previous bladder problems with your last pregnancy, so that the staff caring for you are aware.

Many women have temporary bladder problems in pregnancy and after childbirth, please do not feel embarrassed to discuss any problems with your midwife or doctor who can offer advice and support.

If you have any questions, please contact the Urogynaecology Link Midwives on 0151 702 4321

For more information:- www.bladderandbowelfoundation.org

Please note that Liverpool Women’s NHS Foundation Trust is a smoke free site. Smoking is not allowed inside the hospital building or within the hospital grounds, car parks and gardens.

Staff are available to give advice about stopping smoking, please ask your Nurse or Midwife about this.

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the Botulinum Toxin for Overactive Bladder Information leaflet in PDF

Why am I being offered this treatment?

You are being offered this treatment because you have an overactive bladder. People with overactive bladders have to rush to the toilet to pass water (urgency), and they have to pass water very often (frequency).

You will have already tried conservative treatments for overactive bladder. But, as you know, the tablets and bladder training sometimes don’t work very well. We can offer treatment with botulinum toxin (Botox) when these treatments have not worked or only partially worked.

What is botulinum toxin?

The treatment is called botulinum toxin A. You may have heard of this drug under the brand name BOTOX®. It is used as a beauty treatment to get rid of wrinkles or to stop people sweating, but it can also treat muscle disorders, including cerebral palsy. Injections of this drug have successfully treated patients who develop bladder problems after spinal injury. The benefits for people with spinal injuries last between six and nine months.

We are using this drug as a treatment for overactive bladder. The botulinum toxin is injected into the bladder wall muscle in several places. This will be performed in the Ambulatory Suite in Gynaecology Outpatients. You will be awake for the procedure, local anaesthetic will be used.

What are the benefits of this treatment?

The injection paralyses part of the bladder muscle which means that the bladder can no longer squeeze out urine as effectively. The bladder becomes more relaxed and stretchy meaning that you should be able to hold on longer before feeling the need to empty your bladder. This should help to reduce the episodes of urgency and urge incontinence (leakage).

How long does the treatment work for?

The effects of Botox usually start within seven days of the injection. The effect can last between 6 and 12 months; it cannot be reversed but will gradually wear off with time. Because the effects cannot be reversed, you should be certain you want the procedure to be done.

Most people with overactive bladders need repeated injections every 6 months. Botox has been used for at least 20-25 years for treatment of other muscle problems but has only been used in the last 15 to 20 years in the bladder. As it is a relatively new treatment, we do not yet know enough about the long-term effects of repeated treatments. However, no major long-term effect has been reported to date.

What tests will I need to see if I am suitable for the treatment?

We will give you a bladder diary to take home and fill in. We will ask you to write down how much bother your bladder is, how often you are passing urine, and how urgent it is.

You will be seen by one of the doctors in the Urogynaecology team. They will check your medical history and make sure it is safe for you to have the injections. They will also check the results of the bladder test you had when you were told that you had an overactive bladder. You may need an ultrasound scan to make sure your bladder empties properly. This is the type of scan used on pregnant women. It takes about five minutes and is painless.

You will need to be taught how to use a urinary catheter before you have Botox in case you are unable to pass urine normally after receiving Botox. This will be taught by one of the specialist nurses and further details of this will be provided when you are assessed for Botox in clinic.

What happens next?

A very thin tube called a cystoscope, that has a camera on the end, is inserted into your bladder through the urethra (the tube you pass urine from). Gel is inserted into the urethra before the cystoscope is inserted This enables us to see inside the bladder so we can check the bladder is healthy and inject the Botox safely into different sites in the bladder wall. There will be 9 injections; this may be increased if the dose of Botox is increased.

After the treatment, you will be escorted into the recovery lounge, where there are toilet facilities. You can go home after 30 minutes of receiving the Botox if you have passed urine and feel well enough to travel home. 

After your first treatment of Botox, you will attend 2 weeks later for a bladder scan to check you are emptying your bladder fully. Advice regarding frequency to catheterise, if needed, will be given at this appointment.  Once you are established having regular Botox injections you can self-refer into the service – further information will be provided when you’re ready to self-refer. 

Are there any alternatives?

You have been offered this treatment because other treatments have not worked. Alternative treatments to Botox include different tablets or Percutaneous Tibial Nerve Stimulation (PTNS). This involves inserting a very small needle into the ankle, similar to acupuncture, this will be discussed in more detail in clinic.  Very rarely patients with very severe symptoms are offered major surgery to increase the size of their bladder (clam cystoplasty) or to divert their urine into a bag worn on the skin (urinary diversion).

What are the side effects of this treatment?

No operation is without risk; however, the majority of procedures are carried out without any problems. Please read this section and discuss any concerns with your doctor.

About one person in six may have difficulty emptying their bladder. This could last a few days or weeks. If you have this kind of difficulty, we would advise you use the catheters intermittently until you can pass urine normally.

Operation side effects

There are side effects when the drug is given for muscle diseases such as cerebral palsy – but these are rare. They include weak muscles near the injection site, flu like illness, aching muscles and a feeling of nausea.

We don’t know what all the side effects are when the drug is injected into the bladder, but they are likely to be less than the side effects for muscle diseases because the dose is lower.

Useful Websites

www.incontact.org

www.2womenshealth.com

www.promocon2001.co.uk

www.continence-foundation.org.uk

The leaflet is detailed below, or you can download the 'Going home with an Indwelling Urethral Catheter' leaflet in PDF.

You are being discharged home with an indwelling urethral catheter. It should have been explained to you already why you need to have an indwelling urethral catheter, if not, please ask your health professional to explain this to you.

This leaflet is intended to give you information on how to look after your catheter and drainage system at home. 

What is an Indwelling urethral catheter?

It is a hollow, flexible tube which drains urine from your bladder. A small balloon in your bladder, filled with water, stops the catheter from falling out. 

Your catheter may be short term or long- term depending on your medical condition. This will be discussed with you by your health professional.

Indwelling urethral catheters and drainage bags

The urine will drain out through the catheter and into a drainage bag attached at the end. There are two types of drainage bag, a leg bag and a bed bag. You generally wear a leg bag during the day and at night you connect this to a larger bed bag.

During the day- Leg bags are worn under your clothing during the day. You will need to empty the urine out into the toilet every few hours via the tap at the bottom of the bag. Leg Bags are worn on your thigh, under your clothing, making them discreet to wear. They are held securely to your leg with either Velcro straps or a cotton sleeve. 

Leg bags are available in three different sizes, 350mls, 500mls, and 750mls and with varying tube lengths. Your nurse will be able to advise you on the products available and which may be the best one for you.

During the night - At night, a larger drainage bag (bed bag) can be used to drain the urine when you are asleep. The bed bag is connected to the end of the leg bag, leaving the leg bag tap open to allow drainage. A bed bag needs to be supported off the floor or bed by hanging it on a stand.

It is advisable that you loosen the Velcro straps of the leg bag or remove the cotton sleeve at night.

Changing the drainage bags?

It is recommended that you change your leg bag every 5-7 days. However, if the bag gets damaged or becomes uncomfortable you may change it sooner. 

To change your leg bag first wash your hands, then remove a new bag from its packaging. Empty the urine out of your existing leg bag then gently remove the bag from the end of the catheter and put it into a plastic bag for disposal. Remove the dust cap from the end of the new leg bag and insert the bag into the end of the catheter making sure it is pushed up as far as it will go.

When discarding your old leg bag, make sure it is empty, place it in a plastic bag in your household waste bin and wash your hands.

It is recommended that you use a non-drainable bed bag as this is emptied and discarded (as above) every morning and reduces the risk of infection.

Indwelling catheters with catheter valves

An alternative to drainage bags is a catheter valve. This is a simple tap that is attached to the end of the catheter and every 3-4 hours it is recommended that you open the valve and let the urine drain out of your bladder into the toilet. 

Catheter valves are small and discreet and are supported either by tucking them into your underwear or wearing a special catheter leg strap around the top of your thigh. It is recommended that catheter valves are changed every 5-7 days. Your health professional will show you how to do this before you go home.

Not everyone is suitable for a catheter valve, and they should only be used after discussion and on the advice of your healthcare professional.

Personal hygiene  

Personal hygiene is very important when you are living with an indwelling urethral catheter to help prevent infection. The following points are important to remember.

• Always wash your hands before and after emptying your drainage bag or opening your catheter valve.
• Try to have a bath or shower every day. Always empty your drainage bag first. If you are using catheter straps on your leg bag you may wish to have a pair just for use in the bath and shower.
• Never apply creams or talcum powder as they may cause “clogging” around the catheter entry site and may increase your risk of infection.
• Change your underwear daily.
• After having your bowels open always wipe your bottom from front to back. Wet wipes are useful and can be used to clean after having your bowels open.

Should I be drinking and eating anything different?

It is very important that you drink lots of fluid when you have an indwelling urethral catheter in place. Try to drink at least 2 litres (about 8 glasses) of fluid a day. This helps to keep the urine dilute and helps to prevent infection. Try to avoid caffeinated drinks (e.g. tea/coffee), fizzy and sugary drinks and alcohol. 

You should continue to eat a normal, healthy balanced diet to avoid getting constipated. Constipation could affect how your catheter drains. Try to include plenty of fresh fruit, vegetables and whole grains to provide sufficient fibre. If you think you may be constipated you GP may be able to prescribe medication to help.

What about sex?

You can still have sex with a catheter in place if you follow the following steps.

• Tape the catheter onto your abdomen out of the way.
• Both partners should wash their genitals before and after intercourse.
• It may help using a lubricant, like KY jelly, YESWB or YESOB.

You must never remove your catheter unless you have been taught to do so.

If you have any problems or questions do not hesitate to discuss this with your health care

Can I travel with a Catheter? 

Having a catheter should not stop or limit your ability to travel. You may connect a larger drainage bag (night bag) to your leg bag, if you desire however a leg bag should be sufficient for travel as long as it is emptied as recommended. If you intend to fly, then try to avoid alcohol as altitude dehydrates the body. Be sure to take spare catheters and other supplies with you on holidays or long journeys.

What problems can occur with a catheter?

When you first have your catheter inserted you may experience some or none of the following:

• A feeling you need to pass urine. This may be caused by irritation to the bladder or urethra and should settle after a few days.
• A bladder spasm or cramp from time to time. Again, this usually settles after a few days and is nothing to worry about. Walking around whilst you have a spasm can help or alternatively, take a mild painkiller.
• Urine leaking around the catheter. This may happen when you have a bladder spasm. As long as urine is draining into the bag or out through the valve this is not an emergency. However, if it continues you should inform the health professional who is managing your care.

If you find the urine has stopped draining into the bag or no urine comes out when you open the catheter valve, then you need to check the following:

• Make sure there are no kinks in the catheter or tubing of the drainage bag.
• Check the drainage bag is below the level of your bladder.
• Check the drainage bag is connected the right way up  Make sure you are drinking enough fluids
• Are you constipated?

Could I get a urine infection with an indwelling urethral catheter?

Yes, it is a risk. Having a catheter can increase your risk of getting a urine infection. You can help prevent this happening by making sure you drink plenty of clear fluids, such as water or diluted juice, avoid constipation, ensure you maintain a good level of hygiene and never let anyone else empty or change your catheter or drainage bag unless they have been trained to do so.

Symptoms of a urine infection include dark, cloudy, offensive smelling urine, increased body temperature and aching and pain.

When do I ask for help or advice?

You will need to contact someone for advice if you experience any of the symptoms described in this below

If you have prolonged pain which has not been relieved with painkillers or movement

• If your urine has not drained after 2-3 hours
• If there is blood in your urine which does not clear after drinking extra fluids
• If you think you have a urine infection
• If urine keeps leaking around your catheter

Your GP or local Walk-in centre can advise, if this is closer to home. Please remember to take you catheter passport along.

The following are contact number at the Liverpool Women’s Hospital: -

Gynaecology Emergency Department 0151 702 4140

Non urgent answer phone service - Urogynaecology Nurse practitioners 0151 702 4321

Maternity Assessment Unit (MAU)  i0151 702 4413

Main hospital Number 0151 708 9988

Trial Without Catheter (TWOC)

You may need to attend the TWOC clinic to have your catheter removed. This clinic is held in Gynae Outpatients Department (GOPD).

How long will I be at the clinic?

You may be at the clinic for 2-4 hours but could be longer depending on your hydration.

If you have a catheter valve, please do not open your valve for two hours prior to attending the clinic we also advise you drink 500mls water, slowly over 1-2 hours before your appointment. This will allow your bladder to fill before you arrive in the clinic.

What will happen at the clinic?

Once your catheter is removed, we will assess how well you can pass urine.

If you have had a catheter valve and your bladder is full, then we will assess how you can empty your bladder immediately. If you have had a catheter bag, then you will need to fill your bladder. We have a waiting area where you will have access to drinking water or alternatively you can bring in your own drinks.

What if I can’t pass urine?

If you can’t pass urine the nurse will assess how full your bladder is. If your bladder hasn’t filled enough, you will be encouraged to drink a little more and wait a bit longer.

If your bladder is very full, then you will be taught how to self-catheterise (insert a catheter into your bladder yourself).  If you are unable to do this, then the nurse will reinsert an indwelling catheter with a catheter valve.

Going Home?

The nurse will inform you of future follow up appointments and provide you with contact phone numbers.

Contact phone numbers: -

Non urgent answer phone service - Urogynaecology Nurse practitioners 0151 702 4321

Gynaecology Emergency Department 0151 702 4140

Maternity Assessment Unit 0151 702 4413

Main hospital Number 0151 708 9988

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Pelvic Health Physiotherapy Appointment' leaflet in PDF

We provide specialist treatment and assessment to women for a variety of pelvic health problems including –

• Urinary Incontinence
• Fecal Incontinence
• Constipation
• Overactive Bladder Syndrome
• Dyspareunia (pain during sexual intercourse)
• Pelvic Pain
• Pelvic Girdle Pain

What to expect during your appointment –

Be prepared to talk about your symptoms, how long you have experienced them and how they affect you. This will help your Physiotherapist piece together a picture of what is happening and how best to help you. Following this, we may decide it is necessary to complete an internal examination (vaginal/ rectal), an abdominal examination, or a functional assessment. This is not compulsory and will only be completed with your full informed consent. You will have the opportunity to discuss this in more detail with your physiotherapist, and please feel free to ask questions.

If you would like a chaperone during any examination, please ask your physiotherapist and this will be provided by a member of our team.

Physiotherapy Dept direct line – 0151 702 4170

 

 

 

 

The leaflet is detailed below, or you can download the 'Catheter Test' leaflet in PDF. 

What is a catheter test?

The catheter test is a common procedure. It gives your doctor the opportunity to perfect the technique needed to do your actual transfer in cases where it is suspected to be difficult.

Why is a catheter test done?

Having a catheter test is a lot like having an embryo transfer. During embryo transfer we use a very soft catheter which contains your embryo and is performed as gently as possible. A difficult embryo transfer has been associated with lower pregnancy success rates. In cases where we think that difficulty might be anticipated during the actual embryo transfer in view of your history we may recommend you to have a catheter test beforehand.

What does the catheter test involve?

The catheter test is usually done before starting the IVF cycle. You will probably be told to come that day with a full bladder. This is because your full bladder pushes the uterus into a position which makes the procedure easier. A speculum will be used to help your clinical practitioner visualize the neck of your womb (cervix), more like having a smear test, and place the catheter into and through the cervix into your uterus.

You may feel cramping or a sharp but tolerable pain when the catheter is placed. Some women only feel slight discomfort like during a pap smear, and nothing more.

What is the aim of the procedure?

The aim of the procedure is to choose  the best catheter to use with your particular anatomy, to make sure there is nothing to prevent the catheter from entering the cervix smoothly and figure out the best path from your cervix into your uterus, this may vary according to the position of the uterus.

How do I know that I might need a catheter test?

If you had any previous surgeries to your cervix, uterine abnormalities, cervical fibroids, or any other factor that can make the passage through your cervix into the uterine cavity difficult.

Do I need anaesthetic?

No, the procedure is performed whilst you are awake. The procedure should be as gentle as possible and painless similar to Embryo transfer. However, you may experience some discomfort especially if the passage through the cervix is difficult which may lead your doctor to offer you a further procedure.

Are there any risks?

It is generally considered a very safe procedure. There is a very rare chance of developing an infection. If you develop a fever within a few days of the procedure, experience severe cramping, or unusual bleeding (not just spotting), or offensive vaginal discharge, or If you are concerned at any time, please contact the Hewitt Centre for further advice. There is also a small chance that the procedure gets abandoned due to difficult entry, hence a subsequent procedure would then be required.

How much does it cost?

Currently if your treatment is funded by the NHS, you may be eligible to have the procedure performed without cost. However, if you are paying for your treatment an additional will be incurred.