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                             

Polycystic Ovarian Syndrome (PCOS): A lifestyle-related Problem?

Polycystic Ovarian Syndrome (PCOS) is one of the most common female endocrine disorders in the Middle East. PCOS is a heterogeneous combination of signs and symptoms of impaired glucose-insulin-homeostasis, androgen excess, and ovarian dysfunction due to epigenetic and environmental influences, including diet, and lifestyle factors.

“Is your lifestyle making you infertile?” is an often raised question[1] linking PCOS to insulin resistance and diabetes, a lifestyle condition the Middle East suffers from in almost epidemic proportions. The relationship between PCOS and insulin resistance seems obvious in the UAE where one in five of the female population suffer from type 2 diabetes and other metabolic syndromes. The prevalence of PCOS has been investigated in many studies in many continents. A particularly high incidence of PCOS in the Middle East/GCC with approximately 20-25% of women may be due to hereditary and ethnic influences as well as due to certain lifestyle related conditions. Some researches assume that cases can reach up to 30% or even higher in the sub fertile population group in the region[2].

A systematic review and meta-analysis on the prevalence of PCOS in reproductive-aged women of different ethnicity, published by NCBI in 2017[3], conducted searches in PubMed, The Cochrane Library, EMBASE, CINAHL up to January 2017. The results suggested the lowest prevalence in Chinese women (2003 Rotterdam criterion: 5.6% 95% interval: 4.4–7.3%), and then in an ascending order for  Caucasians  (1990 NIH criterion: 5.5% 95% interval: 4.8–6.3%), Middle Eastern (1990 NIH 6.1% 95% interval: 5.3–7.1%; 2003 Rotterdam 16.0% 95% interval: 13.8–18.6%; 2006 AES 12.6% 95% interval: 11.3–14.2%), and black women (1990 NIH: 6.1% 95% interval: 5.3–7.1%). The results from the above analysis have suggested that, – using the same diagnostic standards -, Chinese women would have the lowest risks of developing PCOS, and then in an ascending order, followed by Caucasian women and women residing in the Middle East, with black women having the highest risk of developing this syndrome. Considering the wide variation in the clinical presentations associated with PCOS among distinct ethnicity, the study postulates a need for the establishment of ethnicity-specific guidelines for this condition. This may help to prevent the under- or over-diagnosis of PCOS.

In daily clinical practice as a gynecologist in Dubai, I see a lot of women affected by PCOS-associated conditions. Some women present with irregular periods, bloated intestines, weight-gain, retention of water, hair loss, or skin problems with increased androgen levels causing hirsutism and acne. Other women are being picked up because they are facing problems to conceive and seek advice for conception counselling in subfertility. Some women are not at all aware of any hormone imbalance and never wondered, how come they have skin pigmentation disorders such as acanthosis nigricans, i.e. dark coloured skin patches related to insulin resistance. Overweight and obesity affects a lot of women with PCOS and they do present a higher prevalence of both impaired glucose tolerance and type 2 diabetes. But also, the normal weight women affected by PCOS do have an underlying insulin resistance in over 60%, an impaired glucose tolerance in over 40% and 10% a predisposition to develop type 2 diabetes in over 10% of the cases. The underlying pathophysiology of PCOS is a divine blend of hyperandrogenism, insulin resistance and other factors causing follicular arrest. Multiple immature antral follicles seen in the transvaginal ultrasound imaging can be observed. The follicular arrest maturation arrest contributes to anovulatory cycles and hence causes irregular menstruations and fertility problems.

Depending on the individual complaints presented by a woman a wide range of investigations can be offered to evaluate extend and degree of hormonal imbalance, including laboratory tests and ultrasound examinations. Accordingly, depending on the wishes and needs of a patient, the reason for seeking advice is the key to the adequate case-to-case PCOS management. Does a woman wish to conceive and is struggling to fall pregnant? Is an adolescent woman suffering from acne and severe skin problems, but does not think of family planning yet? Is she struggling with weight control and irregular menstrual bleedings?

Lifestyle changes, including nutrition advice, carb-controlled diet, and physical exercise, are the first-line treatment options for adolescent girls and women with PCOS. Pharmacologic treatments including oral contraceptives, insulin sensitizers, prednisone, leuprolide, clomiphene, and spironolactone and others are options to be considered if lifestyle changes fail, which is rarely the case. Nutrients supply (diet) and nutrients utilization, metabolism and physical exercising remain crucial in the management of PCOS. Nutrition education can therefore not be overrated when looking at incidence figures of PCOS anywhere in the world.

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