Urinary Incontinence

The treatment of urinary incontinence is based on symptom severity and quality of life. There are multiple reasons for incontinence: stress (urethral hypermobility, decreased urethral pressure, elevated abdominal pressure), urgency (detrusor overactivity or bladder spasm), overflow (poor emptying of the bladder), or mixed urinary incontinence (a combination of stress and urge). Stress urinary incontinence refers to the type of urine leakage that commonly occurs with some sort of activity (cough, sneeze, run, jump, exercise, laugh, lift, have sex). Urgency urinary incontinence refers to the type of urine leakage that commonly occurs when an urge to void is felt. Some women experience urine leakage spontaneously. Different types of urinary incontinence are treated differently: surgical, medical, expectant.

A suburethral sling is an outpatient surgery intended to treat stress urinary incontinence. It may be placed behind the pubic bone (retropubic) or underneath the bones adjacent to the vagina (transobutrator). Risks of surgery include bleeding, infection, injury to surrounding organs, recurrence, frequency, retention, incontinence, mesh erosion, and anesthesia risks. Many studies report success as high as 90%, which appears to last for several years. Suburethral slings can be performed more than once should urinary incontinence recur later in life.

Physical therapy is the least invasive treatment for urinary incontinence, and may be used to treat other pelvic floor disorders such as fecal incontinence, overactive bladder symptoms, and pelvic pain. Women selecting physical therapy will be evaluated and treated by a female physical therapist specialized in pelvic floor rehabilitation. Treatment frequency is dependent on the initial evaluation and may occur weekly for 4-12 weeks. Success may be as high as 75%. In general, women need to regularly perform the exercises and maneuvers learned from the physical therapist in order for success to be achieved and maintained.

News flash:  Check out the recent study and summary below regarding pelvic floor muscle training with a physical therapist versus functional magnetic stimulation using the Magneto STYM device.  Other functional magnetic stimulation devices include EMSELLA (available in Honolulu,HI) and BioBravo. Urinary incontinence symptoms, quality of life scores, and pelvic floor muscle measurements improved in both groups in the randomized study and neither therapy was superior to the other. 

In a separate recently published review, several studies indicate that pelvic floor muscle training is a cost-effective treatment for urinary incontinence whereas out of pocket costs for functional magnetic stimulation range from $1800-$2400. 1

Pelvic Floor Muscle Training versus Functional Magnetic Stimulation for Stress Urinary Incontinence in Women: A Randomized Controlled TrialBackground: There is strong evidence that specific pelvic floor muscle training (PFMT) reduces stress urinary incontinence (SUI), but the application of functional magnetic stimulation (FMS) is still under discussion. Objective: To evaluate and compare the effects of FMS and PFMT on pelvic floor muscle function, urinary incontinence symptoms and quality of life (QoL) in women with SUI. Methods: A randomized controlled, parallel-group trial was executed in an outpatient physical medicine and rehabilitation centre. The study included 68 women and was fully completed by 48 women (n = 24 in each group) aged 29–49 years, with SUI, who were randomly assigned to PFMT and FMS groups. The symptoms of urinary incontinence and their impact on quality of life were assessed with two questionnaires: the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) and the Incontinence Impact Questionnaire–Short Form (IIQ-7). Perineometer (Pelvexiser) was used to measure the resting vaginal pressure, pelvic floor muscle (PFM) strength and endurance. All outcome measures were taken at baseline and after 6 weeks of interventions. Cohen’s effect size (d) was calculated. Results: A significant improvement (p < 0.05) of ICIQ-SF and IIQ-7 was observed in both groups with a high effect size in the PFMT group (d = 1.56 and d = 1.17, respectively) and the FMS group (d = 1.33 and d = 1.45, respectively). ICIQ-SF and IIQ-7 scores did not differ significantly between groups after the 6-week treatment period. Resting vaginal pressure, PFM strength and endurance increased (p < 0.05) in both groups with a medium (d = 0.52) to large (d = 1.56) effect size. Conclusion: No significant difference between groups was found in any measurement of perineometry. PFMT and FMS significantly improved SUI symptoms and the quality of life of the study participants. None of the applied interventions was superior to the other in the short-term effect.

Chinese language version (for all types of urinary incontinence)

妇女尿失禁 可以治疗的症状

数以百万计的女性在非自愿情况下丧失尿称为尿失禁。有些妇女可能会在运行或咳嗽时失去几滴尿液。有些人小便前会感到一种强烈的冲动。许多妇女有两症状。尿失禁可以稍微或极麻烦的。对于一些女性来说，这可能会导致公众尴尬，让他们不能享受许多与他们的家人和朋友的活动。失禁也可影响性活动, 导致巨大的情绪困扰。

妇女失禁的频次比男性多两倍。女性尿道的结构, 怀孕, 分娩，和更年期，是导致妇女失禁频率的原因。但是，出生缺陷，神经损伤，中风，多发性硬化症，以及老龄化有关的物理问题，女性和男性都可以失禁。

老年妇女比年轻女性更经常地体验失禁。但是，随着年龄的增长,尿失禁不是不可避免的。失禁是一个医学问题。你的医生或护士可以帮助你找到一个解决方案。没有任何单一的治疗适用于每个人，但很多女性可以找到改善。

尿失禁发生于肌肉和神经问题。人体存储尿液在膀胱。膀胱连接到尿道将尿液排泄到身体外。在排尿过程中，膀胱的肌肉收缩，迫使尿液到尿道里。同时，尿道周围的肌肉放松，让尿液通过尿道。如果你的膀胱肌肉突然收缩或括约肌的肌肉不够强忍住尿液，尿失禁就会发生。如果尿道周围肌肉受到损伤, 尿液可能在相对较低的膀胱压下逃脱。肥胖，与腹压增高也可加重尿失禁频率。幸运的是，减肥可以降低其严重程度。

尿失禁的类型

压力性尿失禁

若失禁出现在咳嗽，笑，打喷嚏，或其他运动，提高对膀胱压力的情况下，你可能有压力性尿失禁。从怀孕，分娩，更年期造成的物理变化往往会导致压力性尿失禁。这种类型的尿失禁是常见的妇女失禁类型。在排尿过程中,膀胱壁中的肌肉收缩，迫使尿液从膀胱进入尿道。同时，尿道周围的括约肌放松，让尿液通过尿道。如果你的膀胱肌肉突然收缩或括约肌的肌肉不够强忍住尿液，尿失禁就会发生。如果肌肉受到损伤, 引致膀胱的位置变化,尿液可能在低的膀胱压下逃脱，。肥胖，这导致腹压增高，可增重尿失禁。幸运的是，减肥可以降低其严重程度。

分娩可损伤支持妇女膀胱的架构, 如盆底肌肉，阴道，膀胱和韧带的支持。如果这些结构减弱，膀胱向下移动，稍微推向骨盆底外的阴道内。这可以防止紧密挤压尿道的肌肉强烈地关闭尿道。结果，在压力下尿可以漏出尿道。挤压肌肉弱化也可导致压力性尿失禁。

月经期前一周压力性尿失禁可能恶化。在那时，低雌激素水平可降低尿道周围肌肉的压力，增加的泄漏的机会。绝经后压力性尿失禁的发病率会增加。

急迫性尿失禁 如果你突然感觉需要输尿或小便的冲动，你可能有急迫性尿失禁。急迫性尿失禁最常见的原因是不恰当的膀胱收缩。异常的神经信号可能是膀胱痉挛的原因。 急迫性尿失禁的病人可能在睡眠时，在膀胱排空后，在喝少量水，听或触摸到流水，当你或它的运行（如洗碗时，或听到别人洗澡，）也可失禁。某些液体和药物，如利尿剂，如焦虑或可加重这种情况。一些病症，如甲状腺功能亢进，未控制的糖尿病，也可能导致或加重尿失禁。 急迫性尿失禁可能是因为膀胱的神经，神经系统（脊髓和大脑），或肌肉本身受损。并可能由于多发性硬化症，帕金森氏症，阿尔茨海默氏症，中风，伤害，包括受伤，在手术过程中可能发生的膀胱神经和肌肉损害。

膀胱过动症 膀胱过动症是由于异常的神经信号, 在错误的时间, 发送到的膀胱，导致于不发出警告的情况下,膀胱肌肉收缩。一般女性一天排尿7次是正常的。膀胱过动症的病可能一天排尿超过10多次 具体而言，膀胱过动症的症状，包括：

功能性尿失禁 因病干扰思维，移动或通信的病人可能会有功能性尿失禁。例如，一个患阿尔茨海默氏症病人可能不能计划及时到厕所。一个坐在轮椅上的人，可能很难有时间去厕所。一些在养老院的老年失禁妇女是由于功能性尿失禁。

溢流性尿失禁

溢流性尿失禁发生在满溢膀胱。膀胱肌肉薄弱或尿道阻塞可导致这种类尿失禁。神经损伤，糖尿病或其他疾病可导致膀胱肌肉薄弱，肿瘤和泌尿系统结石可阻塞尿道。溢流性尿失禁在女性中是罕见的。

其他类型的尿失禁 在女性通常同时有压力和急迫性尿失禁。被称为混合性尿失禁。混合性尿失禁是最常见的失禁。 瞬态尿失禁是一种临时大小便失禁。药物，尿路感染，精神障碍和行动不便者都可以有瞬态大小便失禁。严重便秘可引起短暂的大小便失禁。感冒也可能引起大小便失禁。