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
  • Bladder function problems and urinary incontinence symptoms
  • Bladder pain and urinary tract infection (UTI) symptoms
  • Changing symptoms

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).

Although pelvic organ prolapses, urinary incontinence, bladder pain and problems with UTIs are all different conditions, people told us that there was sometimes overlap in the symptoms. Also, many of the people we spoke to had more than one urogynaecological condition and experienced a combination of symptoms. For these reasons, the people we talked to found that it was not always easy to know which condition or diagnosis related to which symptoms.

Vicky had a range of urinary symptoms, including tingling, feeling she needed to wee all the time, and difficulty knowing when her bladder was full.

Not everyone we spoke to with a particular condition had the same symptoms or experienced them in the same way as other people. For example, Jan knows that other women with prolapses describe feeling a “heavy weight down below” but this was not something she had particularly felt.

Eve talks about the constant presence of her prolapse and urinary incontinence symptoms, and how they affect things like going for a walk with her son.

Sometimes symptoms were mostly or only noticeable at particular times and during activities, like exercise or having sexual intercourse. For example, most of the people we spoke to who had urinary incontinence without prolapse didn’t describe their symptoms as painful, but Rosie found that having sex could be very uncomfortable.

Early signs and recognising that something is not ‘right’

Many people we talked to described having early feelings, sensations, and signs that something was not ‘right’. Feeling like something was ‘off’ could be difficult to pinpoint and put into words.

An area of the body (like the lower tummy) might feel more sensitive, heavy, achy, or painful than usual, or everyday activities might be affected (for example, needing to go to the toilet more often or urgently). Before developing recognisable symptoms of UTI, Jane recalled first being “a little bit too aware” of her urethra (the tube linking the bladder to the outside of the body).

Those who had grown up with urinary incontinence sometimes thought this was ‘normal’. Others had a gradual realisation that other people did not have the same symptoms and concerns, such as needing to be able to get to a toilet very quickly or regularly leaking urine.

Alice has always needed to know where the toilets are when out and about. Whilst working from home during the Covid lockdown, she realised she wanted help with her symptoms.

María had stress urinary incontinence for nearly 10 years but initially didn’t recognise it as such. It took several years before she was “ready” to see herself as having symptoms of a condition. For others, like Amy, it was immediately apparent that something had changed about their body with the arrival of clear and sudden symptoms of prolapse, like seeing or feeling tissue bulging out of the vagina.

Pelvic organ prolapse symptoms

Prolapse symptoms could vary, depending on type and severity.

Often prolapses were described as feeling like there is “a bulge” or “lump”. People used different comparisons to explain this, like sitting on a “melon”, “sponge”, “cushion”, or “dislodged tampon”. Some had a sense of something “dropping down” or “falling out”, often with feelings of “heaviness”, “dragging”, “aching”, or “pressure” in the pelvic area. This could cause a lot of discomfort. For Jo and Phoebe, it was intensely painful. For Elly, the severe pain went down to the top of her legs. Catherine said that, after standing for a long time, her hips had a dull ache.

Jenny describes how her rectocele prolapse feels like having a “lump there that shouldn’t be there”.

We talked to women who had a sense of the uterus (sometimes called the womb) and nearby anatomy not being in the ‘right’ place, looking different, or being lax (looser). Kezia described thinking of her body as having “a huge kind of empty cavernous space where things can fall out of and you can’t close”, adding “I don’t feel like I know where anything is down there anymore”.

Since giving birth, Beth has become aware of different and changing sensations in terms of prolapse.

Amy, Vickie, and Phoebe didn’t have any urinary incontinence symptoms, but many others with prolapse did. For Sharon, urinary incontinence was the main symptom of prolapse. There were also symptoms related to the bowel and pooing, especially for those with rectoceles (where part of the rectum walls bulges into the vagina).

Chloe had had some urine leaks, and Sharon and Liz had experienced times where larger quantities of wee had accidentally come out. Other bladder and bowel symptoms included: frequency (needing to go to the toilet often); urgency (needing to go quickly); struggling to tell how full the bladder was, and difficulty telling the difference between trapped wind and the need to poo; and feeling that the bladder or bowel wasn’t fully emptied after going to the toilet.

With her prolapse, Chloe says it is never "just a quick trip to the loo anymore".

Jessy, Jo, Chloe and Vicky said that they sometimes had to move into different positions to find an angle to get all the wee out. Some women we talked to used a technique called splinting, where the hand is used to push on the vaginal wall to help physically manoeuvre poo out.

Vickie was grateful that she didn’t experience any urinary symptoms with her prolapse, but she had lower back pain and a dragging sensation, and needed to splint (a technique to help move poo out).

Bladder function problems and urinary incontinence symptoms

Urinary incontinence is the unintentional loss of wee/urine. Some had more than one type of urinary incontinence, such as stress incontinence or urge incontinence or overactive bladder, others had mixed urinary incontinence which could include symptoms of leaking urine, urgency and frequency.

There are many other forms of bladder symptoms that can bother people that do not involve incontinence, such as needing to wee/urinate a lot, getting up to wee at night, or difficulties emptying the bladder.

Stress incontinence is when urine leaks out in response to activities like sneezing, coughing, laughing, lifting heavy things, and exercising. It does not usually involve physical pain, but women told us that it was embarrassing and limited their actions.

Jan talks about stress urinary incontinence and the shock she felt when she began to have accidental urine leaks.

The amount of urine leaked varied from person to person. For Mehar, panty liners were enough to absorb any leaks. Emma had used menstrual pads for protection, whilst others like Jessy and Cynthia wore daily pads. Sue Y, Freia, and Mary Y used thicker incontinence pads all the time or particularly at nighttime.

For some, quite a lot of urine came out when they lost bladder control. Minnie said that urine sometimes “dribbles down my legs” if she can’t make it to the toilet in time.

Minnie sometimes feels that she hasn’t fully emptied her bladder and she finds that going for a wee can be very “stop start”. At other times, urine leaks out unintentionally.

Sharon and Iris had only one experience of total urinary incontinence (loss of a lot of urine). For others, this happened often or most of the time. Mary Y described how “now it [urine] just leaks out constantly, it’s like a slow dripping tap”. Sabrina has an accident most weeks and, although normally it is not her whole bladder that empties, it is enough to mean that she has to take a shower and change her clothes. Julie and Freia said they had woken up soaked in urine after accidents during the night. Freia has also had some urgency to get to the toilet to poo in time and is worried about this getting worse.

Freia’s urinary incontinence has got worse and she now sometimes wakes up soaked in urine after 3 hours. She worries about having accidents when visiting other people.

As well as the embarrassment and inconvenience of changing clothes, and potentially bedsheets and cleaning carpets, María says smelling of urine “is always in my mind, like am I stinky?”

Iris has symptoms of stress urinary incontinence and urgency. She mostly has urine leaks but once had a fuller accidental loss of her toilet functions, which was very distressing for her.

Urge incontinence and overactive bladder involve having frequent and sudden urges to wee. While they had not had urinary leaks, Parminder and Minnie described urgency (needing to rush to the toilet quickly) and Alice and Sue X reported frequency (needing to go wee more often).

Minnie found that she often did not feel empty after going for a wee, and so she regularly self-inserts a catheter (a tube used to remove urine from the bladder) to reduce urinary leaks.

Bladder pain and urinary tract infection (UTI) symptoms

Whilst bladder pain, interstitial cystitis, and various types of UTI (recurrent, embedded, chronic) are different diagnoses, the people we talked to often described having some similar symptoms. These included discomfort or pain in the pelvic area (lower tummy), the bladder or urethra, and a strong sense of needing to wee urgently or often. A high temperature, feeling unwell and nausea were also common.

The urine could also be different, especially at the start of a new episode of UTI or a flare-up of ongoing UTI symptoms. Jenny and Jessy said their UTIs often involved smelly and cloudy urine. Jane, Leah, Clare, and Sarah told us that they have had blood and clots in their urine.

Jane gets UTIs which come back time and time again. She experiences a progression of pain, difficulties and discomfort weeing, and visible changes to her urine.

For Anita and Rowan, bladder and urinary symptoms left them worried about being far away from a toilet. Chelsea, Phyllis, Megan, and others found they felt they needed to wee more often, while Jordan and Laura both described the urge to wee as “constant”. Rebecca, Anna, Clare and others also had a desperate urge to wee but then found little to no urine came out; as Sarah explained: “you get a feeling like you probably want to wee and you know you’ve only just been”. Phyllis described getting out of bed up to 15 times a night to go for a wee. Jane told us about times when “I literally could not leave the bathroom. So, all night I would be in the bathroom, trying not to fall asleep on the loo, so I’d end up lying on the floor”.

At times, Mehar, Jane, and Rebecca had urinary leaks because of UTIs. Felicity wore pads at nighttime because she leaked first thing in the morning.

Discomfort and pain were key symptoms. Some had “burning”, “stinging”, or stabbing pains when they needed to wee, after they had been for a wee, or almost constantly during a ‘flare up’. Holly said her pain came in waves, while Jane and others described spasms. Chelsea said it was “an ache almost constantly”. Helen described it as a constant balance act of going to the toilet: “I can’t wee too often because if I wee too often that makes the pain worse. But if I don’t wee enough that makes the pain worse”.

Sarah gets a “bit of an ache” when a UTI is setting in.

Bladder pain is Megan’s main ongoing symptom. She takes medication which helps with the urgency and frequency of needing to wee.

The pain could be relentless, and difficult to manage and relieve. Phyllis described her pain as like “a burning hot wire up the urethra”. To Jane it felt like a twisting knife, and she added that, if it would give some relief, “you’d gladly rip your own bladder out rather than go this agony”. Holly and Leah think they have developed overly tense pelvic floors as a result of being in constant pain.

Megan, Leah, and Laura found that bladder pain could be made worse by everyday things, like travelling on a train or bus, or sitting on a hard seat. Laura described the agony of a long car journey and counting down “the seconds to get through it”. Leah found it more comfortable to stand at times because of severe bladder pain which went up her thighs and back, and Rowan could not lie or sit because of the pain.

Having ongoing, persistent or recurring UTI symptoms could be quite different from one-off episodes of UTI. When Anna first had a UTI, she would get a “nebulous pain” in her abdomen whereas this pain has changed as her UTIs continued as she had “extreme spasms” in her bladder.

Rebecca finds that her UTI pain fluctuates from “low-level symptoms” to “huge flare ups”.

Several people had more body-wide symptoms as bladder pain and problems with UTIs continued. This included a general sense of feeling very unwell, hot-cold flushes, headaches, and aches in other parts of the body, bloating, diarrhoea, vomiting, and tiredness. Felicity at first feared that her bladder pain might indicate something “sinister”. The unpredictability of these symptoms could have a major impact.

Changing symptoms

The symptoms and severity of urogynaecological conditions could change – for better or worse – and for a range of reasons (see also section on causes and contributing factors). Those who had complications from mesh surgery sometimes found that they had developed additional or different symptoms.

Compared to the problems Leeanne has had since mesh surgery in 2016, she wishes she could “turn the clock back to having that and having only that” in terms of her stress urinary incontinence and prolapse symptoms.

Symptoms could have many impacts – on various aspects of life like socialising, work and financessex and relationships, and emotions and wellbeing. After having symptoms, most people we talked to then went to see a healthcare professional for more information and to see what sources of treatment and support were available.