Why So Many Women Suffer in Silence with Dr Fadi #173

In this episode, consultant obstetrician and gynaecologist Dr Fadi joins Laura for an open, practical conversation about pelvic floor health, incontinence, prolapse and the realities of modern obstetrics.

Dr Fadi explains how childbirth, ageing and menopause affect the pelvic floor, and why so many women end up living with stress incontinence, prolapse and faecal incontinence in silence. He walks through the full range of treatment options — from physiotherapy and pessaries to urethral bulking, Botox, sacral neuromodulation, robotic surgery, and the mesh procedures paused in Ireland since 2018.

The conversation also takes in interstitial cystitis, vaginal oestrogen, the impact of long inductions on older mothers, and the trade-offs women now weigh up between a vaginal delivery and a caesarean section. Dr Fadi closes with a reflection on his time working with Syrian refugees, where he met 13-year-old mothers and a 26-year-old grandmother.

🔑 Key Points

1. Pelvic floor problems are common and treatable — Stress incontinence, prolapse and faecal incontinence are usually linked to childbirth, not an inevitable part of being a woman.

2. Mesh for incontinence has been paused in Ireland since 2018 — Ireland is the only country in the world where this procedure is currently unavailable, and patients are being sent to Spain to access it.

3. There is no single fix for incontinence — Treatment depends on the type, from physiotherapy and urethral bulking to mesh slings, Botox into the bladder wall, and sacral neuromodulators.

4. Prolapse is not just the womb — Bladder, womb and rectum can all prolapse, each with their own grade and treatment pathway.

5. Pessaries give women back some control — Different types of pessary can hold a prolapse in place, and many women can learn to manage their own at home.

6. Faecal incontinence is more common than women admit — Third and fourth degree tears at delivery can damage the anal sphincter, and primary repair at the time of birth gives the best outcome.

7. Vaginal oestrogen is a low-risk, high-impact tool — It can ease overactive bladder, recurrent UTIs, dryness, and slow the progression of prolapse after menopause.

8. Older mothers face different trade-offs — Long inductions, instrumental deliveries and unplanned caesareans are more common, which is why some women are now actively asking for a planned section.

📚 Resources

Love Your Vulva — Laura Dowling

fabÜ Hello Healing

Continence Foundation of Ireland

⏱️ Timestamps

01:46 — Introducing Dr Fadi and urogynaecology

02:49 — Why pelvic floor problems happen

04:14 — Assessing pelvis and baby size before delivery

05:09 — Robotic surgery and vault prolapse

06:34 — Stress incontinence and mesh as the gold standard

09:01 — Why mesh has been paused in Ireland

12:31 — Sending Irish patients to Spain for mesh

14:25 — Botox for overactive bladder and Interstim

15:43 — Faecal incontinence and tears at delivery

19:17 — Interstitial cystitis and hyaluronic acid

21:21 — Types and grades of prolapse

24:25 — How a pessary works

28:01 — Surgery for prolapse

34:18 — Vaginal oestrogen and pelvic floor

36:08 — Epidurals and instrumental delivery

37:25 — Why more women are asking for caesareans

45:00 — Working with Syrian refugees

48:32 — Advice for young people and the meaning of life

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