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Urogynaecology Leaflets

Each of the Urogynaecology leaflets (LWH) are available below, select the heading of the one you would like to view and the content will expand with an option for you to download the PDF version.

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  • Care after Bladder Botox

    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.

  • Urodynamic Investigations - Cystometry

    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

  • Vaginal Pessary

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

    What Is A Pessary?

    A pessary is a plastic or silicone device that fits into your vagina to support a prolapsed bladder, rectum or uterus (womb). There are different types but the most commonly used are either a ring or a shelf pessary. 71%- 90% of women are successfully fitted with a pessary.

    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. It is possible for women to have more than one type of prolapse. 50% of women can get a prolapse. Patients can have varying symptoms such as vaginal heaviness, pelvic pressure bulging into the vagina and backache.

    What Are The Different Types Of Prolapse?

    Cystocele

    A cystocele occurs when the vaginal wall that is next to the bladder becomes weakened. This causes the bladder to lean (or prolapse) into the vagina, where it may then be felt as a lump (See Figure 1)

    Rectocele

    A rectocele occurs when the vaginal wall next to the rectum becomes weakened. This causes the rectum to lean (or prolapse) into the vagina, where it may then be felt as a lump. This type of prolapse may cause difficulty when opening your bowels. (See Figure 2)

    Uterine prolapse

    A Uterine prolapse occurs when the structures that support the womb weaken. This may cause the front and back walls of the vagina to weaken as well and then cause the womb to slip down into the vagina or even outside of the vagina completely. (See Figure 3)

    What Are The Benefits Of Using A Ring Or Shelf Pessary?

    These devices will help to relieve the symptoms of prolapse and can sometimes help improve urinary incontinence or bladder symptoms.

    These devices are suitable for anyone who does not wish to have surgery or if surgery is not appropriate.

    Are There Any Alternative Treatments For Prolapse?

    Some small prolapses can be treated with physiotherapy.

    Different types of prolapse can be corrected with different types of   operations. Your Doctor will be able to explain these to you and whether they would be suitable for your type of prolapse.

    What Kind Of Pessary Will I Use?

    Your doctor/nurse specialist will decide which type of pessary you should use depending on the prolapse you have and also if you are still sexually active. Most times the first pessary that is inserted fits comfortably.

    After the first fitting you will probably be seen within a few months to make sure all is well. After that you will probably be seen every 4- 6 months to have a check-up and a new pessary inserted. Sometimes the size or shape of the pessary may need to be altered. This will include removing the pessary, performing a vaginal examination to review the skin inside the vagina. In some circumstances we may not be able to reinsert the pessary immediately.

    How Do I Care For My Pessary?

    You do not need to do anything; most pessaries can be worn for many months before they have to be taken out and changed. It is very important that you attend your check-up appointments.

    It may also be possible to put the pessary in (or change it) yourself. Please ask the Doctor/Nurse if this is suitable for you.

    Can The Pessary Cause Any Risks Or Side Effects?

    You may notice more vaginal discharge than normal. Your vaginal discharge may also develop an odour. If this happens then you must see your GP who may need to take some swabs and check the vagina for any infection. Vaginal discharge is a common complaint with using pessaries. There is a 32% chance of bacterial vaginosis(vaginal infection) in comparison to 10% of women who don’t have a pessary in place.

    Vaginal irritation is another possible side effect. Women who are past menopause are more likely to have this problem and may need to use an oestrogen cream or tablet which is applied to the affected area every night over a period of time.

    There is a risk of erosion (wear and tear) to the vaginal skin, this can cause bleeding and/or discharge. If you have any abnormal bleeding do not ignore this. Seek medical advice.

    Some women find that after the pessary has been inserted that they can leak urine. This can settle within a short period of time however there may be a more suitable alternative pessary that can be offered.

    Can The Pessary Get Lost Or Fall Out?

    The vagina is a tubular structure with no opening on the inside (See Figure 4) and the pessary can't go anywhere else inside the body. The pessary can fall out of the vagina, especially if you strain or lift something.  The pessary can also fall out if you get constipated. In this case please see your GP for something to help empty your bowels.

    What Else Should I Know?

    Some pessaries can be kept in place during intercourse; your doctor/nurse will advise you about this. Please inform your doctor/nurse as soon as possible if you have any of the following:

    • Discomfort from the pessary
    • Difficulty passing urine
    • Difficulty having a bowel movement
    • Vaginal bleeding.

    If you have any queries or complications with your pessary, such as the pessary falling out, any bleeding or discharge do not hesitate to contact the nurses on of the phone numbers listed below. Please leave a message and a contact number and the nurses will get back to you as soon as it is possible.

    Phone Numbers:-

    Urogynaecology Outpatients Dept. - 0151 702 4321

    Aintree Centre for Women's Health: Assessment Unit 0151 529 2025

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

    You will not be seen in the emergency room if your pessary has fallen out. It is not an emergency to refit your pessary.

  • Bladder Instillation for Interstitial Cystitis/ Painful Bladder

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

    What Is Interstitial Cystitis?

    Interstitial cystitis is a long term (chronic) inflammation of the bladder wall. 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
    • Pain or burning when passing urine

    See interstitial cystitis and painful bladder 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. If required an anaesthetic gel can be used
    • 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 straightaway 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 t in some people 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.

    Useful websites for advice and support:-

    www.bladderandbowelfoundation.org

    www.ichelp.org

    www.iuga.org

  • Bowel Incontinence

    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

     

  • Pelvic Inflammatory Disease

    The leaflet is detailed below, or you can download the 'Pelvic Inflammatory Disease' leaflet in PDF.

    What is Pelvic Inflammatory Disease

    Pelvic Inflammatory disease (PID) is a condition that involves infection and inflammation of the upper female genital tract, including the womb (uterus), fallopian tubes, and ovaries. Any or all of these parts may be affected. PID is usually caused by an infection in the vagina and the neck of the womb (cervix) passing to the internal reproductive organs.

    As the infection develops within the pelvis and becomes more widespread, PID may be diagnosed. If the infection remains untreated, the inflammation can eventually spread to the whole of the fallopian tubes. This can sometimes cause abscesses (pockets of infected fluid) to develop. The infection can then spread through the tubes and into the ovaries. The outer surfaces of the tubes may also start to stick to other organs such as the bladder and bowel.

    About 1 in 50 women a year develop PID. It most commonly develops in sexually active women who are between 15-24 years of age. However, this figure may be an underestimate because many women with PID experience few or no symptoms.

    When Diagnosed Early, PID Can Be Successfully Treated With Antibiotics and Rest.

    If PID goes untreated in can lead to serious long-term complications; including chronic pelvic pain, ectopic pregnancy (a pregnancy that occurs outside the womb), or infertility. Unfortunately many women do not know that they have PID until permanent internal damage has been caused. If you have PID, further infection is common. After a first episode of PID, 20% of women have further episodes, mostly within two years.

    Symptoms

    The symptoms of pelvic inflammatory disease (PID) are not always very specific, meaning that the condition can be difficult to diagnose. Symptoms may appear suddenly, they may come and go or they may be constant:

    • Thick or unusual vaginal discharge
    • Bleeding between periods
    • Fever and vomiting
    • Pain in the rectum (back passage)
    • Discomfort or pain during sexual intercourse
    • Ache or pain in the lower abdomen

    You may have PID without being aware of it. Sometime s, there are no symptoms at all or, if there are, they may not be obvious – for example, you may only experience mild discomfort.

    Causes

    PID can be caused by many types of bacterial infection, but the majority of cases occur as a result of a sexually transmitted infection (STI), most commonly Chlamydia or Gonorrhoea.

    PID is often caused by more than one type of bacteria, and it can sometimes be difficult to pinpoint the bacterium responsible. A combination of antibiotics may therefore be prescribed to treat the condition so that a variety of bacteria can be treated.

    Sometimes, the infection that leads to PID may start as a result of bacteria introduced into the vagina or upper genital tract during childbirth, an abortion or miscarriage, or a procedure to take a sample of tissue from the inside of the uterus for laboratory testing (endometrial biopsy).

    In rare cases, PID can develop as a result of appendicitis, treatment following an abnormal cervical smear, or after the fitting of an IUD (intrauterine device).

    In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs. Although harmless to the vagina, this type of bacteria can cause infection in other parts of the body. Infection in this way is most likely to happen when there has been damage to the cervix or if you have had PID before.

    Risk Factors

    Having multiple sexual partners is one of the main risk factors for developing PID. The more partners you have penetrative sex with, the more likely you are to be exposed to bacteria that can cause PID, particularly if you are not using barrier contraception (condoms).

    Diagnosing PID

    There is no single test available for diagnosing PID. PID is diagnosed by the symptoms and by a gynaecological examination. This will usually involve a specimen being taken from inside the vagina and cervix, using a cotton wool swab. Examining the specimen in the laboratory will reveal the type of bacteria that is causing the infection.

    Because PID is difficult to diagnose by the symptoms alone, you may also have a blood test, or an ultrasound scan.

    In some cases, a laparoscopy may be used to diagnose PID. A laparoscopy is a minor surgical procedure where two small cuts are made in the abdomen. A thin telescope is inserted so that the internal organs can be seen, and, if necessary, take tissue samples (request ‘Laparoscopy’ Leaflet for more information).

    Treatment

    If diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated quickly and efficiently. However, if left untreated, it can lead to more serious, long-term complications (See the ‘Complications’ section). Treatment involves:

    Antibiotics

    A combination of at least two antibiotics is usually prescribed to treat PID. This is because PID often involves several different types of bacteria. Quick and efficient treatment of PID is essential for minimising the risk of infertility.

    Antibiotics that are commonly prescribed to treat PID include Ofloxacin, Metronidazole and Doxycycline. You will usually have to take the antibiotics for 14 days. It is very important that you complete the entire course of antibiotics; otherwise the treatment may not be effective. You partner may also need to be tests and treated with antibiotics.

    In particularly severe cases of PID, you may have to be admitted to hospital where you will receive antibiotics intravenously (through a drip in your arm),

     

    Surgery

    The bacteria that cause PID can leave scar tissue and collections of infected fluid (abscesses) on the lining of the fallopian tubes. This makes it very hard for an egg to pass along it. The longer PID is left untreated, the more likely scarring will occur. Prompt treatment is essential for minimising the risk of damage to the fallopian tubes and other reproductive organs. Studies suggest that even delaying treatment by a few days can increase the risk of impaired fertility. Sometimes, blocked or damaged tubes can be repairs with surgery, such as a laparoscopy, which can help remove the lesions on the living of the tubes. However the results are mixed and it can sometimes cause further scarring.

    A more radical form of surgery is a salpingectomy. This involves the removal of one or both of the fallopian tubes to help stop the spread of further infection. This is only to be considered as a last resort, as the rem0oval of both fallopian tubes will mean you will no longer be able to conceive naturally.

    In the most serious cases of PID, it may be necessary to perform surgery through an abdominal incision (laparotomy) to drain abscesses. In this situation a large drain may be inserted into the abscess to allow it to drain. This would then be removed at a later date.

    Avoid Sexual Intercourse

    While you are receiving treatment for PID, you should avoid having sexual intercourse because it can interrupt the healing process. It is also important that any partners that you have had sexual contact with in the six months before your first symptoms are tested and treated to stop the infection recurring. If you have not had a sexual partner is the last six months, then you should contact your most recent partner.

    Complications

    Recurrent Pelvic Inflammatory Disease

    Recurrent PID is where a woman develops PID on a recurring basis. The more often a woman gets PID, the more likely she is to get it in the future. The condition can recur if the initial infection is not entirely cured or because a sexual partner has not been tested and treated. If an initial case of PID damages the cervix, this can make it easier for bacteria to move into the reproductive organs in the future, making it more likely that the condition will develop again.

    Abscesses

    Sometimes PID can cause abscesses on the lips to the entrance of the vagina and on the lining of the fallopian tubes. An abscess is a collection of infected fluid. It can sometimes be treated with antibiotics. If an abscess does not respond to antibiotics, you may require surgery. It is important that abscesses are either treated or removed, as an abscess which bursts can be potentially life-threatening.

    Ectopic Pregnancy

    The word ectopic means in the wrong place. In a normal pregnancy, the fertilised egg implants in the womb lining. An ectopic pregnancy is one which occurs outside the womb. Over 95% of ectopic pregnancies occur in the fallopian tube. If PID develops in the fallopian tubes, it can scan the lining of the tubes making it more difficult for eggs to pass through. If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe internal bleeding. Ectopic pregnancy is a potentially fatal condition.

     

    Infertility

    It is estimated that 20% of women become infertile as a result of PID. This means they are unable to conceive (get pregnant) naturally. PID can make a woman infertile by scarring the fallopian tubes so severely that it makes it virtually impossible for the egg to travel down into the uterus (womb). Delaying treatment for PID can dramatically increase your chances of becoming infertile.

    Prevention

    The most effective way to prevent Pelvic Inflammatory Disease (PID) is to protect yourself from sexually transmitted infections (STIs). This means using a condom, femidom or cervical cap. It is also important to get regular sexual health check-ups.

    You can get a check-up easily at your local sexual health clinic. You can find your nearest clinic by visiting the Family Planning Association website (www.fpa.org.uk) which allows you to search for your local clinic using your postcode.

    You should also have a sexual health check if you have had sexual contact with someone who you think may have been infected with either an STI or PID.

    References

    www.womenshealthlondon.org.uk/leaflet/PID

    www.fpa.org.uk

    Royal College of Obstetricians and Gynaecologists (2003) Green top Guidelines No 32: Management of acute PID.

  • Having Anorectal Tests

    The leaflet is detailed below, or you can download the 'Having Anorectal Tests' leaflet in PDF.

    What Are These Tests For?

    Anorectal tests are offered here at LWH as part of the routine follow up for Obstetric Anal Sphincter Injury (OASI).  This is due to the fact that women that have had these types of tears are more likely to experience difficulty controlling the muscles around the back passage. This may be because the anal sphincter muscles have become weak or damaged.  This may cause you to have urgency or leakage of stools (faecal incontinence), or you may have trouble with controlling wind (flatal incontinence). Anorectal studies enable us to gain a better understanding about how your tear has healed and how your back passage is functioning.

    What Are Anorectal Tests?

    There are two different tests that provide information about the sphincter muscles and how they are working. These are:-

    • Endo-anal ultrasound

    This uses ultrasound to provide an image of the anal sphincter muscles to see if there are any defects present. An ultrasound probe is passed into the back passage and gently withdrawn to allow different views of the anal sphincter to be seen.

    • Anorectal manometry

    This provides information on the strength of the anal sphincter muscles and its ability to relax and contract. A small flexible tube is passed through the back passage into the rectum. On the end of this tube is a transducer that records the pressure inside. During this test the tube is slowly pulled outwards from the back passage to the edge of the anal sphincter. You will be asked to squeeze the muscles in your back passage several times during this test, in the same way you do your pelvic floor exercises.

    The appointment for these tests is 45 minutes; however the actual testing takes no more than 10 minutes to perform.

    Where Will These Tests Take Place And Who Does Them?

    These tests take place in the Urogynaecology Department and are done by a Doctor or the Urogynaecology Link Midwife. Sometimes there may be a member of staff who is training observing the tests, however you will be informed of this and you can decline to have them present.

    Will I Need Any Special Medication And Will I Be Able To Take My Usual Medication?

    The tests will be more comfortable for you if you have been able to empty your bowel prior to the test. No specific medications to empty the bowel, such as laxatives, are required for the tests. You should continue with any other medication that your doctor has prescribed for you.

    Questionnaire

    You will be asked to complete an online questionnaire (ePAQ) as part of your care. This is a self-assessment questionnaire which gives us more information about your symptoms.  It is confidential.

    What Will Happen When I Arrive At The Urogynaecology Department?

    You will need to use the self-check-in machines located in the main reception of the hospital or the gynaecology outpatient main reception. This then informs you of the waiting area you should head to and lets the staff know you are in attendance. You will then be called through by the Midwife when she is ready.

    What Will Happen During The Tests?

    • The Midwife will take you into the room where you will be asked questions similar to those you were asked when you attended for your 6-8 week follow up, regarding any bladder or bowel symptoms you may have experienced.
    • Each test will be explained to you and you will have the opportunity to ask any questions.
    • You will then be asked to change into a hospital gown and taken to the treatment room for the examination to be performed.
    • You will then lie on your left side on an examination couch.
    • You will have a sheet to put over you.
    • When all the tests are complete you will be able to get dressed.
    • Occasionally patients feel the need to go to the toilet immediately following the test. This is due to the stimulation of the rectum and is quite normal so no need to worry.

    Are The Tests Painful?

    You may have a feeling of pressure during the tests but they should not cause any pain. You can ask the person performing the tests to stop at any point if you are not comfortable.

    Should I Attend If I Am On A Period?

    Yes. Being on a period does not affect the results of the tests.

    When Will I Get The Results Of My Test?

    The Urogynaecology Consultant will see you after the examination and discuss the results with you. You will also be advised regarding the mode of delivery we would recommend for future pregnancies, depending on the results of the tests and taking into consideration any symptoms you may have.

    If you have any questions about these tests you can contact the Urogynaecology Link Midwife on 0151 702 4321 for advice.

    If you need to rearrange your appointment please telephone the Patient Appointment Centre on 0151 702 4328 (option 2) as early as possible.

    Some useful resources:

    www.rcog.org.uk

    www.perineum.net

    www.yourpelvicfloor.org

    www.csp.org.uk

    www.rcm.org.uk

The links below are relating to external leaflets which are deemed appropriate for services that we at Liverpool Women's provide.

Please note: The formatting of these leaflets are mandated externally and Liverpool Women's does not have the authority to amend these.

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