Pelvic Floor Weakness

Pelvic floor laxity occurs when the pelvic floor muscles, supporting tissue and ligaments stretch and weaken and no longer provide adequate support to hold the pelvic organs in place, in particular in certain physical exercises. Pelvic floor weakness can affect women of any age. But it often affects women who've had one or more vaginal deliveries.

Possible symptoms of pelvic floor weakness include

• Sensation of something pulling down in your lower abdomen
• Urinary problems, such as accidental urine leakage in coughing, sneezing or laughing
• Voiding difficulties with retention of residual urine after micturition or post-micturation dribble
• Overactive bladder symptoms with a strong urge to go
• Increased number of trips to the bathroom and voiding at night (nocturia)
• Problems to empty the bladder in one go or interrupted flow (staccato-voiding)
• Constipation and trouble having a bowel movements

Some of the most common reasons for weakened pelvic muscles and tissues include:  

• Pregnancy and childbirth
• Prolonged labour and birth trauma
• Tearing in childbirth
• Previous history of pelvic surgeries
• Delivery of a large baby or twins
• Obesity and a high BMI
• Chronic increase of intra-abdominal pressure by repeated heavy lifting, asthma or chronic coughing, severe obstipation with trouble having bowel movements

Simple ways to strengthen the pelvic floor:

Exercise regularly and target the pelvic floor muscles. You can try Yoga, Pilates, swimming and targeted physiotherapy focusing on these muscles, especially after you had a baby. Physiotherapy of the pelvic floor can help to correct posture, stretch & relax tight muscles and strengthen weaker muscle groups. It can help increase endurance, fine coordination and tones of the muscles for better bladder control, tightening and lifting of the pelvic floor. Pelvic floor physiotherapy can include biofeedback, kegel exercises, electrical stimulation and bladder education - just as needed.

Try to prevent from constipation by drinking plenty of fluids and eat a healthy diet with high-fiber foods to maintain bowel movements. Eat between 35 – 55 grams a day. You can get them through your vegetables, grains like white rice, or brown rice, or wild rice. And clean your ecosystem with
natural probiotics. Examples of foods that act as prebiotics are leeks, asparagus, beans, legumes, banana, garlic, sweet potatoes, squash, and onion. You don’t need all of these every day. Just rotate through a wide diversity of vegetables, legumes and some fruits.

Avoid heavy lifting and when lifting, use your legs instead of your waist or back.

Control coughing, get treatment for a chronic cough or bronchitis, reduce exposure to allergens, dust and quit smoking. An air purifier in your bedroom can help with better sleep at night without coughing and helps regulate air humidity.

Find out your ideal and implement weight-loss strategies

To find out what will work best for you, visit us and get a pelvic examination including dynamic pelvic ultrasound.

Dr. Amelie Hofmann-Werther

Specialist in Obstetrics & Gynaecology

(Facharzt Germany)

Cervical Dysplasia & Coloscopy

Master Class in Fetal Medicine  

Palpable Breast Findings

Palpable Breast Findings

Newly recognized lumps and nodules in the breast are a reasonable cause for many women to be highly alerted. Self-detected, when showering or applying body lotion, lumps and nodules, as well as painful swellings in the breast give rise to concerns, especially when being abroad, not in your home town community and not knowing where to address your concerns to…

Good to know, that in fact most of the findings in women’s breast are of benign, meaning non-malignant, non-cancer origin. They may show up according to menstrual cycle, predominantly prior to onset of menstrual bleeding, while bleeding or mid-cycle near ovulation time.

All of a sudden, bra holders put pressure to your chest and sleeping on your belly is uncomfortable…

Now, Rule No.1 is applying: Keep calm!

What’s common, is common! And what’s rare, is rare!

And  90 % of all detected breast findings are benign, meaning non cancerous.

Nevertheless, uncertain suspicious findings all need to be thoroughly looked at.

The most common findings in a women’s breast are listed below as a brief overview

•      Structural changes of breast tissue density = Mastopathia

•      Pain & Tenderness = Mastalgia

•      Rtention of fluid = Cyste

•      Changes in duct system & glands = Papilloma

•      Benign solid nodule = Fibroma

•      Acute infammation = Mastitis

Mastopathia

This term refers to benign, meaning non-malignant structural changes in the breast tissue, that is composed of glandular tissue, fatty tissue and fibroid tissue. Changes are due to hormone imbalance. Cysts and lumpy glandular areas may occur, combined with feeling of tension and tenderness of the breast.

Mastalgia
Pain and tenderness mostly enhanced in the second half of menstrual cycle close to bleeding time. The breasts may feel heavy, sensible, tense and firm or lumpy. Since the breast tissue reacts very sensible to hormonal changes, complaints occur more often in irregular cycles and in women with bleeding disorders.

Cysts

cyst is a non-malignant fluid filled dilated area of a glandular duct in the breast. It is an important entity since it can cause irritating focal pain and discomfort or cause anxiety when being palpated by a woman herself as a suspicious nodule. To detect a cyst in the breast, an ultrasound examination is the assessment of first choice.

Fibroadenoma

A fibroadenoma is the most common finding amongst benign nodules in the breast. It most commonly affects young women as a solitary finding. Only 7% of patients present several fibromas. Typical criteria in ultrasound is their round to oval shape with smooth surface and clear margins. The fibroadenoma is a benign solid mass that only in very rare cases (0,1 – 0,3 %) may include cancer precursor cells (Carcinoma in situ).

Papilloma

A rather rare entity with 1 - 1,5% of all findings that is located intra-ductal.80% of all Papilloma show secretion of fluid from the nipple. In case of blood stained secretion, further investigations need to be performed by a radiologist using contrast to visualize a glandular duct extension in the breast.

Abscess & Mastitis

An acute inflammation of the breast most commonly is seen in breast feeding women consulting a doctor due to acute pain, swelling, rash and maybe fever. In the the lactating breast, inflammation occurs as a result of bacteria invasion. Tiny scars in the sore nipple area allow bacteria to affect underlaying tissue and cause infection spreading along the lactation ducts of the breast.

Please note:

In case of a positive family history regarding malignant cancerous or pre-cancerous diseases in close relatives, normal check up visits with your doctor should be adjusted in frequency and intensity.

Screening-Guidelines for breast ultrasound and Mammogram for patient without pre-dispositioning high risk constellation recommend examination of the breast starting with the age of 40 and above.

Dr. Amelie Hofmann-Werther

Specialist in Obstetrics & Gynaecology

(Facharzt Germany)

Cervical Dysplasia & Coloscopy

Master Class in Fetal Medicine                             

The 💯 Faces Of Endometriosis

What is Endometriosis?

The uterus has a thick muscular layer called the myometrium. It is responsible for contractions during childbirth and those wonderful menstrual cramps we all know. The inner lining layer of the uterus is called endometrium and is the ‘functional’ part. The endometrium grows and sheds with each menstrual cycle and is responsible for the bleeding: during the first half of the menstrual cycle it grows and then breaks down in the second half of the cycle and finally sheds off during menstruation. 

Endometriosis is defined as patches of endometrium-like tissue that is found outside the uterus. Endometriosis is responsive to hormones just like the normal endometrium, so throughout the menstrual cycle, endometriosis grows and bleeds, but unlike the normal endometrium, the blood has actually nowhere to go because its inside the pelvic cavity. Whether or not endometriosis does actually ‘bleed’ can vary but the pure presence of endometriotic lesions does lead to inflammation and pain, depending on the extent and location of endometriosis in the pelvis. More important as what endometriosis is, is what endometriosis is not! Endometriosis is not an infection of any kind, it’s not communicable, it’s not a cancer and is not fatal, however just because something is not fatal, doesn’t mean it can’t take your quality of life away. For sure endometriosis is a very complex condition that requires a holistic and personalized approach.

Some women with endometriosis have painful periods, some don’t. One woman may have severe pelvic pain, depression, anxiety and bowel pain, whereas another woman may have no pain or psychological symptoms, but is infertile due to endometriosis, these two cases would require very specific and

different approaches.

What are typical symptoms of endometriosis?

Everything, nothing and all things in between! Some women are only diagnosed when they are having an operation for another condition, or when there is an investigation for something linked to endometriosis like fertility issues.

For those experiencing symptoms, the most common one is pain, such as dysmenorrhoea which is defined as excessively painful periods that cause interference to the daily life and massively clouds the overall emotional well-being. If periods are causing someone to regularly miss school/work/social occasions because they are so painful, this is not ok and could very well be a sign of an underlying medical condition, like endometriosis.

Another of the common symptoms associated with endometriosis is chronic pelvic pain. Chronic pelvic pain can be continuous or intermittent and can be associated with a variety of factors, for example exercise, specific foods or certain activities, or it may just come on randomly. Painful sex (also known as dyspareunia) is one of the symptoms of endometriosis that doesn’t get much

attention since it is a very personal and private matter, which can understandably be difficult to talk about. Endometriosis symptoms vary from person in frequency and severity, including leg pain, bloating, painful urination, painful bowel movements, heavy menstrual bleeding, spotting in between periods and fatigue. A lot of sufferers want to rest and be left alone.The pain takes so much out of them, sometimes taking a nap feels like the only option to escape. Trying to summon enough energy to continue with the day but for at least the first three or four days of period, they just want to sleep a lot.

Which types of endometriosis do we know?

Endometriosis is usually categorized into stages (minimal, mild, moderate and severe) which depend on type, extent and location of the disease. The stage of disease does in no way correlate with the symptoms experienced, so a woman with severe disease can have no symptoms and a women with minimal disease can have debilitating symptoms and vice versa. Superficial endometriosis are lesions that can be found anywhere around the pelvic area, most frequently found on the surface of organs/ligaments/structures of the pelvis and can be as small as to be almost invisible to the naked eye, or about as large as a pea and any size in between. They often show scarry tissue associated with them which can pull or restrict the surrounding tissue leading to pain such as pain in emptying the bladder or in bowel movements, intercourse or sports.

Another entity type are endometriotic cysts. Most commonly found on the ovaries, these endometriosis cysts are filled with old blood that takes on a brown color, giving them the undeservedly pleasant name ‘chocolate cysts’. Endometriosis cysts can grow to be quite large, ranging from a few centimeters

to massive cysts in very rare cases.

The third type is called deeply infiltrating endometriosis (DIE). As the name suggests these lesions actually penetrate deep into the tissue of the pelvis and are known to cause the more severe symptoms associated with endometriosis.

Who can get endometriosis?

We do know that endometriosis affects more then 1 in 10 women of reproductive age, but endometriosis can affect anyone, of any age and of any race/socioeconomic background. Women with a family history of endometriosis are more likely. Still, because of a lack of awareness and education about endometriosis, the majority of sufferers remain not diagnosed.

What are treatment options?

Endometriosis is not a uniform disease so there are many treatment options pathways open for women with endometriosis and it is often quite a minefield of trial and error to find the right one for each woman. Endometriosis for sure requires a holistic approach to therapy that considers all aspects and impact the disease has on a person’s life.

There are several types of hormonal medication that women with endometriosis may be offered, the most common ones are: Birth control pills (BCPs), Progestin only pills (POPs), Gonadotrophin releasing hormone analogues (GnRHa), Aromatase inhibitors, complimentary therapies and surgical treatment options.I can’t emphasize enough the importance of education in endometriosis in order to find the best treatment for every single affected women.

Dr. Amelie Hofmann-Werther

Specialist in Obstetrics & Gynaecology

(Facharzt Germany)

Cervical Dysplasia & Coloscopy

Master Class in Fetal Medicine

http://www.fetalmedicine.ae/#dr-amelie

Hereditary Breast Cancer

The body is made up of trillions of living cells. These cells grow, divide, and die in an orderly fashion. This process is tightly regulated and is controlled by the DNA machinery within the cell. When cells of the body at a particular site start to grow out of control, they may become cancerous. Cancer cell growth is different from normal cell growth. This shift from normal cellular growth to abnormal cellular growth is caused by a damage of specific genes or DNA controlling cellular division.

DNA damage known as mutation may be inherited from parents; this will result in hereditary cancer. However, it may result from spontaneous problem that occurs during the lifetime of a person. DNA damage may also be triggered by exposure to certain environmental toxins such as those present in cigarette smoke, this will result in sporadic cancer. Hereditary form often occurs earlier than the sporadic form of the same cancer.

Breast cancer follows the same rules as other cancers. BRCA1 and BRCA2 are the most common genes involved in hereditary breast and ovarian cancers. Breast cancers linked to these mutations occur more often in younger women and more often affect both breasts than cancers not linked to these mutations. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer. Tests that measure likelihood for a disease are called “predictive genetic tests.” Testing these genes does not detect whether a person has cancer or not; it indicates whether a person carries a change in one of these genes which can increase cancer risk.

Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. If you have a family history of breast cancer, you should see genetic specialist to determine your risk and to explain for you the procedure to follow to determine if you have genetic susceptibility for breast cancer.

 

For early detection of sporadic breast cancer, every female has to do self-breast examination monthly starting at 20 years old. She should have a breast exam by doctor at least every 3 years starting at 20 and every year starting at 40 years. Mammogram is also recommended every 2 years starting at 40 years.

For hereditary breast cancer genetic counselling and genetic tests are not the only things to do. The screening strategy is more frequent with breast self-exam monthly from 18 years, clinical breast exam by doctor every 6-12 months from 25 years and annual Mammography screening from 25 years or younger if family history of breast cancer before 25 as well as annual MRI screening.

Early detection is very important as it will affect treatment modalities with better prognosis and lower risk of recurrence.

Dr. Azza Abd El Moneim Attia Mohamed

French Board

Consultant Clinical Genetics

Feto Maternal and GenetYX Center