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)
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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 intraabdominal 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
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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>.