Pelvic Floor Health and Incontinence Treatment

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Urinary incontinence in women is a group of conditions where urine leaks involuntarily. This symptom can happen anytime, including at night, triggered by exertion or occurring spontaneously. It affects more than 38% of women, but only 10% seek help from a doctor on time. Many consider the situation too delicate or are unaware of effective treatment methods, so they suffer for years from the leaking urine, which reduces their quality of life.

Causes of Urinary Incontinence in Women

The causes of urinary incontinence in women are diverse. Structural changes in the bladder, other organs, pelvic muscles, as well as disruptions in nerve function and central regulation of the urination process, play a role in its development.

Involuntary urine leakage can occur due to conditions such as:

  • Bladder, urethra, or ureter pathologies
  • Congenital anomalies in the urinary system development
  • Prolapse of the vagina and uterus
  • Urinary fistulas resulting from trauma or infectious processes
  • Complications after pelvic organ surgeries
  • Stroke, multiple sclerosis, and other neurological disorders
  • Mental health disorders affecting bladder emptying control.

In elderly patients, urinary incontinence often arises alongside serious underlying conditions like heart failure, kidney disease, or diabetes. Nighttime urinary incontinence is common in obstructive sleep apnea and other sleep disorders.

Risk Factors

The main unchangeable risk factor is age. Younger patients rarely experience urinary issues, but after 40, the chances increase. Among women over 60, incontinence occurs in 40-50% of cases. At this age, hormonal changes lead to atrophy in the urinary system.

Other significant risk factors include:

  • Complicated childbirth involving urethral or pelvic trauma
  • Physical labor or frequent heavy lifting
  • Congenital connective tissue disorders
  • Genetic predisposition.

Patients who take diuretics, alpha-blockers, or certain antidepressants for a long time are also at risk. These medications can negatively affect the urinary system, increasing the likelihood of developing urinary problems.

Types and Symptoms of Urinary Incontinence in Women

In urology, we categorize urinary incontinence by severity. With mild cases, symptoms occur only when there’s a sudden increase in abdominal pressure: leaking urine when sneezing, coughing, straining, or brisk walking. Moderate severity involves urine leakage during relaxed walking or other light activities. Severe cases involve uncontrollable urine leakage when changing positions or even without any triggers.

The types of the condition are also defined by the International Continence Society (ICS) guidelines, which consider the causes and mechanisms of the condition’s development. According to these guidelines, there are three common forms of the disease: stress, urgency, mixed, and some rare types. The characteristics of each will be described further.

Stress Urinary Incontinence in Women

This is the most common type of urinary leakage in women. It happens when the bladder sphincters are weak and can’t hold urine when abdominal pressure increases. Weak pelvic muscles and ligaments also contribute. It’s common in older women.

Stress leaking occurs with actions like sneezing, coughing, laughing, or physical exertion, releasing a few drops to 20-50 ml of urine.

Urge Urinary Incontinence in Women

This is uncontrollable urination due to sudden bladder muscle contractions. It’s marked by a strong urge to urinate that can’t be ignored. Symptoms occur anytime without triggers and are often due to an overactive bladder.

Mixed Type

This is a mix of urge and stress incontinence, common in women over 40 with multiple risk factors.

Other Forms

Less common types, but serious, needing special treatment:

  • Nocturnal enuresis (bedwetting)
  • Situational leaking, triggered by specific situations like stress, cold, intimacy, or alcohol
  • Paradoxical incontinence, periodic urine release with a chronically full bladder.

Which Doctor Treats Urinary Incontinence in Women

If a patient is bothered by involuntary urination, they should see a urologist. The visit starts with a consultation and keeping a urinary diary. During the first visit, the doctor learns about symptoms, medical history, possible risk factors, and conducts a physical examination.

The urologist understands the sensitivity of the situation, behaves tactfully during the consultation, and adheres to medical ethics. All health-related questions are asked to better understand the condition, so it’s important to answer them as thoroughly as possible.

Then, the doctor conducts a comprehensive examination to determine the causes of the condition and plans further actions. If necessary, the urologist may refer the patient to a gynecologist, neurologist, or other specialists. Advanced diagnostics using modern medical equipment helps understand why urinary incontinence occurs in women and how to get rid of it.

Diagnosis

To confirm the diagnosis and determine the type of condition, simple questioning and examination aren’t enough. Patients undergo instrumental visualization methods. The most informative tests include:

  • Pelvic ultrasound, a basic method to detect any remaining fluid in the bladder and assess the condition of the reproductive and urinary organs.
  • Cystoscopy, an endoscopic examination of the bladder to identify signs of chronic organ pathologies.
  • Uroflowmetry, a urodynamic test to assess the speed, volume, and other parameters of urination.
  • CT or MRI scans of the pelvic organs, for detailed diagnosis of organic pathologies in the urinary system.

Conservative Therapy

Non-drug Methods

According to recommendations, conservative treatment is the first step in managing urinary incontinence in women. It helps control symptoms, improve well-being, and quality of life.

Usually, a combination therapy is used:

Kegel exercises for urinary incontinence in women, which strengthen sphincter tone, pelvic floor muscles, and the anterior abdominal wall. Good results are seen after at least 6 months of regular exercise – improvement is noticed by 75-80% of patients with mild forms of the disease.

Biofeedback. To enhance the effectiveness of exercises for urinary incontinence, special sensors are used to monitor muscle contraction intensity during exercise and provide feedback if the woman is doing it correctly.

Behavioral therapy. Patients learn to delay urges to urinate and visit the toilet regularly to reduce the volume and frequency of involuntary urination. Treatment for 3-4 months establishes a new bladder emptying pattern, improving the condition in 50-86% of cases.

Pessaries. These special devices are inserted into the vagina to support pelvic organs in the right position, reducing symptoms. They’re usually prescribed for elderly patients with severe forms of the disease and contraindications to surgery.

Comprehensive therapy includes hardware treatments: electrical stimulation, laser therapy for urinary incontinence in women. These methods improve the tone of soft tissues in the pelvic floor and perineum, stimulate metabolic processes, and enhance blood flow to the organs.

Drug Therapy

Tablet treatment for urinary incontinence in women is most effective for urgency. Medications are used to reduce detrusor muscle contractions and increase bladder capacity. They reduce the frequency of involuntary urination and alleviate pain. For stress incontinence, serotonin reuptake inhibitors are used to increase urethral sphincter tone and normalize pelvic organ innervation.

For age-related urinary incontinence, women are prescribed hormone replacement therapy with estrogen. These medications positively affect the genitourinary system, improve blood supply, and prevent atrophy.

Surgical Treatment

Surgery is recommended for frequent and severe urinary incontinence in women that can’t be corrected by other means. Sling surgeries show good therapeutic results in stress and mixed forms of the disease. A sling made of synthetic materials is placed around the urethra to prevent involuntary urination when abdominal pressure increases.

Whenever possible, minimally invasive methods are used for surgical correction of urinary incontinence:

  • Botulinum toxin injections into the bladder for imperative form of the disease to relax the detrusor and eliminate pathological muscle contractions;
  • Periurethral injections of bulking agents, which compress the initial part of the urethra, partially replacing the impaired sphincter function in stress incontinence.

For involuntary urination, standard lab tests are conducted: complete urine analysis, bacterial urine culture, and vaginal swab for cleanliness. Clinical and biochemical blood tests help rule out inflammation and evaluate the patient’s overall health.

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