Urogynaecology | Cape Town
Pelvic floor, bladder, and prolapse care
Clear guidance for leaking urine, urgency, prolapse, bladder irritation, bowel-pelvic floor overlap, and when symptoms need earlier assessment.
Use this hub to work out which symptom pattern sounds most like yours, what assessment usually involves, and which treatment routes often help before jumping straight to surgery.
Consulting at Life Kingsbury Hospital in Claremont, Cape Town, with subspecialist urogynaecology care focused on bladder control, pelvic support, recovery after childbirth, and pelvic floor symptoms around menopause and after surgery.
When to seek urgent care
Same-day assessment matters if you have any of the following:
- Fever, rigors, flank pain, or feeling acutely unwell with urinary symptoms.
- Sudden inability to pass urine, a painful overfull bladder, or not being able to empty at all.
- Visible blood in the urine with clots, or significant bleeding from prolapse tissue.
- A bulge that has become very painful, stuck outside, ulcerated, or suddenly much worse.
- Severe new pelvic pain after pelvic surgery, childbirth, or a procedure.
- Pregnancy-related bladder or prolapse symptoms that feel severe, rapidly worsening, or hard to manage.
If symptoms feel urgent, use same-day medical care rather than email.
Start with the main problem
Which symptom sounds most like yours?
Choose the card that fits best. Symptoms often overlap, but starting with the main pattern is usually the easiest way to find the right next page.
I leak urine
Leakage with coughing or exercise, leakage before reaching the toilet, or a mixed pattern.
I keep needing the toilet
Strong urge, going often, waking at night, or feeling that the bladder is controlling the day.
I feel a bulge or heaviness
Pressure, dragging, something coming down, or support symptoms that are worse by the end of the day.
I keep getting UTI-type symptoms
Burning, repeated urine infections, bladder irritation, pressure, or symptoms that keep coming back.
I have bowel emptying or leakage problems
Constipation, incomplete emptying, stool leakage, or bowel symptoms that seem linked to the pelvic floor.
Sex is painful or pelvic muscles feel too tight
Pain, tightness, fear of penetration, or discomfort with intimacy that may relate to the pelvic floor.
Assessment and treatment
What usually happens next?
Assessment in this practice is structured and practical. The aim is to define the symptom pattern properly, check the basics well, and then only add tests or treatment steps that are likely to change the plan.
In the consultation
History, symptom pattern, and focused examination
The starting point is a careful history, understanding the symptom pattern properly, and a focused pelvic floor examination. That usually tells us whether we are dealing mainly with bladder control, urgency, emptying, prolapse, bowel-pelvic floor overlap, pelvic floor overactivity, or a mixed picture.
Core urogynaecology assessment
The baseline checks I commonly use
My assessment would typically include urine analysis, a post-void residual to check how well the bladder is emptying, and a perineal ultrasound as part of the pelvic floor and prolapse assessment. These are often the tests that make the first consultation more useful.
Further tests if needed
Bladder diary and urodynamics are add-on tests, not routine for everyone
A bladder diary is a simple record over a few days of how often you pass urine, how much you drink, when urgency happens, and when leakage occurs. Urodynamics is a bladder function test used when the picture is mixed, previous treatment has failed, or the answer would genuinely change planning.
Tailored treatment
Treatment is matched to the diagnosis and to your goals
Once the picture is clear, treatment may include pelvic physiotherapy, bladder or bowel strategies, pessaries, medication, procedures, or surgery. The aim is not to push everyone down the same pathway, but to choose the right level of treatment for the problem in front of us.
If symptoms overlap, the most useful next step is usually getting the diagnosis and bladder-emptying picture clear first, rather than trying disconnected treatments at random.
When symptoms often change
Symptoms often make more sense in context
Timing matters. The same symptom can mean something different after childbirth, around menopause, or after pelvic surgery.
After childbirth
Leakage, heaviness, pain, and recovery questions after vaginal birth or caesarean should not be left for months if they are affecting daily life.
Go to after childbirthAround menopause
Urgency, burning, dryness, recurrent UTI-type symptoms, and support changes often become more noticeable with the hormone transition.
Go to around menopauseAfter hysterectomy or previous surgery
New bladder, support, or emptying symptoms after surgery deserve a structured review rather than assumptions that recovery just needs more time.
Go to after hysterectomyLonger-standing symptoms affecting confidence
If you are planning toilets, relying on pads, avoiding exercise, or working around symptoms every day, it is reasonable to ask for a clearer long-term plan.
See later-life supportUseful tools
Helpful next pages and tools
These pages are useful when you already know the symptom pattern, or when you want something practical to bring into the consultation.
Bladder diary
A short bladder diary often helps make urgency, frequency, leakage, and fluid-pattern discussions much clearer.
Open the bladder diary pagePelvic physiotherapy
Pelvic floor physiotherapy can help with leakage, prolapse symptoms, bowel function, pelvic floor overactivity, and recovery after birth.
See pelvic physiotherapyNot sure where you fit?
If symptoms overlap, the old symptom quiz can still help you identify the nearest starting point before you book.
Open the symptom quizFrequently asked questions
Common questions about urogynaecology
Does leaking urine or prolapse always mean I will need surgery?
No. Many patients start with pelvic floor physiotherapy, bladder retraining, constipation work, vaginal support measures, pessaries, or medication. Surgery is only one part of the treatment toolkit.
Can pelvic floor physiotherapy really help?
Often yes. It can help with stress leakage, urgency, prolapse symptoms, bowel dysfunction, pelvic floor overactivity, and recovery after childbirth or surgery, depending on the diagnosis.
Does prolapse always get worse over time?
Not always. Symptoms can stay stable for long periods, and how much prolapse matters depends on both the physical findings and how much it affects your comfort, bladder, bowel, exercise, and daily life.
Why do I keep getting UTI-type symptoms if tests are not always positive?
Burning, urgency, bladder irritation, menopause-related tissue change, pelvic floor tension, and overactive bladder can all mimic infection. Recurrent symptoms need a diagnosis, not only repeated antibiotics.
Are bladder and pelvic floor symptoms after childbirth or around menopause just normal?
They are common, but that does not mean you have to simply live with them. If symptoms affect quality of life, it is reasonable to ask for assessment and treatment.
Will everyone need urodynamics or a long list of tests?
No. Tests are chosen when they are likely to answer a useful question or change treatment decisions. Many patients do not need extensive testing at the first step.
Next step
Not sure which symptom page fits best?
If symptoms are affecting confidence, comfort, sleep, exercise, intimacy, or daily planning, book a consultation and we can work through the likely diagnosis and most sensible treatment options together.