Female Pelvic Floor Relaxation and Urinary Incontinence

Additional information on female incontinence

Pelvic floor relaxation, a very common problem in women, frequently is associated with the bladder, reproductive organs and rectum to be out of place and usually is associated with urine loss.

The Principles of Urination

Normal bladder function consists of only two conditions: storage and emptying. The storage phase depends upon the bladder being able to appropriately relax and be properly supported within the pelvis. Emptying depends upon contraction of the upper portion of the bladder and relaxation of the lower portion known as the bladder neck and urethra.

There are two types of urinary incontinence frequently found in women: (1) urge incontinence. This occurs when the bladder contracts inappropriately. (2) is stress incontinence. This is when the bladder is displaced because it is not appropriately supported in the pelvis.

The bladder has some unique functions. One of the most unique is that the upper portion of the bladder can expand without increasing pressure. This is known as compliance. At times, though, when it is appropriate to empty the bladder, and when instructed by the central nervous system, this portion contracts and empties. The muscles that make up the pelvic floor and the bladder sphincter are controlled by the central nervous system; when the bladder empties these muscles relax. Later, after the bladder is empty and the bladder returns to the storage phase, and the pelvic floor muscles contract.

Urinary incontinence is present in about 25 per cent of women under the age of 60 and about 40 per cent of women over that age. Urinary control requires some basic abilities and motivation by the patient. First, the patient needs to be able to move easily from one location to another and has to be motivated to stay dry and needs a lower urinary tract which has near normal function.

Basic Assessment

Patient assessment includes a medical history, physical examination, urinalysis and a specific evaluation of the bladder. One of the simplest methods of assessing bladder function is called a voiding diary.

A voiding diary is a record accumulated for a day or series of days that allows the patient to keep tract of when urination has occurred, how much is passed, how often the patient needs to go and whether there is any leakage. Urodynamics is a method of testing the bladder. A small catheter is placed in the bladder. Electro patches are placed on the abdomen and perineum (the bottom). This information tells the physician about the interaction of the central nervous system, the urinary bladder, and sphincter mechanism. In summary, it tells us if the bladder is doing its two basic functions: storage and emptying.

Treatment Options

There are two prominent medications that can help the bladder hold urine. One is Detrol and the other Ditropan XL.

Ditropan XL

Detrol

These are pills that only have to be taken once in a 24-hour period. The application of these medications, though, depends upon what we have learned about the bladder’s function and how its activity varies from normal.

Pelvic support depends upon the tone of the muscles and fascia, a leather-like substance that covers muscles, and these substances make up the pelvic floor.

Many women do not have good support in this area because when they are pregnant and deliver babies through the vaginal canal, the pelvic floor is stretched out of shape and does not recover its normal strength. As a result, the bladder, instead of staying in its appropriate position, tends to "fall down". There are a variety of ways of testing to see how this significant this problem is. The simplest is observation done at the time of pelvic examination. There are other ways, though, many of these depend on sophisticated x-ray studies. All can give us valuable information.

Once we understand the condition of the pelvic floor, there are times that we can improve or even cure the problem with "physical therapy". This is basically a form of muscle exercise of the pelvic floor muscles.

Biofeedback is a learning system that can aid the patient in understanding how to contract these muscles and, as a result, return them to strength. The biofeedback process involves instruments that can monitor the activities of the pelvic floor, record the activities on a computer monitor so the patient can see the activity and understand when he/she has activated the correct muscles. Dr. Kegel developed exercises of the pelvic floor, and these are probably the best known strengthening activities and are known as Kegel exercises.

The result of either Kegel exercises or the more formal biofeedback makes the pelvic floor strength return toward normal.

Sometimes, however, it is so badly stretched out of shape…for instance, by multiple vaginal deliveries…..that exercise alone cannot restore the condition of the pelvic floor to adequately support organs such as the bladder.

At other times it can involve not only the bladder but the rectum, uterus and even small bowel. These organs, then, can protrude through the vaginal canal, essentially turning the vagina inside out.

Vagina (Inside out)

In cases of lack of support of the major degrees discussed, surgical treatments are required to restore the normal condition. There are times when the condition is not severe, yet pelvic floor exercises alone are not sufficient to bring about continence.

The problem of urinary incontinence can sometimes be solved by placing a material called collagen into the urethra with a needle to assist the sphincter in being able to close more efficiently.

Contigen

The collagen in this case is referred to as Contigen and can be placed into the urethra through a cystoscope. This is done through the urethra or the tube that the woman normally voids through. And with the use of local anesthesia, it can even be done in the office setting. Dr. Riemenschneider has seen circumstances where the injection of Contigen done in this manner has enabled the patient who has come in with incontinence and being wet actually walk out dry.

Summary

The basic problem in urinary incontinence is the function of the bladder and the muscles that contain the urine which are known as sphincter muscles. If incontinence exists, one or more of these functions is abnormal. The abnormality must be understood and remedies such as medicine, exercise or surgery can be applied to solve the problem. The most important message is that this is a very common problem among women and can be treated successfully. It is very reasonable to consider and expect from using the diagnostic treatment options described that in almost all cases the problem can be significantly improved.

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