Bladder Control Problems Treatment

Many people who have incontinence do not seek treatment because they believe the only treatment available to them is surgery.

This is a misconception; treatments for incontinence include behavioral, medical, and surgical.

Generally, behavioral therapies are the first choice; because they are noninvasive and have no side effects, they are the safest. A variety of medical treatments are available. Surgery is usually reserved for people whose problem does not improve with behavioral and medical therapy.

Your overall medical condition, the type of bladder control problem you have, and your lifestyle will all determine which treatments are right for you. Talk to your health care provider; together you can come up with a treatment plan that works for you.

http://www.emedicinehealth.com/bladder_control_problems/page6_em.htm

Bladder Control Problems Causes

Bladder Control Problems Causes

Incontinence is a symptom with a wide variety of causes. The most common causes include the following:

1. Urinary tract infection
2. Side effect of medication: Examples include alpha-blockers, calcium channel blockers, antidepressants, antihistamines, sedatives, sleeping pills, narcotics, caffeine-containing preparations, and water pills (diuretics). Occasionally, the medicines used to treat some forms of incontinence can also worsen the incontinence if not prescribed correctly.
   Impacted stool: Stool becomes so tightly packed in the lower intestine and rectum that a bowel movement becomes very difficult or impossible.
3. Weakness of muscles in the bladder and surrounding area: This can have a variety of causes.
4. Overactive bladder
   
5. Bladder irritation
   
6. Blocked urethra, usually due to enlarged prostate (in men) Many of the causes are temporary, such as urinary tract infection. The incontinence improves or goes away completely when the underlying condition is treated. Others are longer lasting, but the incontinence can usually be treated. Risk factors: Underlying causes or contributors to urinary incontinence include the following:
   
7. Smoking: The connection with incontinence is not completely clear, but smoking is known to irritate the bladder in many people.
   
8. Obesity: Excess body fat can reduce muscle tone, including the muscles used to control urination.
   
9. Chronic constipation: Regular straining to have a bowel movement can weaken the muscles that control urination.
   
10. Diabetes: Diabetes can damage nerves and interfere with sensation.
    
11. Spinal cord injury: Signals between the bladder and the brain travel via the spinal cord. Damage to the cord can interrupt those signals, disrupting bladder function.
    
12. Disability or impaired mobility: People who have diseases such as arthritis, which make walking painful or slow, may have "accidents" before they can reach a toilet. Similarly, people who are permanently or temporarily confined to a bed or a wheelchair often have problems because of their inability to get to a toilet easily.
    
13. Neurologic disease: Conditions such as stroke, multiple sclerosis, Alzheimer disease, or Parkinson disease can cause incontinence. The problem can be a direct result of a disrupted nervous system or an indirect result of having restricted movement.
    Surgery or radiation therapy to the pelvis: Incontinence can result from certain surgeries or medical therapies.
    
14. Pregnancy: One third to one half of pregnant women have problems controlling their bladder. In most of these women, incontinence stops after delivery. However, 4-8% of pregnant women experience renewed incontinence after delivery (postpartum). Risk factors for postpartum incontinence include vaginal delivery, long second stage of labor (the time after the cervix is fully dilated), and having large babies.
15. Menopause: Studies have not demonstrated a consistent increase in risk of incontinence following menopause. The relationship between postmenopausal hormone replacement therapy and incontinence is unclear.
    
16. Hysterectomy: Women who have had a hysterectomy may have incontinence later in life.
    
17. Enlarged prostate: In men with an enlarged prostate, the prostate can block the urethra, causing urine leakage. However, less than 1% of men treated for benign (noncancerous) enlargement of the prostate report incontinence.
    Prostate surgery: Up to 87% of men whose prostate has been removed report problems with incontinence.
    
18. Bladder disease: Certain disorders of the bladder, including bladder cancer, can sometimes cause incontinence. There are several types of urinary incontinence. Many people have more than one type. A combination of stress and urge incontinence is especially common.
19. Stress and urge incontinence are the most common types.
    
20. Stress incontinence: This occurs when you do anything that strains the muscles around the bladder, such as laughing, coughing, sneezing, bending, or even walking in some people. It is caused by weakness or injury to the muscles of the pelvis or the sphincters. The underlying causes include physical changes due to pregnancy, childbirth, or menopause. It is a frequent type of incontinence in women.
    
21. Urge incontinence: This is a sudden uncontrollable desire to urinate regardless of how much urine is in the bladder. It is believed to be caused by inappropriate contractions of the bladder. The term "overactive bladder" has been adopted to describe urge incontinence, detrusor instability, and hypersensitive detrusor. Urgency, frequency, and urination at night (nocturia) are common in people with this condition. This is due to disruption of signals between the bladder and the brain. Environmental cues, such as running water or putting the key in the front door, may prompt urgency or leakage. It is a frequent type of incontinence in both men and women.
    
22. Mixed incontinence: This is a mixture of stress and urge incontinence.
    Overflow incontinence: This results when you retain urine in your bladder either because your muscle tone is weak or you have some sort of blockage below your bladder. Symptoms include dribbling, urgency, hesitancy, low-force urine stream, straining, and urinating only a small amount despite a sensation of urgency. It is a frequent type of incontinence in men.
    
23. Neuropathic incontinence: This results from a problem affecting one or more nerves. Either the detrusor muscle overcontracts or the interior sphincter lacks the tension to hold urine in.
    
24. Fistula: This is an abnormal internal connection between organs or structures such as the bladder, ureters, or urethra. This can cause incontinence.
    Traumatic incontinence: This is incontinence that occurs after injury to your pelvis (such as a fracture) or as a complication of surgery.
    Congenital incontinence: This may occur in people born with their bladder or one or both ureters out of place.
    
25. Obstruction to urine flow: This may cause incontinence.

http://www.emedicinehealth.com/bladder_control_problems/page2_em.htm

Bladder Control Problems Causes

Incontinence is a symptom with a wide variety of causes. The most common causes include the following:

Urinary tract infection

Side effect of medication: Examples include alpha-blockers, calcium channel blockers, antidepressants, antihistamines, sedatives, sleeping pills, narcotics, caffeine-containing preparations, and water pills (diuretics).

Occasionally, the medicines used to treat some forms of incontinence can also worsen the incontinence if not prescribed correctly.

Impacted stool: Stool becomes so tightly packed in the lower intestine and rectum that a bowel movement becomes very difficult or impossible.

Weakness of muscles in the bladder and surrounding area: This can have a variety of causes.

http://www.emedicinehealth.com/bladder_control_problems/page2_em.htm

Bladder Leaking

The treatments you need to help stop your bladder leaking will depend upon the cause of your leaking.

There are two main causes of bladder leaking:

The urethra (the tube which carries urine from your bladder to the outside of your body) should act like a valve to hold urine in the bladder. If you leak urine when you cough, sneeze, laugh, run or lift, your urethra is not working properly. This is called stress incontinence.

If you have to go to the bathroom too often (frequency); if you get a strong urge to pee which makes you hurry to get to a toilet (urgency); if you start to leak urine before you can get your clothes off (urge incontinence), the bladder storage system is not working as it should.

Many women have a combination of stress and urge incontinence- we call this "mixed incontinence".

Diagram of the Female Bladder and Urethra

The urinary bladder stores urine prior to its elimination from the body (functions of the urinary system). At micturation/urination, the bladder expels urine into the urethra, leading to the exterior of the body. The bladder is a musculomembranous sac located on the floor of the pelvic cavity, anterior to the uterus and upper vagnia (in females).

Outer surfaces of the Bladder: The upper and side surfaces of the bladder are covered by peritoneum (also called "serosa"). This serous membrane of the abdominal cavity consists of mesthelium and elastic fibrous connective tissue. "Visceral peritoneum" covers the bladder and other abdominal organs, while "parietal peritoneum" lines the abdomen walls.

Ureters: The ureters deliver urine to the bladder from the kidneys (one ureter from each kidney - see components of human urinary system). The ureters pass through the posterior surface of the bladder at the Ureter Orifices (shown above). Urine drains through the ureters directly into the bladder as there are no sphincter muscles or valves at the ureter orifices.

Structure of Bladder (Detail): The bladder itself consists of 4 layers:

- (1) Serous - this outer layer being a partial layer derived from the peritoneum,

(2) Muscular - the detrusor muscle of the urinary bladder wall, which consists of 3 layers incl. both longitudinal and circularly arranged muscle fibres,

(3) Sub-mucous - a thin layer of areolar tissue loosely connecting the muscular layer with the mucous layer, and

(4) Mucous - the innermost layer of the wall of the urinary bladder loosely attached to the (strong and substantial) muscular layer. The mucosa falls into many folds known as rugae when the bladder is empty or near empty.

The features observable on the inside of the bladder are the ureter orifices, the trigone, and the internal orifice of the urethra.

The trigone is a smooth triangular region between the openings of the two ureters and the urethra and never presents any rugae even when the bladder is empty - because this area is more tightly bound to its outer layer of bladder tissue.

Exit from Bladder: When urine is released from the bladder is flows out via the neck of the bladder (in the trigone region). The internal urethral sphincter is a sphincter (circular) muscle located at the neck of the bladder and formed from a thickening of the detrusor muscle. It closes the urethra when the bladder has emptied.

More detail about the above is included on the page about the bladder.

The female urethra

At only about 1.5 inches (35 mm) long, the female adult urethra is shorter than the adult male urethra (approx. or 8 inches, or 200mm). The female urethra is located immediately behind (posterior to) the pubic symphysis and is embedded into the front wall of the vagina.
The urethra itself is a narrow membranous canal that consists of three layers:
Muscular layer - continuous with the muscular layer of the bladder, this extends the full length of the urethra.

Thin layer of spongy erectile tissue - including plexus of veins and bundles of smooth muscle fibres. Located immediately below the mucous layer.
Mucous layer - internally continuous with the bladder and lined with laminated epithelium that is transitional near to the bladder.

After passing through the urogenital diaphragm (as shown in the diagram), the female urethra ends at the external orifice of urethra - which is the point at which the urine leaves the body. This is located between the clitoris and the vaginal opening.

The passage of urine along the urethra through the urogenital diaphragm is controlled by the external urethral sphincter, which is a circular muscle under voluntary control (that is, it is innervated by the somatic nervous system, SNS). See the page about micturation for more about control of these structures by the nervous system.

The female urethra is a much simpler structure than the male urethra because it carries only urine (whereas the male urethra also serves as a duct for the ejaculation of semen - as part of its reproductive function).

http://www.ivy-rose.co.uk/Topics/Urinary_Bladder_Urethra_Female.php

Uterine Prolaps

DESCRIPTION

Pelvic organ prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of prolapse in later life, but because many women don't seek help from their health care provider the actual number of women affected by prolapse is unknown. Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse. Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.

Uterine prolapse is a condition that develops when muscular support for the uterus is lost and the uterus has fallen or dropped from its normal location, causing it to bulge into the vagina. The uterus is normally held in place by the pelvic muscles and supporting ligaments. When these muscles become weakened or injured, uterine prolapse can occur. In mild cases, a portion of the uterus descends into the top of the vagina. In more serious cases, the uterus may even protrude through the vaginal opening and outside the vagina. A prolapse can be associated with or accompanied by a urethrocele and cystocele (urethra and/or bladder bulge along the front wall of the vagina) and rectocele (rectal wall bulges into the back wall of the vagina).

TYPES OF PELVIC PROLAPSE

There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse. Prolapse of the Anterior (Front) Vaginal Wall
Cystocele (Bladder Prolapse): When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.

Urethrocele (Prolapse of the Urethra): When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).

Prolapse of the Posterior (Back) Vaginal Wall
Enterocele (Prolapse of the Small Bowel): Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below).
Rectocele (Prolapse of the Rectum or Large Bowel): This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).

Vaginal Vault Prolapse: The vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

http://www.moondragon.org/obgyn/disorders/uterineprolapse.html

Pelvic Floor Exercises (Kegel Exercises)

Pelvic floor exercises help prevent prolapse by strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do, but it's important to do them correctly, and many women benefit from guidance from a physiotherapist. Start by locating the muscles you need to exercise.

There are a few different ways to do this:

Place one or two fingers in your vagina and squeeze your muscles until you can feel your vagina tighten around your fingers. These are your pelvic muscles. Imagine you're trying to stop the flow of urine mid-stream. The muscles you tighten (contract) are your pelvic floor muscles.

The other way to identify the correct muscles is to imagine you are trying to stop yourself from passing gas. The muscles you squeeze to do this are your pelvic muscles. Once you've identified the correct muscles you're ready to begin. The exercises can be done while lying down, sitting or standing, with your knees together or slightly apart. Set 1 - Slowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four.

As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times. Check that you're not tightening the muscles in your legs, abdomen or buttocks, as it's important to use only your pelvic muscles. Remember to keep breathing. Set 2 - Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times. As a preventive measure, try to do the exercises two or three times a day. If you have a prolapse, you may be advised to increase the number of times you do the exercises, but don't overdo it. Excessive exercising of the pelvic muscles can cause muscle fatigue and make the exercises less effective.

You can do the exercises anywhere, anytime, but studies show that when women do them at home, they are more likely to do them correctly. Some women find it helps to set aside specific times to do the exercises, such as before getting out of bed in the morning and before going to sleep at night. If you think you're doing the exercises incorrectly or need help locating your pelvic floor muscles, a physiotherapist will be able to help you. Ask your health care provider for a referral.