Urinary incontinence (NTM) affects one in eight women up to the age of 39, every second after menopause. Most hide this problem even from their doctor. And urinary incontinence is a disease that, although it is chronic, can be successfully treated. What does urinary incontinence mean and what does it cause?

Incontinenceaffects both genders, but women suffer from it twice as often as men. The most common occurrence isstress urinary incontinence , which is manifested by passing urine sometimes during even slight exertion - when coughing, sneezing, lifting objects, walking, jogging or exercising.

For most women, this is an extremely embarrassing problem, which is also confirmed by statistics. Nearly 2/3 of women with urinary incontinence have never consulted a doctor. And those who decided to talk to a specialist, delayed on average 3 years. If you haven't done anything to your problem so far, it's time to change it.

Urinary incontinence: causes

Stress urinary incontinence will not go away by itself. On the contrary, it will proceed. Usually it starts after 45-50. years of age, when the level of sex hormones drops, but it can appear much earlier. Professionals divide urinary incontinence into three types:

  • stress incontinence- losing various portions of urine (from drops) during exercise, coughing, sneezing, lifting heavy objects, and in the most severe form - even getting up from a chair. The disease is favored by obesity (NTM occurs 4 times more often in obese women than in lean women), menopause and postmenopausal period, chronic cough, some neurological diseases, pregnancy and childbirth (especially surgical), high birth weight of a child, depletion of the reproductive organ, frequent urinary tract infections , constipation, heavy physical work and smoking.
  • Urgent Urinary Incontinence able to predict. The consequence is urine leakage - from a few drops to complete emptying of the bladder. The cause of this form of the disease is an oversensitive bladder, that is, one that shrinks (demandseven with little urine. This may be the result of inadequate nervous control over the activity of the lower urinary tract. Recurring urinary tract infections can be a causative factor. Another reason is systemic diseases, e.g. diabetes, Parkinson's disease, Alzheimer's disease, multiple sclerosis, senile dementia. This form of NTM can also be caused by medications, e.g. dehydrating drugs.
  • overflow incontinenceis characterized by a drop in urine due to an overfilling bladder and a significant stretching of the bladder walls.

In addition, there may betransient urinary incontinence- we deal with it in people who usually consciously control the emptying of the bladder and only periodically have a problem with it, e.g. due to inflammation bladder, taking certain medications (e.g. diuretics or muscle relaxants), drinking alcoholic and caffeinated drinks (they have a diuretic effect) or citrus fruit drinks (irritating the bladder in some people).

Urinary incontinence: diagnosis

Diagnosing urinary incontinence begins with an overall he alth assessment. A gynecological and obstetric or urological interview should be performed, as well as a neurological interview. The patient should be able to tell the doctor about when he has a problem, how urinary incontinence affects his quality of life and how he assesses the amount of involuntary loss of urine.

The next steps to make a diagnosis are:

  • abdominal examination
  • Gyno exam
  • rectal examination
  • neurological examination
  • ultrasound examination
  • urinalysis and urine culture
  • assessment of the amount of residual urine after voiding
  • cystouretroscopy
  • urodynamic test

An important diagnostic element is a questionnaire for the assessment of urinary incontinence and a voiding diary.

The patient has to answer the following questions:

  • how often does he lose urine
  • how much urine is lost
  • in what situations urine is lost unknowingly
  • after which event the leakage occurred
  • is pain associated with urination
  • Does bedwetting occur at night
  • how often does urine pass during the day

In addition, during the conversation with the doctor, the patient presents a micturition diary, which documents ailments related to incontinence disorders and allows you to evaluate dietary habits regarding drinking and urinating.

Voiding diary shouldinclude:

  • number of voids per day
  • frequency of episodes of uncontrolled urination
  • amount of involuntary urination
  • number of episodes of night urination

See what you should know about urinary incontinence and other diseases of the urinary system

Urinary incontinence: three stages

Specialists have adopted a three-point scale that allows them to determine the severity of the disease:

  • 1st degree - uncontrolled outflow of urine occurs during sudden abdominal tension, when pressure in the abdominal cavity increases rapidly (sneezing, laughing, physical exertion, e.g. lifting a heavy object, coughing)
  • 2nd degree - urine leakage occurs during normal activities such as jogging, manual work, and climbing stairs. Any activity that makes us spread our legs wide can be a pretext to urinate
  • 3rd degree - urine leakage occurs in virtually every situation, so the problem is not only the flow of urine itself, but also its smell, and it can also lead to secondary infections

Urinary incontinence: conservative treatment

In the case of urgent urinary incontinence, the woman is offered conservative treatment, which consists in changing the lifestyle, changing the diet, type and amount of fluids (e.g. limiting drinking coffee), exercising the pelvic floor muscles and pharmacotherapy.

Drugs that are used in this group of women are to "calm down" the bladder so that it does not react with a rapid emptying of urine that flows into it. These drugs work around the clock, but - importantly - do not interfere with physiological urination. If these methods fail, it is possible to inject the bladder with botulinum toxin.

In the case of minor stress urinary incontinence, a woman should learn to consciously strengthen the pelvic floor muscles through appropriate exercises. The ideal situation is the rehabilitation of the pelvic floor muscles through electrostimulation.

Another method of strengthening these muscles is biofeedback, which is controlled by both the doctor and the patient, exercising pelvic floor contractions with the use of special equipment.

Ladies who, for various reasons, cannot reach a specialist clinic, can buy an individual electrostimulator for their own use (cost about PLN 500) and use it according to the doctor's instructions.

Urinary incontinence: invasive procedures

Women who experience significant worsening of urinary incontinence are offered an operation by the doctor. But, differentFor reasons, the procedure can also be performed with a less advanced disease.

Currently, most clinics use a technique for the surgical treatment of urinary incontinence, which involves implanting a synthetic polypropylene tape under the urethra. Over time, the tape grows with the patient's tissues and stimulates the local production of collagen. New collagen fibers support the urethra, which prevents urine leakage.

The procedure is performed transvaginally, without disturbing the abdominal wall. The method is minimally invasive and the procedure is short. With proper qualification for surgery, its effectiveness is estimated at 90%.

Abdominal surgery is also possible. This method is used when, in addition to urinary incontinence, there is another medical problem (e.g. uterine fibroids) that must be resolved surgically. For several weeks after the procedure, a woman may experience vaginal discomfort, and a blood-colored discharge appears, which is a sign of healing and cleansing of the vagina.

Usually, after the operation, the patient receives a sick leave (about a month). In the postoperative period, it is advisable to avoid physical exertion, lifting heavy loads, and intensive sports.

If you have a cold, ask your doctor for cough stopping measures so as not to strain the pelvic floor muscles and damage the strap. The operated area takes 6 weeks to heal and you should refrain from vaginal intercourse during this time. Then you can go back to normal intercourse. The partner will not feel the presence of the tape.

Most women feel a significant improvement right after the surgery. For others, you need to wait about 2 weeks for the effect. It is also important to refrain from activities that caused urinary incontinence after the procedure. It is worth taking care of a proper body weight, avoiding constipation and eliminating very spicy spices, large amounts of alcohol and coffee from the menu.

Some surgeries and clinics offer urinary incontinence treatment with jagged erbium lasers. However, the Polish Urogynecological Society, taking care of the interests of Polish patients and providing them with reliable treatment, neither recommends nor supports the treatment of urinary incontinence and lowering of the pelvic organs with the use of a laser, considering this method experimental, unproven, doubtfully effective and possibly burdened with late complications. Full text of the position PTUG

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Cothe tenth Pole has problems with urinary incontinence

The fact that urinary incontinence is a chronic disease, but it can be effectively treated, says prof. Tomasz Rechberger, head of the Gynecology Department and Clinic of the Medical University in Lublin and Anna Sarbak from the UroConti Association of Persons with Urinary Incontinence.

Video source: newseria.pl

You must do it
  • Hormones help

One form of pharmacological treatment of stress urinary incontinence is hormone therapy. Small doses of hormones are given just to make up for their deficiencies in the body.

  • Sometimes surgery is needed

Don't be shy about him if other methods of dealing with the problem have failed. There are many techniques (as many as 120) for performing such procedures, some of them do not require cutting the abdominal wall. Your doctor will suggest the best method for you.

  • Drink as much as you want

Refraining from drinking is a big mistake. First, it may dehydrate the body. Second, it will not make your urine less, but it will become very concentrated. Condensed urine irritates the skin and mucous membranes of the genital organs, which can be a significant cause of e.g. vaginitis.

  • Limit Citrus

Eliminate or reduce bladder irritation from your daily diet. These include: alcohol, sodas, coffee, milk, citrus fruits, tomatoes, chocolate, and hot spices.

  • Regulate bowel movements

The residual fecal matter compresses the bladder, which reduces its capacity. They can also block the urethra, making it difficult for the bladder to empty completely.

  • Stop smoking

Smoking often causes a chronic cough that can weaken the support of the urethra. Nicotine acts directly on the urinary detrusor muscles, causing them to contract, and also interferes with the effect of estrogens.

  • If you are overweight, lose weight

Obesity causes weakness in the pelvic floor muscles. It also leads to the reduction of pelvic organs, which is a very common cause of urinary incontinence.

  • Take special care of hygiene

Urinary incontinence is the cause of bacterial infections of the urinary tract and genital tract. If you need to prevent urine leakage, use only "breathable" urine inserts. They are more absorbent and have a special antibacterial insert that additionally neutralizes the smell of urine. They do not containlatex, so they do not cause chafing and burns. This is important because the skin around the perineum is hypersensitive, it is easy to damage, and the wounds there are difficult to heal.

Category:

Urology and Nephrology