Urinary incontinence dramatically worsens the quality of life of patients, leads to the development of psycho-emotional disorders, professional, social, family and household maladaptation. Incontinence is not an independent disease, but only a manifestation of pathological processes of various origins. The approach to the treatment of urinary incontinence should be determined taking into account the underlying disease.
WHAT IS URINARY INCONTINENCE?
Urinary incontinence is the involuntary leakage of urine, which cannot be controlled by volitional force. The pathology is widespread throughout the world. Data on the incidence of urinary incontinence are contradictory, due to both differences in the choice of the studied populations and the fact that only a small proportion of patients suffering from various forms of urinary incontinence turn to medical institutions.
Averaged data suggest that about 20% of the world's population suffers from some form of urinary incontinence. Russian urological researchers say that urinary incontinence is observed in 12-70% of children and 15-40% of adults. With age, the incidence of urinary incontinence increases in both men and women. In a group of people under the age of 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.
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Classification of urinary incontinence
Allocate false and true urinary incontinence.
False urinary incontinence . False urinary incontinence refers to involuntary leakage of urine during congenital (total epispadias of the urethra, extrophy of the bladder, ectopia of the mouth of the ureter with access to the vagina or urethra, etc.) or acquired (urinary fistula after trauma) defects of the urethra, ureter, or ureter.
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 disturbances of sensitivity . Multiple or complicated births, obesity, chronic inflammatory diseases of the pelvic organs, pelvic surgery, weight lifting and some other sports can alter the normal anatomical position of the pelvic organs and affect the sensitivity threshold of nerve receptors. Urinary incontinence results from changes in the urinary canal, bladder, ligaments and fascia of the pelvic floor.
Hormonal causes of urinary incontinence . Estrogen deficiency in 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 with 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 Incontinence
First, consider the process of normal urination. Urine is produced by the kidneys, enters the bladder, accumulates and stretches its walls. Detrusor (a 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 strains, the sphincter of the bladder relaxes. Urination occurs when the pressure in the detrusor exceeds the pressure in the urethra. Normally, a person can control urination by straining and relaxing the sphincter and pelvic floor muscles.
Stress urinary incontinence
Stress is called urinary incontinence, which occurs in a condition that is accompanied by an increase in intra-abdominal pressure (intense physical activity, cough, laughter). There are no urge to urinate.
Stress urinary incontinence occurs due to weakening of the pelvic floor with a reduced collagen content in the pelvic ligaments. A decrease in collagen levels is congenital, but more often develops with a lack of estrogen in menopausal and postmenopausal age.
Stress incontinence often develops in women who smoke. Smoking leads to lower levels of vitamin C in the body. Since a decrease in vitamin C levels affects the strength of collagen structures, some researchers believe that collagen deficiency is also a cause of stress urinary incontinence in smoking women.
One of the causes of stress urinary incontinence is the development of excessive mobility of the neck of the bladder or the failure of the press (sphincter) of the bladder. The neck in these conditions is stretched or displaced. The sphincter cannot fully contract. Lack of sufficient resistance with increased intra-abdominal pressure 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 surgery on the prostate gland, etc.).
Urgent incontinence is called urinary incontinence, which occurs when imperative (imperative) urination. The patient feels the need to urinate immediately and cannot delay urination even for a very short period of time. In some cases of urgent urinary incontinence, the urge is not expressed or weakly expressed.
Detrusor stress in the filling phase (bladder hyperactivity) is the norm in children under the age of 2-3 years. Then the detrusor tone changes. However, in about 10-15% of people, overactive bladder persists throughout life. In this case, urinary incontinence appears if the pressure in the bladder exceeds the pressure in the urethra.
In some cases, overactive bladder develops during pathological processes in the central and peripheral nervous system. External irritants (nervous excitement, drinking alcohol, the sound of flowing water, leaving the warm room in the cold) can act as a provoking factor in urgent incontinence. The importance of urination control in some cases causes a neurotic “binding” of urgent urinary incontinence to certain events (for example, appearance in humans).
Mixed urinary incontinence
With mixed incontinence, a combination of symptoms of urgent and stress urinary incontinence is observed.
Paradoxical urinary incontinence (overflow incontinence)
It 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). It is associated with overfilling and overstretching of the bladder due to long-standing obstacles to the outflow of urine.
Temporary (transient) urinary incontinence
In some cases, urinary incontinence develops when exposed to a number of external factors (acute cystitis in the elderly, severe intoxication, constipation) and disappears after the elimination of these factors.
Diagnosis of urinary incontinence
Diagnosis begins with the determination of the causes and severity of urinary incontinence. Collect patient complaints, a detailed history of incontinence. The patient fills the urination diary, which reflects the volume and frequency of urination. With urinary incontinence in women, the consultation of a gynecologist with a gynecological examination, during which cystocele, omission of the uterus and vagina, 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 the loss of urine, a cushion test is performed.
The anatomical state of the pelvic floor, cumulative and evacuation functions of the bladder are examined using ultrasound of the bladder or urethrocystography. A laboratory study of urine is carried out, urine culture on microflora is performed.
Urinary incontinence treatment
Nowadays, urinary incontinence is treated both conservatively (drug and non-drug therapy), and promptly. The therapeutic technique is selected by the urologist individually after a detailed examination of the patient, determining the causes and degree of urinary incontinence. An indication for the surgical treatment of urinary incontinence is the ineffectiveness or inadequate effect of conservative therapy.
Non-drug therapy for urinary incontinence
All patients with urinary incontinence are shown bladder training. Patients are advised to perform pelvic muscle exercises. General measures are being taken (normalization of physical activity, a diet that promotes weight loss).
Bladder training consists of three stages: training, drawing up a urination plan and completing this plan. In a patient suffering from urinary incontinence for a long time, a special stereotype of urination is developed. 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 carried out in order to gradually increase the time interval between urination. An individual urination plan is drawn up for the patient. If the urge to urinate appears at an inopportune time, the patient should restrain them, intensively reducing the anal sphincter. Initially, the minimum interval between urination is set. Every 2-3 weeks, this interval is increased by 30 minutes until it reaches 3-3.5 hours.
As a rule, training the bladder is carried out simultaneously with the course of drug therapy. Treatment lasts about three months. After this period of time, the patient usually forms a new stereotype of urination. With successful treatment, drug withdrawal should not cause increased urination or lead to urinary incontinence.
A special bladder training technique has been created for patients with severe intellectual impairments - the so-called “urination at the prompt”. Training is carried out in three stages. At first, the patient is taught to determine when he is dry, and when - wet after urination. Then they teach to recognize the urge and communicate about it to others. At the last stage, achieve complete control of the patient 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 urgent incontinence. Medicines are prescribed to increase the functional capacity of the bladder and reduce its contractile activity.
The drugs of choice in the treatment of urgent 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. 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. With the resumption of urinary incontinence, repeated courses of drug therapy are carried out.
Surgical treatment of urinary incontinence
In most cases, conservative methods can achieve a good result in the treatment of urinary incontinence. With insufficient effectiveness or lack of effect of 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 stressful and paradoxical urinary incontinence, less often for patients suffering from urgent urinary incontinence.
Minimally invasive urinary incontinence treatments
There are minimally invasive treatments for urinary incontinence. The patient is injected with collagen, homogenized autogyro, Teflon paste, etc. This technique is used for stress urinary incontinence in women, if there are no neurogenic disorders of urination (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 are used (set of TVT, TOT), a flap from the front wall of the vagina, a muscle-aponeurotic or skin flap. The greatest efficiency (90-96%) is achieved using synthetic materials.
NATURAL RECIPES FOR URINARY INCONTINENCE
- Take 45 grams of grass and St. John's wort flowers. Further, this amount is poured into 1000 ml of water heated to a temperature of 96 degrees Celsius. After this, the infusion in the container is closed with a piece of red cloth, and it is infused for 3 hours. 10 ml is taken 3 times a day for 10 days.
- Take 30 grams of St. John's wort grass and 30 grams of centaury grass. Further, this amount is poured into 1000 ml of hot water (temperature 90 - 96 degrees Celsius). After this, the infusion of herbs is covered with a piece of red cloth, insist 3 hours. Some grandfathers advise taking 7 ml 3 times a day for 10 days.
Take lingonberry berries 1 tablespoon, St. John's wort grass 1 tablespoon, lingonberry leaves 1 tablespoon. Put everything in 500 ml of water. Bring to a boil. Let it brew for 2 hours. Strain through cheesecloth. Take 100 ml 4 times a day for 20 days.
1 teaspoon of St. John's wort grass, 1 teaspoon of lingonberry leaves, finely chopped with a ceramic knife, 1 teaspoon of lingonberry. All this is taken and filled with 300 ml of water and boiled for 3 minutes. Then the solution cools. Give children 50 ml 6 times a day.
Before going to bed, some give half a teaspoon of honey to the child for 10 days. Then give a quarter teaspoon for 10 days. Then give one sixth of a teaspoon for 10 days. This recipe can be used only if there is no allergy to honey, beekeeping products.
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