1. Female Stress Urinary Incontinence Shunzaburo Kida University of Rhode Island Biomedical Engineering

2. Index Types of Urinary Incontinence(UI) in Women Causes & Affects Treatments Study Results

3. Types of UI - Involuntary loss of urine(International Continence Society (ICS) 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

4. 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 intra- abdominal pressure, urethra can drop causing involuntary release of urine –In women: menopause, childbirth, and pregnancy Affects –Quality of life reduced Emotional Social Physical Sexual

5. 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

6. 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

8. 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;

10. 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

12. Works Cited 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.. 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.. "Kegel Exercise -." Wikipedia, the Free Encyclopedia. Web. 04 Mar. 2010.. 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.. "Pelvic Floor Muscle Rehabilation." Seekwellness. Web. 03 Mar. 2010.. "Sexual Function and Quality of Life in Women with... [J Sex Med. 2010] - PubMed Result." National Center for Biotechnology Information. Web. 02 Mar. 2010.. "Urinary Incontinence -." Wikipedia, the Free Encyclopedia. Web. 04 Mar. 2010.. "WikiAnswers - How Do You Tighten Your Vagina." WikiAnswers - The Q&A Wiki. Web. 04 Mar. 2010..