Urinary incontinence is a significant problem leading to social maladaptation of a man, limiting his opportunities for labor and domestic activities, leading to psycho-emotional stress and often to forced isolation from society. But most importantly: urinary incontinence in men is very difficult to treat. And although this disease does not threaten life, it nevertheless significantly reduces its quality. Let's look at the forms and manifestations of urinary incontinence in men, methods of diagnosis and treatment, and, of course, in ways of maintaining hygiene.
WHAT ARE THE MANIFESTATIONS OF UNCONTROLLED URINE OUTPUT?
One of the problems in the treatment of uncontrolled urine output in men is too late to contact a urologist. According to statistics, no more than 30% of those suffering from this disease go to the doctor, and this is facilitated by the so-called false shame. However, certain forms of urinary incontinence are treated quite successfully if therapy is started on time and not self-medicated.
The main manifestations of uncontrolled urine output are:
Enuresis (Enuresis) , or sleep- related incontinence, is mainly a childhood and adolescent disease, adult men account for less than one percent of the total number of people suffering from this disease.
Incontinence (Incontinence) - actually "incontinence" in translation from Latin, has several varieties, depending on the cause.
Leakage of urine after urination (PMD - Post Micturition Dribbling) - when an uncontrolled discharge of a few drops of urine occurs. It is due to male physiology, which is expressed in a longer (10-15 cm) urethra than in women.
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Causes of urinary incontinence in men
The causes of male incontinence are very diverse, they can be grouped as follows:
- Lesions of the central nervous system (CNS):
- Due to diseases (stroke, Parkinson's disease, multiple sclerosis, circulatory disorders in the brain);
- traumatic origin (congenital malformations of the central nervous system, damage to the brain or spinal cord);
- with chronic intoxication (diabetic, alcoholic, narcotic, etc.).
- Postoperative urinary incontinence due to surgical manipulations on the pelvic organs, bladder, urethra, prostate gland, especially in case of unsuccessful operations.
- Age-related disorders of local blood supply, neurohumoral regulation of physiological functions.
- Dysfunctions of the bladder, urethra, ureters of neurogenic origin.
- Tumors of the organs of the urinary system and pelvis, including cancer and benign prostatic hyperplasia (adenoma) (BPH).
- Infectious diseases of the urinary tract (prostatitis, cystitis, urethritis).
- The prolapse (ptosis) or displacement of the internal organs of the abdominal cavity and pelvis, exerting pressure on the bladder and prostate, which occurs when the muscles and connective tissues are weakened, excessive physical exertion, a sedentary lifestyle, or chronic constipation.
- Urolithiasis and kidney stones.
- External remote radiation therapy in the treatment of prostate cancer.
- Chronic stress or mental illness.
- Side effects of drug therapy (due to the use of antidepressants, tranquilizers, diuretics, antihistamines and decongestants that affect muscle tone, etc.).
- Anomalies in the development of the genitourinary system (congenital malformations) and genetic causes.
Classification and features of incontinence in men
As mentioned above, the classification of incontinence in men is based on the causes of urinary incontinence. According to this, six main types of uncontrolled allocation of urine are distinguished. Consider them briefly.
Despite the fact that stress incontinence, or incontinence under the influence of effort (tension), is much more common in women, men are also affected. It manifests itself against the background of a sudden sharp increase in abdominal pressure as a result of coughing, sneezing, laughing, lifting weights, getting up from a sitting or lying position, loss of balance during walking and some other provocative situations. A key feature of this type of urinary incontinence is the lack of urge to urinate immediately before uncontrolled urine output, the degree of incontinence is drip or light.
According to epidemiological studies conducted in several countries of the world, the incidence of stress urinary incontinence is 50% of all other types of incontinence (VA Mikassian, HP Dralzetal., 2003).
Urgent (imperative) urinary incontinence (Urge Incontinence)
It is characterized by sudden, strong and unbearable urge to urinate, which is very difficult or impossible to overcome, putting off going to the toilet at a later time. Even a small filling of the bladder provokes a spasm, as a result of which urine is lost. It is characteristic that limited fluid intake does not produce a positive effect, the additional risk factors for this type of incontinence may be the sound of pouring water, as well as touching the jet. With urgent incontinence, the need to use the toilet arises no more than 2 hours later, and this interval is maintained day and night. The suddenness and strength of the urge is such that the person suffering from this ailment often does not have time to empty the bladder in a timely manner and loses urine on the way, for example, from the bed to the toilet.
Blame hyperactivity of the bladder, which can be caused by neurogenic causes, as well as infections of the genitourinary system and tumors, is to blame. Age is an additional aggravating factor in the development of urgent urinary incontinence in men. Epidemiological studies conducted in different countries of the world have shown that imperative (urgent) incontinence is the second most common type of urinary incontinence among men - 14% (VA Mikassian, HP Dralzetal., 2003).
Mixed (combined) urinary incontinence (Combined Incontinence)
As the name implies, such urinary incontinence in men involves a combination of 2 or more types of incontinence, most often urgent and stressful, the symptoms of which can be expressed to varying degrees.
Statistics based on recent epidemiological studies show that mixed urinary incontinence in men is approximately 32%, and a high proportion of this type of incontinence compared to other types of uncontrolled urine excretion is due to the frequency of manifestations of stress and urgent incontinence, often found in combination (VA Mikassian HP Dralzetal. 2003).
According to statistics, the first three forms of incontinence are the most common, although there are others listed below, they together account for about 5% of all manifestations of urinary incontinence in men.
The cause of postoperative incontinence is surgery on the prostate and urethra, for example:
- radical prostatectomy (removal of the prostate in oncology);
- transvesical or posterior adenomectomy (removal of a benign tumor of the prostate);
- transurethral resection (truncation, removal) of the prostate (TUR of the prostate for cancer, benign neoplasms, chronic inflammatory processes);
- surgery for urethral stricture;
- operations for traumatic injuries of the urethra;
- other operations and manipulations on the urethra.
Strictly speaking, postoperative urinary incontinence in men can be attributed to a special case of stressful (with tension) incontinence, which can pass on its own during the first year and a half years, but still requires conservative treatment - if we are talking about a mild degree of uncontrolled urine excretion, and Surgical - if the urologist is faced with a severe form that is not amenable to therapy with medicines, exercise therapy exercises and hardware. Surgical methods today are quite diverse, their spectrum varies from periurethral injection of volume-forming substances and special devices (minimally invasive method) to performing a sling operation and installing an artificial urethra sphincter.
Any of these types of surgery has its own indications and contraindications, so it is important to undergo a thorough examination and consult with several specialists.
This type of incontinence, also called paradoxical ischuria, is caused by blockage of the urethra against the background of prostatic hypertrophy through which the urethra passes, and various types of tumors of the canal itself. Thus, the urethra is narrowed, and by itself is a pedobubic barrier, as a result of which urine is excreted in small volumes, but often. For this reason, this form of urinary incontinence in men is often called drip incontinence. But it is important to understand that the concept of “drip incontinence” can be misleading, since the bladder is never completely empty and a certain amount of urine always remains in it, which in some cases leads to inflammatory diseases. Moreover, voluntary urination is sometimes absent altogether.
With urinary incontinence in men from overflow of the bladder are observed:
- constant uncontrolled discharge of urine in small volumes throughout the day;
- frequent use of the toilet;
- a feeling of heaviness, pressure on the bladder, dull pain over the bosom may be present;
- the impossibility of complete emptying;
- when urinating, urine is secreted by a weak and thin stream, which is also accompanied by a feeling of overflow.
Transient (temporary) urinary incontinence (Transient Incontinence)
Typical causes of uncontrolled urination in men of a temporary nature include infectious diseases, intestinal disorders, various intoxications, undesirable effects from taking certain medications (see above), diseases that interfere with the work of neuromuscular activity related to the regulation of urinary emptying function bladder, strong psycho-emotional experiences. When eliminating an external provoking factor, transient urinary incontinence in men passes independently.
Diagnosis of urinary incontinence in men
A set of diagnostic measures to determine the form and degree of uncontrolled urine allocation in men in a recommendatory order includes:
A detailed medical history (a survey of the patient and relatives about the history of the disease and living conditions before it is detected).
Self-completion of questionnaires / questionnaires on the impact of urinary incontinence on quality of life: ICIQ-SF, ICSmaleSF, UCLA PCI – incontinencesection, I-QOL, SEAPI-QMM.
General and urological examination.
A three-day diary of controlled and uncontrolled urine output in order to determine the amount of daily urine output, the ratio of day and night urination, the amount of urine lost and the causes of incontinence.
A daily pad test, or a test with gaskets / liners, to accurately determine the amount of urine loss (for example, with stress incontinence of 3 or less gaskets in 24 hours, it means mild incontinence, 4–6 - medium, over 6 - heavy).
- General clinical analysis of urine and blood.
- Ultrasound examination (ultrasound).
- X-ray studies (urethrocystography for the detection of strictures and cystography for the objective registration of uncontrolled allocation of urine into the proximal urethra).
- Endoscopic examination (urethrocystoscopy to collect information about the mucous membrane of the urethra and bladder, the state of the vesicourethral anastomosis).
- Urodynamic research (uroflowmetry, profilometry, cystometry, press-flow, sphincterometry) to determine the capacity and extensibility of the bladder, the characteristics of uncontrolled detrusor contractions in the phase of urine accumulation, the state of the urethral closure apparatus, for synchronous recording of detrusor pressure and urination speed.
- The above diagnostic measures allow with a high degree of certainty to determine the cause of urinary incontinence in men, which means that they give the opportunity to choose the optimal strategy and treatment tactics.
Treatment of urinary incontinence in men
Like many other diseases, incontinence can be treated with both conservative and surgical methods. Of course, this depends on the form and severity of incontinence, on the effectiveness of the treatment methods used before, on existing indications and contraindications.
Conservative treatments include:
- Drug therapy (including drugs that have a tonic effect on the corresponding muscle groups; improve blood microcirculation in the genitourinary system; improve central nervous system control over the function of the urinary tract; have antimicrobial and anti-inflammatory effects; regulate the hormonal background in relation to those hormones that are responsible for the speed and volume of accumulation urine).
- Physiotherapy (percutaneous electrical stimulation, extracorporeal magnetic exposure).
- Pelvic floor muscle training (Kegel exercises for men) using the biofeedback technique (BFB) and a programmable urination rhythm (timing of urination and controlled emptying of the bladder), adherence to the diet established by the doctor.
In some modern studies, an attempt was made to establish a relationship between the consumption of certain substances (products), as well as body weight and urinary incontinence in men, in the form of abstracts, preliminary results are as follows:
- the index and body weight do not significantly affect the function of the lower urinary tract of men;
- it has been reasonably proven that there is no significant relationship between fluid intake and urinary incontinence;
- reduced consumption of caffeinated and alcohol-containing drinks does not lead to a decrease in the severity of symptoms of incontinence, if we are not talking about dosages that lead to intoxication;
BUT (!) In smokers, the symptoms of urinary incontinence are approximately 50% more pronounced than in people who have stopped smoking tobacco or non-smoking men.
So, the treatment of most types of urinary incontinence in men, although difficult, is possible using only conservative methods, and only with some forms of incontinence and with a severe degree of incontinence, and also not earlier than six months after the operation, they resort to surgical intervention. What is today in the arsenal of modern surgical medicine?
Surgical treatments for male urinary incontinence:
Implantation of the artifactal sphincter (annular valve) of the bladder It is an effective solution in more than 3/4 cases for men after radical prostatectomy (removal of the prostate in oncology) and in 2/3 cases for patients undergoing surgery for benign prostatic hyperplasia (adenoma) (BPH). Artifact sphincter implantation is performed in patients with insufficiency of the internal sphincter of the bladder with normal function, as well as with urinary incontinence due to pelvic injury. The complications of sphincter implantation include: erosion, periprosthetic infections, damage to the components of the prosthesis. An artificial bladder sphincter is contraindicated in male incontinence due to uncontrolled contraction of the bladder, as it keeps the urethra (urethra) closed until the patient is ready to empty the bladder.
Periurethral injection of collagen therapy is successful in half the cases in patients with surgical interventions for benign and malignant prostate tumors. A significant disadvantage of this method of treatment is considered to be the temporal effect due to migration and resorption of collagen. Based on statistics, injection therapy cannot be considered a reliable treatment for urinary incontinence in men.
Implantation of a male loop, or sling operation , involving the creation of support for the urethra by wrapping it with a mesh of synthetic fiber and attaching the other end of the mesh to the pelvic bones. The loop, thus, provides continuous compression of the bulbous section of the urethra and thereby prevents leakage of urine. One of two accesses is used to install the loop: perineal and lateral. The positive effect is achieved in the range from 75% to 90% of cases and is constantly growing with the development of technology.
It should be added that at least two hundred varieties of implants, their modifications and installation procedures have been developed today, so when you turn to a highly qualified urologist-surgeon, you can always find the best implantation option for the specific clinical picture.
Male Incontinence Hygiene
Urinary incontinence in men does not belong to the natural elements of the aging process, although this condition is often correlated with age. With certain forms of uncontrolled urine output, elementary physical exercises help, which should be performed regularly, but, as a rule, patients have to deal with the root causes of the problem in question. In any case, you need to learn how to live a full life. For this, men suffering from incontinence are forced to turn to urological hygiene products for the period of treatment and adhere to several recommendations.
The main hygiene products for male urinary incontinence are:
- Urological inserts (pads) of an anatomical form with drip, mild and moderate incontinence
- Elastic adjoining mesh panties for reliable fixing of loose leaves (laying)
- Disposable absorbent briefs for moderate to severe urinary incontinence
- Diapers for adults with severe and very severe incontinence
- The basis of individual absorbent (absorbent) urological hygiene products is a superabsorbent that can bind liquid in a proportion of 1:50. In addition, the composition of hygiene products includes fluffy (processed by various methods) cellulose, polyethylene and polypropylene films.
- Combinations of these materials may be different, but must meet the conditions:
- high-quality absorption and retention of urine,
- protection against smell and leakage,
- stealth and comfort
- protecting the skin from damage (irritation), maintaining an optimal level of acid-base balance of the skin (pH 5.5),
- antibacterial protection.
Some recommendations for men with urinary incontinence:
keep the required volume of fluid you drink (2 l) and in no case reduce it under the pretext of incontinence, since an increased concentration of urine will lead to significant irritation of the mucous membrane and skin, and the amount of fluid consumed is not associated with the problem of incontinence;
- observe the usual mode of emptying the bladder, using a timer if necessary - visit the toilet at least every 2 hours;
- regularly exercise the muscles of the sphincter of the bladder according to the Kegel system;
- at home, change wet laundry to dry;
- for severe and very severe incontinence, consider using special urinal systems for urine removal, including a penis tip (like a condom), drainage tubes, a urine reservoir that is fixed to the thigh or lower leg; monitor the level of urine in the urinal, do not forget to wash and disinfect it as often as possible;
- try to wash the skin in the inguinal area twice a day, then wipe it thoroughly and lubricate it with special protective creams or liquid paraffin, vegetable oil, baby cream, dusting the skin with powder.
HERBAL RECIPES FOR URINARY INCONTINENCE
- A number of villages use an ancient secret recipe. Grind the seeds of plantain in a glass mortar. Take a poppy head, boil in 100 ml of ordinary water. Add crushed plantain seeds in 25 ml of poppy broth. Give children 1 time in the evening 10 ml of the resulting solution.
- Take 500 grams of plantain seeds. At the beginning of the technological process, powder is prepared from the seeds of plantain. Then, 0.5 grams of powder is taken once a day in the evening and washed down with 200 ml of room temperature water.
- Take 20 grams of plantain leaves. Add them to 250 ml of water, bring to a boil. The broth needs to stand for 30 minutes. After cooling, take 1 tbsp 4 times a day for 20 days.
- Take 32 grams of dried sage grass, pour 250 ml of ordinary water, previously heated to a temperature of 90 degrees Celsius. Infusion is given to young children 50 ml 2 times a day. Adolescents 100 ml 2 times a day. Adult women 120 ml 2 times a day. Adult men 130 ml 2 times a day.
- Some people like to use plant roots. They believe that herbal medicine can help even with a serious illness such as enuresis. An odorous violet root is taken. Wash thoroughly with hot water. It is ground in a glass mortar. Absorbed in the mouth at 0.3 grams 3 times a day. Take 10 days. In other villages, 10 grams of dry grass of violets was added to 200 ml of water, brought to a boil, the solution was cooked for 15 minutes. Next, the broth was filtered through cheesecloth. You can use 1 tablespoon 3 times a day after meals for 10 days. You can add a little sugar.
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