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The Health | january, 2019
Wonder Women
Pelvic floor dysfunction
Pelvic floor dysfunction can
be caused by trauma such as very
bad pelvic accident which directly
affects the pelvic area and the
muscles that are involved.
KPJ Tawakkal Specialist Hospi-
tal Obstetrician and Gynaecologist
consultant Dr Patricia Lim Su Lyn
disclosed that it could be child
birth – as it could be the use of
forceps which pose a higher risk as
it tears through and through the
muscles from behind the vagina to
the anus.
“Patient may experience dif-
ficulty holding the urine, wind or
faeces. If the repair is not done
properly, then the patient can get
fecal incontinence.”
“Even with normal delivery, if
the baby is really big, or the person
helping the mother to deliver is not
very skilled in terms of protecting
the perineum, then a woman can
get pelvic floor dysfunction.”
The other reason could be
inherent laxity – age wise after
50’s and after menopause, the lack
of estrogen which can cause stress
incontinence.
“Although it was a very trau-
matic delivery but if repair is done
properly, then the patient is sent
back with stool softeners and told
to do pelvic floor exercises and
reassessed back. -The Health
Planning
motherhood
years in advance
Incontinence
during – after
pregnancy
G
enerally, during pregnancy itself, a lady
can experience incontinence. It’s because
of the heavy uterus with the baby pressing
down – the gravity of it and second because of
the hormones which actually loosens the urethra
and all the muscles.
KPJ Tawakkal Specialist Hospital Obstetri-
cian and Gynaecologist consultant Dr Patricia
Lim Su Lyn disclosed that it is quite common for
some ladies to experience stress incontinence
when they sneeze, or when they cough.
“They may leak a bit of urine, which is a good
indicator. If someone has that during pregnancy,
it is very likely that they may experience the
same after pregnancy. Generally when I have
patients complaining of that, I tell them to start
their pelvic floor exercises.”
Pelvic floor exercises
family planning... Dr Eeson
Sinthamoney explaning how AMH
testing is able to help women make
sound decisions in terms of family
planning.
Developments in women’s
fertility science help women
plan ahead for parenting
W
omen in Malaysia are
having children later in life.
The Department of Statistics
(DOSM) found that from
2001 to 2015, the mean
age of first-time mothers
increased from 26.6 years old
to 27.7 years old. This means that on average, women
in Malaysia are becoming parents at a later age.
This could be due to any number of reasons.
Obstetrics and Gynaecology Society Malaysia
(OGSM) president Dr Eeson Sinthamony disclosed
that it is important for women who would like to
have children to start planning for the future now
and gain an understanding of their bodies. There
are many options available now to help them make
plans to have children later in life, such as AMH
According to Eeson, 10 per
cent of women in their early
30’s have significantly reduced
fertility. While this rate of
decline varies from person to
person, numerous studies have
established that in the 30’s
age group, a woman’s ovarian
reserve begins to decline.
testing and egg freezing.
According to Eeson, 10 per cent of women in their
early 30’s have significantly reduced fertility. While
this rate of decline varies from person to person,
numerous studies have established that in the 30’s
age group, a woman’s ovarian reserve begins to
decline.
“’Ovarian reserve’ refers to the number of eggs a
woman has in her body to be fertilised, and it is also
known as ‘egg count’. Each woman is born with a total
of two million eggs, which are all of the eggs she will
have in her lifetime. After a spike during puberty,
this number begins to decline throughout her life.”
“Women who want to know how fertile they are
may take an Anti-Müllerian Hormone (AMH) test.
This will give them an indication on their remaining
fertile years, and help give their doctor an idea of
whether it will be easy for them to conceive, in the
present or in the future.”
An AMH test is a simple blood test that can
indicate a woman’s fertility. Blood levels of the Anti-
Müllerian Hormone (AMH) are used as a marker of
a woman’s ovarian reserves (remaining supply of
eggs available for fertilisation). This is an important
consideration for women who are either planning for
pregnancy or struggling with infertility.
For those who wish to plan for future motherhood,
there is the option of freezing your eggs.
Currently, around 50 million couples worldwide
are affected by infertility, and around 15 percent
of women of reproductive age face fertility issues.
Prior to the introduction of AMH testing, the most
conventional female fertility test involved an invasive
trans-vaginal ultrasound procedure. The AMH test is
far more convenient by comparison, cutting out both
discomfort, waiting time and confusion, as women
can request a test from their physician at any time
– The Health
The way to do pelvic floor exercises is what we
call kegels – which is as if you’re trying to stop
the urine half way, which we are supposed to do
for at least 80 times a day.
“Some ladies my not know how to do it
especially older women. So, what we have is a
‘bio-feedback’ which is a probe that is inserted
into the vagina and we make them squeeze to see
whether the pressure is good enough.”
In the market, there are few devices that helps
with pelvic floor exercises.
“Biofeedback is not encouraged during
pregnancy as anything inserted into the vagina
is discouraged as we do not want to introduce
infections. But after pregnancy, they can use
that.”
“Generally we give six weeks for the hor-
mones to get out of the system and the body to
reverse back to normal after pregnancy to see if
the incontinence still persist.
“If it’s still present, then obviously after
making sure she doesn’t have any anatomical
Hello Doktor
problems, or infections,
then she would be given
few options.”
“K e gel exerc is es
is very good but it
demands a lot of dedica-
tion and they would
only start to see some
effect after three to
six months. For quick
measures, it would be
the feminine laser that
helps to strengthen
the bladder neck
by stimulating the
If you suffer urine
incontinence during collagen.”
This however would
pregnancy, very
only last if she doesn’t
likely you would
get pregnant again. In
suffer the same
the event where she
after.
does, symptoms may
return, and she might need to do the treatment
again.
“In cases where incontinence is very bad
and very stressing and if she has already com-
pleted her family, then she might consult an
urogynaecologist.”
Options could be a sling that is a surgical
procedure where it is inserted to hitch up the
bladder neck again. But it is an operation done
under anesthesia and done from the vagina.
The other method would be through a tummy
laparoscopy or open surgery. – The Health