Tuesday, September 27, 2022

Estrogen Cream For Urinary Incontinence

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Local Estrogen In The Treatment Of Fecal Incontinence

Incontinence During Peri-Menopause & Menopause

Regarding AI, one small RCT compared local estrogen with placebo in 36 menopausal women with fecal incontinence . The authors found no difference between the groups with respect to subjective improvement assessed by the Wexner score .

Table 1 summarizes the study quality in general as well as the profile of evidence regarding pelvic floor disorders and efficacy of LET.

Table 1 Efficacy of local estrogen therapy on pelvic floor disorders: quality of studies and profile of evidence

What Is Urinary Incontinence

Urinary incontinence means that you cant always control when you urinate, or pee. The amount of leakage can be small?when you sneeze, cough, or laugh?or large, due to very strong urges to urinate that are hard to control. This can be embarrassing, but it can be treated.

Millions of adults in North America have urinary incontinence. Its most common in women over 50 years of age, but it can also affect younger people, especially women who have just given birth.

Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, and skin and urinary tract infections. Also, you may find yourself avoiding social situations because of fears about your urine leaking and embarrassment. This can be avoided.

What Are The Next Steps

No matter the reason, frequent urination doesnt have to take over your life. Answers are only an appointment away.

Because once you know whats causing your frequent urination, youre that much closer to a peaceful nights sleep, uninterrupted jog around the lake or worry-free time doing whatever you like on your own terms.

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Estrogen Treatment For Urinary Incontinence: Never Now Or In The Future

DuBeau CE.

JAMA. 2005 293:9981001.

This large, randomized clinical trial of MHT seems to resolve the controversy around estrogen and UI. The primary aim was to determine the effects of MHT on the 1-year incidence and severity of symptoms of stress, urge, and mixed UI in healthy postmenopausal women. Treatment with daily tablets of 0.625 mg of conjugated equine estrogen alone or 0.625 mg of CEE plus 2.5 mg of medroxyprogesterone acetate increased new-onset UI among continent women and worsened the characteristics of UI among already-incontinent women. This effect persisted through 3 years.

What then is the biologic background of these findings? On the basis of a recent study of estrogens effect on connective tissues, the investigators suggested that estrogen might actually alter collagen metabolism, which would result in damage to the periurethral connective tissues essential for effective urethral closure.

The take home messages from this study are these: first, long-term oral conjugated equine estrogens can no longer be regarded as an effective treatment option for UI in postmenopausal women. Second, we should remember that this trial dealt only with oral administration, and whether topical estrogens might prove beneficial remains unknown. Finally, more investigation in basic science is needed to discover the functional role of estrogen in normal and aging urinary tract and pelvic floor composition.

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The Vagina As Drug Delivery System

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In 1918 Macht demonstrated that the vagina was able to absorb drugs including morphine and atropine. While drugs administered vaginally are often used to treat local conditions, these drugs may also act systemically. Some oral agents are commonly used vaginally for non-FDA indications such as misoprostol for labor induction. Oxybutynin was initially marketed as an oral formulation and now is available in a vaginal ring for treatment of overactive bladder. The use of the vagina as a drug delivery system will most likely continue to increase because of the many qualities that make it suitable for absorption of drugs. Oral administration of drugs may be complicated by vomiting, variations in GI absorption, and drug interactions. Similarly, transdermal application is susceptible to variable outcomes based on levels of adiposity. One of the major advantages of vaginally administered drugs is avoidance of hepatic first pass effect, which affects the absorption, distribution and excretion of orally administered drugs. This results in use of lower doses to achieve equivalent therapeutic effect. Also, patients may benefit from less frequent dosing which decreases fluctuations in drug levels and can result in fewer side effects.

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How To Use Vaginal Estrogen Cream

If youre going through menopause and experiencing some of the discomforts of a hormonal imbalance, estrogen cream can help alleviate some of those symptoms.

Vaginal cream is designed to be used inside your vagina. It can be used right at the vaginal opening or inserted deeper inside.

To use vaginal estrogen cream, you need to be able to insert it into your vaginal canal. Follow these steps to get your applicator filled with the correct dosage:

  • Wash your hands thoroughly with soap and warm water.
  • Remove the cap from the tube of vaginal cream.
  • Screw the nozzle part of the applicator onto the open end of the tube.
  • Find the correct dosage. The applicator has markings on it that indicate how much cream will be inserted. Your doctor will give you the dosage amount they want you to use.
  • Gently squeeze the tube so the cream fills the applicator to the required dosage mark.
  • Unscrew the applicator from the tube, replace the cap on the tube, and set the tube aside.

Now that your applicator is filled and ready for use, you can insert it. You will be inserting the applicator tip into your vagina, so give yourself a few minutes of privacy and either wear easy-access clothing like a robe or remove your clothing. You will need to be in a room where you can lie down on your back.

How to insert the applicator:

Management Of Urge Incontinence

This usually starts with simple measures, such as using vaginal oestrogen and seeing a physiotherapist to help with pelvic floor rehabilitation. Learning how to retrain your bladder to hold larger amounts of urine can help reduce the urge to pass urine.

Retraining the bladder includes learning how to contract pelvic floor muscles repeatedly and practising how to hold the contraction for a specific period of time. Wiggling your toes can also help reduce urge incontinence as this sends a signal to the bladder to relax.

If you are overweight, even 5% weight loss can improve urinary urgency significantly. Removing bladder irritants can also help reduce the urge symptoms. Common bladder irritants include alcohol, caffeine and fizzy drinks. If you are postmenopausal, vaginal oestrogen may be prescribed to use as a vaginal cream or tablet. Oestrogen can plump up the lining of the vagina, which thins out once you go through menopause, and may provide some improvement in incontinence. However, the effect wears off once you stop using the treatment. The amount of oestrogen that gets absorbed into the body is very small and considered safe. Women who have had breast cancer should consult with their doctor to discuss whether or not they can use vaginal oestrogen.

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Local Estrogen In The Treatment Of Oab Syndrome

In OAB, the use of LET has demonstrated efficacy in clinical trials. Randomized, placebo-controlled trials and also various guidelines have demonstrated significant improvement over placebo in urinary frequency, nocturia, urgency incontinence and volume at first sensation to void . Moreover, Erikson et al. performed a double-blind, randomized, placebo-controlled trial which showed that frequency, urgency, urgency incontinence and stress incontinence significantly improved with LET. However, one has to mention that some of the subjective improvement in these symptoms may simply represent local estrogenic effects reversing urogenital atrophy rather than a direct effect on lower urinary tract function . In an RCT published by Nelken et al., postmenopausal patients with OAB symptoms received either an estradiol-releasing vaginal ring or oral oxybutynin 5 mg twice daily. Those women who received oral oxybutynin had a mean decrease of 3.0 voids per day compared with a decrease of 4.5 voids per day in women using the estradiol ring, with a significant improvement in QoL parameters in both groups . The authors concluded that the estradiol-releasing vaginal ring and oral oxybutynin are similarly effective in OAB syndrome.

What Follow Up Is Required In Women Who Have Pessary To Treat Pelvic Organ Prolapse

Vaginal Dryness and Menopause Related Urinary Symptoms

All women with a long term pessary require regular follow up to ensure that they are not developing complications or problems related to the pessary. Regular checks are performed by a doctor every 4 to 6 months with removal and cleaning of the pessary and inspection of the vaginal tissues before the pessary is replaced. The interval between pessary checks can be extended by the doctor depending on the individual patient and the healthiness of the tissues at the time of the pessary check up.

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Influence Of Hrt On Fi

Staller et al. studied the association between HRT and risk of FI among 55.828 postmenopausal women , and current or past use of HRT was associated with a modestly increased risk of FI among postmenopausal women. These results support a potential role for exogenous estrogens in the impairment of the fecal continence mechanism .

Selective Estrogen Receptor Modulators In The Treatment Of Oab

Regarding SERMs and OAB, Schiavi et al. assessed the effectiveness of Ospemifene in the improvement of the urgency component in women with MUI who underwent mid-urethral sling surgery. After surgical intervention, 38/81 patients received Ospemifene , and a significant difference was observed regarding mean number of voids, urgent micturition episodes/24 h, UUI, nocturia events and OAB-QoL symptoms. The authors concluded that Ospemifene is an effective therapy after MUSs in women with MUI, improving urgency symptoms and quality of life . Another study, also published by Schiavi et al., demonstrated that Ospemifene is also an effective therapy for postmenopausal women with VVA affected by OAB, improving sexual function and quality of life .

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Vaginal Maturity Index Assessment

Cytological evaluation was performed using vaginal smears collected from the vaginal lateral wall and evaluated in our pathology department. The cytotechnologist estimated the proportion of parabasal, intermediate, and superficial cells, summing to 100, in the sample. All examinations were interpreted by the same blinded cytopathologist.

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Get Effective Treatment With A Team Approach

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Women need to know that there are many options available to reduce and sometimes eliminate pelvic organ prolapse. I encourage women not to accept their symptoms as milestones of motherhood or aging. With active research into advanced techniques and new developments each year, women should feel empowered to ask their doctors for the latest treatments for incontinence and pelvic discomfort.

Find out more about pelvic organ prolapse treatment today. Call or request an appointment online.

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Why Does Your Estrogen Level Matter

Estrogen is a hormone. Although present in the body in small amounts, hormones have big roles in maintaining your health.

Estrogen is commonly associated with the female body. Men also produce estrogen, but women produce it in higher levels.

The hormone estrogen:

  • is responsible for the sexual development of girls when they reach puberty
  • controls the growth of the uterine lining during the menstrual cycle and at the beginning of a pregnancy
  • causes breast changes in teenagers and women who are pregnant
  • is involved in bone and cholesterol metabolism
  • regulates food intake, body weight, glucose metabolism, and insulin sensitivity

Girls who havent reached puberty and women approaching menopause are most likely to experience low estrogen. Still, women of all ages can develop low estrogen.

Common symptoms of low estrogen include:

The Pattern Of Incontinence Is Often Mixed

Symptoms of overactive bladder include frequency and nocturia . Some women also feel they need to pass urine, having only just done so due to over activity of the bladder muscle.

Recurrent urinary tract infections

UTIs can affect women of all ages, but this problem increases with age as a result of estrogen deficiency.

Management of urinary problems

Local estrogen

Local estrogen replacement therapy has been shown to alleviate urgency, urge incontinence, frequency, nocturia, dysuria and also to reduce urine infections.

Genuine Stress Incontinence would not appear to be helped by estrogen alone, but it does seem to improve the action of other treatments currently used.

The newer treatments including Ospemifene, DHEA and laser therapy may all have a beneficial effect on bladder problems.

Pelvic floor exercises

These can strengthen the pelvic floor reducing the risk of uterovaginal prolapse. Many women have learnt these techniques from childbirth, but it is well worth revisiting them.

Pelvic-floor physiotherapists are specialists in this field and are able to fully assess and monitor a womans pelvic floor function and teach appropriate techniques to strengthen it and retrain the bladder. They often use devices to help women perform appropriate exercises, such as weighted vaginal cones, or vaginal trainers. Your practice nurse or GP should be able to refer you to a specialist pelvic floor physiotherapist.

Surgery

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Why Does Menopause Make Your Bladder Weaker

Your ovaries stop making estrogen during this time in your life. That hormone is essential to women as it kicks in for puberty, as it controls your menstrual cycle, and during pregnancy. When its gone, your body gets to have a break from working so hard at all these stages.

You may know this life shift comes with hot flashes, night sweats, and mood changes. But some other changes can lead to bladder control issues for some women.

  • Your vaginal tissue becomes less elastic.
  • The lining of your urethra, the tube that empties urine from your bladder, begins to thin.
  • Your pelvic floor, the group of muscles that supports both your urethra and bladder, weakens.

Other Approaches To Treating Stress Incontinence

Contiform Vaginal Pessary For Women’s Incontinence

Using stool bulking agents or softeners will help avoid constipation and having to strain when opening your bowels. When emptying the bowels and bladder, it may also help to use a low stool to elevate the knees slightly higher than hips, relaxing the pelvic floor and the abdomen. Additionally, avoiding heavy lifting can help avoid raised intra-abdominal pressure leading to SUI.

Some women may be able to use a continence pessary, which is inserted into the vagina and supports the bladder neck, helping to reduce leakage.

Another non-surgical option is duloxetine, an antidepressant medication known as a serotonin and noradrenaline reuptake inhibitor . It may help some women but its use is not approved for this purpose in Australia or New Zealand.

Your doctor may recommend surgery if other treatments have not helped. You may be referred to a specialist urogynaecologist to discuss the benefits and risks of surgery for SUI. The types of surgery available for SUI include urethral bulking agents, midurethral slings, colposuspension, or an autologous fascial sling.

None of the types of surgery currently available have a 100% cure rate, however for 80-90% of women, their surgery will provide significant improvement at 12 months post-surgery.

For incontinence caused by neurological disorders, such as multiple sclerosis or spinal cord injury, management should be tailored to the individual woman’s needs.

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Losing Weight If Youre Heavy May Also Help

Biofeedback has also been used to treat incontinence. Biofeedback uses complex machines that give pictures and sounds to show how well you are controlling your pelvic muscles.

Functional electrical stimulation is another option for those unable to voluntarily contract their pelvic muscles.

Vaginal cones and pessaries are other options that your doctor may recommend. These devices are placed in the vagina to help control urinary flow when the muscles of the pelvic organs are weak.

Topical Vaginal Estrogen For Postpartum Obstetric Anal Sphincter Injury Recovery

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
Recruitment Status : Not yet recruitingFirst Posted : April 7, 2022Last Update Posted : April 14, 2022
  • Study Details
Condition or disease
Obstetric Injury Pelvic FloorSexual DysfunctionAnal IncontinenceUrinary Incontinence Drug: Estradiol 0.01% Vag CreamDrug: Placebo vaginal cream Phase 4

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Lower Urinary Tract Symptoms

Many women find that they have problems with their urinary tract in association with the menopause due to estrogen deficiency.

Some suffer from stress incontinence leaking of urine on coughing, sneezing or jumping, whilst others experience urge incontinence presenting as difficulty holding on once there is recognition of a need to empty the bladder. They may also leak and start to pass urine before they can get to the toilet.

What Is Genitourinary Syndrome Of Menopause

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According to a 2014 article published in the journal Maturitas:

“GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation sexual symptoms of lack of lubrication, discomfort or pain, and impaired function and urinary symptoms of urgency, dysuria and recurrent urinary tract infections.”

Of note, according to the authors of this study, in order for you to be diagnosed as having GSM, your symptoms must be bothersome and unattributable to another etiology or cause. Moreover, many women with GSM may experience some but not all of these symptoms.

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