Mediclinic Stellenbosch welcomes its first urogynaecologist

Dr Colin Montgomery, who plans to establish a pelvic floor service at Mediclinic Stellenbosch, believes in treating patients with minimally invasive techniques.

Urogynaecology is a relatively new sub-speciality that deals with the diagnosis and management of conditions that affect the female pelvic organs – usually the bladder, bowel, uterus, and the muscles and connective tissue that support these organs.

Dr Colin Montgomery, who recently joined Mediclinic Stellenbosch as its first urogynaecologist, is in the planning stages of establishing a pelvic floor service at the hospital.

“In layman’s terms, I diagnose and treat woman with bladder problems like urinary leakage, bladder dysfunction, bladder pain, recurrent bladder infections, leakage of stools, and prolapse [when you feel a bulge or general pressure in your genitals]. However, I am still a gynaecologist who assists my patients with regular gynaecology examinations, pap smears, family planning and abnormal menstruation.”

Women most commonly develop pelvic organ prolapse several years after childbirth, after a hysterectomy, or post-menopause. “Woman may think they will be spared from this, but,statistically, 50% of woman who have had children will struggle with this as they get older,” says Dr Montgomery.

Although urogynaecological problems are seldom life-threatening, they can significantly impact someone’s quality of life. “Many women struggle with bladder problems in silence,” Dr Montgomery says. “Think of your own family – many of us know of an aunt or grandmother who smelled like urine or suffered from pain or bleeding. They may have been too embarrassed to talk about it and to seek help.”

Studies have shown that urinary leakage can cause depression, social isolation, and even increased falls with hip fractures and long-term hospital admission. “Statistically, all women have a 12% lifetime risk of a pelvic floor disorder (PFD) before the age of 80,” Dr Montgomery explains.

Dr Montgomery completed his fellowship in the sub-specialty of urogynaecology at the University of Cape Town under the mentorship of Dr Stephen Jeffery and Dr Lamees Ras.

“Urogynaecologists offer life-enhancing treatments – including medication and surgical procedures – that can improve a woman’s quality of life,” he says. “It’s important for patients to know help exists for the embarrassing conditions many don’t feel comfortable talking about.”

The soon-to-be-established dedicated, multidisciplinary pelvic floor service at Mediclinic Stellenbosch will provide patients with a “one-stop shop” for PFDs. The team will comprise physiotherapists, a surgeon, urologists, and a dietician. “As a team we’re able to discuss challenging cases and plan the best and most appropriate treatment for the patient,” Dr Montgomery explains. “This ensures efficient care pathways and improved patient outcomes.”

Patients are usually assessed using a combination of history taking and clinical examination. “An abdominal ultrasound will show where the prolapse is. Hopefully, we’ll be able to acquire a urodynamic machine to help us differentiate between the types of incontinence patients suffer from,” Dr Montgomery says.

“We often ask the patient to use a bladder diary to keep track of daily fluid intake and the number of voids during the day and night. Further investigation might include an abdominal CT scan or MRI to clarify certain findings.”

The 3 types of pelvic organ prolapse:

1. Anterior compartment prolapse – bladder or urethra bulges into the vagina.
2. Mid compartment prolapse – uterus or vaginal vault bulges into the vagina.
3. Posterior compartment prolapse – rectum or small bowel bulges into the vagina.

The 5 types of incontinence:

1. Stress urinary incontinence – involuntary leaking of urine with coughing or sneezing.
2. Urge urinary incontinence – involuntary leakage of urine with an urge to go to the bathroom.
3. Mixed urinary incontinence – mixture of stress and urge incontinence.
4. Overflow incontinence – leakage of urine due to an over–full bladder.
5. Functional incontinence – inability to reach the toilet due to cognitive, functional or mobility impairments.

Treatment of PFDs usually starts with conservative measures, such as lifestyle modifications, pelvic floor muscle training (Kegel exercises), fluid modification and bladder training. Urge urinary incontinence is treated with medications. If medication fails, more invasive options,like Botox injections in the bladder or stimulation of one of the sacral nerves, can provide relief. Stress urinary incontinence and pelvic organ prolapse is treated with surgical treatment. Pessary rings and other vaginal pessaries can also help.

“It might not be a diamond ring, but it certainly can be a girl’s best friend,” quips Dr Montgomery. “It can help to improve your bowel and bladder function and even for you to take control of your own health again.”

“The most common procedure I perform is the sacrocolpopexy, which is used to treat pelvic organ prolapse. This surgery entails attaching surgical mesh to the front and back walls of the vagina and then to the sacrum [tail bone]. This pulls and lifts the vagina back into place. It offers the lowest risk of re-occurrence and the highest efficacy.”

Dr Montgomery adds that having a successful first surgical procedure is always best, and the chance of failure is higher if the doctor doesn’t have the necessary experience. Being able to consult a specialist urogynaecologist reduces this risk.