Urinary incontinence is seen in men and women. Females attain bladder control before males, but as age progresses there can be incidences of accidental leakage in both men and women. The causes are different. The embarrassment due to accidental leak creates a stigma and emotional distress for the women preventing her from enjoying outdoor activities or sexual activities. But like every disease has a cure, urinary incontinence is also curable.
Women face the embarrassment of urine leakage after pregnancy, childbirth or during menopause. The alignment of the bladder in the female pelvis also makes her twice as much vulnerable to leaks as compared to males. The causes of incontinence are the same in men and women except for the addition of childbirth and menopause.
The functioning of the bladder is controlled at the local level by a micturition reflex and by the spinal cord and the brain at the higher level. The brain has centers that tell the individual if it is the right place and time to urinate. These centers are affected in conditions like Stroke, Parkinsonism, Alzheimer’s and Brain tumor because of which the person may urinate immediately after she gets the urge. The person may pass urine in bed, in a gathering etc. This is a type of urge incontinence.
At times the person may suffer from spinal cord injury. The spinal cord has nerves that carry sensation of bladder fullness from the bladder to the brain. As soon as the brain senses bladder fullness, it instructs the individual to go to the washroom to relieve him. Till such a place is found the brain sends signals through other nerves to keep the bladder opening closed. But in cases of spinal cord injury, this connection between the brain and bladder is lost as the spinal cord nerves are cut. In this case the person gets the urgency to void urine and she does it immediately. This is also a type of urge incontinence. Also in spinal cord injury the bladder gets spastic or overactive. A little bit of urine causes reflex contraction of bladder resulting in its contraction and expulsion of small amounts of urine with increased frequency. This is known as overactive bladder.
In conditions such as diabetes mellitus or other nerve diseases, the bladder muscles become weak and nerves causing the bladder contraction are diseased. As a result even after the bladder is full, there is no reflex contraction and emptying of bladder and the bladder keeps filling up till it overflows. This is known as overflow incontinence or dribbling.
Vaginal delivery or any other surgery causes injury to the pelvic floor muscles which actually provide strength to the radial sphincter muscles that surround the opening of the bladder. As a result the bladder is never fully closed and some amount of urines leaks. This is known as genuine stress incontinence and occurs in situations where intra-abdominal pressure increases as in running, laughing, coughing, sneezing, lifting weights and obesity etc. lowered estrogen seen a few days before menses and during menopause is also responsible for incontinence as the sphincter muscles around the bladder mouth become weak.
Retropubic Suspension :Uses surgical threads called sutures to support the bladder neck. The most common retropubic suspension procedure is called the Burch procedure. In this operation, the surgeon makes an incision in the abdomen a few inches below the navel and then secures the threads to strong ligaments within the pelvis to support the urethral sphincter.
This common procedure is often done at the time of an abdominal procedure such as a hysterectomy.Sling procedures are performed through a vaginal incision. The traditional sling procedure uses a strip of your own tissue called fascia to cradle the bladder neck. Some slings may consist of natural tissue or man-made material. The surgeon attaches both ends of the sling to the pubic bone or ties them in front of the abdomen just above the pubic bone.
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