Female Incontinence – Diagnosis, Treatment and Surgery from Best Hospitals & Leading Surgeons in India
Female Urinary Incontinence
Bladder Control and Causes of Urinary Incontinence
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.
- Maintaining a Diary on number of times you need to go to the washroom to relieve yourself is also a good indicator of incontinence.
- Bladder Stress Test – is done by coughing vigorously. The doctor watches for loss of urine from the urinary opening.
- Urinalysis and Urine Culture – Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
- Ultrasound – This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra to see for any abnormality or compression.
- Cystoscopy – The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.
- Urodynamics – Various techniques measure pressure in the bladder and the flow of urine.
Treatment for Female Urinary Incontinence
- Behavioral modification : Involves bladder training and timed voiding. Adjusting the time of fluid intake before bedtime or before going for a car trip or party can help avoid accidents during sleep or parties. Also timed voiding involves emptying of bladder after regular intervals. This technique is suitable for people with mechanical compression of bladder or overflow incontinence.
- Kegel Exercise : Involves strengthening of the pelvic floor muscles which help to keep the sphincter muscles tight which in turn keep the bladder outlet closed during strenuous activities. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10 repeats. This is possible with the help of biofeedback also. This helps people with stress incontinence.
- Medications : Certain medications help to relax the bladder and surrounding muscles to allow full emptying (Alpha blockers). Anticholinergics relieve the bladder muscle spasm thus preventing sudden bladder contractions.
- Neurostimulation : Of the nerves that leave the spinal cord and supply the bladder can help by modulating the nerve signals to the bladder which helps to control voiding. It is helpful in some people.
- Vaginal Devices : Like pessaries are a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition 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.
- Surgery for Stress Incontinence : In some women, the bladder can move out of its normal position, especially after childbirth. Different techniques have been developed by surgeons for supporting the bladder back to its normal position. The three main types of surgery are retropubic suspension and two types of sling procedures.
- 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.
- Midurethral Slings : are newer procedures that can be done on an outpatient basis. These procedures use synthetic mesh materials that the surgeon places midway along the urethra.The two general types of midurethral slings areretropubic slings, such as the transvaginal tapes (TVT), andtransobturator slings (TOT). The surgeon makes small incisions behind the pubic bone or just by the sides of the vaginal opening as well as a small incision in the vagina. The surgeon uses specially designed needles to position a synthetic tape under the urethra. The surgeon pulls the ends of the tape through the incisions and adjusts them to provide the right amount of support to the urethra. If you have pelvic prolapse, your surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy.
- Catheterization : This can be done if the bladder does not empty completely in cases of poor muscle tone, past surgery, or spinal cord injury. It can be an indwelling catheter or intermittent type
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