Urinary incontinence: Involuntary loss of urine: common problem among older women.
Two main types of incontinence: possible to have both types at the same time:
Stress incontinence: Loss of urine during jogging, laughing, coughing, or sneezing.
Increase the intraabdominal and intra-pelvic pressure.
Most common problem in women of childbearing age.
Risk factors:
Previous pregnancies.
Weak perineum
Movement of the bladder from its ordinary position and increase the angle of the bladder and the urethra.
Signs, Symptoms and Clinical Presentation:
Leakage of small to medium amounts of urine only when they increase their intra-pelvic pressure.
Do not wet the bed.
Normal bladder studies.
Normal bladder musculature.
Normal urinary bladder dynamic studies.
Urge incontinence: Strong urge to urinate secondary to various stimuli resulting in the loss of urine before reaching the bathroom.
Risk factors:
advanced age.
Pelvic surgery.
Neurologic
Frequent urinary tract infections,
Bladder cancer
Signs, Symptoms and Clinical Presentation:
Overactivity of the bladder musculature: Autonomic nervous system control
Not related to a filled bladder.
Can happen even with small amounts of urine in the bladder.
Can happen just thinking of voiding or hears sound of running water.
Secondary to an overactive bladder.
Overactive bladder: Increase in the muscle tension in the bladder muscles.
May wet the bed.
Release large amounts of urine.
Cannot get to the bathroom on time to void.
Urinary bladder muscle trabeculation
Increase in urine bladder muscle tension on urodynamic studies.
Emotional stress can precipitate it.
Irritation of the bladder muscle can cause it.
Increase in urge incontinence among patients with stroke or Parkinson’s disease.
Management of Urinary incontinence:
Behavioural:
Bladder training: Attempting to hold the urine for up to ten minutes at a time when there is an urge to urinate.
Double voiding: Voids first until the bladder feels empty and then voids a few minutes later to completely empty the bladder.
Kegel exercises: good for stress incontinence: strengthen the perineal muscles: stop the flow of urine, holding the muscles tight for several seconds: repeated several times per day to strengthen the muscles that hold back urine during increased intra-pelvic pressure.
Electrical stimulation: imitate exercises using electrode applied to the perineal muscles to strengthen the pelvic floor muscles: works for both urge and stress incontinence.
Medical: Address the hyperactivity of the bladder muscles:
Anticholinergic therapy: drugs that decrease the overactivity of the bladder: darifenacin, tolterodine, and oxybutynin.
Medication to relax the bladder muscle and increases bladder capacity: mirabegron (Myrbetriq).
Topical estrogen therapy rejuvenates the perineal and bladder muscles to hold back urine easier.
Oral estrogen therapy: not recommended: problem worse.
Devices:
A urethral insert: Small device inserted into the urethra holds back the flow of urine
Pessary: Ring inserted into the vagina holds the bladder and uterus up so that the angle of the bladder and urethra is decreased.
Surgical: last resort:
Bladder neck suspension surgeries: change the angle of the bladder and the urethra, decreasing stress incontinence.
Bladder sling surgery: mesh or body tissue to create a sling to hold the bladder up inside the pelvis.
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