More than half of women at least once faced with the problem of incontinence. Sometimes it occurs in young girls after childbirth, sometimes it causes inconvenience to older people, and some accompanies for a long time.
Fear of missing urine can lead to psychological, sexual disorders, cause depressive states and impede personal and career growth. Incotination (another name for incontinence) always reduces the quality of life, and therefore requires special attention.
There is even a special international organization for the retention of urine, which conducts research and develops all sorts of treatments. Incontinence urine experts call any involuntary discharge. But depending on the conditions, time of day, circumstances of incontinence, there are several types of it.
Types of incontinence
- imperative (urgent)
- other species (continuous urine leakage, bedwetting, unconscious incontinence)
- iatrogenic incontinence (due to medication)
The first three types are most common and characteristic for women.
This type of incontinence is half of all cases of uncontrolled urination. The main cause of this condition is the abnormal work of the special muscle, the urethral sphincter. The weakening of this muscle, together with the periodic increase in intra-abdominal pressure, leads to urinary leakage or even complete emptying of the bladder.
The reasons that can cause stress incontinence, a huge variety
Almost all women in an interesting position experience discomfort due to leakage of a small amount of urine. They are forced to plan their walks, based on the location of the toilets. And in the first weeks of pregnancy and shortly before birth, the symptoms of incontinence appear stronger. This is due to the changed hormonal background and the pressure of the uterus on the pelvic organs.
Particularly often, incontinence occurs after independent delivery of large fruit with a perineal incision and other manipulations. As a result, the muscles and ligaments of the pelvic floor are damaged, intra-abdominal pressure is distributed unevenly and the sphincter ceases to perform its function. It is after ruptures or inaccurate perineal incisions (episiotomy) that urinary incontinence joins urine incontinence.
- Operations on the pelvic organs
Any interventions associated with the uterus, bladder, rectum, cause adhesions and pressure changes in the pelvis. In addition, operations are sometimes complicated by fistulas between the organs, which also leads to incontinence.
With age, the elasticity of the ligaments and muscle tone decrease, which inevitably leads to dysfunction of the sphincter. After the onset of menopause, the body is deficient in estrogen, which is the cause of urinary incontinence in older women.
In addition to these underlying causes, there are risk factors. They can be a background for the development of urinary incontinence, but their presence does not necessarily lead to this disease.
- european race
- heredity (if there is a disease in the next of kin or in cases of enuresis in childhood, the risk of incontinence is greater)
- obesity (especially in combination with diabetes)
- neurological diseases (stroke, heart attack, parkinsonism, spinal injuries)
- urinary tract infection
- digestive disorders
- taking certain medications
Stress incontinence gives women a lot of trouble. Refusal to play sports, fear of losing urine on people, constant nervous tension adversely affect health. Therefore, it is important not to be shy and not hush up this topic, and in time to consult a doctor.
Normally, the urge to urinate appears after a certain amount of urine accumulates in the bladder. Feeling this urge, a woman can successfully hold him back to the nearest toilet room. With increased bladder reactivity, even a small amount of urine is enough for a strong, unbearable urge. And if, by chance, there is no toilet nearby, then there is a risk of losing urine.
The cause of this disease is considered hyperreactive bladder. Due to the special mobility of the psyche and the speed of nerve impulses, the muscles of the sphincter and bladder react to the slightest irritation. Therefore, the urine can be missed with a small accumulation in the bladder, especially if there is any external stimulus (bright light, the sound of pouring water, etc.)
The main symptoms of imperative incontinence
- frequent urination
- urges are almost always sudden
- irrepressible desire to urinate
- the emergence of the urge is often triggered by external circumstances
The risk factors for imperative urges are exactly the same as for stress incontinence, because these types are often combined.
Differential diagnosis of urinary incontinence
Some drugs in the list of their side effects have a violation of urination:
- adrenomimetics (pseudoephedrine) can cause urinary retention and subsequent incontinence, are used to treat diseases of the bronchi,
- all diuretics,
- colchicine (for the treatment of gout),
- some estrogen drugs
- sedatives and antidepressants
After the end of taking these drugs, the unpleasant symptoms go away by themselves.
Other types of incontinence
More rare causes of missing urine are usually associated with organic pathology. It can be damage to the brain and spinal cord as a result of tumor processes, injuries, strokes, multiple sclerosis.
Only a doctor can determine the exact cause of the problem. Usually, during incontinence, women turn to gynecologists and urologists. Recently, a narrow specialty has emerged - urogynecology, which deals with issues of the female urogenital sphere.
Detailed story to the doctor about complaints
Factors that cause incontinence, the time of onset of symptoms, their severity, additional complaints are important. In addition, you need to ask your mother, grandmother, sisters about similar symptoms to identify hereditary predisposition. It is necessary to note if in childhood there were cases of chronic nocturnal enuresis.
You can fill out a questionnaire created specifically for people with incontinence. Incontinence Symptom Questionnaire, ISQ (Incontinence Symptom Questionnaire):
1. How long have you been experiencing incontinence symptoms?
2. Has the volume of missed urine changed since the onset of the disease?
3. How has the incidence of urinary incontinence changed since their appearance?
4. Indicate how often the following steps lead to incontinence (never, sometimes, often).
- exercise, including running, sports
- weight lifting
- change in body position: moving from sitting to vertical position
- the kind or sound of the bubbling water
- psycho-emotional stress
5. Do you have any insistent urge to urinate?
6. How long can you hold urine when urging appears?
7. How often do you lose urine?
8. When is urinary incontinence more frequent?
9. Do you feel the laundry getting wet without urinating?
10. Do you wake up at night to urinate?
11. Please indicate how much urine you normally lose.
12. Assess on a 5-point scale the degree of influence of urinary incontinence on your daily life: _____ (0 - does not affect, 5 - significantly affects).
Keeping a urination diary
Detailed records of urination and incontinence will help the doctor to make the correct diagnosis and prescribe treatment.
And so on, all 24 hours.
Often, the concepts of "many" and "little" are different for different women, so it is difficult to assess the degree of the disease. Here the test with gaskets or the PAD test comes to the aid of the doctors. This method is used to obtain objective data on the amount of urine missed.
For examination, a woman must wear urological pads, weighing them before and after use. The test duration can vary from 20 minutes to two days, more often - about 2 hours. When performing a short test, it is recommended to drink half a liter of non-carbonated water.
Examination of the genital organs with the help of gynecological mirrors is necessary to exclude other diseases. During examination, the doctor can detect:
- atrophy of the mucous membrane of the vagina. Post-menopausal genital dryness due to estrogen deficiency may aggravate urinary incontinence.
- prolapse or prolapse of the pelvic organs (see symptoms of prolapse of the uterus)
- major fistula
On examination, a cough test is performed: when coughing, urine excretion from the urethra can be noticed.
Analysis of urine
Very often with inflammatory changes in the organs of the urogenital system, incontinence occurs in small portions of urine. Therefore, the detection of leukocytes, red blood cells or bacteria in the urine gives rise to examination for infections. For an accurate result, you need to know the basic rules for collecting urine:
- use the first “morning” urine
- collect medium urine
- carry out a thorough toilet vagina before urinating
- cover the vagina with a clean cloth during collection
Visualization (ultrasound, MRI)
Urodynamic studies (allow to find out the type of incontinence)
Urinary incontinence treatment
Depending on the cause of urinary incontinence in women, the treatment is carried out by gynecologists, urologists in the clinic or surgeons in the hospital.
- general treatment methods
- stress incontinence treatment
- imperative incontinence treatment
Therapy for any type of urinary incontinence should begin with the simplest and most accessible methods. Such methods include lifestyle correction and special exercises. This is a lifestyle correction:
- Weight control for obesity
- Reduced consumption of coffee, tea and other caffeine-containing beverages.
- To give up smoking
- Establishment of urination
- Pelvic floor muscle training
- Treatment of chronic respiratory diseases
- Psychological setting to distract from the desire to urinate
The essence of such a gym is as simple as possible. First you need to "find" the right pelvic floor muscles: perivaginal and periurethral. For this purpose, you need to sit sitting and imagine the urge to urinate and try to hold this imaginary stream of urine. The muscles involved in this process should be trained regularly.
Three times a day to make their reduction and relaxation, gradually increasing the time for performing reductions from a few seconds to 2-3 minutes. This process will be invisible to others, so you can engage not only at home but also at work, driving in traffic and in any free time.
After establishing control over the muscles at rest, you can complicate the task: try to reduce them by coughing, sneezing and other provoking factors. You can vary and manipulate the muscles to achieve the best effect.
- slow compression
- fast cuts
- pushing (by analogy with the laboring period)
- jet retention during urination
The main disadvantage of simple Kegel exercises is the inability to control their implementation. Sometimes women, along with the necessary muscles, strain others that increase intra-abdominal pressure. This not only negates the entire workout, but can aggravate the problem.
A set of exercises with biofeedback (BFB) includes a special apparatus for recording muscle tone. With it, you can monitor the correctness of the implementation of cuts, and if necessary - to produce electrostimulation. BOS training has been shown to improve muscle tone and urinary control.
Contraindications to BFB training:
- malignant neoplasms
- inflammatory diseases in the acute phase
- severe diseases of the heart, kidneys, liver
Using special simulators
For training, a lot of compact devices have been created that allow to strengthen the pelvic floor muscles with maximum efficiency and perform all the exercises necessary for incontinence in women.
One of such simulators is PelvicToner. This device, based on the properties of the spring, allows gradually and correctly to increase the load on the intimate muscles, strengthening them. It is easy to use and maintain, and its effect is confirmed by clinical trials.
Stress incontinence treatment
In addition to the common methods of incontinence control described above, the treatment of stress incontinence requires the intervention of a physician. Conservative treatment with drugs is not very popular, as it helps only in a small number of cases.
With a mild degree of stress incontinence, when the anatomical structures have retained their integrity, they are sometimes used:
- Adrenomimetics (Gutron) increase the tone of the sphincter and urethra, but they also affect the tone of the vessels. Applied extremely rarely due to low efficiency and side effects (high blood pressure)
- Anticholinesterase drugs (Ubretid) also increase muscle tone. Recommended for women who have bladder hypotension as a result of tests.
- The antidepressant Duloxetine (Simbalta), effective in half the cases, but with side effects on the digestive system.
Treatment of stress incontinence with pills is very rare due to frequent recurrences and side effects.
When stress urinary incontinence in women, surgery is the method of choice. There are several surgical procedures that vary in complexity of execution. Preference is given to a particular operation depending on the degree of incontinence and the anatomical features of the urethra of a woman.
Contraindications to all types of surgical treatment are:
- malignant neoplasms
- inflammatory diseases of the pelvic organs in the acute phase
- diabetes mellitus in decompensation phase
- blood coagulation disorders
Treatment of imperative incontinence
Unlike stress incontinence, with imperative urging, surgical treatment is ineffective. All women with such a problem are first recommended to try general methods of treatment (non-drug). Only with their ineffectiveness can we think about drug therapy.
In the treatment of imperative urinary incontinence in women, tablets are very effective. There are several classes of drugs, the main task of which is to restore normal nervous regulation of urination.
- Drugs that reduce the tone of the bladder wall, reduce the strength and frequency of its contractions. The most common medicines are: Driptan, Detruzitol, Spasmex, Vesicare.
- Drugs that relax the bladder in the filling phase and improve its blood circulation: Dalfaz, Caldura, Omnick.
- In case of incontinence in women of menopausal age, when there is an estrogen deficiency, hormone replacement therapy or special ointments are used. An example of such an ointment is Ovestin - a cream containing an estrogen component. Its use reduces dryness and itching of the mucous membranes, reducing the incontinence rate.
Treatment of urinary incontinence in women is a complex task that requires an integrated approach and a clear implementation of all the recommendations of a specialist. A few simple rules will allow you to avoid or delay the manifestations of this disease.
Urinary incontinence prevention
- Maintain water balance of the body. To do this, drink 1.5-2 liters of non-carbonated water per day. Excessive and inadequate drinking can be harmful to health.
- Try to create your own urination regimen. It is quite possible to train yourself to empty your bladder at a certain time. For example, in the morning before going to work, during the lunch break, immediately upon arrival home, go to the toilet and fix this habit.
- Fight overweight (alone or with the help of a specialist)
- To refuse from bad habits
- Reduce consumption of caffeinated foods and salinity
- Combat constipation, if any. To do this, you can eat foods rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, drink half a cup of kefir at night. In case of chronic constipation, vegetable herbal remedies can be used (after consulting a doctor (see laxatives for constipation)
- Engage in strengthening the muscles of the pelvic floor before planning pregnancy, thus avoiding perineal tears during labor
- Enjoy life and maintain a positive attitude.
- Urinary incontinence is a very common problem among women.
- Without treatment, urination problems are unlikely to go away on their own.
- To determine the type of incontinence you need to undergo an examination, including the need to fill out a questionnaire and keep a urination diary.
- Стрессовое недержание лечится с помощью операций, а императивное – путем приема лекарств.
- You can independently engage in the prevention of incontinence, leading a correct lifestyle and strengthening the muscles of the pelvic floor
Urinary incontinence is a serious problem requiring treatment. It is better to spend a little time going to the doctor and eliminating it, rather than being shy and tormented all your life.
Depending on the etiological factor, the pathogenesis can be different. It is important to understand that the leakage of urine is a symptom that does not appear on its own. In all cases, there must be a root cause. For example, in men after 60 years of age, urinary incontinence often indicates prostatitis. Only by getting rid of the underlying disease can symptomatic treatment be carried out.
In women after 50 years, urinary incontinence occurs against the background of the weakening of the pelvic muscles. They lose the ability to hold organs in a physiological position. As a result, the descending bladder begins to put pressure on the vagina, causing a number of other ailments.
Thus, there are two mechanisms for the development of urinary incontinence:
- Sphincter pathology or directly urethra, due to which the function of the circuit is broken.
- Changing the location of the urethra against the background of a weakened musculo-ligamentous apparatus.
In order to establish the true cause of the disease, you must consult a doctor. Only a specialist can tell you how to treat urinary incontinence in each case.
There are two main classifications of the disease. The first identifies the following forms of incontinence:
- Overflow incontinence (another name is paradoxical).
- Temporary (transistor).
According to another classification, incontinence comes in the following forms:
- Night enuresis.
- Leak after urination.
In most cases, the following forms of urinary incontinence are diagnosed:
- Stress (stress leakage). This type of incontinence is detected most often. In such cases, both men and women have urinary incontinence when sneezing, laughing, coughing, running, lifting heavy objects, etc. In other words, urine leakage occurs due to factors that increase intravesical and intraperitoneal pressure. The cause of stress urinary incontinence in women and men is the weakening of the ligaments in the pelvic floor. This is due to a decrease in collagen production. As a result, the neck of the urethra becomes extremely mobile, and the urethral sphincter is also impaired. The latter ceases to fully close, due to which a certain amount of liquid involuntarily stands out. As a rule, stress urinary incontinence is diagnosed in women after 50 years (during menopause), in men after surgery in the prostate gland and in smokers.
- Urgent (or imperative). Characterized by unexpected urge to urinate. At the same time, it is impossible to hold urine in the body even for a few minutes. Patients note that urine excretion begins before they have time to reach the toilet. In some cases, the urge is absent or extremely weak. The provoking factors are: changes in ambient temperature, the sounds of pouring water, overexcitement, alcohol intoxication. It occurs in both men and women frequent urination without pain. The cause of this condition is a malfunction of the peripheral and central nervous system. Against the background of the disease, leakage is often associated with events. For example, when appearing in public.
- Transistor (or temporary). Involuntary discharge of urine occurs when drinking alcohol-containing beverages, with constipation, inflammatory processes in the vagina or directly in the bladder. If these factors are eliminated, the leakage of the urine will stop without any drug treatment.
- Incontinence overflow. As a rule, this form is diagnosed in the elderly, suffering from diseases of the urogenital system. Leakage in this case is associated with excessive stretching of the bladder walls against the background of existing obstacles to the outflow of fluid. The latter may be neoplasms or strictures.
- Mixed In practice, often combined forms of incontinence. The most frequently detected symptoms of stress and urge incontinence. In most cases, the mixed form occurs without pain. In women, the cause of frequent urination becomes nervous tension and weakening of the muscular-ligamentous apparatus. In men, this form is extremely rarely diagnosed.
How to treat urinary incontinence depends on the patient's age, gender, physical activity, as well as on existing diseases.
If an alarming symptom occurs, you should contact your urologist or gynecologist. The doctor will issue a referral for a comprehensive examination, based on the results of which will be the most effective treatment. Also, the specialist may additionally refer you to an endocrinologist, psychiatrist, neurologist, or oncologist for consultation.
The primary diagnosis is to interview the patient, gynecological examination (for women) and palpation. The doctor must provide information on whether urinary incontinence occurs during the day or at night, how often, about the amount of urine secreted. In addition, it is important to indicate whether the patient is taking any medications.
In the process of gynecological examination, the doctor may detect inflammation, prolapse or prolapse of the uterus and vagina. On palpation, localization of painful sensations (if they are present) is detected, it is also possible to detect various kinds of tumors.
Based on the results of the primary diagnosis, the doctor draws up a referral for a comprehensive examination. It includes:
- General urine analysis. Allows you to identify the inflammatory process.
- Sowing urine microflora. Baccalysis is necessary in order to detect and identify the pathogen. In addition, the study assesses the degree of its sensitivity to antibiotics and other drugs.
- Cytological and histological analysis of biopsy. Appointed if the cause of urinary incontinence is a tumor. The biomaterial is taken by puncture. During the analysis, the nature of the tumor is determined.
- Ultrasound of the bladder. In women and men, the state of the pelvic organs is also assessed during the study. With the help of ultrasound it is possible to identify tumors and inflammatory processes.
- Retrograde cystometry. It is performed with a full bladder. The doctor determines the pressure inside the body, so that he gets the opportunity to evaluate its reservoir function.
- Cystography. This is an x-ray examination of the bladder, which is performed using a contrast agent.
- Uroflowmetry. The method involves the registration of the rate of outflow of urine during urination.
- Urethrocystoscopy. The study of the cavity of the body using endoscopic equipment.
- Electromyography. Allows you to assess the contractility of muscles and sphincters.
In addition, it is shown to conduct urodynamic tests. The approximate amount of involuntarily excreted urine can be determined using sanitary pads. In addition, the doctor directly at the reception may ask to cough. In case of urinary incontinence, urine will begin to flow out.
Also within 2 days the patient must keep a special diary. He should record the frequency of urging, the volume of urine, as well as the number of involuntary leakage of fluid.
Information on how to treat incontinence should be provided by a doctor. This is due to the fact that only on the basis of the results of diagnostics it is possible to make an effective therapy regimen In addition, in some cases it is not required to take medication. It is enough to follow the recommendations of the doctor.
Non-drug treatment includes the following items:
- Dieting. The patient should exclude from the diet foods and beverages that irritate the mucous membrane of the bladder and urethra.
- Reduced body weight. After successful treatment, the weight must also be strictly controlled.
- Doing exercises. There is a special complex designed specifically to strengthen the bladder. The main exercise in it is the following exercise: during a controlled release of a liquid, it is necessary to stop the stream by willpower for a few seconds. Then continue urination. At the same time, it is important to remember which muscles were strained in order to do several repetitions during the day.
- Urination schedule. The doctor individually creates a plan according to which the patient needs to go to the toilet.
In addition, according to indications can be installed pessary.
Drug therapy, if necessary, is carried out in all forms of incontinence. The purpose of medication is to increase the functional capacity of the body and reduce its contractile activity.
Regarding how to treat incontinence. Mandatory prescribed antidepressants and antispasmodics. Currently, the most effective drug shows "Oxybutin". This drug, the active substance of which interrupts irritating and irregular impulses from the nervous system, and also helps to relax the detrusor. The dosing regimen is compiled individually. Duration of treatment is at least 3 months.
With properly selected therapy, urinary incontinence does not appear after discontinuation of the drug.
In most cases, a positive result is achieved on the background of conservative treatment. If it turned out to be ineffective, the doctor decides the question of the feasibility of surgical intervention. The method of treatment depends on the form and cause of the disease.
Currently, minimally invasive methods are successfully used. The patient is injected with collagen, Teflon paste or homogenized auto-fat. After injection, episodes of incontinence cease. Before the intervention, a bladder ultrasound scan is performed on women. This is necessary in order to confirm or exclude a significant omission of the organ, which is a contraindication to injections.
Nontraditional therapy methods
Folk urinary incontinence treatment is permissible, but only after the permission of the attending physician. This is due to the fact that some medicinal products may worsen the course of the pathology or reduce the effectiveness of medications.
The most effective recipes:
- Take 20 g of seeds of dill, pour 200 ml of boiling water over them. Let it brew for several hours. The resulting tool strain. It is necessary to use infusion daily before a meal on 200 ml a day. The tool is contraindicated in pregnant women and people suffering from low blood pressure.
- Take a small amount of lingonberry and hypericum. Mix components in equal proportions, pour 200 ml of boiling water over them. Let it stand for several hours. The resulting remedy should be taken in small sips in the afternoon.
- Take 20 g of crushed roots of elecampane. Pour 200 ml of boiling water over them and put the container on fire. After 25 minutes, cover it with a towel and put it in a cool place. After a few hours the tool will be ready. Eat 100 ml of broth daily and before each meal.
Regular use of folk methods allows you to quickly get rid of the disease.
Choice of urological pads
These are special products that are helpful to people with urinary incontinence. There are pads for both men and women. These hygienic products are distinguished by their large size, the presence of an absorbent and high-quality filler, their surface does not irritate the skin. Thus, the patient may not worry about the possibility of an unpleasant smell.
The most popular urological pads:
- Seni. Used not only for incontinence, but also in the postpartum period. They have 7 sizes and an exact anatomical shape, due to which liquid leakage is excluded. Urological pads "Seni" easily attached to both men's and women's underwear.
- Molimed. Produced in Germany. Have a neutral pH level, covered with antibacterial layer. Can also be used in the postoperative period.
- Abri-San. These are Czech-made hygiene products intended for people suffering from severe forms of incontinence. Inserts are universal. Their shape allows them to be used by both men and women.
Features of pathology in children
In order to find out the cause of the disease, urological and neurological studies are appointed. Pathology is a pediatrician. Consultation with a urologist and a neurologist is often required.
The main causes of urinary incontinence in children:
- Injuries to the spinal cord and brain.
- Infectious diseases.
- Cerebral palsy.
- Mental pathologies (autism, epilepsy, mental retardation, schizophrenia).
- Features of the anatomical structure of the urogenital system.
- Endcrine diseases.
- Sleep apnea.
- Acceptance of some medications.
- Urogenital pathology.
- Allergic reactions.
- Nerve strain.
The treatment can also be both medicamentous and not involving medication. Additionally, it is necessary to create a favorable atmosphere around the child, surround him with attention and prevent him from falling into stressful situations.
The term "urinary incontinence" refers to a pathological condition in which the release of urine occurs involuntarily. Another name for the disease is incontinence. Urinary incontinence is not an independent disease, it is always a symptom of a developing pathology in the body.
If you have any warning signs, you should contact your gynecologist or urologist. The doctor will conduct a primary diagnosis, based on the results of which will issue a referral for laboratory and instrumental studies. You may also need to consult other narrow profile specialists.
Treatment can be carried out both conservative and operational methods. In addition, it is possible to achieve positive dynamics if you regularly use alternative medicine recipes.
What is urinary incontinence?
Urinary incontinence is the involuntary separation of urine, which cannot be prevented by willpower. In humans, the sensitivity disappears, so that the patient can not control the process of urination. All aspects of life suffer from this - social, business and personal. The patient cannot fully work, contact with relatives and live a normal family life.
Incontinence experts classify as follows.
- Stress incontinence. Sudden urination occurs when excessive physical exertion or strong tension, which occurs in the case of reflexes such as coughing, sneezing and others.
- Imperative incontinence, or hyperactivity of the bladder - a problem with urination occurs due to the pathology of the organ itself or the disruption of the nervous system. Urinary excretion occurs during rest, without physical exertion. Concomitant symptoms are frequent urging to the toilet more than eight times a day and once at night.
- Neurogenic bladder. Disruption of the bladder due to a malfunction of the nervous system.
- Infravesical obstruction, or subvesical obstruction of the urinary tract. Involuntary urination due to weakening of the walls of the bladder during its filling.
- Extraurethral incontinence. Urination occurs due to the pathological communication between the organs of the genital and urinary system or the congenital anomaly of the ureters. In this case, the woman has a desire to use the toilet, but she is unable to stop urination.
- Enuresis. In women, this condition is observed during the night rest. Urine is excreted suddenly, without urging to the toilet.
- Mixed look. It combines stress and imperative incontinence. It usually occurs in women after the birth of a baby, when mechanical damage to the pelvic organs or muscles has occurred during labor. Symptoms - urine during urge to toilet or during physical exertion.
- Podkapyvanie After visiting the toilet, urine accumulates in the urethra and residual discharge occurs when leaving the bathroom.
Causes of the violation and suggestive factors
Involuntary urination in women occurs for several reasons. Usually the appearance of incontinence is due to pathologies and age-related changes in the body.
When menopause occurs, there is a shortage of female hormones - estrogen. This leads to atrophic changes in the membranes of the urinary and genital organs, muscles and ligaments located in the pelvis.
During pregnancy and after childbirth
Pregnancy and labor provokes this problem. Во время родов создается повышенная нагрузка на органы малого таза и при появлении малыша на свет происходит их травмирование и повреждение мышц. Вследствие этого возникает недержание.
Заболевания и травмы
Заболевания и травмы, вызывающие инконтиненцию:
- мочекаменная патология мочевого пузыря,
- кашель, имеющий хронический характер,
- патологии желудочно-кишечного тракта,
- gynecological pathology,
- abnormal structure of the urinary or genital organs,
- diabetes mellitus of any type
- infections constantly present in the bladder,
- Parkinson’s or Alzheimer's pathology,
- prolapse of organs located in the pelvis,
- oncological pathology of the bladder.
Other causes of urinary incontinence in women:
- surgery on the pelvic organs,
- unstable emotional background,
- radiation exposure
- large body mass
- harmful addictions - smoking and alcohol abuse,
- taking certain medications
- excessive consumption of coffee, sugary carbonated drinks,
- improper nutrition.
Incontinence manifests itself as follows:
- leakage of urine
- unexpected urge to urinate,
- the desire to visit the toilet arise during the hours of night rest,
- after urinating there is no relief, and there is a feeling that the bladder is full,
- feeling that there is a foreign body in the vagina,
- often urge to go to the toilet.
The use of drugs is possible if there is no abnormality of the structure of the organs of the urinary system. This is the main way to treat pathology. Medication prescribed depending on the cause, which led to the occurrence of incontinence.
- Drugs, the main active component of which is estrogen. The doctor prescribes such medications with a low level of the female hormone.
- Sympathomimetics. Improve the contraction of muscles involved in urination. The drug that is usually prescribed is Ephedrine.
- Antidepressants. The doctor prescribes them if incontinence develops due to an unstable emotional background.
- Anticholinergic drugs. Promote relaxation and increase the volume of the bladder. The doctor usually prescribes Tolteradin, Driptan, Oksibutin.
- Desmopressin. The doctor prescribes such a drug for temporary incontinence. The tool reduces the amount of urine.
- Sling method. The duration of the operation is half an hour. During the procedure, general anesthesia is not used. Enough local anesthesia. The essence of the operation - the introduction of a special mesh, which has the form of a loop, under the urethra or neck of the bladder. It prevents involuntary urination with increasing pressure in the abdominal cavity.
- Injection of bulking agents. The essence of the procedure is the introduction of a special substance into the urethra using a cystoscope. After this manipulation, the urethra is placed in the correct position.
- Laparoscopic kalposuspenziya. Before surgery, the patient is general anesthesia. The essence of the procedure - the tissues that surround the urethra, are fixed on the inguinal ligaments. This prevents involuntary urination.
Specialists recommend Keel exercises to do women, no matter what type of incontinence is observed. Classes are aimed at improving the condition of the muscles located in the pelvis.
Manipulations are carried out in the morning, in the afternoon and in the evening. The duration of the procedure is 10 seconds. After muscle contraction, relaxation should follow. The muscles also relax for 10 seconds, and then shrink again. Only under this condition can we expect a positive effect from the procedure. Some time after the start of gymnastics, the time for tension and muscle relaxation increases.
The total duration of one session should be 20 seconds.
Along with these exercises, it is also recommended to wear a small ball during the day, which is clamped between the legs. The higher its location, the better the effect.
Infusion on the seeds of dill
To prepare this effective homemade recipe, you will need:
- fennel seeds - 1 big spoon with a hill,
- water - 1 cup.
The water is brought to a boil, and dill seeds are poured over it. The container in which the preparation is prepared is insulated and left to insist for three hours. When the time is up, the medium is filtered. Drink consumed at a time.
- dried yarrow herb - 10 g,
- water - 1 cup.
Medicinal plant is filled with water. The container is set on fire and the medium is brought to a boil. After that, the drink is brewed for another 10 minutes. Capacity with broth is removed from the stove, insulated and left to insist for 60 minutes. The tool is filtered. The frequency of admission - in the morning, noon and evening 0.5 cups.
Infusion based on corn stigmas
For cooking means will be required:
- corn silk - 1 big spoon,
- water - 1 cup.
The medicinal plant is poured with the specified amount of boiling water. Capacity is insulated and left for half an hour to insist. The tool is used for half a cup in the morning and evening hours.
- honey - 1 big spoon,
- natural apple puree - 1 tablespoon,
- chopped to a mushy onion - 1 large spoon.
All products are combined and mixed. The received means is used in the morning, in the afternoon and in the evening.
For therapy also use infusion prepared on the basis of sage.
Frequent types of urinary incontinence and their causes
Urinary incontinence is a pathology characterized by an uncontrolled process of urine excretion. This disease affects millions of women worldwide. What is incontinence? Various factors can trigger the development of this pathological condition. Urinary incontinence occurs due to the weakening of the pelvic floor muscles and / or small pelvis, disorders in the urethral sphincter. These problems can be provoked by the following diseases and conditions:
- childbirth and childbirth,
- overweight, obesity,
- advanced age
- bladder stones
- abnormal structure of the genitourinary system,
- chronic bladder infections,
- chronic cough,
- Alzheimer's, Parkinson’s,
- bladder cancer,
- prolapse of the pelvic organs,
- chronic cough.
Some drugs and foods may increase incontinence. For example, medications with a diuretic effect or a relaxing effect on the bladder (antidepressants) can increase urinary incontinence in women. The use of alcohol, tobacco, tea, coffee, soda, a diet based on products that irritate the bladder will increase the manifestation of incontinence. Depending on the characteristics, circumstances, occurrence of urinary incontinence, experts divide this disease into the following types:
- involuntary leakage of urine,
- urine leakage after the bladder emptying process.
Involuntary urination during sleep is called bedwetting. Older women often suffer from them due to hormonal changes in their bodies, which lead to a decrease in estrogen and a weakening of the muscles of the perineum, the condition of the mucous membrane of the urethra and the urogenital diaphragm. At a young age, incontinence at night appears as a result of stretching the muscles of the pelvic organs, which is triggered by childbirth with tears or dissection of the perineum. Inflammatory processes in the bladder lead to exacerbation.
In case of involuntary discharge of urine during the day, permanent incontinence occurs. Often the cause is age-related changes in the body, nervous disorders and dysfunction of the urinary tract. In older women, spontaneous reduction of the detrusor, physical stress (for example, coughing) becomes a frequent cause of this phenomenon. To correct the situation with incontinence in mild or moderate disease, special exercises for training the pelvic floor will help.
Symptoms and signs of urinary incontinence
Women more often than men face the problem of urinary incontinence. This is due to the structural features of their urogenital system. In women, incontinence is expressed by the following symptoms: urine leakage, sudden uncontrollable urge to go to the toilet, a feeling of an incompletely emptied bladder, a sensation of the presence of a foreign body in the vagina.
What to do and how to treat urinary incontinence
How to fix incontinence problem? If you find a qualified urologist, then he will be able to help the woman do everything possible to get rid of the problems with urination. When talking with the doctor, the patient must be frank about his symptoms of urinary incontinence. If necessary, the doctor will prescribe a woman to undergo additional studies to determine the exact diagnosis. Often, doctors refer these patients to the following examinations:
- urinalysis to identify / eliminate the presence of infection in the urogenital system,
- vaginal examination to clarify the presence / absence of gynecological diseases,
- A PAD test that gives information about the amount of urine being missed,
After examination, the doctor will give recommendations on what methods and preparations to use to eliminate problems with urination. There are two types of urinary incontinence treatment: conservative and surgical. The first of them includes performing special exercises, training the muscles of the pelvis using special devices, physiotherapy, and medications. Treatment in a conservative manner continues throughout the year.
How to treat uncontrolled urination? The use of tablets and other drugs to get rid of urinary incontinence is effective in the stress type of the disease only when the anatomy of the urinary organs is not disturbed. Sometimes for drug treatment used adrenomimetics and anticholinesterase drugs to improve the tone of the sphincter, duloxetine. In case of incontinence of imperative nature, a number of drugs give a positive result (Driptan, Spazmeks, Vesicard, Detruzitol, hormonal drugs, antibiotics for inflammation).
Effectively helps to prevent involuntary urination pessary. It is a rubber device that is inserted into the vagina at the cervix to support the urethra in the closed position and to keep the urine in the bladder. This device is well suited for comfortable jogging and other physical activities. Many types of pessaries are intended for permanent use, but there is a possibility of urinary infections.
Treatment of folk remedies
There are many recipes for the treatment of urinary incontinence folk remedies. They help eliminate inflammation in the urogenital system and normalize the bladder. The basis of these recipes are herbal ingredients that do not cause side effects when used correctly. Often these methods are used to treat urinary incontinence in older women. To get rid of urination problems, you must apply the following folk remedies:
- with nightly uncontrolled urination, weekly intake of a mixture of honey (1 tablespoon), grated apple (1 tablespoon), grated onions (1 tablespoon), helps 3 times a day.
- drink plantain juice (1st. l.) 3 times a day,
- drink plantain tincture (1 tablespoon of leaves of the plant per 1 tablespoon boiling water) 4 times a day for a glass,
- use 2 times a day for a glass of tincture of 1 tbsp. l corn silk, filled with 1 cup of boiling water and infused for 30 minutes.
Surgical treatment of urinary incontinence
If a conservative method of treatment did not give a positive result, then the doctor will recommend surgery to eliminate problems with urination. It can not be used for people with cancer, diabetes, with exacerbation of inflammatory processes. There are several types of surgical methods for getting rid of incontinence:
- Loopback or sling operations. During surgery, a mesh is inserted under the urethra in a loop.
- Injection into the mucous membrane of the urethra-forming drugs. As a result, missing tissues are compensated, and the urethra is fixed in the correct position.
- Burch laparoscopic colposuspension.
- Colporrhaphy (vaginal closure).
Video: gymnastics for women
Although the view is widespread that incontinence is incurable, there are effective ways to treat this urination problem. One of them is physical exercises aimed at strengthening the muscles of the small pelvis. How to perform this gym look at the video. Regular classes will help to forget about the problem with the uncontrolled leakage of urine and enjoy life again, confidently communicating with people.
Elena, 36 years old, Omsk: After the birth of my second child, I noticed that when I cough, sneeze, my urine is secreted. It is especially inconvenient when such confusions occur during physical exertion outside the home. At first I was treated with eggshell, warming up, but to no avail. The doctor, after the examination, said that surgery was needed to stop urinary incontinence. I was afraid, but decided to do it. After surgery, the problem disappeared.
Tatiana, 50 years old, Moscow: For more than 10 years she didn’t tell anyone about her illness, but experienced painful experiences. But once tired of constantly wearing pads when incontinence, and decided that something needs to be done. I went to the doctor, he recommended surgery. After the operation, I again felt like a full-fledged person.
Zinaida, 30 years old, Voronezh: After the birth of my first child, I got pregnant six months later. After a cold at the 6th month of pregnancy, I noticed that I had urinary incontinence when I cough. When I told the gynecologist about this, he recommended doing Kegel exercises. After 2 weeks of this charge, this problem disappeared.
Causes and symptoms of urinary incontinence in women
There are the following types of urinary incontinence:
Other forms, for example, enuresis in case of bladder overflow, continuous urine leakage, unconscious incontinence, etc.
In women, the first three types of urinary incontinence are most common, so it is worthwhile to dwell on them in more detail.
Incontinence in women
Incontinence of urine in women is an involuntary and uncontrolled urine excretion from the urethra, due to violations of various mechanisms of regulation of miccia. According to available data, every fifth woman faces involuntary urine release in reproductive age, every third woman in perimenopausal and early menopausal age, and every second woman in the elderly (after 70 years). The problem of urinary incontinence is most relevant for women who have given birth, especially those with a history of natural childbirth. Urinary incontinence has not only hygienic, but also medical and social aspects, since it has a pronounced negative effect on the quality of life of a woman, accompanied by a forced decrease in physical activity, neurosis, depression, sexual dysfunction. The medical aspects of this disorder are considered gynecology, urology, psychotherapy.
Classification of female urinary incontinence
According to the place of urine excretion, transurethral (true) and extraurethral (false) incontinence are distinguished. In the true form, the urine is excreted in the intact urethra, in the false one - from abnormally located or damaged urinary tracts (from ectopically located ureters, extroverted bladder, urinary fistulas, etc.). In the future, we will focus exclusively on cases of true incontinence.
Women have the following types of transurethral incontinence:
- stressful - involuntary urine excretion associated with failure of the urethral sphincter or weak pelvic floor muscles
- imperative (urgent urinary incontinence, overactive bladder) - intolerable, unrestrained urge due to increased reactivity of the bladder,
- mixed - combining signs of stress and imperative incontinence (a sudden, unstoppable need to urinate occurs during physical exertion, followed by uncontrolled urination,
- reflex incontinence (neurogenic bladder) - spontaneous discharge of urine, caused by a violation of the bladder innervation,
- iatrogenic - the intake of certain medicinal substances is caused,
- other (situational) forms - enuresis, urinary incontinence from overflow of the bladder (paradoxical ischuria), during sexual intercourse, etc.
The first three types of urinary incontinence in women are found in most cases, the rest fall to no more than 5-10%.
Causes of urinary incontinence in women
The mechanism of stress urinary incontinence in women is associated with insufficiency of the urethral or cystic sphincters and / or weakness of the pelvic floor structures. An important role in the regulation of urination is assigned to the state of the sphincter apparatus - when the architectonics changes (the ratio of muscle and connective tissue components), the contractility and stretchability of the sphincters are disturbed, as a result of which the latter become unable to regulate urine output.
В норме континенция (удержание) мочи обеспечивается положительным градиентом уретрального давления (т. е. давление в уретре выше, чем в мочевом пузыре). Непроизвольное выделение мочи происходит в том случае, если этот градиент изменяется на отрицательный. An indispensable condition for voluntary urination is a stable anatomical position of the pelvic organs relative to each other. When the myofascial and ligamentous apparatus is weakened, the support-fixation function of the pelvic floor is disturbed, which may be accompanied by a prolapse of the bladder and urethra.
Prerequisites for stress urinary incontinence in women can be obesity, constipation, drastic weight loss, heavy physical labor, radiation therapy. It is known that urinary incontinence often affects women who have given birth, and the number of births is not as important as their flow. The birth of a large fetus, narrow pelvis, episiotomy, breaks in the muscles of the pelvic floor, the use of obstetric forceps - these and other factors are determinant for the subsequent development of incontinence.
Involuntary urination is usually noted in patients of menopausal age, which is associated with an age deficiency of estrogen and other sex steroids and the resulting atrophic changes in the organs of the genitourinary system. Pelvic surgery (oophorectomy, adnexectomy, hysterectomy, panhysterectomy, endourethral interventions), prolapse of the uterus, chronic cystitis and urethritis contribute to the development of stress urinary incontinence in women. The immediate producing factor is any tension that leads to an increase in intra-abdominal pressure: coughing, sneezing, brisk walking, running, sudden movements, lifting weights, and other physical effort.
The pathogenesis of imperative urinary incontinence in women is associated with impaired neuromuscular transmission in the detrusor, leading to bladder hyperactivity. In this case, the accumulation of even a small amount of urine gives rise to a strong, unbearable urge to miccate. The prerequisites for the emergence of urgent urges are the same as in stress incontinence, and various external stimuli can act as provoking factors (harsh sound, bright light, water pouring from the tap, etc.)
Reflex-incontinence can develop as a result of injuries of the brain and spinal cord (injuries, tumors, encephalitis, stroke, multiple sclerosis, Alzheimer's disease, Parkinson's disease, etc.). Iatrogenic incontinence occurs as a side effect of certain drugs (diuretic, sedatives, adrenergic blockers, antidepressants, colchicine, etc.) and disappears after the withdrawal of these funds.
Treatment and prevention of urinary incontinence in women
If there is no coarse organic pathology that causes incontinence, treatment begins with conservative measures. The patient is recommended to normalize weight (with obesity), quit smoking, provoking a chronic cough, eliminate heavy physical labor, follow a caffeine-free diet. In the initial stages of urinary incontinence in women, exercises aimed at strengthening the pelvic floor muscles (Kegel gymnastics), electrical stimulation of the perineal muscles, BOS-therapy can be effective. In case of comorbid neuropsychiatric disorders, the help of a psychotherapist may be required.
Pharmacological support in the stress form of incontinence may include the administration of antidepressants (duloxetine, imipramine), topical estrogens (as vaginal suppositories or creams) or systemic HRT. M-cholinolytics (tolterodine, oxybutynin, solifenacin), α-adrenergic blockers (alfuzosin, tamsulozin, doxazosin), imipramine, hormone replacement therapy are used to treat imperative urinary incontinence in women. In some cases, the patient may be administered intravesical injections of botulinum toxin type A, periurethral administration of autofat, fillers.
Surgery of stress urinary incontinence in women has more than 200 different methods and their modifications. The most common methods of operational correction of stress incontinence today are sling operations (TOT, TVT, TVT-O, TVT-S). Despite the differences in the technique of execution, they are based on a single general principle - fixation of the urethra with the help of a “loop” of inert synthetic material and reduction of its hyper-mobility, preventing urine leakage. However, despite the high efficiency of sling operations, 10–20% of women develop relapses of stress urinary incontinence. Depending on the clinical indications, it is possible to perform other types of surgical interventions: urethrocystopexy, anterior colporrhaphy with bladder reposition, implantation of an artificial bladder sphincter, etc.
Prevention of urinary incontinence in women consists in the rejection of bad habits and addictions, weight control, strengthening of the abdominal muscles and pelvic floor, control over defecation. An important aspect is the careful management of childbirth, adequate treatment of urogenital and neurological diseases. Women who are faced with such an intimate problem as urinary incontinence must overcome false modesty and seek specialized help as early as possible when conservative measures can be effective.
Folk treatment of urinary incontinence in women
Opponents of traditional methods of treatment are probably interested in the question of how to treat urinary incontinence with folk remedies. In this aspect, there are several recipes:
- Perfectly help the seeds of dill garden. 1 tablespoon of seeds is poured with a glass of boiling water and left for 2-3 hours, well wrapped. Then the resulting infusion filter. All the glass means you need to drink for 1 time. And so do every day to get the result. Folk healers claim that urine incontinence can be cured in this way in people of any age. There are cases of complete recovery.
- Sage herb infusion: one cup should be consumed three times a day.
- Steamed infusion of yarrow herb should be drunk at least half a glass 3 times a day.
- Yarrow is a grass that is found almost everywhere - a real storehouse for traditional healers. If you need to get rid of involuntary urination, then take 10 grams of yarrow with flowers in 1 cup of water. Boil 10 minutes on low heat. Then leave to insist for 1 hour, do not forget to wrap your decoction. Take half a cup 3 times a day.
In the treatment of folk remedies, it is important not to start the process of urinary incontinence and to prevent the development of more serious diseases, which may be caused by involuntary urination (for example, cystitis, pyelonephritis).
Incontinence in elderly women after 50 years
Most often, elderly women over the age of 50 are dominated by a mixed form of urinary incontinence, that is, there is both a stressful and an urgent component.
The reasons that lead to the disease can be many, so the doctor during the examination will definitely clarify the following points:
Does a woman suffer from neurological pathologies?
Does she have any mental disorders?
Does a woman have signs of Parkinson's disease?
Does a woman suffer from diabetes?
Does she have weight problems?
Are there hernias of intervertebral discs, or other degenerative diseases of the spinal cord that can affect the functioning of the bladder?
Has the woman had a history of operations on the pelvic organs? If there were any, then it is important to find out if they have provoked the formation of adhesions and fistulas.
All these diseases can be the cause of urinary incontinence, as one way or another can affect the functionality of the bladder. It is possible that a woman has “overflow incontinence”, that is, due to the reduced sensitivity of the organ, the signal for its emptying is transmitted to the brain too weakly or is completely absent.
It is important to find out exactly which drugs the woman is taking. Particular attention is paid to sedative and antihypertensive drugs, diuretics.
Elderly patients diagnosed with stress incontinence in 30% of cases show pelvic organ prolapse, namely, bladder prolapse. Therefore, the approach to both the diagnosis of the existing problem and the treatment of older women must be individual. Nor should we overlook the fact that urinary incontinence may develop against the background of relative health due to the lack of estrogen production in the postmenopausal period.
Comprehensive urodynamic examination of elderly women who complain of urinary incontinence is prescribed without fail.
Exercises with biofeedback (BFB) are superior in effectiveness to Kegel exercises, since they allow you to strain only the muscles you need. For the implementation of the complex will require specialized equipment. It is designed not only to control the process of muscle tension, but also to stimulate them additionally with the help of electrical impulses.
It is proved that BFB-training allows you to achieve control over urination in a fairly short time. However, exercise is prohibited to be implemented in the presence of malignant tumors, inflammatory diseases in the acute stage, pathologies of the heart, liver and kidneys.
The use of simulators for the treatment of urinary incontinence
Devices that allow you to train the muscles of the pelvic floor, there are so many. Many of them are very compact and convenient to use. For example, the PelvicToner simulator allows you to competently increase the load on the muscles, gradually strengthening them. The device is very easy to use, and its effectiveness has been proven in clinical studies.
When you have urge to urinate, you can try to escape from them, transferring thoughts in a different direction. For example, to think about upcoming plans for life, read interesting literature, etc. The main task that a woman faces is to delay urination for at least a short time.