Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

Reviewed by SIAHMSR

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Urinary problems in women

   The most common complaints in women of various age groups include urinary infections, increased urinary frequency, painful urination and incontinence etc.

 In majority of elderly women mostly the underlying problem is either urinary tract infection, urinary incontinence without infection, or bladder pain without infection that may be termed painful bladder syndrome/interstitial cystitis [1]

Urinary tract infections [UTI]

The most common urinary problem in women is the UTI. UTI is defined as the presence of microbes causing infection in the urinary tract with associated symptoms such as painful and frequent urination, fever etc. The infection may affect bladder urethra and kidneys. Infections of urethra are very common. Bladder infection is called cystitis. Fever and flank pain indicates infection of the upper urinary tract.

Urinary incontinence

Urinary incontinence is a very common problem in old women and it causes the involuntary loss of urine. There are various causes of incontinence that range from diseases to medications. 

Sometimes urinary infections may present with incontinence.

 Urinary incontinence is common in women during pregnancy and after childbirth, or after the hormonal changes related to menopause.

The incontinence is more common in women over the age of 50.There are four types of urinary incontinence:

 Urgency, stress, functional and overflow incontinence.

                             SIAHMSR                       

Urgency incontinence:

This is the inability to hold urine long enough and associated with a strong, sudden urge to urinate. It may have various causes. Urge incontinence may be urological problem itself or may be the manifestation of an underlying disease.

Stress incontinence: This is the leakage of urine or incontinence associated with strenuous activities. This type of incontinence may be associated with exercise, coughing, sneezing, laughing, lifting heavy objects etc. Any strenuous activity that put pressure on the bladder may cause leakage of urine in this condition.

Functional incontinence:

 This is urine leakage is associated with some physical conditions, such as arthritis, injury or other disabilities.

Overflow incontinence:

 Leakage occurs when the quantity of urine produced exceeds the capacity of the bladder to hold it. This may cause urine leakage if you do not get to the restroom in time

Symptoms of urinary incontinence  in women

·       Urine leakage with movements or exercise

·       Leakage of urine that prevents activities

·       Urine leakage with coughing, sneezing or laughing

·       Leakage of urine that started after surgery

·       Leakage of urine that causes embarrassment

·       Constant feeling of wetness without sensation of urine leakage

·       Feeling of incomplete bladder emptying

Treatment

·       Medications are prescribed depending on the type of incontinence, infections etc.

·       Behavioral therapies

·        Nerve stimulation and surgery are some of the treatments available for managing urinary incontinence.

Behavioral therapies:

·       Bladder training:

In this method women are trained to resist the urge to void or pass urine and gradually expand the intervals between voiding.

·       Toileting assistance:

Habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.

·       Diet modifications:

Avoid consumption of bladder irritants, such as caffeine, alcohol and citrus fruits.

·       Pelvic muscle rehabilitation

Exercises to improve pelvic muscle tone

Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence.Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.

·       Vaginal weight training:

Small weights are held within the vagina for tightening the vaginal muscles.

·       Pelvic floor electrical stimulation:

Mild electrical pulses stimulate muscle contractions.

                       Bladder pain syndrome [BPS]

BPS is a chronic, or long-lasting, condition that causes painful urinary symptoms.

It is a condition which is not completely understood in medical science and the exact cause is still unknown.

It's also called interstitial cystitis or painful bladder syndrome.

Diagnosis of this condition is difficult as there is no single test that confirms the condition. It is diagnosed by ruling out all other conditions related to bladder and urinary system.

Symptoms of BPS (interstitial cystitis) include:

 Pelvic pain or lower abdominal pain with filling of bladder with urine and relieved by urination. Urge to pass urine comes suddenly. Increased frequency of urination particularly at night disturbing sleep. Urinary  incontinence and blood in your urine (haematuria).

These symptoms can sometimes be caused by other conditions, such as cancer of the bladder also. So your health care provider will do various tests or investigations to rule out other diseases before diagnosing BPS.

BPS is comparatively more common in women than men, usually  in women who are in their third decade of life.

The symptoms of BPS is recurrent.it comes and goes often with intervals of pain attack and remission.

The damage to the bladder lining, can irritate the bladder and surrounding nerves in this condition. Probably it is an inflammatory reaction mediated by the immune system.

In some people BPS (interstitial cystitis), may have a history of long-term (chronic) urinary infection (UTI) in the bladder. It may also be associated with chronic conditions such as fibromyalgia, myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) and irritable bowel syndrome (IBS).

Treatment :

·       lifestyle changes-Avoid alcohol, caffeine, and high-acid foods.

·        bladder training

·       physical therapy

·       medicines

·        bladder hydrodistention, bladder instillation

·       Surgery

·        A combination of these treatments.

References
1.    https://pubmed.ncbi.nlm.nih.gov/19231602/
2.    https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-incontinence/urinary-incontinence-in-women
3.    https://www.sciencedirect.com/science/article/abs/pii/S0095454308000973
4.    https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome

u