Urogynecology

Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause are common events that cause stress incontinence. It is the most common form of incontinence in women and is treatable.

Pelvic floor muscles support your bladder. If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvic toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress.

Stress incontinence also occurs if the muscles that do the squeezing weaken.Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.

Urge Incontinence

If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions.

Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Your doctor might call your condition "reflex incontinence" if it results from overactive nerves controlling the bladder.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when someone else is taking a shower or washing dishes).

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors, and even injury that occurs during surgery - all can harm bladder nerves

Overflow Incontinence

If your bladder is always full so that it continually leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.

Other Types of Incontinence

Stress and urge incontinence often occur together in women. Combinations of incontinence-and this combination in particular-are sometimes referred to as "mixed incontinence."

"Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow. or muscles.

For most causes of urinary incontinence, the following are commonly used as a conservative starting point in treatment.

Kegels Exercises

You can use a type of exercise called "Kegels" to strengthen the pelvic floor muscles that control urination. When doing Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. A special form of training called biofeedback can help you locate the right muscles to squeeze. It helps to start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum. While this sounds unpleasant, there is no pain associated with this therapy.

Another technique that can strengthen the pelvic and bladder muscles is the use of weighted cones. The tampon-shaped cone is inserted into the vagina and held there by contracting your pelvic muscles. As your muscles strengthen, the weight of the cone is gradually increased. This helps improve your ability to hold urine until you get to a bathroom. While pelvic exercises often help, the mainstay of OAB treatment is the use of medications called anticholinergics.

Bladder Training with Timed Voiding

This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercises help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

Timed voiding is another way of saying bladder training. This technique helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting - for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.

Treatment for Overactive Bladder:

Additional treatments are necessary when faced with overactive bladder. With OAB an inappropriate signal from our nervous system causing the muscles in the bladder wall to contract and release urine at the wrong time. Medications called anticholinergics can combat this problem by blocking the nerve signals and reducing bladder muscle contractions. They relax the smooth muscle of the bladder, reducing detrusor muscle contraction and subsequent urgency, frequency and urge incontinence (wetting accidents).

Treatment of Stress Urinary Incontinence:

Stress Urinary Incontinence occurs when the position of the urethra is not maintained when pressure is applied to activities such as coughing, sneezing, laughing or lifting. The above treatments may not sufficiently address this form of urinary leakage. Treatment addresses supporting the urethra either mechanically by a vaginal device known as a pessary or by vaginal reconstructive surgery.

Pessaries

A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps re-position the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.