Urinary incontinence affects approx...

Urinary incontinence affects approximately 10% to 25% of women and up to 5% of men between the ages of 15 and 60 years, creating preciousnesss of $7 billion annually for affected community-dwelling individuals and $33 billion for residents of nursing homes(1) The psychosocial costlinesss of urinary incontinence cannot be measured, nevertheless many individuals with urinary incontinence restrict or avoid excursions outside their hearths social interactions with friends and family members, and sexual activity.

There are several patterns of urinary incontinence, and the treatments vary depending onward the cause and type of incontinence. This article reviews bladder and urethral anatomy, micturition physiology, and collagen injection therapy for common type of urinary incontinence--stress urinary incontinence (SUI), which is defined as the unwanted urinary los that arises in the presence of increased intraabdominal pressure(2)

ANATOMY AND PHYSIOLOGY

The bladder wall is compos of the epithelium, a subepithelial layer of connective and elastic tissues, and the detrusor muscle. Although the bladder neck is commonly referr to as the internal sphincter, it is not a truthful circular sphincter, but a thickening that is created on muscle fibers of the detrusor that form the polished muscle of the urethra.(3)

The longitudinal even muscle layer of the 4-cm prolonged female urethra is continuous with the bladder wall. Surrounding this layer are circular sleek muscle fibers that constitute the actual involuntary urethral sphincter. Around this lies the circular striated (de voluntary) sphincter. The male urethra, which is 20 to 25 cm lengthy contains two separate areas of sphincter activity: the proximal and distal urethral sphincters. The proximal sphincter contracts in replication to pelvic nerve stimulation, and the distal sphincter is beneath voluntary control via the pudendal resolution Urinary continence in males hangs on the combined function of the pair sphincters.(4)

For the human bladder to fill, it must accommodate increasing books of urine at low influences have adequate sensation, have a pertinent bladder outlet at rest that is maintained during periods of increased intraabdominal compressing and have a stable detrusor muscle. For the bladder to void it must have a coordinated contraction of the detrusor muscle with synchronized relaxation of the sphincters and no anatomic obstructions.(5)

A combination of compression, tension, and support normally maintains a watertight seal during bladder filling and an render free of access conduit for urine passage during micturition. Abnormalities in any of these three factors may cause voiding dysfunction.(6)

Compression,. During bladder filling, the urethra should form a watertight seal, whereas during micturition, the urethra widens and shortens to facilitate bladder emptying. Estrogen facilitate urethral compression in women from promoting mucosal secretions that help create this watertight seal.

Tension. The vascular network in the urethral submucosa creates urethral closure hurry during bladder filling. In males, urethral glossy muscle fibers contribute tension that advances urethral closure during bladder filling. The striated muscles of the pelvic floor in the couple genders provide support and tension, which further urethral closure during bladder filling and storage.

Support. The distal third of the female urethra is attached to the lower portion of the symphysis pubis and remains relatively fixed during the couple physical stress and micturition. The proximal sum of two units thirds of the female urethra, however, is mobile during bladder filling and micturition. The female pelvic muscles, endopelvic fascia, and vaginal wall provide support to the bladder and proximal portion of the urethra. The male pelvic floor also provides support for the urethra and bladder base. These structural supports are necessary for effective closure during bladder filling and for efficient voiding. Lack of pelvic support disturbs the hurry transmission ratio between the bladder and urethra, and distortion of the urethra during bladder filling diminishes the watertight seal of the urethra during physical stres Lack of anatomic support also may allow the bladder to fall below the horizontal of the urethral outlet during micturition and contribute to SUI and urinary proceed obstruction (Figure 1).

[Figure 1 ILLUSTRATION OMITTED]

Failure to store urine related to sphincter dysfunction arises when abnormalities in compression, tension, or anatomic support allow urine to leak in the air of physical stress (ie, SUI). For example, urine leakage come into views when intravesical pressure overrides the voluntary sphincter (ie, sphincter incompetence).(7)

STRES URINARY INCONTINENCE

There are three models of SUI, classified by bladder vent and urethral response to upright positioning and exertion.

* original I involves a functional drift in the muscle tone of the proximal sphincter mechanism (ie, bladder neck lay opens during physical stress, causing urine leakage). This archetype of SUI is best treated with pelvic floor exercises (eg Kegel) or medication (eg ephedrine, estrogen)(8)