Urinary Tract Disorders in Women

Many people have the misconception that urologists only treat men. However, women suffer from urinary tract disorders as well. The main conditions that afflict women include urinary tract infections (UTIs), urinary incontinence, pelvic floor prolapse and pelvic pain.

Occurring in all age groups, we do not know why certain women get urinary tract infections, while others do not. Although sexual activity may increase the risk of an infection, UTIs do not come from another person, a toilet seat, or lapses in hygiene. If three or more infections occur in a cluster, it is prudent to see a urologist to be sure that the urinary tract is healthy. Many different methods of intervention are available, including self-medication, low-dose daily suppression antibiotics for three months, and post-sex medications. If there is some suspicion of an infection, but treatment is not readily available, over-the-counter relief can be obtained through taking pyridium or Cystex®, which will slow down the replication of the bacteria until antibiotics can be obtained. Prevention is difficult to recommend since we do not know why these infections occur in the first place. Most importantly, as painful as a UTI may be, it will not scar the bladder or the kidneys. Once it is treated, the bladder lining regenerates and no evidence of an infection is left behind.

Urinary incontinence refers to any unwanted loss of urine. The two main types of urinary incontinence that are seen in women include urge incontinence and stress incontinence. Urge incontinence occurs when the loss of urine is preceded by an intense urge to urinate. Caused by involuntary bladder spasms, it is seen to some degree in most women as they get older, and is more prominent in women with neurological conditions such as Parkinson’s disease, strokes, and dementia. Although urge incontinence may be an inevitable result of aging, it is controlled with behavioral intervention, exercise, and medication. Stress incontinence occurs when urine is discharged during physical activity, such as laughing, coughing, walking, or sneezing. Unlike urge incontinence, stress incontinence has nothing to do with the bladder itself. It results when the support structures under the urethra (the tube that urine passes through) are weak. The treatment is exercise and surgery.

TYPES OF LEAKAGE

More common in post-menopausal women, pelvic organ prolapse refers to the collapse of one or more of the pelvic organs into the vaginal canal. It presents itself with either a sensation of fullness or pressure in the vagina, or with a ball of tissue that comes through the vaginal opening. The organs that can fall into the vagina include the bladder, the rectum, the cervix, or the small intestine. Most women with this problem will notice it during periods of exertion, such as after a bowel movement, or at the end of a busy day. The treatment is either the insertion of a pessary, which is a rubber ring similar to a diaphragm, or surgery. Although alarming to the patient, pelvic organ prolapse is eminently treatable.

Pelvic muscle spasms and interstitial cystitis are the two most common urological causes of pelvic pain. Pelvic muscle spasms occur when the muscles that make up the floor of the pelvis contract uncontrollably, resulting in frequent urination, night-time urination, and burning. Many women report that they feel as if they have a urinary tract infection, except that it doesn’t burn with urination: it burns before and after.

TREATMENT INCLUDES:

• anti-inflammatory medications, warm baths, and stretching exercises;

• muscle relaxants; and

• pelvic floor physical therapy.

Interstitial cystitis is a little understood condition that is defined by a symptom complex of frequency, urgency, and pain that has been present with no relief for a six-month period. Many women will experience these symptoms over a shorter period of time, but interstitial cystitis cannot be diagnosed unless the symptoms have been present for many months. There are many different treatment modalities, including medication, bladder instillations, and behavioral modification.

Dr. Elizabeth KAVALER

NY Urological Associates

245 East 54th Street

NY, NY 10022

(212) 570-6800