Thursday, July 26, 2007

Stress and Incontinence

Urinary incontinence is a surprisingly common condition that affects roughly 35% of women over fifty. It's also known as "stress urinary incontinence," genuine stress incontinence, and urethral hypermobility. This condition is characterized by an involuntary loss of bladder control caused by physical exertion or intra-abdominal pressure. Coughing, sneezing, physical exercise, laughing, lifting and standing could all cause urine loss when coupled with this condition. Approximately 60% of women with incontinence have stress incontinence.

Stress incontinence is a bladder storage problem in which the strength of the urethral sphincter is weakened, and the sphincter is not able to prevent urine flow when there is increased pressure in the abdominal area. The inability to control urine flow, even in small amounts, can be terribly distressing and embarrassing.

In many instances, stress urinary incontinence may begin gradually, but become more frequent and severe over time. The wetness, odor, discomfort, and skin irritation, that this condition causes can be particularly damaging to the self-esteem of those afflicted. It can also affect the sufferer's social life and relationships.

Women with stress urinary incontinence report that the condition has affected their sexual relationships because of the fear of urine leakage during sexual activity. The condition can also cause depression and social withdrawal. People suffering from stress urinary incontinence may become so anxious about the location of nearby toilets that they'll plan their routes ahead of time. This type of behavior is called "toilet mapping."

What Causes Stress Incontinence?

There are a number of factors that increase a person's risk of developing stress urinary incontinence.

Age: Stress urinary incontinence is usually associated with women who are forty-five to sixty-five years old. The frequency and severity of attacks often increases with age.

Race: Caucasians are more likely to develop stress urinary incontinence than men or women of other races, although scientists are not entirely clear on why this is. One theory suggests that Caucasian women have a shorter urethra, weaker pelvic floor muscles, and a lower bladder neck than women of other races, thus making them more likely to have incontinence. There is no data on the relationship between stress urinary incontinence and race in men.

Pregnancy and Childbirth: Pregnancy and vaginal childbirth greatly increase the risk of stress urinary incontinence in women. Vaginal delivery involves significant loosening and lengthening of the pelvic floor muscle to permit the passage of an infant. Factors that occur during delivery such as the use of forceps, episiotomy, and pudendal anesthesia may further increase a woman's risk of developing the condition.

Menopause and Hormonal Changes: After menopause, the pelvic muscles begin to relax dramatically in response to the general aging process. The hormonal changes associated with menopause, namely, the depletion of estrogen, is also associated with reduced urethral mucosa vascularity and thickness. This weakens the urethra's ability to maintain a tight seal, especially when intra-abdominal pressure increases.

Pelvic surgery: Women who have had a hysterectomy or other types of pelvic surgery often experience a 40% increase in their risk of developing stress urinary incontinence. This may be caused by scarring, or the loss of structural support to the bladder.

Smoking: There is significant intra-abdominal pressure exerted on the bladder and urethra during coughing. The chronic and frequent coughing often associated with smoking may lead to damage of the structural supports of the vagina and bladder.

Obesity: Being overweight or obese increases the risk of developing stress urinary incontinence due to the increased pressure on the bladder from excess weight.

Physical Activity: Stress urinary incontinence can affect both men and women who are fit, slim, and in shape. Intense physical exercise can cause the condition to develop. Up to one third of women experience urine loss during physical activities. Muscle fatigue, and over exertion of the abdominal muscles may provoke the condition. Physical activities most likely to be associated with stress urinary incontinence include any sports that require jumping and jarring of the abdominal muscles such as gymnastics, basketball and volleyball.

Medications: Several medications can cause over-activity of the bladder and loss of pelvic muscle control. Diuretics, anticholinergic medications, sedatives, depressants, and muscle relaxants can all affect bladder control, urinary retention, fecal impaction, and sedation.

Chronic diseases: Diseases such as multiple sclerosis, spinal cord injury, diabetes, Parkinson's disease, and stroke can increase a person's risk for developing stress urinary incontinence as they affect the nervous system and the neuropathy of the bladder.

Caffeine: Caffeinated foods and beverages irritate the bladder and can cause spasmodic bladder and urethral contractivity.

"Spirit of Women" Series

There will be another installment of the "Spirit of Women" health series at Banner Desert Medical Center, in Mesa, AZ on September 22, 2007 at 9:30am.

I will be giving a talk entitled "Do Men in our Lives Need Hormone Replacement Therapy?- For the Women Who Love Them".

It will be the third such talk I will have given. Prior talks I have given for this seminar series were:

"Female Sexual Dysfunction- When Does Less-Than-Perfect-Sex Become a Problem?"

"The Most Active Thing About My Life is My Bladder- Urinary Incontinence"

Any interested parties who wish me to speak on female health topics such as these can post a reply, and I will respond to them.

Tuesday, July 24, 2007

Local Estrogen replacement therapy

Topical or local application of estrogen to the vagina is useful to treat many conditions. The goal of such treatment is to reverse or diminish age-related changes to the vagina. There is limited systemic absorption of estrogens applied locally, yet locally it increases blood flow, reduces vaginal pH, and increases secretions. Topical replacement estrogen can be appropriate for peri-menopausal or post-menopausal women who have the following problems:

Vaginal dryness
Pain with intercourse
Recurrent bladder infections
Urinary urgency, or urge incontinence

Vaginal atrophy is an inevitable change with age as a result of estrogen loss that can be progressive. Women are often embarressed and don't often seek treatment. Restrictions on taking oral estrogen replacement due to potential cardiovascular risks makes vaginal atrophy more likely to occur, and can be addressed easily. Topical creams or even small suppository pills can be used. Women who have a history of breast or endometrial cancer, or undiagnosed bleeding should not use topical vaginal estrogen.