Urinary incontinence is the inability to fully control the functioning of the bladder. This is a common ailment, although there are still no accurate statistics on it - people suffering from incontinence do not always seek help from a doctor. For example, older patients consider what is happening to be a personal problem that accompanies aging and wear and tear of the body. This is not true - urinary incontinence can be successfully treated and the situation can be brought under control.
How does urination occur?
The detrusor muscle located in the bladder is responsible for urination. In the normal state, the sphincter muscles located in the neck of the bladder are tightly closed. The accumulating urine stretches the walls of the bladder, the pressure stimulates the receptors located in them. The detrusor tenses, the bladder relaxes and the person realizes that it is time to visit the toilet.
For urination to occur, the pressure in the urethra must be lower than in the detrusor. A healthy person reflexively controls the force of pressure using his own muscles.
In the case of pathology, a person cannot control the process of urination - completely or partially. Nerve impulses imitate false urges, and uncontrolled urination occurs.
The delicate nature of the problem leads to the fact that people try to hide the illness from their family and others and become isolated psychologically. A person suffering from enuresis feels awkward in everyday life, is embarrassed to go out to the shops or to work, or to maintain friendly connections. In the worst cases, psycho-emotional deviations become fixed in behavior.
Causes of urinary incontinence
Enuresis is not an independent disease, but a consequence of processes occurring in the human body.
The causes of urinary incontinence can be divided into three categories:
- Hormonal. In 60% of women, frequent urination or urinary incontinence occurs during menopause. At this time, the level of estrogen in the body decreases, and in the tissues of the bladder and sphincter there are receptors that respond to their amount. Lack of estrogen leads to atrophic changes in the pelvic floor organs, which can also cause urinary incontinence.
- Anatomical. Body changes can be congenital or acquired. If they lead to disturbances in the natural arrangement of the pelvic organs and decreased sensitivity, enuresis may occur. The causes of anatomical disorders can be: obesity, chronic inflammatory processes, surgical interventions on the female reproductive organs, prolonged and heavy physical activity, childbirth, and prostate pathologies.
- Injuries to the urinary system. May be the result of surgery or external trauma.
Temporary causes of uncontrolled urination can be infections - vaginal or urinary tract, chronic constipation, consumption of alcoholic beverages, spices, foods high in ascorbic acid and certain medications (a number of sedatives and muscle relaxants).
Symptoms of urine leakage may accompany pregnancy.
Types of urinary incontinence
- Stress urinary incontinence. If the sphincter muscles are weakened or overstretched, it is difficult for a person to hold urine while moving, laughing, or lifting heavy objects. A certain amount of urine (from a few drops and the volume of a tablespoon) flows out if a person sneezes or coughs, then the muscular abdominal wall tenses and presses on the bladder.
This is the most common type of enuresis among older women. In men, due to physiological characteristics, stress urinary incontinence is less common.
- Overactive bladder. This is a situation when there is no need to urinate yet, but the brain is already sending persistent signals to the detrusor to void. Another option is also possible: contraction of the detrusor squeezes fluid into the urethra and the person experiences a painful desire to urgently visit the toilet. In this case, the bladder can be half full or even less, and will produce only a few grams of urine.
The urge occurs at any time of the day or night, sometimes so often that the person does not have the opportunity to relax and fully rest. Also called urge incontinence, more than 30% of men and 40% of women have an overactive bladder. The cause of the disease can be prostate disease in men, the onset of menopause in women, and even adherence to a strict diet - regardless of the gender of the patient.
- Reflex incontinence. In this case, urine leakage occurs as a result of pathological reflex work of the spinal cord. The person does not receive signals about the need to urinate and the liquid leaks out on its own. This disorder occurs with spinal cord injuries.
- Incontinence as a result of overflow (urge incontinence). A disease more common in men with prostate disease or an operated prostate. Incontinence occurs when the bladder cannot hold more urine or the flow is obstructed by a urinary stone, enlarged prostate gland, or tumor. Or in the case when the detrusor has become less elastic and does not “lock” the liquid reliably enough.
With this type of incontinence, urine is released in drops, and you want to go to the toilet often.
One person may experience symptoms of several types of incontinence at the same time. This is mixed urinary incontinence.
The degree of the disease is determined by the amount of urine excreted in 3-4 hours:
- up to 50 ml of urine - mild incontinence;
- 100-200 ml of urine - average degree of incontinence;
- over 300 ml of urine - severe incontinence.
Diagnosis of urinary incontinence
What to do if urinary incontinence occurs? You should not be ashamed of this problem and consult a doctor. A urologist examines patients with uncontrolled urine output.
Be prepared to answer questions:
- when and how often does urine excretion occur, is the process accompanied by pain, discomfort, tension;
- whether there are chronic intestinal diseases, operations on the pelvic organs;
- Are there any bad habits?
- number of pregnancies;
- what medications are you taking?
In older and more excitable people, the doctor will assess the mental status.
Assessing your general health, the doctor will palpate the abdominal organs, rectum, genitals and pelvis, and check neurological reflexes.
- urine test for urinolysis;
- bacteriological culture;
- residual urine examination;
- stress test;
- cystography;
- urodynamic study;
- cystoscopy;
- endoscopic examination;
- Ultrasound of the bladder and adjacent organs.
The causes of urinary incontinence in women may be improper functioning of the central and peripheral nervous systems, as well as disturbances in the nervous regulation of bladder functions.
Stress-induced urinary dysfunction is associated with a decrease in collagen during menopause and subsequent muscle weakening and pelvic organ prolapse.
After childbirth, a mixed form of stress and urge incontinence may manifest itself, as a consequence of traumatic muscle damage. Characterized by an unbearable desire to urinate and leakage of urine when lifting heavy objects.
Permanent incontinence is associated with structural disorders of the urinary tract. And also with too long or, conversely, rapid labor, complicated by ruptures of the pelvic floor structures.
There are also exercises that strengthen the muscles responsible for urination and volitional control techniques, changing behavioral factors. Conservative methods are indicated for young women or patients who are undesirable to undergo surgery.
Drug therapy includes the use of sympathomimetics, anticholinergics, antidepressants, estrogens, and, for temporary incontinence, drugs that reduce the amount of urine.
If surgical intervention is necessary, women are given:
- minimally invasive sling surgery, which involves inserting a synthetic mesh or loop under the bladder neck or urethra;
- laparoscopic colposuspension, where the tissue around the urethra is raised to the inguinal ligaments. This operation gives a good effect in both immediate and long-term results;
- injections of drugs that compensate for the volume of soft tissues and fix the urethra in the desired position. The operation is performed under the control of a cystoscope.
Urinary incontinence in men
The most common causes of male enuresis:
- consequences of operations on the pelvic organs, urethra, prostate gland;
- age-related blood supply disorders;
- prolapse or displacement of abdominal organs;
- neurological diseases;
- weakness of the pelvic muscles due to a sedentary lifestyle;
- chronic intoxication (alcohol, drugs, diabetes).
Drug therapy for urinary incontinence in men includes drugs that tonic muscles and improve blood microcirculation; stimulating the central nervous system, antimicrobial, antiviral and hormonal.
Physiotherapy has a good effect - transcutaneous electrical stimulation and extracorporeal magnetic stimulation. Pelvic floor muscle training, controlled bladder emptying and a special diet are practiced.
Surgical methods offer:
- implantation of a bladder ring valve. The most effective solution to the problem of male enuresis following the removal of the prostate, adenoma and insufficiency of the internal sphincter;
- collagen injections. It is not a reliable method of treating men due to the temporary effect - collagen is redistributed and absorbed over time;
- implantation of a male loop (sling operations). The urethra is returned to its proper position after being wrapped in mesh and attached to the pelvic bones. A positive effect is achieved in 90% of cases.
Therapy for urinary incontinence can take place in three areas:
- Carrying out the operation. It is practiced in severe cases of pathology when other treatment methods have failed.
- Non-drug treatment. Gymnastics is designed to strengthen the pelvic floor muscles - Kegel exercises, holding the legs in weight in the “scissors”, “corner” exercises, raising the legs and pelvis upward in the “birch tree” exercise.
- Treatment with drugs. Gives a stable effect in case of urgent urinary incontinence. Medications relieve bladder overactivity, which increases bladder capacity. Antidepressants, antispasmodics, anticholinergics are used strictly under medical supervision.
- Lifestyle correction. Reducing the consumption of diuretics - coffee, chocolate, alcohol. Preventing constipation, as an additional factor of pressure on the pelvic floor muscles. Normalizing the drinking regime by increasing the amount of liquid drunk to 2 liters - this way the urine becomes less concentrated and does not irritate the walls of the bladder. Overweight control
Hygiene for urinary incontinence
Modern technologies make it possible not to bring the situation to the point of using symptomatic hygiene products. But as a temporary measure or in cases where the patient’s treatment options are limited, hygienic urological products can be used.
For mild and moderate forms of enuresis, urological pads are used to maintain the usual lifestyle. They are produced separately for men and women, taking into account the anatomical shape.
For people suffering from severe incontinence, diapers, diapers and sheets are intended.
Urological pads and diapers retain moisture for up to 12 hours, provide a feeling of dryness, absorb unpleasant odors and do not irritate the skin.
Urocondoms are intended for men; they are attached to the penis, and the tube that removes urine is directed into a urinal attached to the leg. He is invisible to others.
To avoid skin irritation and infections, the urethral area is kept clean using special cosmetics for patients with enuresis. After water procedures, it is better to treat the skin around the urethra with protective creams.
Consequences of urinary incontinence
If you do not consult a doctor, the quality of life of a person suffering from enuresis will deteriorate:
- Dermatological problems will appear: diaper rash, dermatitis;
- Cystitis, urethritis and other infectious diseases of the urinary tract will occur more often;
- A person’s constant companion will be psychological discomfort and fear of communicating with people. Intimate contacts become more difficult, frequent awakenings at night will not allow you to get enough sleep and rest.
Prognosis for the treatment of urinary incontinence
The prognosis for successful treatment of urinary incontinence is quite high; drug and surgical treatment leads to restoration of urinary control in 90% of cases. The doctor determines what type of therapy to use, taking into account the causes of the pathology and how willing the patient is to participate in health-improving activities.
Prevention of enuresis
If diseases are caused by heredity, injuries, or are complications after operations, it is difficult to prevent their occurrence. But the risk can be reduced by:
- healthy lifestyle;
- proper nutrition;
- maintaining optimal weight;
- quitting smoking and alcohol;
- control of hypertension and diabetes mellitus.
Stress and urgency urinary incontinence
0 RUB
Stress and urgency urinary incontinenceUrinary incontinence (incontinence) is an involuntary leakage of urine that cannot be controlled by volition. The pathology is widespread throughout the world. Data on the prevalence of urinary incontinence are contradictory, which is explained both by differences in the selection of study populations and by the fact that only a small proportion of patients suffering from various forms of urinary incontinence go to medical institutions.
Average data suggests that about 20% of the world's population suffers from urinary incontinence in one form or another. Russian researchers in the field of urology claim that urinary incontinence occurs in 12-70% of children and 15-40% of adults. With age, the incidence of urinary incontinence increases in both men and women. In the group of people under forty, incontinence is more common in women. In the older age group, the proportion of men increases due to age-related changes in the prostate.
Urinary incontinence sharply worsens the quality of life of patients, leading to the development of psycho-emotional disorders, professional, social, family and everyday maladjustment. Urinary incontinence is not an independent disease, but only a manifestation of pathological processes of various origins. The approach to treating urinary incontinence should be determined taking into account the underlying disease.
Classification of urinary incontinence
There are false and true urinary incontinence.
False urinary incontinence. False urinary incontinence is the involuntary leakage of urine due to congenital (total urethral epispadias, exstrophy of the bladder, ectopia of the ureteral orifice with an outlet in the vagina or urethra, etc.) or acquired (urinary fistula after injury) defects of the urethra, ureter or bladder.
True urinary incontinence. If urinary incontinence develops in the absence of the listed and similar gross defects, it is called true.
Causes of urinary incontinence
Anatomical disorders and local sensitivity disorders. Multiple or complicated childbirth, obesity, chronic inflammatory diseases of the pelvic organs, surgery on the pelvic organs, weightlifting and some other sports can change the normal anatomical position of the pelvic organs and affect the sensitivity threshold of nerve receptors. The consequence of changes in the urinary canal, bladder, ligaments and fascia of the pelvic floor is urinary incontinence.
Hormonal causes of urinary incontinence. Estrogen deficiency during menopause leads to the development of atrophic changes in the membranes of the genitourinary organs, ligaments and muscles of the pelvic floor, which, in turn, causes urinary incontinence.
Injuries and diseases of the central and peripheral system. Urinary incontinence can develop due to circulatory disorders, inflammatory diseases, injuries and tumors of the spinal cord and brain, diabetes mellitus, multiple sclerosis and some malformations of the central and peripheral nervous system.
Types of Urinary Incontinence
First, let's look at the process of normal urination. Urine is produced by the kidneys, enters the bladder, accumulates and stretches its walls. The detrusor (the muscle that expels urine) is in a relaxed state during the filling of the bladder. At a certain pressure, receptors in the wall of the bladder are excited. There is a urge to urinate. The detrusor muscle tightens and the bladder sphincter relaxes. Urination occurs when the pressure in the detrusor exceeds the pressure in the urethra. Normally, a person can control urination by tensing and relaxing the sphincter and pelvic floor muscles.
Stress urinary incontinence
Stressful urinary incontinence occurs when a condition is accompanied by an increase in intra-abdominal pressure (intense physical activity, coughing, laughter). There is no urge to urinate.
Stress urinary incontinence occurs due to a weakening of the pelvic floor with reduced collagen content in the pelvic ligaments. A decrease in collagen levels can be congenital, but more often develops with a lack of estrogen in menopausal and postmenopausal age.
Stress incontinence develops more often in women who smoke. Smoking leads to a decrease in the level of vitamin C in the body. Because decreased vitamin C levels affect the strength of collagen structures, some researchers believe that stress urinary incontinence in women who smoke is also caused by collagen deficiency.
One of the causes of stress urinary incontinence is the development of excessive mobility of the bladder neck or failure of the bladder sphincter. In these conditions, the cervix is stretched or displaced. The sphincter cannot fully contract. Lack of sufficient resistance when intra-abdominal pressure increases causes urinary incontinence.
The cause of stress urinary incontinence in some cases is direct damage to the sphincter (with a fracture of the pelvic bones, damage to the external sphincter in men during prostate surgery, etc.).
Urgent urinary incontinence
Urgent incontinence is called urinary incontinence, which occurs with an imperative (imperative) urge to urinate. The patient feels the need to urinate immediately and cannot postpone urination even for a very short period of time. In some cases of urgency urinary incontinence, the urge is not expressed or is weakly expressed.
Detrusor tension during the filling phase (overactive bladder) is normal in children under 2-3 years of age. Then the detrusor tone changes. However, approximately 10-15% of people continue to have overactive bladder throughout their lives. Urinary incontinence occurs when the pressure in the bladder exceeds the pressure in the urethra.
In some cases, bladder overactivity develops as a result of pathological processes in the central and peripheral nervous system. External stimuli (nervous excitement, drinking alcoholic beverages, the sound of running water, leaving a warm room into the cold) can act as a provoking factor for urge incontinence. The importance of urinary control in some cases becomes the reason for the neurotic “linking” of urge urinary incontinence to certain events (for example, appearing in public).
Mixed urinary incontinence
With mixed incontinence, there is a combination of symptoms of urgency and stress urinary incontinence.
Paradoxical urinary incontinence (overflow incontinence)
Develops in elderly patients suffering from diseases of the genitourinary organs (more often - prostate adenoma, less often - urethral stricture of various etiologies and prostate cancer). Associated with overfilling and overstretching of the bladder due to long-term obstructions to the outflow of urine.
Temporary (transient) urinary incontinence
In some cases, urinary incontinence develops under the influence of a number of external factors (acute cystitis in the elderly, severe alcohol intoxication, constipation) and disappears after eliminating these factors.
Diagnosis of urinary incontinence
Diagnosis begins with determining the causes and severity of urinary incontinence. Collect patient complaints and a detailed history of the development of incontinence. The patient fills out a urination diary, which reflects the volume and frequency of urination. For urinary incontinence in women, consultation with a gynecologist with a gynecological examination, during which cystocele, prolapse of the uterus and vagina are detected, is of great diagnostic importance. A cough test is performed (with pronounced prolapse of the uterus and anterior vaginal wall, the test is sometimes negative; in this case, a possible latent form of urinary incontinence is assumed). To accurately determine urine loss, a pad test is performed.
The anatomical state of the pelvic floor, storage and evacuation functions of the bladder are examined using ultrasound of the bladder or urethrocystography. Laboratory testing of urine is carried out, urine cultures are performed for microflora.
Treatment of urinary incontinence
Nowadays, urinary incontinence is treated both conservatively (drug and non-drug therapy) and surgically. The therapeutic technique is selected individually by the urologist after a detailed examination of the patient, determining the causes and degree of urinary incontinence. The indication for surgical treatment of urinary incontinence is the ineffectiveness or insufficient effect of conservative therapy.
Non-drug therapy for urinary incontinence
Bladder training is recommended for all patients with urinary incontinence. Patients are recommended to perform exercises for the pelvic muscles. General measures are taken (normalization of physical activity, diet to promote weight loss).
Bladder training consists of three stages: training, creating a voiding plan, and executing that plan. A patient who has suffered from urinary incontinence for a long time develops a special urination stereotype. The patient is afraid that urination may occur at the wrong time, so he tries to empty the bladder in advance, when the first weak urge occurs.
Bladder training is done to gradually increase the time interval between urinations. An individual urination plan is drawn up for the patient. If the urge to urinate appears at inopportune times, the patient must restrain them by intensively contracting the anal sphincter. First, a minimum interval between urinations is established. Every 2-3 weeks this interval is increased by 30 minutes until it reaches 3-3.5 hours.
As a rule, bladder training is carried out simultaneously with a course of drug therapy. Treatment lasts about three months. After this period of time, the patient usually develops a new urinary pattern. If treatment is successful, discontinuation of medications should not cause increased frequency of urination or lead to urinary incontinence.
A special method of bladder training has been created for patients with severe intellectual disabilities - the so-called “prompted urination”. The training is carried out in three stages. First, the patient is taught to determine when he is dry and when he is wet after urination. Then they are taught to recognize the urge and report it to others. At the last stage, the patient achieves complete control over urination.
Drug therapy for urinary incontinence
Medicines are used to treat all forms of urinary incontinence. The greatest effect of drug therapy is observed in patients with urge incontinence. Medicines are prescribed to increase the functional capacity of the bladder and reduce its contractile activity.
The drugs of choice for the treatment of urge urinary incontinence are antispasmodics and antidepressants. One of the most effective drugs used in the treatment of urinary incontinence is oxybutin. The drug interrupts irregular irritating impulses from the central nervous system and relaxes the detrusor. The dosage is selected individually. The duration of a course of drug treatment for urinary incontinence, as a rule, does not exceed 3 months. The effect of therapy usually lasts for several months, sometimes longer. If urinary incontinence recurs, repeated courses of drug therapy are carried out.
Surgical treatment of urinary incontinence
In most cases, good results in the treatment of urinary incontinence can be achieved using conservative methods. In case of insufficient effectiveness or lack of effect from drug and non-drug therapy, surgical treatment of urinary incontinence is performed. Surgical tactics are determined depending on the form of urinary incontinence and the results of previous conservative treatment. Surgery is more often required for patients with stress and paradoxical urinary incontinence, and less often for patients suffering from urge urinary incontinence.
Minimally invasive methods for treating urinary incontinence
There are minimally invasive treatments for urinary incontinence. The patient is given injections of collagen, homogenized autologous fat, Teflon paste, etc. This technique is used for stress urinary incontinence in women if there are no neurogenic urinary disorders (neurogenic bladder). Treatment is not indicated for severe prolapse of the bladder and vaginal walls.
In the surgical treatment of urinary incontinence, loop (sling) operations are widely used. To form a free loop, synthetic materials (TVT, TOT set), a flap from the anterior vaginal wall, a muscular aponeurotic or skin flap are used. The greatest efficiency (90-96%) is achieved when using synthetic materials.
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According to studies, about 39% of women in Russia over the age of 40 suffer from urinary incontinence, and only 4% do not consider this phenomenon to be natural.
URINARY INCONTINENCE IN MEN
In men, compared to women, urinary incontinence is much less common and, as a rule, appears after surgical interventions on the prostate gland (transvesical adenomectomy, transurethral resection of the prostate, radical prostatectomy).
WHAT IS THE MECHANISM FOR NORMAL URINE RETENTION?
Normal urine retention carried out through the interaction of four main mechanisms:
1. correct position of the bladder in the body;
2. immobility of the urethra;
3. adequate innervation of the pelvic floor muscles and the muscular lining of the bladder;
4. anatomical and functional integrity of the closing apparatus of the bladder and urethra.
URINARY INCONTINENCE – A DISEASE OR A NORMAL VARIANT?
Urinary incontinence is a pathological condition in which involuntary loss of urine occurs as a result of:
- violations of adequate innervation of the muscular membrane of the bladder and pelvic floor muscles;
- pathological mobility of the urethra;
- failure of the closing apparatus of the bladder and urethra;
- bladder instability.
TYPES OF URINARY INCONTINENCE
According to the International Continence Society, there are six types of urinary incontinence:
1. Urgent urinary incontinence– involuntary release of urine with a sudden, strong and unbearable urge to urinate.
2. Stress urinary incontinence (stress incontinence)– involuntary release of urine during physical activity, coughing, sneezing, etc., i.e. in cases of a sharp increase in intra-abdominal pressure.
3. Reflex urinary incontinence.
4. Involuntary leakage of urine.
5. Bedwetting (enuresis).
6. Urine leakage after finishing urination.
The most common and common are urge urinary incontinence and stress urinary incontinence.
WHAT ARE THE RISK FACTORS FOR URINary INCONTINENCE?
1. Gender of the patient – more common in females.
2. Age of the patient - more common after 40 years.
3. Increased weight of the patient.
4. Hereditary factor – genetic predisposition to the development of urinary incontinence.
5. Neurological factor – the presence of various diseases of the nervous system.
6. Anatomical factor – anatomical disorders of the pelvic floor muscles and pelvic organs.
7. Surgical interventions - damage to the pelvic nerves or muscles.
8. Pregnancy, childbirth.
WHAT ARE THE MAIN SYMPTOMS OF URINary INCONTINENCE?
1. Involuntary loss of urine during physical activity, coughing, sneezing, sexual intercourse, or at rest.
2. Episodes of involuntary urine loss with a strong, sudden urge to urinate.
WHAT TO DO IF YOU DETECT SYMPTOMS OF URINary INCONTINENCE?
You shouldn’t live with this problem, traumatizing your psyche and giving up a full life! Urinary incontinence can be treated. To do this, first of all, you need to seek help from a qualified specialist (urologist), who will help you choose the most effective and appropriate treatment method for your specific case!
Let's take a closer look stress incontinence(or stress incontinence)– involuntary and uncontrolled release of urine during physical activity, coughing, laughing, dancing. In general, for all conditions accompanied by an increase in abdominal pressure.
This happens due to weakening of the ligamentous apparatus of the urethra, which leads to its hypermobility. The reasons may be different: complicated childbirth, decreased estrogen levels, heavy physical labor, previous surgeries.
This problem significantly reduces a woman’s quality of life. According to European data, about 45% of women aged 40-60 years suffer from urinary incontinence to one degree or another. In Russia, the proportion of women suffering from urinary incontinence is 38.6%.
WHY DOES URINE STOP HOLDING?
Let's consider the functioning of the bladder and urethra (urethra) under normal conditions.
Urine accumulates in the bladder and in order for it to remain there as long as needed, the pressure in the urethra must be greater than in the bladder. With physical activity, coughing, laughing, etc., the pressure in a woman’s abdominal cavity increases. In the normal state of the ligaments, this pressure is evenly transmitted to both the bladder and the urethra. Accordingly, the pressure in the bladder and urethra increases equally. If the ligaments are “weakened,” then when tension occurs, the bladder and urethra move downward. As a result, when intra-abdominal pressure increases, it is transmitted only to the bladder, and the pressure on the urethra leaves the zone of transmission of intra-abdominal pressure. That is, the pressure in the bladder increases, but in the urethra - not. This means that the pressure in the urethra becomes less than in the bladder. The result is loss of urine.
WHY DO LIGAMENTS WEAKEN?
The reasons, as we have already written, are different: difficult childbirth, excessive physical labor, injuries and, of course, insufficiency of female sex hormones - estrogens. Moreover, there may be a lack of estrogen not only during menopause, but also before it.
TREATMENT
- Conservative treatment of stress urinary incontinence.
As a rule, in the conservative treatment of urinary incontinence, a combination of various techniques is used (behavioral therapy + electrical stimulation)
1) Behavioral therapy- special exercises to strengthen the pelvic muscles.
2) Electrical stimulation of the pelvic floor muscles acts directly on the pudendal nerve, which provides contraction of the pelvic muscles and perurethral muscles. Stimulation strengthens the sphincter and pelvic floor muscles without directly correcting the anatomical defect that causes urinary incontinence.
- Surgery.
The goal of surgical treatment of stress urinary incontinence is to create additional support for the urethra in order to eliminate pathological mobility. The choice of one method or another largely depends on the degree of urinary incontinence:
- paraurethral administration of bulk-forming substances in the tissue surrounding the urethra. Through two punctures on the sides of the external opening of the urethra or on the anterior wall of the vagina, several milliliters of gel are injected into the area of the external sphincter of the bladder. These are either polyacrylamide gels or gels based on hyaluronic biopolymer. Unfortunately, the effect of such intervention is not always long-lasting. As a rule, a repeat procedure is required after a year.
- Urethrocystocervicopexy (Birch operation). Currently widely used, but is a large-scale surgical intervention requiring a long postoperative period
- sling (loop) operations.
There are many options for loop (sling) operations, during which the effect (urinary retention) is achieved by creating reliable additional support for the urethra by placing a loop made of various materials (vaginal flap, skin, cadaveric fascia) under the middle part of the urethra.
The next most common type of urinary incontinence is urge or overactive bladder.
Overactive Bladder (OAB)) is an increase in the number of nerve receptors in the wall of the bladder and their sensitivity, as well as a violation of the control of the central nervous system over urination for various reasons (damage to the spinal cord and brain, multiple sclerosis), the reflex to urinate does not reach the brain and is closed in the spinal cord . Impulses from the bladder (stretching the bladder wall, direct contact with the chemical components of urine) are normally transmitted along sensory fibers to the brain. If there are conditions for urination, then the brain transmits the command to urinate through efferent fibers. When there are no conditions, urine is retained as long as needed. If the transmission of nerve impulses to the brain is impossible, then urination occurs without a command, spontaneously.
The bladder has 2 main functions:
1) Accumulation of urine.
2) Urine discharge.
There are two main muscles in the bladder: the detrusor muscle, which expels urine, and the sphincter muscle, which retains it.
Overactive Bladder– this is a violation of the accumulation phase. It is often confused with cystitis - indeed, the symptoms of these diseases are similar. Both with cystitis and with an overactive bladder, the possibility of urine accumulation in the bladder is impaired, that is, the urge to urinate appears when the bladder is not full. The difference between an overactive bladder and a normal bladder is that the urge to urinate occurs with less urine and the detrusor can contract and the sphincter relax without a command from the brain.
Symptoms of an overactive bladder:
- Frequent urination.
- Sudden urge to urinate.
- Urinary incontinence.
- Urination in small portions.
Treatment of overactive bladder.
Currently, the main “target” in the treatment of overactive bladder is various bladder receptors.
As initial therapy, M-anticholinergic blockers are usually used, which block acetylcholine receptors in parasympathetic (motor) nerve fibers. These medications reduce the frequency of urination and the risk of urine loss. Their main disadvantage is side effects (dry mouth, constipation). If M-anticholinergic drugs are ineffective, endoscopic injections are used botulinum toxin into the detrusor.
It is an effective treatment for overactive bladder, especially when accompanied by urge incontinence. The disadvantage is that these injections must be repeated every 6 to 8 months, and botulinum toxin is quite an expensive drug.
Also used neuromodulation (tibial or sacral), biofeedback therapy.
- Tibialneuromodulation.
biofeedback therapy with biofeedback.
An animated picture is displayed on the screen of the device, for example, a swimming fish. When the muscles are tense, the fish rises up, and when it relaxes, it goes down. In this way, the patient learns to control his muscles, train their strength or relax them.
Today, biofeedback therapy is an effective method for treating urinary disorders and pelvic pain.
PS: Although overactive bladder is a disease that is quite difficult to treat, modern techniques can significantly improve the patient’s condition, and in some cases, completely cure it. To do this, you need a timely visit to a specialist doctor (urologist).
REMEMBER: URINARY INCONTINENCE IS A DISEASE THAT WILL NEVER CURE ON YOURSELF WITHOUT THE HELP OF A QUALIFIED PROFESSIONAL!
Causes of urinary incontinence. Directions for treating the disease. How can you cope with folk remedies?
Urinary incontinence is a disease in which it is not always possible to control the process of urination. This disease does not, at first glance, have physiological consequences, but it definitely does not allow you to feel comfortable and leads to the development of psychological problems against the backdrop of constant thoughts about possible unpleasant odors that other people may smell, so it is necessary to treat it. In practice, the pathology develops in women aged 50–70 years and has the following statistics:
- 5–15% of the total adult population;
- 20–30% of the number of hospitalized;
- up to 70% of those in a nursing home.
Causes of urinary incontinence
The problem may be due to the following factors:
- surgical interventions;
- difficult childbirth;
- taking a number of medications;
- hormonal imbalances (lack of estrogen);
- transferred ;
- pregnancy;
- changes in the central nervous system and so on.
The direct cause of incontinence remains excessive pressure on the bladder, muscle weakness or a problem with their control for objective reasons.
Urinary incontinence can occur in the presence of a number of serious diseases and their treatment. We are talking, for example, about the insertion of a catheter, sepsis, cystitis or bedsores. The use of a number of medications can also be a cause. In any case, when you get rid of the underlying disease or stop taking medications, urinary incontinence automatically disappears.
Symptoms of urinary incontinence in women
The following factors indicate pathology:
- sensation of a foreign body in the vagina;
- dripping urine after visiting the toilet;
- urine leakage;
- regular urge at night;
- the appearance of urine during more or less serious physical activity, when coughing, sneezing or laughing.
Types of urinary incontinence
The disease is divided into two main groups:
- stressful;
- urgent.
The first implies involuntary uncontrolled urination, which occurs when pressure increases from the abdominal cavity. Most often, urinary incontinence is observed when lifting heavy objects, coughing, sneezing, and at the same time no urge is observed.
Urgent urinary incontinence refers to the uncontrolled release of urine, which is necessarily accompanied by a strong urge. The latter occurs even if the bladder is not full and it is not possible to stop urination.
How to quickly cure urinary incontinence in women (enuresis) at home
To get rid of the problem, it is necessary to correctly identify the cause of the pathology. With the urgent type of urinary incontinence, medications are usually prescribed to quickly cope with the disease. Doctors usually prescribe antispasmodics, antidepressants and hormonal drugs. The stressful appearance of not being able to control your urine output can be dealt with on your own. Treatment in the latter case is carried out using the following methods:
- exercises for intimate muscles;
- training the bladder itself;
- physiotherapeutic procedures.
Gymnastics of intimate muscles
This is a great way to strengthen the muscles of the intimate area, which will further improve blood supply to the reproductive system, give more pleasure from intimacy, and help you achieve orgasm faster. First you need to find the muscles responsible for urination and closing the exit of urine from the bladder. To do this, interrupt it and remember the feelings, which you will then need to repeat.
Kegel exercises, which involve tenfold tensing of the intimate muscles and pulling them inward, will help you achieve the desired result and get rid of urinary incontinence. You need to strain them for 10 seconds, followed by a similar relaxation time. It is advisable to do exercises to combat enuresis in the morning and evening after emptying the bladder in one of the following positions:
- lying on your back, legs relaxed and bent at the knees, one hand under the buttocks, and the other under the head;
- lying on your stomach, arms under your head, a small pillow under your pelvis, legs straight apart.
Please note that when performing exercises to combat urinary incontinence, breathing should be even and calm, and it is forbidden to suck in the stomach.
Bladder training
This method of combating enuresis (urinary incontinence) is more difficult and time-consuming. Its essence is to gradually increase the time between trips to the toilet. To do this, it is advisable to draw up a plan in advance and gradually increase the intervals according to it. This will make it possible to better control impulses by training the corresponding muscles, but there are nuances associated with fluctuations in the volume of liquid drunk and, accordingly, the amount of urine formed in the body.
Physiotherapy for urinary incontinence
Usually prescribed by a doctor and carried out in parallel with taking medications. Depending on the situation, electrophoresis, galvanic current or electromyostimulation may be prescribed.
Folk remedies for urinary incontinence in women
Today, a fairly large number of folk recipes for the treatment of urinary incontinence are known. They have proven to be effective, but when using them, pay attention to the following factors:
- consider whether you have any allergies or intolerances to components of traditional recipes;
- if there is no proper result or problems with urinary incontinence quickly reappear, consult a doctor for professional help;
- Before you start using folk remedies for treatment, be sure to consult your doctor (this is especially true if you have any chronic diseases).
Folk recipes for combating urinary incontinence in women are herbal infusions containing special elements that have a beneficial effect on health and relieve unpleasant symptoms. You can purchase these infusions in specialized departments of pharmacies and stores, but you can also prepare them yourself by collecting the necessary plants during the season and drying them properly (we recommend collecting medicinal plants in ecologically clean areas away from roads).
Herbal tea with nettle
- May nettle (100 g);
- marshmallow root (100 g);
- yarrow herb (70 g).
The collection to combat urinary incontinence must be poured with boiling water at the rate of half a liter of water per two tablespoons of dry mixture (it is preferable to use a thermos to slow down the drop in temperature and ensure that the maximum nutrients are extracted from the leaves). The finished solution is filtered 6–8 hours after steaming and taken in small portions throughout the day.
Herbal mixture with chicory
- centaury root;
- yarrow root:
- chicory root.
Take the three components in equal volumes and mix. Two tablespoons of the product are steamed with half a liter of boiling water and infused for an hour. To get the desired effect in the fight against urinary incontinence, drink half a glass of the prepared infusion. You can repeat the procedure up to six times daily.
Rose hip decoction
Take 4 tablespoons of rose hips and one spoon of drupes. Pour the mixture with a liter of water and cook over low heat for 30 minutes. Then add two tablespoons of rosehip flowers to the broth and wait until it boils again. The resulting infusion is filtered after cooling, and for treatment it is taken twice a day, 150–200 milliliters. Please note that this decoction has a general beneficial effect on the body, and not only fights urinary incontinence. As a result, the infusion will help maintain immunity and improve well-being.
Decoction of bay leaves
Take 3-4 leaves and boil them in a glass of water for 15 minutes. Then the broth is cooled and consumed for a week, 100 milliliters three times a day. Within a few days you will notice an improvement in your condition, since the substances contained in the bay leaf are good at combating urinary incontinence.
St. John's wort decoction
Pour 50 grams of dried herbs with a liter of boiling water and leave for four hours. You can drink it without any restrictions during the day.
Decoction of plantain leaves
Pour boiling water over fresh leaves and leave for an hour. After straining the finished infusion, drink half a glass before meals four times a day for two weeks.
How else can you fight pathology at home?
Another way to combat urinary incontinence in women is to normalize their lifestyle. This will reduce symptoms and become an excellent prevention option when the disease either does not occur or appears much later. To do this, adhere to the following rules:
- normalize the amount of water consumed during the day (you cannot reduce the volume of fluid due to dehydration of the body and irritation of the urinary tract due to increased concentration);
- stop smoking;
- increase physical activity (at least try to take 10,000 steps daily);
- reduce the amount of citrus fruits, coffee, sweets, spices, spicy foods and tomatoes you consume, which irritate the bladder;
- bring your weight back to normal (obese people have weaker pelvic muscles, which makes it difficult to retain urine);
- Maintain intimate hygiene, which will prevent infection of the genitourinary system and the development of diseases.
Another cause of urinary incontinence is constipation, when the intestines put pressure on the bladder. To level out this factor at home, adhere to the following rules:
- try to drink enough water daily;
- give preference to steamed dishes;
- Eat more fiber-rich foods (cereals, vegetables, fruits) every day.
Let’s take a special look at freshly squeezed carrot juice. It is ideal for complex therapy, maintaining immunity and vision, and also has an excellent effect on the functioning of the genitourinary system, helping to combat urinary incontinence. To get rid of the problem, drink a glass of this juice every morning before breakfast, which is inexpensive and can be prepared independently at home.
What to do if nothing helps
If you have been using traditional methods of treating urinary incontinence in women for a long time, and there is no desired result or the disease returns quickly, you need to consult a doctor (a visit to the latter is required if pain occurs, fever, or change in the color of urine). After collecting anamnesis, the specialist will conduct a diagnosis, including the following steps:
- general urine analysis;
- examination of the vagina with collection of a smear for laboratory testing;
- Ultrasound examination of the kidneys, bladder and ureter for inflammation.
Additionally, an assessment of the volume of residual urine and an examination of the pelvic organs may be prescribed.
Prognosis for treatment of urinary incontinence
In practice, the problem is treated quite successfully, provided that the cause of the disease is detected in a timely manner and it is stopped. If there are no strong inflammatory processes or objective factors due to which a person cannot control urination, then the problem disappears fairly quickly. An exception would be, for example, pregnancy, when pressure on the bladder from the fetus will disappear automatically after childbirth and recovery.
