1. Urinary Incontinence

2. urinary incontinence in women:
More than 13 million Americans have incontinence, and women are twice as likely to have it as men, according the Agency for Healthcare Research and Quality. About 25% to 45% of women suffer from urinary incontinence, defined as leakage at least once. The rates of urinary incontinence increase with age: 20%-30% of young women , 30%-40% of middle-aged women, and up to 50% of older women suffer from urinary incontinence.
Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

3. Women experience UI twice as often as men
Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurological injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.
Older women experience UI more often than younger women. But incontinence is not inevitable with age.
causes
Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine (water and wastes removed by the kidneys) in the bladder. The bladder connects to the urethra.

4. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder.
Obesity, which is associated with increased abdominal pressure, can worsen incontinence. Fortunately, weight loss can reduce its severity.

5. Types of incontinence :
Stress incontinence
Urge incontinence
Overactive bladder
Functional incontinence
Mixed Incontinence
Overflow Incontinence
Transient incontinence

6. Types of Urinary Incontinence
Stress incontinence is that little leak that happens when you cough, laugh, sneeze -- any motion that stresses or puts too much pressure on the bladder.
Stress-incontinence can result from pregnancy and childbirth, when pelvic muscles and tissues can get stretched and damaged. It can also occur from high-impact sports, as a result of aging, or from being overweight.

7. Urge incontinence aka
overactive bladder," is a bit different - it's the urgent need to go, followed by an involuntary loss of urine -- with anything from a few seconds to a minute's warning. It is thought to be due to spasms of the bladder muscles. Conditions such as multiple sclerosis, Parkinson's disease, or a urinary tract infection can cause urge incontinence.

8. Urge incontinence can happen during sleep, after drinking a small amount of water, or when touch water or hear it running. Certain fluids and medications such as diuretics or emotional states such as anxiety can worsen this condition. Some medical conditions, such as hyperthyroidism and uncontrolled diabetes, can also lead to or worsen urge incontinence. Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves.

9. Mixed Incontinence
means you have more than one type of incontinence, with stress and urge or overactive incontinence being the typical mix. For these patients, it is helpful to identify the most bothersome symptom and treat accordingly.
"I think most women have both types," adds Brubaker. "I don't believe there's as much distinction between the two types as we might think."

10. Overflow incontinence
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning.  If you can't empty your bladder every time you go to the bathroom and experience a frequent or constant dribbling of urine, you have overflow incontinence.

11. Certain medications can cause this problem, and people with nerve damage from diabetes or men with prostate issues can also experience this type of incontinence. The symptoms of overactive bladder include:
- Urinary frequency (urination eight or more times a day or two or more times at night).
- Urinary urgency (sudden, strong need to urinate immediately).
- Urge incontinence (leakage or gushing of urine that follows a sudden, strong urge).
- Nocturia (awaking at night to urinate).

12. Functional incontinence
Women with urinary incontinence caused by chronic impairment of physical or cognitive function, or both, are said to have functional incontinence. These patients have overactive bladder relative to the ability or speed with which they can get to the toilet. Because many functionally impaired persons can also have other types of urinary incontinence that may respond to specific treatments, pure functional incontinence should be a diagnosis of exclusion.

13. Transient incontinence
Transient incontinence is a temporary version of
incontinence. Medications, urinary tract infections, mental impairment, and restricted mobility can all trigger transient incontinence. Severe constipation can cause transient. incontinence when the impacted stool pushes against the urinary tract and obstructs outflow. A cold can trigger incontinence, which resolves once the coughing spells cease.

14. History and Physical Examination
Diagnosis of urinary incontinence can be made on the basis of a history, physical examination and a few simple office and laboratory tests.
Initial therapy may be based on these findings.
History
- The medical history (diabetes, stroke, chronic lung disease, fecal impaction and cognitive impairment).
-The obstetric and gynecologic history should include gravity; parity; the number of vaginal, instrument-assisted and cesarean deliveries; the time interval between deliveries; previous hysterectomy and/or vaginal or bladder surgery; pelvic radiotherapy; trauma; and estrogen status.

15. Coping With Incontinence: Lifestyle Changes
a little absorbent pad is their first weapon, a lifestyle change their second.
"You can't drink two big bottles of water at one time, because it comes through your system as one big [wave] of fluid," "If you have a little at a time, it's much easier for the bladder."
-"Also, caffeine is a diuretic, coffee, any drink with caffeine make you leak more," . Perhaps you just need to urinate more frequently - especially before getting onto the tennis court, for example.
-You may also simply learn to brace yourself when you laugh or cough, tightening your pelvic muscles to prevent leaks.

16. Incontinence Treatments
Muscle training:
-For stress incontinence, learning muscle control can help manage leakage. That means regularly practicing pelvic muscle (Kegel) exercises.
"You learn to feel the muscle that controls the bladder, and build strength in that muscle.
Relaxation exercises
Electrical stimulation
Biofeedback: This involves becoming attuned to your body's functioning, to gain control over muscles to suppress urges.

17. Biofeedback : biofeedback helps the pt learn how her body works
Biofeedback : biofeedback helps the pt learn how her body works. A therapist puts an electrical patch over the bladder and urethral muscles. A wire connected to the patch is linked to a TV screen. the therapist watch the screen to see when these muscles contract, so she can learn to control these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to help control stress incontinence and urge incontinence

18. Hormone Creams: Estrogen creams are intended to restore the tissue of the vagina and urethra to their normal thickness, says Galloway - but they don't really help incontinence.
-"Hormone creams are more effective with vaginal dryness than they are with resolving incontinence. Some [studies] demonstrate significant improvements using hormone creams and others have not shown a benefit.“

19. Bladder Training With Scheduled Toilet Trips: With this technique the clock dictates your toilet visits, not your bladder. Using this method you take routine, planned bathroom trips, usually every two to four hours.

20. The pelvic examination.
Bladder Diary:
The 24-hour bladder record can provide an accurate record of urinary output, average voided volume, frequency of voiding, and frequency and nature of incontinent episodes, as well as type and volume of fluid intake.
Physical Examination: - The abdominal examination (diastasis recti, masses, ascites)
The pelvic examination.
bimanual examination of vaginal muscles, also include a rectal examination.

21. clitoral sacral reflexes
Bulbocavernosus

22. - Urinalysis and urine culture.
Evaluation of UI:
- Bladder stress test (the pt cough vigorously as the doctor watches for loss of urine from the urinary opening).
- Urinalysis and urine culture.
- Blood test detect other causes of incontinence
- Ultrasound of the kidneys, ureters, bladder, and urethra.
- Cystoscopy.
- Urodynamics ( a thin tube is placed into the bladder to filled it with water. the doctor measures the pressure in the bladder).

23. Other Treatment - smoking Cessation.
- Loss of Excess Weight.
- smoking Cessation.
- Medications: No drug helps with stress incontinence, but a class called anticholinergics does help with urge incontinence.
These drugs include Detrol, Oxytrol, , all with similar effectiveness and similar side effects, like dry mouth and constipation .

24. Occlusive devices such as pessaries prevent loss during vigorous coughing in the standing position with a full bladder. The patient should be able to comfortably insert and remove the pessary, and it should not cause voiding dysfunction .

25. Kegelcones. Weighted vaginal cones used to strengthen the pelvic floor musculature.

26. Minimally Invasive Treatments:
- Injection Therapy:
Injection of collagen in the periurethral tissue for the treatment of stress incontinence.
- Radiofrequency Energy Treatment.

27. Thank you