Urinary incontinence - urine is not controlled by man, which is detected visually.
According to statistics, urinary incontinence occurs in 14-56% of cases. But these figures are controversial, because of seeking medical treatment in this disease is very low.
Classification of urinary incontinence
Urinary incontinence is divided into true and false.
False incontinence is called an involuntary leakage of urine when a person does not feel the urge to urinate. The causes of urinary incontinence can be a false congenital or acquired defects of the ureter, urethra or bladder. As a rule, acquired defects arise as a result of injury, in violation of the integrity of the urinary tract.
True incontinence - involuntary release of urine, causing visually observed and hygienic and social problems.
The true incontinence is divided into:
- Stress incontinence occurs when excessive voltage;
- Urge incontinence - involuntary urination preceded urgent urge;
- mixed incontinence - a combination of urge and stress incontinence;
- enuresis - any uncontrolled loss of urine;
- Permanent enuresis;
- situational incontinence (with a strong laughter or intercourse).
The causes of urinary incontinence can be true by many factors. There is the symptom of spinal cord injuries, running cystitis, spinal hernia, complicated with atrophy of the bladder.
Stress urinary incontinence caused by the weakening of the sphincter of the bladder and a weak tone of the pelvic floor muscles. In men, incontinence is often the case after previous surgeries in the neck of the bladder, seminal hillock or prostate. Women during menopause cause incontinence becomes dysfunction reflex-apparatus bladder detrusor tone or breaking due to estrogen deficiency.
The main causes of urinary incontinence are:
- advanced age;
- estrogen deficiency in women during menopause;
- circulatory disorders;
- bladder outlet obstruction;
- sensory impairments;
- the effect of serotonin and prostaglandins;
- anatomical repositioning of the bladder and urethra;
- myogenic disorders.
Bedwetting occurs predominantly in children, although it also happens in adults. The most common cause of bedwetting is a fear or severe psychological trauma.
Diagnosis of Urinary Incontinence
Certain difficulties in the diagnosis of urinary incontinence are different ectopic ureteral orifice. As a rule, measured at the mouth of ectopic instrumental study (examination of the vagina through the mirror, uretrotsistoskopiya, rectoscopy). Sometimes, to determine the cause of urinary incontinence is advisable to apply indigokarminovuyu sample. To do this, intravenous solution indigo 0, 4% in the amount of 5 ml, and watch as it will be allocated in the urine of ectopic mouth.
Also, in the diagnosis of urinary incontinence, methods such:
- Inspection on the gynecological chair. With this diagnostic method can determine the presence and degree of vaginal wall prolapse, cystocele, uterine.
- Cough test by which we can get a visual proof of stress urinary incontinence.
- The cushioning test.
- X-ray methods of research, such as urethrocystography. Using these methods you can determine the shape of the bladder neck and the position of its dynamic changes during stress and at rest.
- The ultrasonic diagnostic methods. Proper perineal ultrasound provides the same information that urethrocystography only if the patient is not exposed to radiation exposure.
To select the appropriate treatment of urinary incontinence is the basis for urodynamic study patient, supplemented voiding diary. Urodynamic study is conducted to determine the parameters of evacuation and funded bladder function.
Recently, MRI technique is spreading in the survey of women with stress urinary incontinence.
The treatment of urinary incontinence
Depending on the cause of the disease treatment of urinary incontinence can be:
- surgery (surgery for incontinence).
Conservative methods are indicated in patients with mild stress incontinence, urgency incontinence caused by overactive detrusor or urethral. Treatment of stress urinary incontinence is two-fold: inhibition of the detrusor and increase the tone of the bladder reflex-apparatus.
It is believed that the Urge and stress incontinence in women during menopause - the consequences of lack of estrogen, so they prescribe drugs estrogensoderzhaschie. This usually leads to a rather positive results.
When conservative treatment of urinary incontinence doctor normalize diet of the patient, increases his physical activity. For national treatment of urinary incontinence should primarily include physiotherapy exercises. It helps to improve blood supply to the pelvic organs, increases the compensatory function of the respiratory and cardiovascular systems, muscle-strengthening ligaments and helps to normalize the patient's mental state.
Mild incontinence can help such a popular treatment of urinary incontinence as pessaries. Of course, they do not eliminate the cause of the disease, but can help the patient to avoid embarrassment. It should be noted that a significant inconvenience to the patient causing the need for extraction pessary before urinating and its subsequent establishment. Furthermore, some patients have noted that when using the pessary may appear bedsores.
The positive effect in the treatment of urinary incontinence may occur after electrical stimulation of tissues and organs of the pelvis. And with mild incontinence some patients have noted the positive effects of acupuncture.
By minimally invasive operations incontinence include injection treatment in women with severe ptosis bladder and the vaginal wall, as well as with neurogenic bladder disorders. During the injection therapy using a Teflon paste, collagen homogenized autozhir and other substances.
It should also be noted transvaginal surgery incontinence types 1-2 - uretrotservikopeksiyu. In recent years, widespread loop or sling operations for urinary incontinence. The loop is used as a free flap of the front wall of the vagina, musculoaponeurotic flap, flap of skin or synthetic materials. The final outcome of surgical treatment can be judged after at least three years after the intervention.