The internal urethral sphincter is a muscle located inside the body, around the opening of the urethra (the tube that carries urine from the bladder). It plays a critical role in controlling the release of urine. An injury to this muscle can cause a variety of symptoms, such as urinary incontinence, difficulty in controlling urination, or even urinary retention.
Pathophysiology
Pathophysiology refers to how a disease or injury affects the normal functions of the body.
- Structure: The internal urethral sphincter is made up of smooth muscle fibers that are involuntary, meaning you cannot consciously control them. This muscle is located around the internal part of the urethra.
- Blood Supply: The internal urethral sphincter receives blood from the internal pudendal artery, which branches from the common iliac artery.
- Nerve Supply: The muscle is controlled by the autonomic nervous system—specifically, the sympathetic nerves which help contract the muscle, and parasympathetic nerves that help relax it.
Types of Internal Urethral Sphincter Injury
- Partial Injury: Only part of the sphincter muscle is damaged, which may cause mild urinary symptoms.
- Complete Injury: The entire sphincter is damaged, leading to severe incontinence or retention.
- Chronic Injury: A long-term injury that results in persistent symptoms.
- Acute Injury: A sudden injury from trauma or surgery.
- Traumatic Injury: Caused by accidents or physical trauma.
- Post-Surgical Injury: Occurs after certain surgeries, especially pelvic or prostate surgeries.
- Neurological Injury: Damage to the nerves controlling the sphincter, often due to conditions like spinal cord injury.
- Congenital Injury: Present from birth due to abnormal development of the sphincter.
- Aging-related Injury: As individuals age, the sphincter may weaken, leading to injury.
Causes of Internal Urethral Sphincter Injury
- Trauma (e.g., accidents, falls)
- Childbirth (especially difficult deliveries)
- Pelvic surgeries (like prostatectomy)
- Spinal cord injuries
- Pelvic fractures
- Urinary tract infections (UTIs)
- Neurological diseases (e.g., multiple sclerosis, Parkinson’s disease)
- Stroke
- Infections affecting the nervous system
- Pelvic tumors or cancers
- Chronic constipation
- Obesity (extra pressure on the pelvic area)
- Genetic conditions (e.g., congenital defects)
- Aging (weakening of the sphincter with age)
- Hormonal changes (e.g., postmenopausal women)
- Diabetes (nerve damage leading to sphincter dysfunction)
- Excessive alcohol consumption
- Chronic coughing or sneezing
- Medications (certain drugs may weaken the sphincter)
- Prolonged catheter use
Symptoms of Internal Urethral Sphincter Injury
- Incontinence (loss of bladder control)
- Urgency (feeling a strong need to urinate)
- Frequent urination
- Nocturia (waking up at night to urinate)
- Urinary retention (inability to fully empty the bladder)
- Weak urine stream
- Pain during urination
- Dribbling of urine after urination
- Feeling of incomplete bladder emptying
- Pelvic discomfort
- Back pain
- Painful urination (dysuria)
- Urinary leakage during physical activity
- Blood in the urine (hematuria)
- Difficulty starting urination
- Increased risk of UTIs
- Reduced bladder control during coughing or sneezing
- Erectile dysfunction (in males)
- Pain during intercourse (in females)
- Difficulty holding in urine after drinking fluids
Diagnostic Tests for Internal Urethral Sphincter Injury
- Physical Examination
- Urinalysis (urine test to check for infections)
- Ultrasound (to assess the bladder and sphincter)
- Cystoscopy (a camera inserted into the bladder to check for damage)
- MRI (Magnetic Resonance Imaging of the pelvic region)
- CT scan (for assessing internal injuries)
- Urodynamic Testing (measures bladder pressure and function)
- EMG (Electromyography) (measures electrical activity in the sphincter)
- Bladder Diary (records urination patterns)
- Post-Void Residual Test (checks for leftover urine in the bladder)
- Cystometry (assesses bladder pressure and capacity)
- Urinary Flow Study (measures the flow rate of urine)
- X-rays (for checking fractures or structural issues)
- MRI of the Pelvic Floor (to evaluate muscle damage)
- Blood Tests (to rule out infection or other issues)
- Urinary Pressure Profile (measures the pressure inside the bladder)
- Video Urodynamics (combines video and urodynamic testing)
- Cystographic Studies (for evaluating the bladder and urethra)
- Urethral Pressure Profile (measures the pressure in the urethra)
- Pelvic Floor MRI (for assessing the structure and function of the pelvic floor muscles)
Non-Pharmacological Treatments
- Pelvic Floor Exercises (Kegel exercises)
- Bladder Training (scheduled urination)
- Biofeedback Therapy
- Electrical Stimulation Therapy
- Pelvic Physical Therapy
- Fluid Management (limiting fluid intake)
- Weight Management (reducing pressure on the bladder)
- Dietary Adjustments (avoiding bladder irritants)
- Incontinence Pads (to manage leakage)
- Lifestyle Modifications (avoiding heavy lifting, etc.)
- Timed Voiding (urinating at regular intervals)
- Catheterization (using a catheter if needed)
- Vaginal Pessaries (for women, to support pelvic organs)
- Acupuncture (alternative treatment for incontinence)
- Physical Therapy for the Pelvic Floor
- Surgical Consultations (in severe cases)
- Heat Therapy (to relax pelvic muscles)
- Urinary Tracking Apps (helps track symptoms)
- Psychotherapy (for managing stress-related issues)
- Hydration Management (drinking enough water for proper bladder function)
- Avoiding Bladder Irritants (such as caffeine or alcohol)
- Biofeedback (learning how to control the pelvic floor)
- Manual Therapy (muscle manipulation to improve function)
- Urine Retention Management (avoiding holding in urine for too long)
- Proper Posture (during urination to help bladder function)
- Education on Self-Care
- Community Support Groups
- Mindfulness and Stress Management
- Sex Therapy (for sexual dysfunction related to sphincter injury)
- Regular Medical Checkups (for early diagnosis and treatment)
Drugs Used for Treatment
- Anticholinergics (e.g., oxybutynin)
- Beta-3 Agonists (e.g., mirabegron)
- Alpha-blockers (e.g., tamsulosin)
- Topical Estrogens (for postmenopausal women)
- Tricyclic Antidepressants (e.g., amitriptyline)
- Desmopressin (reduces nighttime urination)
- Diuretics (for fluid management)
- Pain Relievers (e.g., ibuprofen for bladder pain)
- Botox Injections (to relax the sphincter)
- Phosphodiesterase Inhibitors (e.g., sildenafil for erectile dysfunction)
- Hormonal Therapy (to support pelvic muscle function)
- Prostaglandins (for bladder and sphincter function)
- Corticosteroids (to reduce inflammation)
- Calcium Channel Blockers (to help with muscle relaxation)
- Nerve Stimulants (to improve nerve function)
- Antidepressants (for related stress or anxiety)
- Antibiotics (for urinary tract infections)
- Centrally Acting Muscle Relaxants
- Opiates (for pain control)
- Muscle Relaxants (to help with bladder spasms)
Surgeries for Internal Urethral Sphincter Injury
- Artificial Urinary Sphincter Implant
- Sling Surgery (to support the sphincter)
- Bulking Agents (injecting substances into the sphincter to improve function)
- Bladder Augmentation
- Sacral Nerve Stimulation
- Prostatectomy (removal of the prostate, in male patients)
- Colposuspension (lifting the bladder neck in women)
- Pelvic Floor Repair Surgery
- Cystectomy (removal of the bladder in severe cases)
- Neuromodulation Surgery (nerve stimulation to control the bladder)
Preventing Internal Urethral Sphincter Injury
- Maintain a Healthy Weight
- Avoid Heavy Lifting
- Stay Hydrated (for bladder health)
- Quit Smoking (as it weakens pelvic muscles)
- Regular Exercise (to strengthen pelvic muscles)
- Monitor and Treat UTIs Early
- Avoid Prolonged Use of Catheters
- Practice Safe Sexual Practices
- Seek Early Treatment for Pelvic Injuries
- Manage Chronic Health Conditions (e.g., diabetes)
- Wear Proper Supportive Gear During Exercise
- Strengthen Pelvic Floor Muscles
- Prevent Constipation (by eating fiber-rich foods)
- Control Coughing or Sneezing (to avoid pressure on the bladder)
- Follow Post-Surgical Guidelines Carefully
When to See a Doctor
- Incontinence that does not improve
- Pain during urination
- Frequent urination that affects daily life
- Inability to empty the bladder fully
- Persistent pelvic pain
- Frequent UTIs
- Blood in the urine
- Difficulty starting urination
- Weak urine stream
- Severe back pain associated with urination issues
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
