Female Stress Urinary Incontinence

1. Female Stress Urinary Incontinence Shunzaburo Kida University of Rhode Island Biomedical Engineering

2. Index • Types of Urinary Incontinence(UI) in Women • Causes & Affects • Treatments • Study • Results

3. 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

4. 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

5. 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

6. 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

8. 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;

10. 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

12. 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>.