Female Stress Urinary Incontinence Shunzaburo Kida University of Rhode Island Biomedical Engineering Index • Types of Urinary Incontinence(UI) in Women • Causes & Affects • Treatments • Study • Results.
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Female Stress Urinary Incontinence
Shunzaburo Kida University 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.
Innerkofler, Petra, Verena Guenther, Peter Rehder, Martin Kopp, Dominic Nguyen-Van-Tam, Giesinger Johannes, 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 and Central, 29 Sept. 2008. Web. 03 Mar. 2010.
"Pelvic Floor Muscle Rehabilation." Seekwellness. Web. 03 Mar. 2010.