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The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual removal of urine. The kidneys have an extensive blood supply via the renal arteries which leave the kidneys via the renal vein. Each kidney consists of functional units called nephrons. Following filtration of blood and further processing, wastes exit the kidney via the ureters, tubes made of smooth muscle fibres that propel urine towards the urinary bladder, where it is stored and subsequently expelled from the body by urination (voiding). The female and male urinary system are very similar, differing only in the length of the urethra.
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
Kegel exercise, also known as pelvic floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many times a day, for several minutes at a time but takes one to three months to begin to have an effect.
Arnold Henry Kegel was an American gynecologist who invented the Kegel perineometer and Kegel exercises as non-surgical treatment of urinary incontinence from perineal muscle weakness and/or laxity. Today pelvic floor exercises are widely held as first-line treatment for urinary stress incontinence and any type of female incontinence and female genital prolapse, with evidence supporting its use from systematic reviews of randomized trials in the Cochrane Library amongst others. Kegel first published his ideas in 1948. He was Assistant Professor of Gynecology at the Keck School of Medicine of USC.
The pelvic floor or pelvic diaphragm is a muscular partition separating the pelvic cavity (above), and perineal region (below). It is formed by the levator ani muscle and coccygeus muscle, and associated connective tissue.
Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects women, up to 16 percent of men are affected as well. Symptoms can include pelvic pain, pressure, pain during sex, urinary incontinence (UI), overactive bladder, bowel incontinence, incomplete emptying of feces, constipation, myofascial pelvic pain and pelvic organ prolapse. When pelvic organ prolapse occurs, there may be visible organ protrusion or a lump felt in the vagina or anus.
Older texts have asserted the existence of a urogenital diaphragm, also called the triangular ligament, which was described as a layer of the pelvis that separates the deep perineal sac from the upper pelvis, lying between the inferior fascia of the urogenital diaphragm and superior fascia of the urogenital diaphragm.
In surgery, a sling is an implant that is intended to provide additional support to a particular tissue. It usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial or the patients own tissue. The ends are usually attached to a fixed body part such as the skeleton.
Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.
The deep perineal pouch is the anatomic space enclosed in part by the perineum, and located superior to the perineal membrane.
The pelvic fasciae are the fascia of the pelvis and can be divided into:
Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life. The frequent need to urinate may occur during the day, at night, or both. If there is loss of bladder control then it is known as urge incontinence. Overactive bladder affects approximately 11% of the population and more than 40% of people with overactive bladder have incontinence. Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder. Overactive bladder is not life-threatening, but most people with the condition have problems for years.
The urethral sphincters are two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are either the male or female external urethral sphincter and the internal urethral sphincter. When either of these muscles contracts, the urethra is sealed shut.
Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.
National Association for Continence (NAFC) is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction, and related pelvic floor disorders.
The pelvis is the lower part of the trunk, between the abdomen and the thighs, together with its embedded skeleton.
Urethral hypermobility is a condition of excessive movement of the female urethra due to a weakened urogenital diaphragm. It describes the instability of the urethra in relation to the pelvic floor muscles. A weakened pelvic floor muscle fails to adequately close the urethra and hence can cause stress urinary incontinence. This condition can be measured with anterior compartment descent. It is sometimes treated with urethral bulking injections.
The vaginal support structures are those muscles, bones, ligaments, tendons, membranes and fascia, of the pelvic floor that maintain the position of the vagina within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to pelvic organ prolapse. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and urinary retention.
Pelvic floor physical therapy (PFPT) is a specialty area within physical therapy focusing on the rehabilitation of muscles in the pelvic floor after injury or dysfunction. It can be used to address issues such as muscle weakness or tightness post childbirth, dyspareunia, vaginismus, vulvodynia, constipation, fecal or urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Licensed physical therapists with specialized pelvic floor physical therapy training address dysfunction in individuals across the gender and sex spectra, though PFPT often associated with women's health for its heavy focus on addressing issues of pelvic trauma after childbirth.
References
- ↑ "urogenital hiatus". TheFreeDictionary.com. Retrieved 2023-06-14.
- ↑ Huang, W. C.; Yang, S. H.; Yang, J. M. (2006). "Anatomical and functional significance of urogenital hiatus in primary urodynamic stress incontinence". Ultrasound in Obstetrics & Gynecology. 27 (1): 71–7. doi: 10.1002/uog.2649 . PMID 16323154. S2CID 22170424.
