Tag Archives: female urinary incontinence

Treatment for UI in women

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Treatment for UI in women

Treatment depends on the type of incontinence and severity of symptoms. For most people, simple lifestyle changes may be sufficient, for others, medication would be necessary. Finally some women may require surgery to treat the condition.

1. Lifestyle changes and physical exercises


– Limit fluid intake at certain times of the day (such as before going to bed or before a long trip). However, note should be taken to increase fiber content in your meals to prevent constipation.
– Cut down on caffeine, alcohol, keep a healthy weight.
– Try pelvic floor muscle exercises such as Kegel exercises. This is to strengthen the muscles that support your bladder and is particularly recommended after childbirth.
– Timed voiding or bladder training therapy : plan regular trips to the bathroom at set times of the day, gradually increase the interval between trips as you gain control.
– Keep a bladder diary: record the times of incidents to help your doctor identify the best treatment for your case.
– Small leakage can be managed by wearing menstrual pads.
Female reproductive organs labeled.

Fig.1: Female urinary and reproductive organs, median section, side view. Note the pelvic floor muscles that support the urinary bladder and the uterus. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

2. Medication

– anticholinergics: these act on nerves to block bladder spasms in overactive bladder, for treatment of urge incontinence.
– estrogen: applied as a cream or patch can help to tone muscles and tissue around the urethra to keep it closed. This is a treatment for stress incontinence.
– some medicines used for treatment of other conditions such as high blood pressure or edema may have adverse effect on your bladder, talk to your doctor to find an optimal solution for your case.

3. Non-surgical therapies

pessary: a medical device in the shape of a ring that can be inserted into your vagina to lift up the bladder. This helps if your condition is due to a prolapsed (dropped) bladder or uterus. The ring would need to be taken out and cleaned regularly.
bulking agents injections: bulking materials such as collagen and carbon-coated beads are injected into the area surrounding the urethra to support and keep it closed. It’s a minimal invasive procedure but usually has to be repeated to be effective in the long term.

4. Surgery

Surgical procedures include:
Sacral nerve stimulation: treatment for overactive bladder that does not response to medication. A small pulse generator device is implanted under the skin of the buttock, the device sends mild electrical impulses to the sacral nerve (the nerve that controls bladder activity) to moderate and control bladder spasms.
– A variety of procedures available to create an artificial support for the bladder neck and/or urethral sphincters: bladder suspension, sling procedures. These usually involve tightening of the bladder  neck and/or urethra to strong ligaments within the pelvis or to the pubic bones. 

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Urinary Incontinence in Women

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Urinary incontinence (UI) is twice more common in women than in men. About one out of three women over the age of 60 is estimated to be incontinent. Pregnancy, childbirth, hormonal changes during menopause, and anatomy of the urinary tract account for this difference.

Urinary incontinence is involuntary leakage of urine. Urine is produced in the kidneys and stored in urinary bladder. Urination is the process of emptying the bladder through the urethra that connects the urinary bladder to the external urethral orifice. There are two sphincters (valves) that keep the urethra closed to prevent leak: internal urethral sphincter located at the neck of the bladder, and external urethral sphincter located right above the external urethral orifice and is supported by the pelvic floor muscles (See Fig. 1). The urethra is much shorter in women than in men.

Urinary organs in female, labeled.
Fig.1: Anatomy of female urinary organs. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

 

When the bladder is full, stretch receptors in the wall of the bladder send a signal to the spinal cord and the brain. At times when it’s not appropriate to urinate, the brain sends back an inhibitory signal to keep the sphincters closed and prevent voiding. When you wish to urinate, this inhibition is removed, the spinal cord instructs the muscle of the bladder (detrusor muscle) to contract and the sphincters to open to let the urine out (Fig. 2).

Below is a narrated animation of neural control of micturition. Click here to license this video and/or other urinary system related videos on Alila Medical Media website.

Neural control of micturition, labeled.
Fig.2: Neural control of urine voiding. Sensory nerve sends the signal from the full bladder to the nervous system; motor nerve brings instruction from the nervous system to the muscles. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Causes of urinary incontinence 

– Problems with the nervous system: stroke, multiple sclerosis, Pakinson’ s disease and spinal cord injuries may affect the neural control loop illustrated in Fig.2 and cause incontinence.
– Weakness of sphincters, or lack of support from underneath muscles (muscles of the pelvic floor) making the sphincters weak so they can not close properly.
– Blocked or narrowed urethra, weakness of bladder muscles: bladder can not empty, urine builds up and leaks.
Female reproductive organs labeled.

Fig.3: Female urinary and reproductive organs, median section, side view. Note the pelvic floor muscles that support the urinary bladder and the uterus. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

Types of urinary incontinence in women and typical cause of each type.

1. Stress incontinence: small amount of urine leakage while sneezing, coughing, laughing or any activity that creates abdominal pressure on the bladder. This usually occurs because the muscles underneath the bladder (pelvic floor muscles) are weakened and can no longer support it  (Fig. 3 and 4). In women, this typically happens as a result of pregnancy, childbirth during which these muscles are overstretched. Stress incontinence symptoms usually worsen during certain times in the menstrual cycle when your estrogen level is low. Incidents are also increased following menopause. This is by far the most common type of incontinence in women.

Stress urinary incontinence
Fig.4: Stress urinary incontinence in women. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Below is a narrated animation of stress urinary incontinence. Click here to license this video (and other related videos) on Alila Medical Media website.

2. Urge incontinence: need to void that can not be deferred, inability to hold resulting in sudden loss of a large amount of urine. This is commonly caused by overactive bladder, a condition in which muscles in the wall of the bladder contract in an uncontrollable manner. The reason why this happens is unclear but it’s likely to involve problems in the nervous system.
3. Overflow incontinence
constant dribbling of urine. This happens when the bladder does not empty properly while voiding making it almost always full and urine overflows. This is due to weak detrusor muscle in the bladder wall or a blocked/narrowed urethra. This type of incontinence is rare in women.

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