Female Stress Urinary Incontinence

Shunzaburo KidaUniversity of Rhode Island

Biomedical Engineering

Index

• Types of Urinary Incontinence(UI) in Women

• Causes & Affects• Treatments• Study• Results

Types of UI - Involuntary loss of urine(International Continence Society

(ICS)• Stress Urinary Incontinence (SUI), primary focus

– Weakened pelvic floor muscles• Urge Incontinence

– Involuntarily release of urine due to feeling the need or urge to urinate• Neurogenic

– Defective CNS inhibitor response• Functional

– Has the urge to urinate, but cannot physically make it to bathroom due to limited mobility.

– Confusion, dementia, poor eyesight, poor mobility, poor dexterity, etc.• Overflow

– Inability to stop bladder from “dribbling”, feeling as bladder is “overflowing”

• Mixed– Common in older females, retention of urination, sometimes caused by

extreme constipation (pressure against bladder), medications, urinary tract infections

SUI Causes & Affects• Lack of strength of the pelvic floor muscles

– Affects normally during excess intra-abdominal pressure: coughing, laughing, sneezing, exercising, and other activities that increase pressure

– Urethra is supported by fascia of pelvic floor; in increased intra-abdominal pressure, urethra can drop causing involuntary release of urine

– In women: menopause, childbirth, and pregnancy• Affects

– Quality of life reduced• Emotional• Social• Physical• Sexual

Treatments• Nonsurgical (primary focus)

– Pelvic Floor Training (a.k.Kegel exercises), is highly urged by doctors before seeking surgical means of treatment along with/without biofeedback, electro-stimulation, and vaginal cones

• Surgical– Modified Burch Colposuspension

• Attaching via a tension free fashion of the vaginal wall to the Coopers’ ligament

– Retropubic Tension-free vaginal tape• placing below the urethra a polypropylene mesh tape

– Transobturator urethral tape suspension• Similar to the retropubic tension-free vaginal tape but

is done by inserting the tape via the small incision points in the groin

Nonsurgical Treatment• Pelvic Floor Training (Kegel exercises)

– Strengthening by contacting and releasing the pubococcygeus muscles• Helps tighten the sphincter that controls urinary disposal

• Biofeedback– Devices are used to make the user aware of various physiological

functions– Typically done using a sensor and feedback monitor– Electromyograph(EMG),feedback thermometer, electrodermograph,

electrocardiograph(ECG), etc.• Electrical Stimulation

– Electrodes are attached to the vagina externally(interferential) or internally

– The current forces the muscles to contract similarly to exercising them• Vaginal Cones

– Weighted cones placed in the vagina and held in place by contracting

Study

• Reviewed 24 studies: 17 of which were Randomized Controlled Trials(RCT) and 7 non-RCT

• Only peer-reviewed studies in English from 1995-2005 were included (mainly due to methodology and updated medical techniques

• Subjects were adult females of all age groups, self-report, or show signs of SUI, were not pregnant nor within six weeks post-partum

• Different studies examined possible combinations of pelvic floor muscle training(PFMT), biofeedback(BF), electrical stimulation(ES), and vaginal weights(VW)

• Cured and cured/improvement are described as such;

Outcome

• Since many of the studies were based on personal opinion, some of the data was regarded as low quality studies– With this in mind, all the studies examined had a positive

feedback about Pelvic Floor Muscle Training• There is strong evidence that SUI treated with PFMT, PFMT+BF,

PFMT+BF+ES, has a high rate of effectiveness (73% cured, 97%, cured/improved

• The main factors that may have affected the results were:– Age, initial severity of incontinence, compliance w/the home

training program, and initial PFM strength• Strengthening the pelvic floor muscles led to reduced symptoms

of SUI– 1 week - 6 months = changes in incontinence are noticeable– Improvement in PFM strength may take at least 3 months

Works Cited• Neumann, Patricia, Karen Grimme, and Yamini Deenadayalan. "Pelvic Floor Muscle Training and

Adjunctive Therapies for the Treatment of Stress Urinary Incontinence in Women: a Systematic Review." PubMed Central. BioMed Central, 28 June 2006. Web. 3 Mar. 2010.

<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586224/?tool=pubmed>.• Innerkofler, Petra, Verena Guenther, Peter Rehder, Martin Kopp, Dominic Nguyen-Van-Tam, Giesinger

Johannes, and Bernhard Holzner. "Improvement of Quality of Life, Anxiety and Depression after Surgery in Patients with Stress Urinary Incontinence: Results of a Longitudinal Short-term Follow-up." PubMed Central. BioMed Central, 29 Sept. 2008. Web. 03 Mar. 2010.

<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569009/?tool=pubmed>. • "Kegel Exercise -." Wikipedia, the Free Encyclopedia. Web. 04 Mar. 2010.

<http://en.wikipedia.org/wiki/Kegel_exercise>. • Neumann, Patricia, Karen Grimme, and Yamini Deenadayalan. "Pelvic Floor Muscle Training and Adjunctive

Therapies for the Treatment of Stress Urinary Incontinence in Women: a Systematic Review." PubMed Central. BioMed Central, 28 June 2006. Web. 3 Mar. 2010. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586224/?tool=pubmed>.

• "Pelvic Floor Muscle Rehabilation." Seekwellness. Web. 03 Mar. 2010. <http://www.seekwellness.com/incontinence/pelvic_floor_muscle_rehab.htm>.

• "Sexual Function and Quality of Life in Women with ... [J Sex Med. 2010] - PubMed Result." National Center for Biotechnology Information. Web. 02 Mar. 2010. <http://www.ncbi.nlm.nih.gov/pubmed/20136705>.

• "Urinary Incontinence -." Wikipedia, the Free Encyclopedia. Web. 04 Mar. 2010. <http://en.wikipedia.org/wiki/Urinary_incontinence#Tension-

free_transvaginal_.28TVT.29_sling>. • "WikiAnswers - How Do You Tighten Your Vagina." WikiAnswers - The Q&A Wiki. Web. 04 Mar. 2010.

<http://wiki.answers.com/Q/How_do_you_tighten_your_vagina>.