Female Urological Disease

Overview

Female urological disorders are prevalent, and they can make it difficult for women to enjoy even the most basic of daily activities. The good news is that these illnesses are treatable and curable—all that is required to get started is to seek proper care. 

 

What is the Urinary System?

The urinary system is made up of the bladder, kidneys, urethra, and ureters. The urinary system is responsible for the production, storage, and elimination of urine. The kidneys produce urine, which is subsequently transported to the bladder via ureters, which are tubes that connect the kidneys to the bladder. When the bladder is full, waste is expelled by the urethra. This system is complicated and might be prone to illnesses or disorders that create blockages or infections. Let's take a deeper look at some of the most frequent urologic issues that women face.

 

What is Female Urology?

Urology is the study of illnesses of the urinary tract system, which includes the kidneys, adrenal glands, ureters, urinary bladder, and urethra. Female and reconstructive urology is a subspecialty of urology that treats and evaluates individuals with urine incontinence, urological disorders, and urinary tract reconstruction.

Female urology is a subspecialty within this subspecialty that treats a variety of female-specific disorders such as urine incontinence, overactive bladder, and pelvic organ prolapse. A female urologist specializes in the treatment of these disorders and is well-versed in female pelvic floor anatomy. Urological disorders that affect both sexes, such as urinary tract infections (UTI), cystitis, kidney stones, kidney cancer, and bladder cancer, can also be treated.

Conditions commonly treated within female urology include:

• Urinary incontinence
• Overactive bladder
• Pelvic prolapse
• Pelvic floor problems
• Urinary tract infections
• Cystitis
• Kidney stones
• Kidney cancer
• Bladder cancer

 

Urinary Incontinence

The involuntary flow of urine is known as urinary incontinence. This medical ailment is most frequent in the elderly, particularly in nursing facilities, although it can also afflict young adult males and girls. Urinary incontinence can have a negative influence on both patient health and quality of life. The prevalence may be underestimated because some people may not disclose their health care providers that they have urine incontinence for a variety of reasons.

 

What causes urinary incontinence?

Urinary incontinence is not a natural feature of aging, although it is more frequent among the elderly. It is frequently induced by particular changes in bodily function caused by illnesses, drug usage, and/or the development of a sickness. It is sometimes the only sign of a urinary tract infection. Women are more prone to develop urine incontinence during pregnancy and after delivery, or as a result of menopausal hormone changes.

 

What are some of the different types of urinary incontinence?

The following are some of the different types of urinary incontinence:

• Urgency incontinence: The inability to contain pee long enough to use the bathroom. It is connected with frequent urination and a strong, abrupt need to pee. It might be a distinct issue, but it can also be a symptom of other diseases or ailments that require medical treatment.
• Stress incontinence: This is pee leakage caused by activity, coughing, sneezing, laughing, lifting heavy things, or other bodily motions that increase strain on the bladder.
• Functional incontinence: This is pee leakage caused by physical ailments such as arthritis, injury, or other limitations that make it difficult to reach a bathroom on time.
• Overflow incontinence. When the amount of pee generated exceeds the bladder's capacity, leakage occurs.

 

What are the symptoms of urinary incontinence?

The following are some of the most prevalent symptoms of urine incontinence. However, each person may experience symptoms in a unique way. Symptoms could include:

• Needing to rush to the restroom and/or losing urine if you do not get to the restroom in time
• Urine leakage with movements or exercise
• Leakage of urine that prevents activities
• Urine leakage with coughing, sneezing or laughing
• Leakage of urine that began or continued after surgery
• Leakage of urine that causes embarrassment
• Constant feeling of wetness without sensation of urine leakage
• Feeling of incomplete bladder emptying

 

How is urinary incontinence diagnosed?

It is critical for anyone suffering from urine incontinence to get medical attention. In many circumstances, patients will be sent to a urogynecologist or urologist, a specialist who specializes in urinary tract illnesses. A full physical examination focusing on the urinary and neurologic systems, reproductive organs, and urine samples is used to diagnose urinary incontinence.

There are several options for dealing with OAB. Everyone has a unique perspective on what works best for them. You can attempt one therapy at a time or several at once. You and your health care provider should discuss your treatment goals and each therapy choice. Treatments for OAB include:

 

Lifestyle Changes

A patient may be asked to undertake lifestyle adjustments before receiving OAB therapy. These modifications may also be referred to as behavioral treatment. To feel better, you may need to consume new meals, adjust your drinking habits, and schedule ahead of time restroom trips. Many people find that these modifications are beneficial.

• Medical and Surgical Treatments

• Prescription Drugs
• Bladder Botox® (botulinum toxin) Treatments
• Nerve Stimulation (peripheral and central)
• Surgery

  

Other people need to do more, such as:

1. Limit food and drinks that bother the bladder. Certain meals and beverages are known to irritate the bladder. To begin, avoid diuretics, which contain caffeine and alcohol and cause your body to produce more pee. You can also try removing various items from your diet and then reintroducing them one at a time. This will show you which foods aggravate your symptoms and allow you to avoid them. To promote digestion, add fiber to your diet. Oatmeal and whole grains are both beneficial. Fruit and vegetables, as well as beans, may be beneficial. Many people feel better when they adjust their eating and drinking habits.
   

Some foods and drinks that may affect your bladder:

• Coffee/caffeine
• Tea
• Alcohol
• Soda and other fizzy drinks
• Some citrus fruits
• Tomato-based foods
• Chocolate (not white chocolate)
• Some spicy foods

1. Maintain a bladder diary. Keeping track of your bathroom visits for a few days will help you better understand your body. This journal may reveal factors that aggravate your symptoms. 
2. Vacuuming twice. This is the process of emptying your bladder twice. This may be useful for persons who have difficulty completely emptying their bladder. After using the restroom, you wait a few seconds before trying again.
3. Delayed voiding. This is when you practice waiting before using the restroom, even if you need to. You only have to wait a few minutes at first. You may eventually be able to wait two to three hours at a time. Only do this if your doctor instructs you to. When people wait too long to use the restroom, they may experience discomfort or pee leaks.
4. Timed urination. This indicates you have a daily restroom routine. Instead of going whenever you feel like it, you go at predetermined periods during the day. An appropriate timetable will be devised by you and your health care practitioner. You should aim to go every two to four hours, whether you need to or not. The idea is to avoid that urgent sensation and recover control.
5. Exercises to relax your bladder muscle.
• Kegel exercises: tightening and holding your pelvic muscles tight, to strengthen the pelvic floor.
• Quick flicks occur when you repeatedly clench and release your pelvic floor muscles. So, if you have the want to go, a few fast flicks may help you suppress your urge. It helps to be calm, relax, and concentrate solely on the activity. These exercises can be taught to you by your doctor or a physical therapist.
• Biofeedback may also assist you in learning more about your bladder. Biofeedback monitors muscle movement using computer graphics and noises. It can educate you how to move your pelvic muscles and how powerful they are.

 

Medical and Surgical Treatments

• Prescription Drugs

When lifestyle modifications aren't enough, taking medication may be the next step. Special medications for OAB might be discussed with your doctor. There are various sorts of medications that can relax the bladder muscle. These medications, such as anti-muscarinics and beta-3 agonists, can help prevent your bladder from squeezing when it isn't full. Some are given orally as tablets. Others include gels or a sticky transdermal patch that deliver the medication via your skin.

Anti-muscarinics and beta-3 adrenoceptor agonists can relax the bladder muscle, allowing it to retain and drain more pee. Combination medicines, such as anti-muscarinics and beta-3 adrenoceptor agonists, may help reduce OAB when one choice alone is ineffective.

Your doctor will want to know if the medication is effective for you. They will examine you to determine if you get relief from the medication or if it produces difficulties known as side effects. Some persons have dry mouth and eyes, constipation, and impaired vision. If one medicine doesn't work, your doctor may ask you to try a new one, give you a different one to try, or have you try two sorts together. Many people benefit from both lifestyle modifications and drugs.

• Bladder Botox Treatment

If lifestyle modifications and medication are ineffective, injections may be recommended. A male and female urologist or a female pelvic medicine and reconstructive surgeon (FPMRS) can assist with this. They could provide Bladder Botox Treatment.

Botox relieves urine urgency and urge incontinence by relaxing the muscles of the bladder wall. It can prevent the bladder muscles from squeezing excessively. Your doctor will insert a cystoscope into the bladder to view within the bladder before injecting botulinum toxin. The doctor will next inject very small doses of botulinum toxin into the bladder muscle. This treatment is carried out in the office under local anaesthetic. Botox's effects might extend up to six months. When OAB symptoms reappear, more treatments will be required.

Your doctor will want to know if the botulinum toxin therapy is effective for you. They will examine you to determine if you are getting relief or if you are not holding in too much pee. If your pee isn't releasing properly, you may need to wear a catheter for a while.

• Nerve Stimulation

Nerve stimulation, also known as neuromodulation therapy, is another therapeutic option for those who want extra assistance. This therapy involves sending electrical pulses to neurons that share the same route as the bladder. The nerve impulses between your bladder and brain do not communicate properly in OAB. These electrical pulses allow the brain and bladder nerves to connect, allowing the bladder to function normally and alleviating OAB symptoms.

There are two types:

• Percutaneous tibial nerve stimulation (PTNS)

Peripheral nerve stimulation (PTNS) is a method of correcting the nerves in your bladder. A tiny electrode is placed in your lower leg near your ankle for PTNS. It delivers electrical impulses to the tibial nerve. The tibial nerve connects nerves in your lower back to your knee. The pulses assist in controlling the signals that aren't performing properly. Depending on how well it works, patients may receive up to 12 treatments.

• Sacral neuromodulation (SNS)

SNS (central) alters the function of the sacral nerve. This nerve transmits impulses from the spinal cord to the bladder. Its function is to aid in the retention and release of urine. These nerve signals aren't working properly in OAB. To alleviate OAB symptoms, SNS employs a bladder pacemaker to manage these impulses. SNS is a two-part surgical procedure. The first procedure is to insert an electrical cable into your lower back via the skin. To provide pulses to the sacral nerve, this cable is initially attached to a portable pacemaker. You and your doctor will see if this pacemaker can benefit you. The second step, if it works, is to install a permanent pacemaker that can control the nerve rhythm.

 

Overactive bladder

Overactive bladder (OAB) is a common urologic disorder in which bladder muscles engage spontaneously, resulting in a frequent and urgent desire to pee. The urge might be quite intense and, in some situations, result in urinary incontinence. OAB affects both men and women, with an estimated 40% of women in the United States suffering from OAB symptoms.

The majority of individuals urinate four to seven times each day. OAB patients may need to use the restroom up to 30 times each day. When women with OAB are unable to reach the bathroom before involuntary peeing begins, they frequently develop urine incontinence.

 

Causes of overactive bladder in women

Strokes, multiple sclerosis, and Parkinson's disease are all medically related causes of OAB symptoms. Overweight women are also more likely than healthy-weight women to have OAB. Menopause, age, and severe urinary tract infections can all enhance a woman's chances of developing OAB.

Although OAB is widespread among the elderly, it is not considered a natural component of the aging process. Alcohol and caffeine, both diuretics, may aggravate OAB symptoms.

 

Treatment of overactive bladder in women

OAB treatments range from behavioral counseling to drugs, injections, and nerve stimulation, as well as surgery.

 

Behavioral and lifestyle changes

Kegels are pelvic floor exercises that strengthen the pelvic floor muscles as well as the sphincter, a urinary muscle. Women can regular their pee pattern by scheduling restroom excursions every couple of hours and monitoring and limiting fluid consumption. Bladder training entails postponing peeing after the initial feeling and gradually increasing the intervals between urinating.

 

Medications

Medications for women with OAB are designed to relax the bladder and alleviate symptoms. Botox bladder injections may prevent the bladder muscles from contracting spontaneously.

 

Nerve Stimulation Therapy (InterStim)

SNS, InterStim, and peripheral nerve stimulation (also known as percutaneous neural stimulation or PTNS) all aim to modulate nerve impulse responses. The surgery uses a detachable, implanted device that may be operated by the patient to provide modest electrical pulses to the sacral nerves around the tailbone. A doctor would often propose a 1-2 week trial of the device for the patient to assess the implant's efficacy.

Nerve stimulation has been demonstrated to benefit persons suffering with urine retention and overactive bladder symptoms such as urge incontinence, urgency, and frequency.

 

Surgery for overactive bladder

Surgery is not a typical treatment option for OAB and is reserved for women whose other treatment options have failed. By replacing and expanding a piece of the bladder with bowel, surgery can enhance the physical size of the bladder. Surgically removing the bladder is always a last option.

 

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a gynecological disorder in which the pelvic organs protrude into the vagina as a result of ligament or muscle weakening. POP is classified based on the compartment of descent. Cystocele is an anterior wall herniation, rectocele is a posterior vaginal wall descent, and vaginal vault prolapse is a sinking of the uterus, cervix, or vaginal apex.

The vagina rests horizontally on top of the levator ani muscles with proper pelvic support. When the levator ani muscles are damaged, they become more vertical in position, opening the vagina and moving support to the connective tissue attachments. It was hypothesized through biomechanical modeling that the second stage of labor leads the levator ani muscles to extend more than 200% over the threshold for harm.

Pelvic organ prolapse (POP) is a prevalent disorder with several etiological factors. Throughout a woman's life, a variety of anatomical, physiological, genetic, lifestyle, and reproductive factors interact to contribute to pelvic floor dysfunction. Many studies have found a link between parity and a high prevalence of POP.

 

Symptoms of Pelvic organ prolapse 

The vast majority of people with pelvic organ prolapse do not report any symptoms. Patients who do report with symptoms, on the other hand, frequently describe a protrusion projecting through the vaginal entrance. During yearly well-woman visits, it is critical to examine women for urine and bulge symptoms, which women are frequently ashamed to discuss during their annual.

A physical examination is required to identify and classify the kind of prolapse. The results of the exam will differ depending on how full the bladder and rectum are. Women with procidentia (prolapse of all three compartments) may have vaginal discharge as a result of vaginal chafing or epithelial erosion. POP patients frequently have comorbid pelvic floor problems. 40% will have urine incontinence, 37% will have hyperactive bladder, and 50% will have fecal incontinence. Patients should be examined for alternative diseases on a regular basis. Prolapse can conceal stress urine incontinence in many circumstances.

Bladder outlet blockage can arise as a result of urethral kinking or urethral pressure. Pelvic organ prolapse can have a detrimental impact on sexual activity, body image, and overall quality of life. Clinicians should constantly remember to test for POP because many patients are embarrassed to admit to symptoms. To accurately identify the kind and amount of prolapse, a comprehensive pelvic examination is necessary.

 

Diagnosis of POP 

When contemplating a POP diagnosis, check for infection, hematuria, and inadequate bladder emptying. If the patient has considerable voiding symptoms, a urodynamic assessment to check bladder and sphincteric function is advised.

In individuals with severe prolapse, detrusor dysfunction with a significant post-void residual is a typical condition. Reduced prolapse during the urodynamic examination will assist to appropriately measure sphincteric function and expose stress urine incontinence by unkinking the urethra, which is frequently linked with severe prolapse that would have been undetected otherwise. In women with severe procidentia, a computed tomography (CT) urogram of the kidney and ureter is recommended because the pelvic anatomy, particularly the right ureter, may be deformed by the descent of the bladder, tugging down on the ureters and producing blockage and hydronephrosis.

 

Pelvic organ prolapse Management

Treatment for pelvic organ prolapse is determined by the kind of prolapse, your symptoms, your age, other health issues, and whether or not you are sexually active.

Your treatment may include one or more of the following:

• Pessary. A detachable device put into the vagina to support the pelvic organs is known as a pessary. Pessaries come in a variety of forms and sizes. Pessaries are frequently the first therapy that your doctor will attempt. Certain pessaries can be used to treat both pelvic organ prolapse and urine incontinence.
• Muscle treatment for the pelvic floor. Your doctor may instruct you on how to perform pelvic floor exercises or send you to a physical therapist for pelvic floor muscle strengthening activities. Pelvic floor muscle workouts can also benefit women who suffer urine incontinence as well as pelvic organ prolapse.
• Changing eating habits. If you have digestive difficulties, your doctor may advise you to consume more fiber-rich foods. Fiber aids in the prevention of constipation and intestinal straining. Learn more about fecal incontinence treatment options.
• Surgery to support the uterus or vagina. During surgery, your doctor may use your own body tissue or synthetic mesh to correct the prolapse and strengthen the pelvic floor. This operation is advised for sexually active women who have severe vaginal or uterine prolapse. Prolapse surgery might be performed through your vagina or abdominal. To repair the prolapse through the abdomen, your doctor may use synthetic mesh. However, due to safety concerns, mesh is no longer utilized to correct vaginal prolapse.
• Surgery to close the vagina. Colpocleisis surgery is used to cure prolapse by closing the vaginal hole. This is a viable alternative for women who do not intend to or no longer have vaginal intercourse.

 

Sexual dysfunction

Female sexual dysfunction can express itself in a variety of ways. Females may feel discomfort during sex, have a low libido, have difficulties gaining pleasure from sex, and have problems achieving an orgasm.

 

What causes sexual dysfunction in females?

Physical, psychological, and social variables can all play a role in female sexual dysfunction. The degree of dysfunction might be modest or severe, and it can be brief or long term. Some forms of sexual dysfunction are primary, or always present, whilst others are secondary, or emerge later in life as a result of other factors. A drug or sickness, for example, might result in secondary sexual dysfunction.

Depending on the circumstances, sexual dysfunction may have a single or numerous contributing elements. A 2018 systematic analysis of 135 earlier research from diverse cultures discovered that the following characteristics are associated with an increased risk of sexual dysfunction:

• Education: A lower degree of education was usually associated with a higher risk of female sexual dysfunction in the review. This includes both general education and sex education.
• Relationship issues: Sources of relationship discontent, such as an unfaithful or uncaring spouse, increase the likelihood of sexual dysfunction.
• Male-centric sexual interaction: While many individuals understand what makes sex exciting for guys, many people are unaware of what makes it enjoyable for females.
• Health issues: Sexual dysfunction can be caused by a general state of poor physical health as well as disorders affecting the genitals and urinary tract. Stress and mental health are also crucial considerations.
• Marriage traditions such as child marriage, arranged marriage, and polygamy are linked to an increased incidence of female sexual dysfunction.
• Religion: According to the review, being religious was associated with greater degrees of dysfunction.
• Domestic violence, sexual assault, and female genital mutilation (FGM) are all examples of abuse.

 

Diagnosis of Sexual dysfunction

Due to the wide range of sexual dysfunction, a doctor may order a few tests to discover the origin of the symptoms and make a diagnosis.

This will begin with some inquiries regarding someone's symptoms, when they occurred, and whether or not anything helps or makes them worse. A doctor may need to ask personal questions, such as how frequently a person has sex and what changes they have made to help with their present symptoms.

Next, they may recommend diagnostic tests. This may include:

• A pelvic exam
• STI testing
• Medical imaging
• Hormone testing
• A mental health assessment

 

Treatment for sexual dysfunction in females

The therapy for female sexual dysfunction is determined by the underlying reason or causes of the symptoms. A medical or sexual health specialist may begin by ruling out any apparent probable reasons, such as prior or present abuse, sexual trauma, or FGM. If these factors are suspected, they may send someone for treatment that explicitly addresses the emotional and physical effects of these events.

If these are not factors, treatment may involve:

• Sex education: People's misconceptions about sex might prohibit them from truly enjoying it. People may assume, for example, that the goal of all sexual activity is orgasm or that most females should be able to climax solely through vaginal penetration. Clearing up any myths or misunderstandings, as well as learning sexual methods, may be really beneficial.
• Relationship counseling: If an unresolved relationship problem is interfering with a person's trust, desire, or attractiveness to their partner, seeing a counselor may be beneficial. Counselors can serve as mediators, helping couples to have good discussions and address concerns.
• A therapist can assist someone in coping with and reducing stress, anxiety, depression, poor self-esteem, post-traumatic stress disorder, and internalized shame or guilt related to sex.
• Hormone replacement therapy, such as topical estrogen or oral hormone replacement therapy, may aid with desire or arousal issues, such as a lack of lubrication, in women with low estrogen levels.
• Dilator training: Dilator training includes putting a smooth plastic dilator into the vagina while attempting to relax the pelvic floor muscles. When a person is comfortable in one size, they go up until they can have intercourse without pain.
• Other forms of pelvic floor exercises, like as Kegels, try to strengthen the pelvic floor as a result of injury or weakness.
• Other medications: Some drugs, such as flibanserin (Addyi) and bremelanotide (Vyleesi), are marketed as "female Viagra." Another alternative is to change or discontinue a medicine that is currently being used and may be interfering with sexual function. People should only do this with a doctor's consent and supervision.
• Surgery may be required in rare circumstances to fix structural issues around the vulva or inside the vagina. Complications from delivery, FGM, or organ prolapse are examples of this. A person may require surgery for a structural difference that exists from birth.

 

Recurrent Urinary Tract Infection

Recurrent urinary tract infections, shown as dysuria or irritative voiding symptoms, are most usually caused by reinfection with the same bacterial isolate in young, otherwise healthy women with no urinary tract morphological or functional abnormalities. In individuals with recurrent dysuria, the frequency of sexual intercourse is the biggest predictor of recurrent urinary tract infections. Recurrent complex urinary tract infections provide a risk for ascending infection or urosepsis in patients with concomitant illnesses or other contributing factors.

The most prevalent pathogen in all patient categories is Escherichia coli, however Klebsiella, Pseudomonas, Proteus, and other species are more common among patients with particular risk factors for complex urinary tract infections. The criterion for diagnosing urinary tract infections in symptomatic individuals is a positive urine culture with more than 102 colony-forming units per mL, while culture is generally unnecessary for identifying typical symptomatic illness.

Continuous or postcoital prophylactic antibiotics can be used to treat women with recurrent symptomatic urinary tract infections; additional treatment options include self-starting antibiotics, cranberry supplements, and behavioral change. Patients at risk of complex urinary tract infections should be treated with broad-spectrum antibiotics at first, followed by urine culture to guide further medication and renal imaging investigations if structural abnormalities are anticipated.

 

Conclusion 

If you are experiencing any of the symptoms listed above, discussing them may make you feel uneasy. However, keep in mind that this is only the first step in receiving the necessary therapy. Furthermore, remember that assistance is accessible and that your problem is curable. All you need to do is make the initial step and contact your healthcare practitioner.