November 2017
In This Issue
Bladder Health

Institute Happenings

Upcoming Events 
  Recent Blogs 

Dear Friends,
 November 1 st marks the start of Bladder Health Awareness Month. While bladder health issues are incredibly common, social stigma may prevent us from discussing them with our friends, family, or even our healthcare providers. In this newsletter, we will take a closer look at several women’s bladder health issues and explore how sex and gender can influence bladder health.    
Nicole C. Woitowich, PhD
Director of Science Outreach and Education 
Bladder Health
The Urinary System 

When talking about bladder health, it’s important to take a closer look at all of the components which make up the urinary system. The urinary system is composed of the kidneys, ureters, bladder, and urethra which work together to maintain fluid balance in the body, remove waste and extra water from the blood, and regulate levels of specific nutrients and minerals. It serves as a drainage system for urine, which consists of excess water, electrolytes, vitamins, and other chemicals, and is produced by the kidneys. Urine is transported from the kidneys to the bladder, via tubes known as the ureters. The bladder acts as a storage container for urine, with a capacity to hold approximately 1.5 – 2 cups of urine. Once the bladder is full, nerves embedded in the bladder wall send a signal to our brain, alerting us to the fact that we need to urinate. Urine is passed from the body from another tube-like structure called the urethra.

The anatomy of the urinary system differs slightly between men and women. In men, the urethra passes through the prostate and penis, and has the capacity to carry both urine and semen. It is considerably longer than the female urethra, with an approximate length of 22 cm compared to 4 cm. The female urethra extends from the bladder, passes through the musculature of the pelvic floor, and ends above the opening of the vagina. As the structures of the urinary system are located within and or next to the genitals, collectively they may be referred to as the urogenital system. 
Sex and Gender Differences in Bladder Health
Below we will explore several bladder health topics which exhibit sex or gender differences in the incidence, symptoms, severity, or treatment outcomes. 

Urinary incontinence
Urinary incontinence is the involuntary leakage of urine. It can range in severity from mild leakage during physical activity to leakage of large amounts of urine without warning. In both sexes, the likelihood of urinary incontinence increases with age. Yet, women are twice as likely to experience urinary incontinence compared to men, with estimates that it may affect anywhere between 15-69% of women in the United States [1]. This may be due to a variety of female specific factors such as pregnancy-related changes to the pelvic floor muscles as well as the hormonal influences on bladder and pelvic muscle control.

There are several different types of urinary incontinence: 
  • Stress incontinence is the involuntary leakage of urine during physical activity or movement. This can occur when someone is laughing, coughing, sneezing, exercising, standing up, or during a variety of other activities. It is caused by weakening of the pelvic floor muscles and sphincter muscles which are similar to a gate, holding the urethra closed. In addition, any force that puts pressure on the bladder, whether through muscle contractions during sneezing or laughing, can cause urine leakage. It is the most common bladder problem experienced by young and middle-aged women, but usually begins around the time of menopause [2].
  • Urge incontinence is characterized by the strong and sudden need to urinate, followed by involuntary leakage of urine. It is less common than stress incontinence, but can have a significant toll on emotional well-being due to its unpredictable nature. It often results from overactive bladder muscles, and as such may be referred to by the term overactive bladder. In general, men are more likely to experience urge, rather than stress incontinence [2].
  • Overflow incontinence occurs when the bladder overfills and the signals which normally alert us to the fact that we need to urinate are absent. Typically, it is more common in men than women, as overflow incontinence can result from obstruction due to an enlarged prostate gland. However, it can also be caused by certain neurological disorders, pelvic organ prolapse, and bladder or kidney stones [3].

Urinary Tract Infections
Urinary tract infections (UTIs) are a result of bacterial growth in the urethra, bladder, ureters, or kidneys. Women are more likely to develop UTIs compared to men, due to the differences in their urinary tract anatomy [4]. The female urethra is located close to the vaginal opening and the anus, both of which harbor bacteria. As mentioned previously, the female urethra is significantly shorter than the male urethra, which makes it easier for bacteria to reach and colonize the bladder.

UTIs can be split into two groups: Asymptomatic and symptomatic. Asymptomatic UTIs are identified by a urine screen, or urinalysis, which detects the amount of bacteria present in the urine. Individuals with asymptomatic UTIs have bacteria present in their urine, but do not have any symptoms of an infection. Typically, asymptomatic UTIs do not require any sort of treatment. Symptomatic UTIs, on the other hand, may cause pain or burning during urination and/or frequent urges to urinate, although not much urine may pass. UTIs which affect the lower urinary tract are routinely treated with antibiotics.
For more information on the urinary tract and other bladder health issues, the National Institute of Diabetes and Digestive and Kidney Diseases has many helpful resources:

For scholarly reviews, we recommend:
Patra and Patra. Curr Urol . 2013 Feb; 6(4): 179–188.

1. Markland et al., J Urol . 2011 Aug; 186(2): 589–593.
2. Nitti, W. Rev Urol . 2001; 3(Suppl 1): S2–S6.
3. Holroyd-Leduc et al., Am Med Assoc . 2004; 291(8):986–995.
4. Foxman, B. Nat Rev Urol . 2010 Dec;7(12):653-60.

Institute Happenings
Registration and abstract submission now open!
The Women’s Health Research Institute at Northwestern University invites you to attend the 2nd Annual Symposium on Sex Inclusion in Biomedical Research . This day-long symposium promotes the advancement of sex-inclusive research within the basic, translational, and clinical research fields. It fosters knowledge amongst interdisciplinary communities who currently conduct or are interested in sex-based research.

This year's theme, "A Spotlight on Autoimmunity," will feature keynote and plenary lectures from nationally recognized experts in sex-based immunology including Drs. Jayne Danska, Sabra Klein, and Maureen Su. In addition, the symposium will feature a panel discussion on the state of sex-inclusive science, invited abstract presentations, and a poster session.

Abstract submissions are currently being accepted for both oral and poster presentations which highlight sex-inclusive or sex-based research. Submission guidelines and additional information can be found here .

The symposium is open to the public and all neighboring institutions. Students, post-docs, faculty, and staff are encouraged to attend. Breakfast, lunch, and coffee breaks are included in the registration costs. Registration is limited, so reserve your spot today

Funding Opportunity
The WHRI is now accepting applications for the Shaw Family Pioneer Awards.

Two awards of $12,000 in direct costs will be granted to research or tenure-line faculty members. Proposals must be directly relevant to sex-inclusive research, focusing on sex-based determinants of health and disease. The application deadline is December 12th . For more information and to access the application, please visit our website at click here.  
Upcoming Events 

Tuesday, November 7th: Monthly Women's Health Research Forum
How to Care for Women with Opioid Use Disorders Who Become Pregnant: What Research Tells Us

Hendree Jones, PhD
Executive Director, UNC Horizons Program
Professor, Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill 

 12:00PM to 1:00PM
Prentice Women's Hospital
250 E. Superior Street
3rd Floor Conference Room L South

This continuing nursing education activity has been approved for 1.0 contact hour by the Ohio Nurses Association (OBN-001-91), an accredited approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Approval valid through 10/30/2019 - ONA Approval #21190, ONA-CE Assigned Approval Number
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