Stress urinary incontinence in women and men: treatment, causes
More and more patients hear the diagnosis of stress urinary incontinence in which the person cannot control the acts of urination. The deviation appears temporarily and on a permanent basis, causing the patient discomfort. The disease develops for a variety of reasons, one of which is stress. Particularly at risk to disease of women after childbirth. Men involuntary urination occurs after surgical intervention in diseases of the prostate, in particular, after the removal of cancer.
Symptoms of stress urinary incontinence
Stress urinary incontinence is most often caused by physical impact. Observed stress incontinence in women when sneezing. This is a manifestation of involuntary, is not accompanied by the urge to urinary act. Possible incontinence of urine when you laugh, and some people have mild leakage of urine is observed while running and during exercise, when increased intra-abdominal pressure. Is bedwetting in children, for example, when jumping rope does not hold urine. Often the child is observed involuntary leakage of urine, jumping on a trampoline.
Patients of different indicators lose urine: some people lose up to 10 milliliters, and some people out the daily amount. To identify indicators in pathology the patient is given a diary in which he noted the amount of discharge for 3 days or more. This person notes how much liquid is left, how often it inadvertently appeared, and how much water did he drink during the day.
The reasons for the development of pathology in women and men
Why is there stress leakage of urine in women and men? Urine is able to stay in the urinary system due to the correlated pressure of the urethra and bladder. The normal functioning of the sphincter is due to their structures and neural regulation. In stressful situations, the sphincter is completely closed, and the capacity of the bladder decreases. Men and women have different factors of the pathology development. The female disease develops on the background:
- frequent vaginal delivery, after which the urethra is completely closed;
- lowering of the uterus in the vaginal area;
- the lack of estrogen in the body;
- appearance of injuries after surgery or radiation.
In males the cause of involuntary urination lies in the methods of treatment of the prostate. Develops as a consequence of surgery or radiation used to treat malignant tumors. Drip stress urinary incontinence excreted in patients who have undergone treatment prostatic hyperplasia benign nature.
What are the risk factors?
There are 3 main groups of risk factors. The first group includes predisposing factors, which include race, hereditary factors and neurological deviations obtained due to injuries. The second group consists of predisposing factors, including patient age, presence of concomitant diseases, excess weight, Smoking and menopause. The third group includes the obstetric and gynaecological factors: pregnancy, childbirth, gestation large fetus, previously performed surgery in the pelvis.
Diagnostic measures for disease
The story of patient about symptoms of concern
In the preparation of the patient’s history includes the time when they began to show signs that the presence of such manifestations in close relatives. Additionally, it turns out, did you notice nocturnal enuresis in a patient in childhood. In addition, the person is asked to fill a specially created questionnaire to determine the causes of stress disease, which includes questions on type and frequency of hard exercise, being in a state of stress, lifting heavy objects.
Diary of urination
For more precise diagnosis the doctor gives a patient diary in which he describes the acts of urination. Man records the time when there is a urination. Describes how much liquid is used the patient per day, in what quantities, what activities were engaged in by the patient, when there was involuntary discharge of liquid. One should note how much urine was released during this period, and whether to this intolerable desire to urinate. Thus, a patient describes what happened to him during the day.
The holding PAD test
Not always according to the descriptions of patients can accurately determine the amount of liquid separated during urination. Uncontrollable urination in women are exploring by using the PAD test. For use of urological pads, which is weighed before testing and after use. The test can last from 20 minutes to 2 hours a day. If the study is designed for short time period, before it, drink a pint of still water.
Investigation of vagina
Female genitals inspected to exclude the presence of concomitant diseases. During examination of the patients, the doctors often show a shrinkage of the vaginal mucosa, the emergence of large fistulas, uterine prolapse. These deviations, revealed with stress incontinence of urine that may lead to complications. Definitely during the inspection of a woman forced to cough, to monitor the discharge from the urethra.
The collection of urinary analysis
If the patient has inflammation in the urinary system, it is in small quantity can be released in urine. A urine test is conducted to determine a person level of leukocytes, erythrocytes, and the presence of harmful microorganisms. To obtain more accurate data, the collection of material occurs in the morning. Before collecting analysis it is recommended to wash the genitals and urinate in a sterile container. Women will also need to cover the vagina with a clean cloth during urination.
Standard methods for the treatment of patients
If the patient does not violate the structure of the urinary tract, he prescribed conservative medical treatment. Complex treatment included the acceptance of agonists and anticholinesterase drugs, which increase sphincter tone. Stress urinary incontinence in women can be treated successfully with the help of drugs such as «Spasmex», «Westar», as well as hormones and antibiotics.
The use of kegels
Kegel exercises are aimed at training perivaginal and periurethral muscles. In the sitting position the patient has the urge to urination, and then mentally holds the jet, using muscles. Exercises should be done 3 times a day with a gradual increase in execution time. A person can perform workouts anywhere, as they are invisible to other people.
The use of biological feedback in exercises
Conducting gymnastics with the use of biofeedback helps to increase muscle tone and the patient is able to control the urinary act. For the method characterized by the use of a special apparatus, which registers muscle tone. But there are a number of contraindications, including the presence of:
- malignant neoplasms;
- inflammation during the acute stage;
- kidney, liver and heart ailments.
To strengthen pelvic muscles patients recommend the use of special equipment. Through training, people develop the ability to control urination. Works is one of the exercise machines, working by a spring, which gradually increases the level of stress on the muscles and strengthens them. Advantage of harmlessness.
Conducting psychological training
To deal with stress urinary incontinence not only with the help of medication and exercises, but also through psychological training, which aims to distract the patient from thinking about the problem. For each patient, classes are chosen individually (e.g., reading books, sleep). It is important that people have forgotten about the exciting problem.
Features of treatment of this disease
Treatment of stress urinary incontinence includes a complex of measures aimed at strengthening the pelvic floor muscles, so that a person can control the urge to urination. Complex treatment includes exercises, use of exercise equipment. Less likely to use conservative medical treatment, because alternative methods are not always give results.
Operative methods of treatment
Sling surgery (TVT or TVT-O)
The surgery is performed using local anesthesia. They last no more than an hour, while the patient is in the neck of the bladder or urethra loop, made of synthetic mesh. With a loop, the urethra remains in its normal physiological state, and the liquid ceases to be allocated under the influence of the increased pressure inside the abdominal cavity.
Considered less traumatic injection of bulking agents, in which in the submucosal layers introduce a solution. The advantage of inputs is the lack of allergies in a patient. As a result, the urethra of the patient is fixed in position, and stops the outflow of urine. But after the injection may cause relapse.
Conducting laparoscopic colposuspension
Stress urinary incontinence resort to complex laparoscopic colposuspension for Burch, in which use General anesthesia. Although the operation has positive results, there is still a number of contraindications. Often the method used for anatomical disorders of the urinary system and the reproductive system.
To stop light incontinence of urine, the patient undergoes Corporatio. During surgery, patients spend the suturing area of the vagina using absorbable threads. Method is used in cases of pelvic organ prolapse. After the surgery may develop adverse effects, and its effectiveness is a few years.
To prevent development of the disease the patient is recommended to abandon the use of alcoholic beverages and Smoking, to lose weight, and to remove from the diet foods that have a diuretic effect. People should do sports, to review the drugs that he takes in the treatment of other ailments. It is always recommended to go to the toilet after sex.