Nocturnal enuresis in adults. Nocturnal enuresis in adult men - causes and treatment Nocturnal enuresis in adults causes treatment

Bedwetting in adult men is a widespread problem, however, the majority of the male population prefers to hide such a delicate ailment, considering it shameful and unacceptable for discussion, even with a doctor. You should not equate the concept of nocturnal enuresis, when the process of urination occurs uncontrollably during sleep, and nocturia - the removal of the bulk of urine from the human body at night, increased urge at night and, in connection with this, frequent awakenings. Modern experts define several main types of enuresis:

1. stress type. With stress enuresis, the emptying of the bladder is carried out suddenly, uncontrollably. Factors such as coughing, strong laughter, sneezing, heavy lifting, and physical activity can provoke stressful urination. Anatomically, this is due to the displacement of the bladder neck, as a result of which the sphincter muscles lose their ability to normal contraction. It is also possible the influence of age-related changes, as well as due to surgical interventions.
2. . Such enuresis type characteristic of bedwetting. In this case, bladder reflexes are not controlled by the nervous system and the process of urination is not regulated by the person. The cause of such a problem can be: different types of stroke, Alzheimer's disease, urolithiasis of the bladder.
3. Complete urinary incontinence (the absolute absence of the urge to urinate). This condition can be caused by several factors: taking medications, neurological pathological conditions, loss of bladder tone, its overstretching, disruption of the sphincter due to habit (conscious suppression of natural urges for a long time). This type of disturbance is also characteristic of nocturnal enuresis.

The causes of bedwetting in men are varied and can be based on both physiological pathological disorders and psycho-emotional problems:

• Infectious and inflammatory diseases in the genital area. Sexually transmitted diseases can lead to tissue changes, scarring, and abnormal functioning of the bladder, sphincters, and urinary tract;
• Infectious processes affecting and damaging the central nervous system, and disrupting the formation of a reflex of the urge to empty the bladder;
• Pathological phenomena associated with a violation of the outflow of urine due to prostate adenoma (benign tumor);
• Cancer of the prostate;
• Strictures of the ureters, urethra (urethra);
• Overactive bladder. With this problem, the number of urges to urinate increases, but involuntary urination at night can also occur after normal bladder emptying due to the urge;
• Transferred emotional shock or severe stressful situation;
• Nervous breakdowns and overexertion;
• The presence of congenital abnormal reflexes of bladder emptying;
• The presence of neoplasms in the bladder;
• Pathological processes in the spine and spinal cord;
• A history of such pathologies: diabetic cystopathy, sleep apnea syndrome, bladder outlet obstruction, endocrine diseases.

Diagnosis scheme

Nocturnal enuresis in adult men is a solvable problem. To prescribe an adequate treatment regimen, it is necessary to conduct a comprehensive diagnosis and identify the etiology of the disease. The first stage of diagnosis is the collection of anamnestic data. The following information is important for making a diagnosis:

1. Time of episodes of involuntary urination;
2. The volume of excreted urine;
3. The amount and type of liquid consumed shortly before bedtime (coffee, tea, alcohol, carbonated drinks);
4. The nature of urination;
5. The presence of infectious processes in the urinary tract;
6. The frequency of nocturnal enuresis;
7. Taking any medications.

It is necessary to be examined by such specialists as a general practitioner, nephrologist, endocrinologist, urologist, neuropathologist. Laboratory research methods include:

• Clinical blood test;
• Clinical analysis of urine;
• Urinolysis;
• Bacteriological culture of urine

Additional research methods include:

1. Uroflowmetry is a special method for studying the nature of urination (speed, urination time, urine volume);
2. Ultrasound examination of the bladder (residual volume of urine after the act of urination).

Treatment of nocturnal enuresis in men

Treatment of nocturnal urinary incontinence in men directly depends on the cause of the disease identified during the diagnosis process. However, there are also universal therapeutic procedures:

• Physiotherapeutic methods of treatment of nocturnal enuresis. The essence of the technique lies in the beneficial effects of weak electrical discharges on the body and improving the transmission of nerve signals (impulses) from the bladder to the brain. Such procedures are completely painless. Electrosleep and electrophoresis contribute to the normalization of sleep and the nervous system. Darsonval (applied locally to the area of ​​the bladder) helps to strengthen the sphincter tissue of the bladder. Magnetotherapy helps to relax the walls of the bladder with their hypertonicity;
• The use of therapeutic mud, paraffin, ozokerite helps to increase blood circulation in the area of ​​​​their application (lumbar region, lumbar region and pubic region) and relieve muscle spasm;
• Acupuncture helps to improve the functioning of the nervous system, normalize the psycho-emotional state, sleep patterns.

Treatment of nocturnal enuresis in adults includes the appointment of various groups of drugs, the combination of which depends on the identified etiological cause of the pathology:

1. In infectious and inflammatory processes of the genitourinary system, antibiotic agents are prescribed (taking into account the causative agent of the disease): Monural, Norfloxacin, Doxycycline, Rifampicin;
2. In case of sleep disorders, tranquilizers are prescribed: "Radedorm", "Eunoktin";
3. For kidney diseases, nitrofuran drugs are used: "Furamag", "Furadonin";
4. For mental and psychological problems, antidepressants are prescribed: Amitriptyline;
5. Nootropic drugs help to improve the functioning of the nervous system: Piracetam, Glycine, Picamilon;
6. With spasm of the muscles of the bladder (and, in connection with this, a decrease in its volume), M-anticholinergics are prescribed: "Sibutin", "Driptan";
7. To reduce the amount of urine excreted at night, drugs are prescribed based on the artificial hormone desmopressin: Adiuretin-SD.

Also, the treatment of nocturnal urinary incontinence includes surgical operations:

• Expansion of the urethra with a balloon;
• Canal resection;
• Implantation of an artificial bladder sphincter.

For maximum effectiveness of the therapy, it is necessary to strictly adhere to all the doctor's prescriptions and take the drugs regularly, in the indicated doses and quantities.

Enuresis is uncontrolled urination during the day or night. With the appearance of this pathology, the quality of life of patients is significantly reduced. Adult patients hide their problem from relatives and doctors for a long time. Enuresis in adult men occurs with the pathology of the prostate gland.

Therapeutic measures for enuresis give positive results due to an integrated approach. This allows the patient to return to normal life.

Etiology of enuresis in adults

The causes of enuresis in adults differ from those in children.

In childhood, enuresis is provoked by stressful situations (divorce of parents, death of relatives, severe fright).

In adults, the following causes of the disease are distinguished:

• infectious diseases of the urethra, bladder;
• congenital or acquired malformations of the genitourinary system;

• operations in the pelvic organs;
• trauma;
• endocrine diseases (diabetes mellitus and obesity);
• sexually transmitted infections;
• nervous tension;
• drugs that can cause enuresis;
• weakness of the muscular apparatus of the pelvic floor;
• neoplasms of the prostate gland in men;
• postpartum period, menopause in women;
• hereditary predisposition;
• alcoholism.

Elderly patients are more susceptible to the incidence of enuresis, as there is a decrease in the concentration of sex hormones and the contractile function of the pelvic floor sphincters. In elderly patients, it is provoked by brain tumors, Alzheimer's disease. As well as the causes of pathology are diseases of the central nervous system.

Men are more likely to suffer from enuresis. Scientists have proven the existence of a causal relationship between childhood and adult forms of enuresis.

Varieties and symptoms of enuresis

Doctors distinguish three classifications of enuresis:

enuresis symptoms

The disease is manifested by the presence of urinary incontinence in the patient at night or during the day,. The patient becomes less sociable and secretive. Patients experience leakage of urine before the urge, pain in the lower abdomen.

Associated symptoms:

• heart rhythm disturbance (bradycardia);
• bluish, cold extremities;
• hypothermia or hyperthermia;
• weakness, drowsiness;
• cloudy urine, the presence of blood clots in it.

Nocturnal enuresis in adults is manifested by uncontrolled nighttime urination. With this type of pathology, the patient loses the awakening reflex when the bladder is filled.

Diagnostic measures

The first link in the diagnosis of urinary incontinence is an examination by a general practitioner, gynecologist or urologist. The doctor collects a detailed medical history. He specifies the time, frequency, nature of urination, the presence of pain. And also finds out the amount of fluid drunk per day and before bedtime.

The doctor records information about heredity and childhood illnesses, and also palpates the prostate gland in men. The gynecologist performs an examination on the chair, takes swabs from the vagina and. The patient gives a general analysis of blood and urine, keeps a diary of urination.

The next step in the examination of the patient is uroflowmetry. During the procedure, the rate, time of excretion and volume of urine are recorded.

The patient undergoes an ultrasound examination to determine the amount of residual volume in the bladder, provoking spontaneous urination during the next urge. The doctor directs to ultrasound of the kidneys and prostate gland (for men).

If necessary, the doctor prescribes an x-ray examination of the kidneys, bladder with a contrast agent to determine their excretory function.

To assess the condition of the mucosa and identify formations in the bladder, ureters and pelvis, an endoscopic diagnostic method is used.

Enuresis treatment

Therapeutic measures include conservative and surgical methods. Conservative treatment includes drug therapy, psychological assistance, therapeutic physical culture, diet therapy, a healthy lifestyle, and physiotherapy.

Diet therapy and healthy lifestyle

In order to improve the general condition of the patient, the doctor recommends a diet. The patient is obliged to drink at least 2 liters of water per day, do not drink before going to bed and walking.

Drinks that stimulate the excretion of urine should be excluded: tea, coffee, sweet carbonated drinks, as well as alcohol (especially beer).

Do not get involved in salty foods, spicy, fatty, fried foods. Nutritionists recommend eating more fruits, vegetables, herbs, bran bread, cereals.

General principles of treatment and care of patients

The patient needs to change behavioral habits. Therapy for enuresis in adults, the causes of which non-patients cannot immediately determine, involves the practice of controlled urination. The patient must empty the bladder forcibly every hour, if necessary every half hour. Gradually, the intervals between urination increase to 3-4 hours.

Before walking and sleeping, you need to empty your bladder. Actively use urological swimming trunks, linings. In bedridden patients, these drugs cannot be used constantly, as this can lead to skin irritation, which is quite difficult to cure.

Methyluracil ointment, Bepanten cream helps with diaper rash.

To protect the mattress from getting wet, special moisture-resistant mattress covers are on sale.

Physiotherapy

Exercise therapy is necessary to strengthen the muscles of the pelvic floor. For this, a special set of exercises was created - Kegel gymnastics. The essence of the technique is rhythmic contractions of the sphincters of the pelvic floor (10 seconds for contraction, 10 seconds for relaxation, 10-15 repetitions).

And also in an attempt to stop the stream of urine during urination. These exercises do not require special efforts from the patient.

Physiotherapy

Physiotherapy for enuresis in an adult is designed to reduce the intensity of contractions of the bladder during its overflow, as well as strengthen the muscles of the pelvic floor.

Actively use:

• electromagnetic effect on the pelvic floor;
• darsonvalization of the walls of the bladder;
• mud treatment.

Apply electrical stimulation of the pelvic floor muscles, which mimics Kegel exercises.

Medical therapy

Includes the use of drugs. These include a group of anticholinergics and M-anticholinergics. These medicines have a positive effect only in conjunction with general activities.

The drug Oxybutynin, Tolterodine, Solifenacin, Darifenacin are widely used in the treatment of enuresis. They have a long-term effect, are applied 1-2 times a day.

Oxybutynin is available both in tablet form and as a patch. The patch needs to be changed every two weeks. These drugs relax the detrusor (the muscle lining of the bladder that contracts to cause urination).

Gynecologists and urologists prescribe the following drugs:

• Minirin;
• Driptan;
• Vizikar.

With nocturnal enuresis in adult women and men, Miridin, Driptan are suitable. The presence of persistent enuresis requires the use of a group of drugs.

Other treatments

With the ineffectiveness of therapeutic measures, doctors turn to invasive methods: an operative method of treatment and stimulation of the sacral and tibial nerve.

Surgical treatment is indicated for patients with tumor-like formations of the urinary system, prostatic hypertrophy, which prevents urine output.

If it is not possible to remove the tumor, a stent is placed inside the urethra, which prevents the walls of the urethra from closing. In most patients, after surgery, enuresis is eliminated almost immediately.

In severe cases of the disease, a minimally invasive method of stimulation is used by means of injections at the level of the 3rd sacral vertebra and into the region of the tibial nerve.

And also these methods strengthen the sphincter of the bladder. Sessions are held once a week. The course of treatment must be observed within 3-4 months. Additionally, the patient is implanted with a neurostimulating implant.

Enuresis in adults is treated successfully thanks to an integrated approach. The behavior of the patient is of great importance in the treatment. Urination training and Kegel exercises greatly increase the chance of a cure. Subject to all the recommendations of doctors, patients can completely get rid of the disease.

Urinary incontinence is a condition of the body in which uncontrolled urination systematically occurs. Enuresis in adult men occurs with age, although a direct relationship cannot be established. There are a number of other factors that increase the likelihood of the disease. As a rule, the disease is not independent, but is only a symptom of more serious problems. Statistics say that about 7% of men under the age of 65 suffer from this disease, and at an older age, the number increases significantly.

Collapse

This problem does not pose a particular threat to health if personal hygiene is maintained at the proper level. You can not ignore this symptom without attention, it is better to immediately contact a medical institution, since the disease can be caused by the following factors:

• cystitis;
• bladder tumor;
• stones that could penetrate the genitourinary system from the kidneys;
• adenoma;
• stroke;
• injury and damage;
• epilepsy;
• mental disorders;
• encephalitis;
• diabetes;
• consequences of alcohol consumption
• consequences of surgical intervention;
• oncology of the prostate.

Studies have shown that a sedentary lifestyle can also cause enuresis. Experts recommend doing more sports or loading the body with simple physical exercises so that the muscles do not atrophy. The disease may appear due to the intake of certain medications:

• diuretics;
• tranquilizers;
• antidepressants;
• anti-allergic drugs;
• drugs for hypertension;
• drug-based painkillers.

In some cases, medications cannot be limited, so there are special methods that allow you to take medications and eliminate side effects.

The main cause of the disease are bacteria that penetrate the human genitourinary system and cause an inflammatory process. Doctors identify a number of reasons for the development of this disease, for example:

1. infectious cause. Basically, an infection in the ureter becomes the cause of the disease. Infection occurs mainly due to hypothermia and low immunity. This reason occurs in most patients. Sometimes bacteria enter in another way through the bloodstream or with lymph.
2. The use of medicines. Some medicines have side effects, for example, the formation of an inflammatory process in the ureter.
3. Allergy. The main treatment is the detection of the allergen, and to exclude contact with it. Sometimes the disease can develop on the background of alcoholism.

There are also factors that increase the risk of developing cystitis:

1. Wearing synthetic underwear.
2. Unprotected promiscuity.
3. Intestinal diseases.
4. Kidney diseases.
5. Hormonal disorders.
6. Weakened immunity.

It can be primary and secondary forms, and also divided into infectious and non-infectious species. From the course of the disease, a form of cystitis is put, which can be chronic or acute. The acute form is determined by severe symptoms, and the chronic form proceeds with hidden, almost imperceptible signs.

The disease has no characteristic signs, they are very similar to other diseases of the genitourinary system, so it makes sense to conduct additional examinations. The main symptoms of cystitis include:

• pain when urinating;
• pain that is localized in the lower abdomen and between the legs. The pain threshold for each person is individual;
• blood in the urine.

If any of the symptoms occur, you should immediately go to the hospital. With the help of several tests, an accurate diagnosis is established. An ultrasound examination is ordered and, if necessary, a biopsy is performed.

If the disease is in an acute form, then it is imperative to observe bed rest, drink plenty of water and diet. The following foods are excluded from the diet: salted, canned, alcoholic drinks. The use of herbal decoctions, physiotherapy and more is recommended.

According to the above symptoms, it will not be difficult to diagnose cystitis. Taking antibiotics will help in a short time to alleviate the well-being of a person. If the patient has pain, then antispasmodics and painkillers are first prescribed. In treatment, it is very important to drink a course of antibacterial drugs. With well-prescribed treatment, it passes within ten days. Cystitis can cause complications, such as blood in the urine. Sometimes the disease spreads beyond the mucous membrane. Pyelonephritis also sometimes develops, the disease spreads to the kidneys and leads to inflammation.

Preventive measures should be taken by every woman. Before and after sexual intercourse, it is necessary to wash the genitals. Treatment of all diseases of the genitourinary system is necessary completely. Try not to overcool.

Varieties of incontinence

There are several types of illness. They differ not only in the causes of occurrence, but also in the nature of the manifestations, as well as methods of elimination. Let's look at them in more detail.

1. Stressful. This condition is a response to significant physical exertion, strong laughter, sneezing or coughing. In this case, a small amount of urine is excreted. The cause may be a disease that disrupts the functioning of the sphincter, which is a muscle designed to hold urine in the bladder.
2. Urgent. In this case, incontinence may be preceded by excessive activity of the muscular layer of the bladder, it is he who is responsible for the movement of urea. The patient experiences a strong, almost unbearable desire to urinate with the release of a large volume of fluid.
3. Night. Occurs for various reasons, is the most common variety. Nocturnal enuresis in adults can develop on the background of a psychological disorder.

Before treatment, it is important to determine the type of incontinence in order to correctly assess the degree of damage and choose an effective therapy.

Therapy includes necessarily several methods of treatment, since it is possible to get rid of the problem only in a complex manner. It is important not only to use medicines, but also to maintain a proper lifestyle and eat rationally. Experts recommend keeping a special diary for recording urination, this will allow the doctor to draw up a picture of the disease in more detail.

First of all, it is necessary to minimize the amount of stress in your life, it is difficult to do this, since even a rash does not belong to this group. Sleep should be healthy for at least 9 hours, while it is necessary to go to bed before 23:00. Before this, you should not drink alcohol or tobacco products, as this negatively affects the muscles of the reproductive and urinary systems. If it is difficult to maintain such a daily routine, then before going to bed you can drink a sedative or herbal decoction. Valerian, calendula decoction, motherwort or lemon balm tea are great.

We recommend not to wait for the urge to empty the bladder, but to work out for yourself a clear system in which going to the toilet will be carried out every 2 hours. After a few weeks, this time can be increased. Even if there is no desire to empty the bladder before going to bed, it is imperative.

The diet for such an ailment is not very strict, but there are several rules that must not be prohibited:

• you should limit the use of salty and sweet foods;
• try to exclude pickled and spicy products from the diet altogether;
• caffeine can be drunk only in the morning and before lunch in very small quantities;
• give up alcohol;
• if the intestines are full, then its walls will begin to press on the bladder, which will cause you to run to the toilet more often or even uncontrolled urination will occur. Therefore, it is important to include foods rich in fiber in food, this component cleanses the digestive system and improves the general condition of the body.

With bedwetting, you should not drink any liquid 1 hour before bedtime. It is advisable to drink about 2.5 liters of water per day, but do it in small portions, preferably one glass at a time, but with interruptions.

Performing special gymnastics allows you to strengthen the muscles of the pelvic thigh, which will allow you to keep urine in the bladder. The basis of these classes are Kegel exercises, they can be performed at home, in the office and even on the road. The main point is the periodic tension and further relaxation of the muscle tissue in the perineal area.

First of all, you should find these muscles. When urinating, a man must stop this process and fix the sensations in his memory. After that, you can proceed directly to the exercise:

• the muscles of the pelvis tense for 3 seconds;
• then relaxes for the same time;
• in the future, the time must be increased;
• the algorithm should be repeated at least 10 times;
• should be performed at least 3 sets per day.

Kegel exercises are aimed at strengthening the muscles. They also have a positive effect on the reproductive system, preventing the development of various diseases, such as prostatitis and adenoma.

If it was not possible to notice visible improvements after adjusting your diet and doing exercises, then it is advisable to use medications. The same solution is resorted to in the case of the infectious nature of the development of the disease. The specialist may prescribe the following means:

1. Antibiotics. They are actively used for inflammation and cystitis, as well as to eliminate the consequences after the removal of stones in the bladder.
2. Antispasmodic drugs. Reduce muscle tone, which normalizes the contraction of the bladder.
3. Antidepressants. They do an excellent job of treating incontinence if the problem is hidden in the psycho-emotional background of the patient.

If incontinence appeared after using certain medications, then this should be reported to the doctor who prescribed them. He should reconsider his decision and prescribe a similar remedy without this side effect.

Features of surgery

In some cases, the treatment of enuresis in adults with medication does not give the desired result, then it makes sense to treat it through surgery. It is prescribed for:

• severe urinary retention;
• chronic incontinence;
• adenoma;
• systematic development of infections;
• skin irritation due to contact with urine.

The attending physician, based on the characteristics of the problem, chooses the procedure. There are several of them, each of which has individual characteristics, let's look at them in more detail:

1. Installation of a new sphincter, it is an artificial apparatus. To do this, an incision is made in the perineal area, into which a silicone prosthesis is inserted directly into the urethra. It consists of a cuff, a container with sterile liquid, and a pump. If you pump up the cuff with a pump, then urine will not come out.
2. A loop of a special inert material is placed under the urethra, its task is to move the urethra up to reduce intra-abdominal pressure. This is how a sling operation is performed.
3. For urge incontinence, some gel may be injected into the urethra. The passage for urine will decrease, which means it will be easier to keep it.
4. If incontinence is caused by oncology of the bladder, then the affected organ is removed. After that, a part of the intestine is taken to create an artificial bladder, the ureters are sewn there. In this case, the emptying process will deteriorate significantly, since additional devices, such as a urinal with a catheter, will have to be used.

Surgical intervention is used only as a last resort, when all other methods have been powerless. The consequences of the operation may not be very pleasant, as this is followed by a long process of recovery and addiction. It is better not to start the body to such a state and, at the first sign of a problem, contact a medical institution. There is no need to be ashamed of incontinence, because it is better to consult a specialist than to experience constant discomfort. In addition, the constant spread of urine leads to the emergence and development of dangerous bacteria, for which such an environment is an ideal habitat.

Female enuresis is a form of dysuria (urination disorder) in women, which is characterized by urinary incontinence at any time of the day. Urinary incontinence has a detrimental effect on both the physical and psychological state: a woman cannot play sports, be in public places, communicate freely with people. This problem is not a separate disease, but only its manifestation. Therefore, enuresis is treated by various specialists: urologists, gynecologists, neurologists.

Enuresis is more common in the weaker sex

Today, more than half of the fair sex suffer from urinary incontinence. This urinary disorder affects both the elderly and middle age. Women over 60 suffer from enuresis due to any disease or age-related changes in the urination system, and in young girls it often occurs after several births.

Types of enuresis

Depending on the pathogenesis (development mechanism), the following types of urinary incontinence in adults are distinguished:

• stress look. The cause of this form is a violation of the normal activity of the urethral sphincter. The pathogenesis is an increase in intra-abdominal pressure, which is provoked by laughter, coughing, lifting weights. In this process, weakened sphincter muscles are unable to hold urine. Risk factors for the development of stress incontinence are genetic predisposition, obesity; infectious diseases of the urogenital area, suffered by women in the past.
• Imperative or urgent view. The mechanism of development of this form of female enuresis is to disrupt the activity of the central nervous system (central nervous system). The cause here can be considered hyperactivity of the bladder, which develops as a result of a violation of its innervation. With such processes, a woman is disturbed by sudden urge to urinate up to 10 times a day. Their appearance is facilitated by bright light, the sound of murmuring water, etc. Urine leakage in this case cannot be controlled. Risk factors for the development of urge incontinence are: age over 60 years, several births, hormone imbalance, bladder tumor, neurological pathologies.

It happens that a woman does not have time to run to the toilet

• Permanent incontinence. The causes of this type of enuresis are anomalies in the structure of the organs of urination, dysfunction of the urethral sphincter. Persistent incontinence is most common in older people.
• Bedwetting (sleep incontinence). Nocturnal enuresis in adults is the uncontrolled excretion of urine during sleep. The causes of this form are hypotension of the muscles of the perineum and pelvic floor due to several births, episiotomy (dissection of the perineum during delivery).

Among adults, the most common stress and imperative forms. In addition to the above, there are iatrogenic (dysuric disorder due to the intake of diuretic and other medications) and unconscious urinary incontinence.

Causes of enuresis

In general, this urination disorder in women is a consequence of hypotension of the muscles of the small pelvis, its bottom, as well as dysfunction of the urethral sphincter. The following diseases can lead to these pathologies:

• urolithiasis disease;
• diabetes;
• stroke;
• spinal cord injury;
• multiple sclerosis;
• Parkinson's and Alzheimer's diseases;
• chronic infectious diseases of the female urogenital area;
• benign and malignant formations in the pelvic organs;
• prolapse of the pelvic organs.

Other conditions that lead to enuresis include:

• the period of pregnancy, delivery (protracted or rapid delivery);
• overweight or obesity;
• old age;
• chronic cough due to smoking;
• alcohol intake;
• taking diuretics.

Diagnosis of enuresis

Differential (comparative) diagnosis is mainly carried out between the stressful and imperative types of this urination disorder. To do this, it is necessary to compare the frequency of symptoms in a patient:

To make a final diagnosis and prescribe appropriate treatment for an adult, the doctor prescribes basic and additional types of research. They consist of clinical, laboratory, and instrumental diagnostic methods.

If enuresis occurs, you should immediately seek help from a doctor.

Clinical researches:

• Collection of complaints.
• Collection of anamnesis.
• Filling in a special questionnaire (ISQ questionnaire). It usually contains questions regarding the following complaints and symptoms:
  • the period of time from the onset of the first symptoms;
  • change in the volume of leaking urine from the onset of manifestations to the day of treatment;
  • frequency of urinary leakage;
  • the presence of factors (coughing, laughter, heavy lifting, the sound of pouring water, etc.) that provoke uncontrolled urination;
  • the presence of an irresistible urge to excrete urine;
  • urinary retention time when urging;
  • frequency of incontinence;
  • the period of the day in which uncontrolled urination most often occurs;
  • the presence of urge to urinate at night;
  • the impact of enuresis on the quality of life (score on a 5-point scale).

The doctor asks the woman to complete the Urinary Incontinence Symptom Questionnaire.

• Keeping a diary of urination. The diary states:
  • time;
  • the amount of fluid consumed (in ml);
  • number of calls per hour;
  • volume of excreted urine (in ml);
  • the presence of an irresistible urge (yes / no);
  • the presence of involuntary urination (yes / no);
  • the volume of urine excreted during uncontrolled urination (in ml);
  • provocative factor of involuntary urination (sports, laughter, coughing, bright light, etc.).
• PAD - test. This test is used to determine the amount of urine leaking. During it, the woman wears special pads that she weighs before and after use. All data should be recorded on paper for later study by their doctor.

Laboratory and instrumental studies:

1. General urine analysis.
2. Bacterial culture of urine according to indications.
3. Inspection of the genital organs on the vaginal mirrors.
4. Ultrasound examination (ultrasound).

Carrying out an ultrasound examination

Enuresis treatment

After the final diagnosis is made, the doctor prescribes the appropriate therapy. Enuresis can be treated conservatively and promptly. Surgical treatment is resorted to after unsuccessful medical treatment for a year.

Conservative treatment:

• Normalization of lifestyle:
  • control over body weight;
  • exclusion of bad habits;
  • reducing the consumption of drinks containing caffeine;
  • restriction of salt intake.

The above methods also serve as preventive measures to reduce the risk of enuresis in adult women.

Herbs can be used to treat enuresis

• Phytotherapy:
  • infusion of dill seeds (1 st. 1 r / day);
  • infusion of sage herb (1 tbsp. 3 r / day);
  • infusion of yarrow (½ tbsp. 3 r / day);
  • tincture of corn stigmas (1 tablespoon 2 r / day);
  • plantain juice (1 tbsp. 3 r / day).
• Kegel exercises.

The essence of these female exercises is the alternating tension and relaxation of the pelvic floor muscles in order to gradually strengthen them.

• Psychological training.

The meaning of the training is to carry out various activities (reading a book, listening to music) when an urge appears. With the help of this method, a person "trains" the central nervous system to restrain the urge to urinate.

With a strong urge to urinate, you can try to distract yourself from thinking about it.

• Medications:
  • Antidepressants - prescribed to eliminate stress as one of the causes of enuresis in women.
  • Means acting on the peripheral nervous system are used to normalize the tone of the muscles of the pelvic floor and the urethral sphincter.
  • Estrogens - are prescribed to restore the balance of sex hormones, the violation of which caused enuresis.

Drugs for the treatment of stress-type enuresis should be used only in the absence of anomalies in the structure of the urinary organs.

Surgery:

• sling operation (imposition of a loop on the ureter);

Sling surgery for urinary incontinence

• laparoscopic colposuspension ("suspension" of the urethra due to the walls of the vagina);
• colporrhaphy (suturing the vagina).

Conclusion

Female enuresis is a fairly common problem among women. To reduce the risk of developing this pathology, it is recommended to follow the right lifestyle, exercise to strengthen the muscles of the small pelvis. When the first signs of urinary incontinence appear, you should consult a doctor to find out the causes and prescribe a rational treatment. Remember, enuresis does not go away on its own, so timely contacting a specialist will help avoid the development of adverse effects.

Enuresis is a disease characterized by the inability to control urine. Often, in patients, the main symptom manifests itself at night, but there are cases during the wakefulness period.

ICD code 10 - F98.0 Enuresis of inorganic breed and R32 Urinary incontinence, unspecified.

Classification and symptoms of the disease

There are 2 types of classification of the disease.

According to the factors that provoked it, the pathology differs in:

• – and active separation of urine;
• - separation of urine due to, or crying;
• incontinence due to an overfilled bladder.

According to the time of manifestation of symptoms, pathology is of the following types:

The main symptoms of enuresis are frequent urge to urinate with the inability to hold urine. In addition, other signs of pathology are noted:

• pain syndrome appears in the lower abdomen (genital area);
• body temperature rises, in rare cases, fever appears;
• blood clots appear in the urine, and;
• drowsiness and malaise.

Causes of the disease

Pathology can develop due to many factors:

The causes of the pathology may be other factors:

• heredity;
• drinking or drinking, as well as caffeine in large volumes;
• spinal injury;
• diseases: diabetes mellitus, infectious pathologies, which include cystitis and adnexitis, and neurotic conditions such as epilepsy, Alzheimer's and Parkinson's disease, seizures or multiple sclerosis;
• psychological trauma, mental disorders and emotional stress;
• alcoholism.

Modern diagnostic methods

The effectiveness of treatment depends on the correct diagnosis and the causes of the disease. The first step is to examine and interview the patient. During this, the genitals are examined and the abdomen is palpated.

Be sure the patient is sent for 2 sessions of ultrasound of the pelvis (full and empty bladder) and the abdominal cavity.

Other diagnostic methods are also carried out:

• Lora's consultation (excludes chronic diseases);
• (intravenous);
• urofluometry;
• the rhythm and volume of emptying is studied at night and daytime.

Treatment of pathology

In the treatment of pathology, various methods are used:

1. Mode change. It is imperative for adults diagnosed with enuresis to avoid stress. Completely excluded from the diet of caffeine, alcoholic beverages and products that have a diuretic effect. After dinner, you need to reduce the volume of fluids consumed, and do not drink at all a few hours before bedtime. To prevent embarrassment, you should develop a schedule for emptying the bladder, including at night.
2. Psychotherapy. Psychological therapy is applied regardless of the type of disease. The most powerful factors are hypnotic, indirect, post-hypnotic and autosuggestion.
3. Abdominal muscle training. During urination, it is necessary to delay the flow of the jet for a while (30-60 seconds is enough) each time. If weakness of the pelvis and pelvic floor is noted, then it is additionally used.
4. Acupressure. In this case, pressure is applied to the reflex zones, which contributes to the activation of important processes in the body.
5. Healing mud. They are applied every other day to the kidney area and lower abdomen at bedtime. The course of using mud is no more than 8 procedures.
6. Hydrotherapy. It implies the adoption of coniferous or nitrogen baths to improve blood circulation and relaxation. As well as the use of a shower with a pressure of different intensity. The procedures also allow you to restore the nervous balance.
7. Animal Therapy. The use of animals for treatment, in particular horses, dolphins and dogs, helps to get rid of diseases based on mental disorders.

Physiotherapy

With urinary incontinence in adults, physiotherapy is very helpful, such as:

• exposure to a pulsed alternating current on the affected area (using the Darsonval apparatus) to strengthen the sphincter;
• low-frequency alternating current directed to the brain area (normalizes sleep);
• acupuncture by introducing thin needles into special points responsible for reflexes to improve sleep, the functioning of the nervous system and normalize the emotional state;
• magnetotherapy to reduce the urge to urinate, which is achieved by relaxing the muscles of the walls of the bladder;
• electrophoresis with anticholinergics, which helps to increase the muscle tone of the sphincter, relax the walls of the bladder and increase its filling.

Medical treatment

Proper nutrition during illness involves multiple meals (4-5 times a day), but you need to have dinner no later than 19.30 or 3 hours before rest. During this period, the use of dry crumbly cereals, eggs, cheese, bread and tea is allowed.

Personal hygiene rules

Enuresis somewhat complicates the observance of personal hygiene in adults. Therefore, careful preparation is required:

People with this diagnosis need to pay more attention to hygiene, so you need to wash yourself several times a day. In this case, it is better to use a solution of manganese, chlorhexidine or a decoction of medicinal herbs.

For bedridden patients, the use of lotions and fluids from bedsores is additionally required.

Enuresis is a pathology that occurs at any age. At the same time, the causes of the disease are not always due to physiology, often it depends on the psychological state. Treatment requires the support of specialists, regardless of the nature of the disease. Self-medication in this case can only significantly complicate the situation.