Options to Manage Urinary Incontinence.docx

1. Options to Manage Urinary Incontinence Urinary Incontinence is defined as the unintended loss of urine through the urinary sphincter. There are several types of urinary incontinence but the most common type of urinary incontinence is stress urinary incontinence, caused by pelvic organ prolapse. Stress urinary incontinence is caused by physical movements such as laughing, coughing, running, and heavy lifting. There are several treatment options for urinary incontinence but treatment through transvaginal mesh slings is one of the most popular long term treatment options. For More information on urinary incontinence, refer to Attn:Grace or Wikipedia here. Urinary Incontinence Types Stress Urinary Incontinence: a condition in which there is insufficient strength to uphold the pelvic floor muscles. Stress Urinary Incontinence (SUI) is the most common type of incontinence and generally happens as a result of cystocele, prolapse of the bladder. Women generally report leaking during physical activity such as running, jogging, laughing, coughing, and lifting. ● Urge Incontinence: a condition which causes sudden leakage for no clear reason. Women often report suddenly needing to urinate. Urge incontinence is generally caused by bladder spasms or contractions. ● Overflow Incontinence: a condition in which the bladder continues to leak or dribble urine for a continuous amount of time after urination. Women report that they essentially continue to urinate and they feel as if their bladders are constantly overflowing. ● Mixed Incontinence: a condition which is best described as a mix of Stress Urinary Incontinence and Urge Incontinence. Symptoms include leakage during sneezing, coughing, ●

2. laughing, and exercise and also include sudden leakage with no apparent impetus. Physicians often turn to transvaginal mesh products to curb complications. Symptoms General symptoms of urinary incontinence include leakage during: Coughing ● Sneezing ● Laughing ● Standing ● Sitting ● Heavy Lifting ● Exercise ● Sexual Intercourse ● Causes Urinary incontinence generally occurs as a result of diminished functionality of bladder muscles and the ability to regulate urine. This may be caused by pelvic organ prolapse or bladder contractions or spasms. The bladder expands and fills with urine over time. There is a small tube, the urinary sphincter, through which urine exits the body which normally stays closed or contracted to stop urine from leaking at unintended times. When one develops urinary incontinence, the urinary sphincter begins to malfunction due to pressure from weakened/prolapsed tissues and movements such as jumping or running. During Stress Urinary Incontinence, your bladder may not be full but leakage still occurs due to force exerted on the abdominal and pelvic muscles as a result of pelvic organ prolapse and certain actions. Causes for urinary incontinence include: Childbirth: During childbirth, weakening of the pelvic floor muscles and nerve damage may occur and create long term pelvic organ prolapse. Stress Urinary Incontinence may begin right after delivery or years later. ● Hysterectomy: A hysterectomy is either the partial or full removal of the uterus, cervix and uterine canal. Based on positioning, the uterus is one of the few organs holding up the bladder and other internal organs. Since the uterus is removed, it becomes much easier for organs to prolapse much more severely. ● Other Contributing Factors: Any sickness that causes chronic coughing or sneezing ● Obesity or weight gain ● Smoking, which causing frequent coughing ● Alcoholism ●

3. Excessive caffeine intake ● Aggressive physical activity ● Hormonal imbalance ● Risk Factors There are several risk factors which increase one’s probability of developing stress urinary incontinence. Risk factors include: Age: While Stress Urinary Incontinence isn’t typical in women, pelvic organ prolapse affects between 30% to 50% of women. These physical changes lead to a gradual weakening of necessary muscles, which may contribute to the development of stress urinary incontinence. ● Childbirth History: Childbirth history may contribute to the development of stress urinary incontinence in two key ways. First, a delayed second stage of labor, when the woman is “pushing” often leads to an increased incidence of pelvic organ prolapse. Secondly, multiple vaginal deliveries is associated with a higher incidence of pelvic organ prolapse and stress urinary incontinence. ● Obesity / Weight: Overweight individuals tend to have a higher incidence of stress urinary incontinence since excess weight directly increases pressure on internal and abdominal organs. This increased pressure often directly creates stress urinary incontinence. ● Complications Emotional Distress: the emotional distress created by stress urinary incontinence often goes understated due to the often-embarrassing nature of the symptoms. Women often have to spend a considerable amount on pads, medications, or even new bedding. They also have to worry about being close to the restroom at all times for if they experience urge incontinence or mixed incontinence. Work and social activities are often disrupted. Lastly, sexual relations are very difficult due to frequent urination. ●

4. Skin rash or irritation: when areas are in constant contact with urine, especially with pads, women report having serious irritation and pain. ● Treatment Treatment of stress urinary incontinence obviously depends on the severity of one’s symptoms. There are often four primary categories of treatment: Behavioural Changes ● With help of bladder leakage products ● Medication ● Pelvic Floor Exercises ● Pessaries ● Surgical Options ● Behavioural Changes: Decreased fluid intake and drinking ● More Frequent Urination ● Avoiding Intense Physical Activity ● Smoking Cessation (quitting) ● Avoiding Alcohol or Caffeine ● Weight Loss for the overweight ● Dietary Changes ● With help of bladder leakage products There are various bladder leakage products available in the market which can be helpful in dealing with the issue of accidental or sudden urine leakage. From incontinence liner to super absorbent incontinence pads, the range and variety of these products are considerably large and continuously evolving according to the customers' needs and requirements. Medication: Medications tend to work best for women with mild to moderate incontinence. Popular Medications include: Anticholinergic drugs for overactive bladder control ( vesicare, oxybutynin, tolterodine, enablex, sanctura, oxytrol, etc) ● Antimuscarinic drugs to block bladder contractions ● Estrogen therapy ● Pelvic Floor Exercises: The most common type of pelvic floor exercises are kegel exercises, which are intended to help control urine leakage and keep the urethral sphincter strong. Studies show that consistent kegel exercises are often effective in curbing the incidence of urinary incontinence.

5. Pessaries: Vaginal Pessaries are devices placed in the vagina to provide support to the pelvic floor and counteract pelvic organ prolapse and stress urinary incontinence. Since pessaries are generally not considered long term options and are often described as uncomfortable, physicians often move on to other more permanent solutions. Surgical Options: Starting in the mid to late 1990s, the option of choice for many physicians has been using transvaginal mesh slings to treat stress urinary incontinence. Slings are generally composed of synthetic mesh material, but may contain biological materials. The purpose of mesh products is to provide netting and support for deficient pelvic floor muscles and keep the bladder in place to limit the potential for pressure. There are several sling types which include tension-free transvaginal tape (TVT), transobturator tape (TOT), mini slings, needleless slings, and adjustable slings. Tension-free transvaginal tape (TVT) The TVT sling procedure is meant to treat stress urinary incontinence by using transvaginal mesh and placing it under the urethra and positioning the bladder to limit prolapse and pressure on the urethral sphincter. The TVT approach involves two small incisions in the retropubic space, which is in the lower abdomen. Complication rates in the retropubic space are comparatively high and complications such as bladder perforation, bleeding, and vaginal pain are possible. Popular TVT Products include: TVT (Gynecare / Ethicon /Johnson & Johnson) ● SPARC (American Medical Systems) ● Transobturator Slings (TOT) After complication rates continued to soar due to problems with blind needle passage in the retropubic space (TVT), the transobturator approach was popularized since it was less invasive. The

6. transobturator approach required needle insertion through the groin via the obturator foramen. Studies show that TOT slings had comparative cure rates as TVT sling and fewer complications. Popular TOT Products include: Monarc Subfascial Hammock (American Medical System) ● TVT-O (Gynecare / Ethicon / Johnson & Johnson) ● Mini-Slings The most recent innovation in slings for the purposes of stress urinary incontinence is the mini-sling. Even though the TOT approach was less invasive than the TVT approach, there was a continued push to make sling products less invasive. Mini slings are placed through a single, vaginal incision without any passages of needles through the abdomen or the groin. Popular Mini-Sling Products Include: Miniarc (American Medical System) ● TVT-Secur (Gynecare / Ethicon / Johnson & Johnson) ● Legal Disclaimer: This content is not intended to replace conventional treatment. All material in this article is provided for general information purposes only and cannot be considered medical advice or consultation. Contact a reputable healthcare practitioner if you’re in need of medical care. Exercise self-empowerment by seeking an additional opinion. Source