Urethral hypermobility

Condition involving excessive movement of the urethra

Diagram showing the female and male urethra.

Urethral hypermobility is a condition characterized by excessive movement of the urethra, often associated with stress urinary incontinence (SUI) in women. This condition occurs when the supportive tissues of the urethra and bladder neck are weakened, allowing the urethra to move more than normal during physical activities that increase abdominal pressure, such as coughing, sneezing, or exercise.

Anatomy and Physiology

The urethra is a tube that connects the urinary bladder to the external urethral orifice, allowing for the excretion of urine from the body. In females, the urethra is approximately 4 cm long and is located anterior to the vagina. The pelvic floor muscles and connective tissues provide support to the urethra and bladder neck, maintaining continence by ensuring proper closure of the urethra during increases in abdominal pressure.

Muscles of the perineum, which support the urethra.

Causes

Urethral hypermobility is often caused by weakening of the pelvic floor muscles and connective tissues. Factors contributing to this weakening include:

• Childbirth, particularly vaginal delivery
• Aging and hormonal changes, such as decreased estrogen levels
• Obesity
• Chronic coughing or constipation
• Previous pelvic surgery

Diagnosis

Diagnosis of urethral hypermobility typically involves a combination of patient history, physical examination, and specialized tests. A common test is the Q-tip test, where a cotton swab is inserted into the urethra to measure the angle of movement during straining. An angle greater than 30 degrees is indicative of hypermobility.

Treatment

Treatment options for urethral hypermobility focus on strengthening the pelvic floor and providing additional support to the urethra. These may include:

• Pelvic floor exercises (Kegel exercises)
• Pessary devices
• Surgical interventions, such as urethral sling procedures

Prognosis

With appropriate treatment, many individuals with urethral hypermobility can achieve significant improvement in symptoms. Pelvic floor exercises are particularly effective in mild cases, while surgical options may be necessary for more severe cases.

Related pages

• Stress urinary incontinence
• Pelvic floor dysfunction
• Urinary incontinence

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  Muscle of the Perineum
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  Female and Male Urethra