Causes and contributing factors of urogynaecological conditions

This section covers:

  • Thoughts on causes and contributing factors
  • Seeking information about the causes of urogynaecological conditions
  • Uncertainty around causes and contributing factors
  • Improving awareness of causes and contributing factors

In this section we use the terms:

Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

Thoughts on causes and contributing factors

There are some factors which are thought to contribute to women developing urogynaecological conditions. These factors include pregnancy, childbirth, menopause, and some types of medical or genetic conditions. However, it can be very difficult to know for sure what the causes of urogynaecological problems are for a particular individual.

In this study, a few people also referred to ‘myths’ about the causes of urogynaecological conditions. Some are very common, such as the belief that having sex can cause or contribute to urinary tract infections, even though this may not actually be true or known for certain. There was concern that these myths could lead people to make unnecessary changes to, or worry about, their lifestyle and activities.

Dr. Matthew Izett-Kay, a consultant urogynaecologist, describes some of the factors that can contribute to developing urogynaecological problems.

People shared their thoughts on the causes and contributing factors of urogynaecological conditions. Even though there was sometimes uncertainty about causes, for some people it was important to make sense of possible causes.

Sharon thinks her prolapse was caused by childbirth and lack of support for postpartum rehabilitation and recovery after birth.

Eve, Cynthia, Kerry, and others thought that the strain put on their pelvic floor, through pregnancy and childbirth, heavy lifting, coughing, or chronic constipation were making things worse. Elly thought a combination of frequent vomiting during her pregnancies (hyperemesis gravidarum), having a disorder that causes fragile tissue, a big baby, and a difficult birth contributed to developing prolapse in her late twenties. Kezia was shocked by how “physically injured” she felt after a delivery with forceps (a medical instrument used to help turn and/or guide a baby in the birth canal). Pauline thought that having four children and being very physically active may have weakened her pelvic floor. Minnie and Sian have had bladder problems since childhood, which for Sian increased after the birth of her second child.

A nurse told Elisabeth that having big babies had contributed to her developing a prolapse later in life.

Jenni first developed incontinence issues after her womb was surgically removed. This resolved after a while, but got worse again after she developed a bad cough.

Pelvic floor muscles can also become too tight and cause bladder problems. A pelvic floor physiotherapist told Iris that her pelvic floor muscles were hypertonic (overworking), which was contributing to her incontinence.

Urogynaecological problems sometimes began, or became worse, around menopause. For Rose, Sue Y, and others, existing urogynaecological problems became worse, while for Jeannie and Melanie, the problem started at this stage in their life.

Having a hysterectomy could also contribute to developing prolapse as it removes supporting tissue, as was the case for Jenni and Jacqueline. Jenny’s GP told her that low oestrogen and vaginal dryness made her more likely to get urinary infections.

Rose found that developing urinary symptoms associated with her prolapse is connected to entering perimenopause.

Seeking information about the causes of urogynaecological conditions

Healthcare practitioners and online forums or websites were common sources of knowledge about the causes and contributing factors associated with urogynaecological conditions. For Elisabeth and others the link with difficult childbirths was quickly identified by medical professionals. Vicky, Leah and Melanie, amongst others, found answers through doing research online. Vicky had a ‘massive lightbulb moment’ after seeing a social media post about low oestrogen, menopause, and urinary infections.

Laura, Jasmine, and Leah found it frustrating that doctors seemed unconcerned with finding the root cause of the symptoms. For Laura, this provided motivation to seek private care. Felicity felt frustrated that her doctors didn’t explain “anything at all” regarding her vaginal atrophy and repeated UTIs, and felt she had to do her own research to find out about medications she could try.

A GP told Anita that her cystitis was “one of those problems with women’s plumbing”, which she felt was not very helpful.

The way that some doctors and nurses talked about the causes of the conditions was sometimes seen as unhelpful, even implying blame or appearing dismissive. Rowan, who has had recurrent UTIs since she was a teenager, would like there to be more research into the causes and for it not to be dismissed as “women’s problems”.

Iris noticed stress and urge incontinence started after an operation to remove abnormal cervical tissue and thought they were connected. She explains how she felt when a healthcare professional believed her.

Friends or family members with similar experiences or medical training sometimes offered advice, if the woman chose to talk to them. A family member flagged to Freia that her weight might have contributed to her prolapse, which was a bit of a “raw nerve” for her.

Uncertainty around causes and contributing factors

While some people became aware of a wide range of things that could cause or contribute to urogynaecological issues, finding a straightforward or satisfactory answer could be difficult. For some, it remained uncertain. Sue Y’s doctors had mentioned a few possible contributing factors but added that it wasn’t possible to say the causes for certain. Rowan has considered contributing factors like undergoing chemotherapy, ageing, and having sex, but hasn’t been able to narrow down a specific cause.

Jane is aware of a variety of factors that may influence her having urinary infections, but hasn’t been able to identify a “particular causal factor”.

Those who had problems with urinary tract infections (UTIs) had often tried to identify factors which caused a flare up. Anna and Jasmine noticed their symptoms began when they first started having sex. Leah thinks she had a UTI within the wall of her bladder which was being dislodged during sex, causing flare ups of symptoms.

People also wondered whether being catheterised, undergoing chemotherapy treatment for cancer, or even sitting on a bicycle seat for a long time could have contributed. It could be difficult to pin down an exact cause, making it necessary to test out different lifestyle changes.

Jasmine noticed when she began having sex with her husband, she started getting urinary tract infections.

Phyllis suspects a genetic factor is contributing to her repeated urinary tract infections. She hopes there will be greater support around women’s health for future generations.

Other medical conditions were also thought to be a contributing factor. Alice has overactive bladder syndrome (which causes a frequent and sudden urge to wee that is difficult to control) which she thinks is caused by anxiety and the complex medical conditions she has had since childhood. Pauline thought that her thyroid issues might be linked to her urinary infections. Freia wonders if her reduced mobility from hip problems might contribute to urinary incontinence, as she can’t always get to the loo in time.

Kerry thinks chronic constipation from coeliac disease (a condition where the body’s immune system attacks its own tissue when gluten is eaten) may have contributed to her prolapse, along with having an episiotomy (a cut made between the vagina and anus during childbirth). Fiona thinks a vitamin D deficiency contributed to her recurrent urinary tract infections. Jordan has a history of sexual trauma and wondered if this was contributing to their bladder pain.

Amy has Ehler Danlos syndrome (EDS), a condition which causes very flexible joints and stretchy or fragile tissue, and thinks that a cervical smear test about five months after giving birth contributed to her organ prolapse.

Improving awareness of what can cause urogynaecological conditions

People said that they would have benefited from knowing more about the causes and contributing factors of urogynaecological conditions before having these problems. Jan, who has prolapse and urinary leakage, is frustrated that she didn’t know more in her fifties about how the menopause can impact women’s urogynaecological health. Looking back, she feels she could have got ahead of things by keeping her pelvic floor strong, keeping her oestrogen levels higher, managing her weight, and avoiding constipation.

Melanie wishes she had known that menopause can contribute to urogynaecology conditions so that she could have sought help earlier.

Vicky hopes that women will be able to learn more about the relationship between bladder issues and menopause in the future.

People we spoke to felt that more could be done to raise awareness of the causes of urogynaecological conditions. Kerry, who has a prolapse, wonders if knowing more about the causes could have helped her to prevent developing one. Elly wanted there to be more awareness that prolapse can happen either directly after, or in the years following, childbirth as well as more information about what symptoms to be aware of.

Signs and symptoms of urogynaecological conditions

There are different symptoms associated with particular urogynaecological conditions. This section covers: Early signs and realising that something is not ‘right’ Pelvic organ prolapse symptoms...