Involuntary urination in men. How to treat uncontrolled urination (enuresis) in men

Involuntary urination

Spontaneous urination in women and men is a consequence of a violation of the urinary system, in which a certain amount of urine flows out of the bladder uncontrollably. According to statistics, every 5th inhabitant of our planet faces such a problem. This condition affects all aspects of a person's life, worsens his social interaction with others, and also causes physical and psychological discomfort.

The causes of urinary incontinence are related to several areas of medicine. The factors that provoked the disease, in one case or another, can be urological, gynecological, neurological, hormonal, as well as a consequence of other conditions of the body. Depending on the underlying cause, approaches to the treatment of involuntary urination vary significantly, therefore, in order to defeat the disease, you must first understand what caused it.

Why is this happening?

Urination disorders in men and women have some differences. So, in the male half of the population, urinary incontinence is more often caused by diseases of the prostate gland, in particular, prostate adenoma, and in women - age-related hormonal changes. However, there are a number of other factors that can act as catalysts for bladder failure:

injuries and various diseases of the spine;
benign and malignant tumors of the urogenital area;
neurological disorders and mental disorders;
gynecological or urological surgical interventions;
excessive physical labor;
serious inflammatory processes of the genital organs.

Forms of the disease

Depending on the causes of incontinence, there are several types of urination disorders:

urgent

In urge incontinence, coughing or laughing can cause urine to leak

The underlying cause of this condition is an overactive bladder. This form of incontinence is detected in about 15% of the adult population, in old age the risk of its development increases. It is noted that women suffer from this form of the disease more often than men. Various irritants (the sound of flowing water, coughing, laughter, nervous excitement, alcohol intake) are capable of provoking the release of urine during urge incontinence.

stressful

Spontaneous urination in women with this type of disorder occurs as a result of weakening of the pelvic floor muscles or damage to the sphincter structure. The loss of normal muscle tone is usually associated with a lack of collagen in the pelvic ligaments.

Among the causes of collagen deficiency are vitamin C deficiency and hormonal changes during menopause. In men, stress urinary incontinence is mainly caused by sphincter damage that can occur during urologic surgery. Another factor that can provoke spontaneous stress urination is spinal cord injury.

Transient

This type of urinary incontinence is also called temporary. Its characteristic feature is that episodes of involuntary excretion of urine occur under the influence of certain external stimuli and disappear after their elimination.

Inflammatory diseases of the bladder, urethra and vagina, accompanied by strong, uncontrolled urge to urinate, can serve as provocateurs of the disease in this case. Sometimes the cause can be a state of intoxication, causing a decrease in the sensitivity of the bladder and loss of control over it.

Overflow incontinence

Bladder overflow

This condition is characterized by difficulty passing urine as a result of overfilling or distension of the bladder. Independent urination is practically absent, but at the same time, urine flows out in small quantities uncontrollably. At the same time, involuntary urination in men often becomes a consequence of the development of a benign tumor of the prostate gland, which blocks the normal outflow of urine.

Diagnostics

For successful treatment, it is very important to accurately determine the cause of the problem. The diagnosis begins with a visit to the urologist. During the appointment, the doctor finds out the patient's disturbing symptoms and how long they have been observed, after which an examination is carried out and additional studies are prescribed. To determine the cause of incontinence, the following examination methods are used:

Also, the patient is asked to keep a diary of urination for several days, in which the frequency and volume of all urination per day is recorded. After analyzing all the information received and identifying the cause of the violations, the appropriate therapy is selected.

When should you see a doctor?

In the presence of urination disorders, patients note that drops of urine appear on the linen during any physical exertion, laughter, coughing. A man may suspect incontinence if some urine drips from the end of the penis after urinating. This phenomenon is also observed in 17% of healthy men, however, more often indicates a disease of the genitourinary system. Therefore, if these symptoms are detected, it is necessary to consult a urologist.

Treatment Methods

There are the following main methods of treatment used for urinary incontinence: surgical, medical and non-medical. For the use of each of them there are indications, so you should not make changes to the course of treatment without the consent of your doctor.

Drug therapy consists in taking drugs designed to restore the normal functioning of the urinary system. This method is most effective for overactive bladder. As a rule, antispasmodics and antidepressants are prescribed to stop excessively frequent urges.

Gymnastics to strengthen the muscles of the pelvis

Non-drug treatment consists of performing a set of exercises aimed at strengthening the pelvic muscles. In addition to exercise, the patient must adhere to the schedule of urination recommended by the doctor, avoiding too frequent emptying of the bladder. Treatment with this method takes about three months and is mainly used as an adjunct to drug therapy.

If conservative treatment does not bring results, a decision is made to perform an operation. Surgical intervention is more often performed for stress urinary incontinence and overflow incontinence.

Prevention

As you know, it is easier to prevent a disease than to fight it. In the case of urinary disorders, prevention also plays a significant role. Prevention of involuntary urination in men allows the timely detection and treatment of diseases of the genital area, in particular, diseases of the prostate gland. Women should pay more attention to strengthening the muscles of the pelvic floor, especially during menopause.

Urinary incontinence today is completely curable, so when the first symptoms appear, you should seek medical help, not hoping that the problem will resolve itself. Remember, the sooner the disease is detected and treatment is started, the sooner recovery will come.

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Causes of urinary incontinence

The choice of drug therapy and preventive measures should be based on the causes of voluntary urination in men. All possible causes are grouped as follows:

Pathological deviations in the functioning of the central nervous system. They are caused by various diseases (urination problems after a stroke, multiple sclerosis), head or back injuries, chronic intoxication (after alcohol, drugs).
Urinary incontinence that occurred in the postoperative period. Occurs if surgical or other medical manipulations on the bladder, prostate, pelvic organs or urethra were performed unskilled, unsuccessfully.
Age changes. Manifested in a decrease in local blood supply. In older men, continence occurs several times more often than in middle-aged men.
Infectious diseases of the urinary system (urethritis, cystitis).
Tumor neoplasms in the genitourinary system and pelvic organs.
Violations of the natural functioning of the ureters, bladder and urinary tract (the so-called dysfunction).
Displacement or prolapse of the internal organs in the pelvis and peritoneum, which “press down” the bladder and prostate tissues with their weight. Similar phenomena are diagnosed in patients with weakened muscle fibers, with significant physical exertion, or, conversely, a sedentary lifestyle.
Stress and depressive conditions of a chronic nature.
The use in therapeutic therapy of drugs with a number of side effects that affect muscle tone and the process of urination (diuretics, antidepressants, antihistamine tablets, tranquilizers).
Formation of stones in the renal pelvis and bladder.
Radiation therapy for cancer.
Pathologies of the development of the genitourinary organs, congenital abnormalities.

Classification and symptoms of the disease

The classification is based on the causes of incontinence. According to these features, 6 main types of uncontrolled urine discharge from the urethra are distinguished.

stress incontinence. 50% of the population go to the urologist with this form of spontaneous urination. It is observed with a sharp change in body position, with coughing, laughing, sneezing. Both men and women suffer from this disease. Increased abdominal pressure and incontinence can also occur as a result of exercise or heavy lifting. In this case, the patient does not feel any urge to urinate.
Urgent form. It is characterized by the opposite picture: the patient feels an acute desire to "go to the toilet", which is difficult or even impossible to put off until later. The urge to urinate occurs at least every 2-3 hours. Even with a partially full bladder, spasm and uncontrolled loss of urine occur. Such an overactive bladder can be caused by various infectious processes in the genitourinary system or by the advanced age of the patient.
Incontinence combined (or mixed). Such involuntary excretion of urine suggests the presence of two or more types of incontinence. For example, stress and urgent.
Postoperative urine output of an uncontrolled nature. It occurs as a result of performing all kinds of surgical or medical manipulations with the urethra and prostate gland of a man. This may be the removal of benign tumors, the elimination of strictures in the urethra or injuries of the urethra. There are cases when incontinence of this form goes away on its own (after a certain time after surgery).
Incontinence due to overflow. If a neoplasm has developed in the urethral canal, then it will partially block the fluid passage. Urine is excreted steadily often, but in small quantities. In medicine, such incontinence is also called drip. The bladder never empties completely, which can lead to inflammation, burning, and discomfort.
Temporary (transient) urinary incontinence. Uncontrolled leakage of urine is temporary. The causes of it are all kinds of intoxication, diseases of infectious etiology, malfunctions in the intestines, taking certain drugs. If the patient manages to quickly cope with the provoking factor, then the incontinence will pass on its own.

Diagnosis of the disease

Test with urological inserts. It is carried out during the day to determine the most accurate volume of urine loss.
Clinical analysis of urine (general) and blood.
Ultrasound examination of the organs of the genitourinary system.
Examination with an endoscope. This analysis will collect information about the condition of the mucous membranes of the bladder and urethral canal.
Diagnosis of urodynamic parameters. Through such testing, it is possible to determine the rate of urine flow (uroflowmetry), the residual volume of biological fluid after emptying, the presence of signs of blockage of the channel, the ability of the muscles of the organ to retain and release urine.

Urinary incontinence treatment

Incontinence refers to such diseases that can be treated conservatively or surgically. It all depends on the stage of the disease, its causes and the general health of the patient.

Conservative treatment is represented by the following methods:

Training of muscle groups that are responsible for the process of urination. If the sphincter of the bladder does not work or has lost its tone, then special exercises will help return this muscle group to its previous state. Treatment of the sphincter of the bladder is carried out using the Kegel complex for men. In addition to physical exercises, the patient is prescribed a therapeutic diet.
Drug therapy. Drugs that delay urination, improve blood flow in the external and internal genital organs, help fight incontinence. Anti-inflammatory and antimicrobial drugs have an excellent effect. The urologist may also prescribe hormonal-type medications to regulate the levels of hormones responsible for the rate and amount of urine accumulation. Dosage and type of drug in any case can not be chosen independently. Treatment should be under the supervision of a specialist.
Physiotherapy treatment. This may be electrical stimulation or a magnetic effect on the genitourinary system.

Surgical intervention

The operation is prescribed to the patient in the event that all conservative methods have not given a positive result. The main goal of surgical operation is to return the bladder to an anatomically correct (working) position.

To do this, the doctor uses a small piece of tissue (the so-called sling), which will support the organ and exclude additional pressure on the bladder. In the postoperative period, the installation of a catheter is shown to ensure the release of urine from the bladder. After the catheter is removed, urination occurs naturally.

Hygiene for incontinence in men

As mentioned earlier, with urinary incontinence in men, problems arise due to psycho-emotional and physical discomfort. Therefore, patients should learn to live a normal, full life. For this, special urological hygiene products have been developed.

To date, there are the following hygiene products for men:

Special underwear. Comfortable, absorbent incontinence pants are made of a special material that will allow you to use them every day. Effective for moderate to severe incontinence.
Pads for patients with urinary incontinence. They exactly repeat the structural features of the male body, are securely held with an adhesive strip. Urological inserts are used in case of drip or moderate incontinence.
Pants made of elastic material that securely fix urological pads (inserts).
Diapers, or men's diapers for night use and especially severe urinary incontinence.

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Why do women suffer from this pathology

There are such causes of urinary incontinence in women:

Menopause. As a result of estrogen deficiency, the tone of the vagina and adjacent structures are reduced, which at a young age provided additional support to the bladder in maintaining its volume.
Older age: the cervical muscles of the bladder lose their tone and cease to "cope" with the retention of urine.
Childbirth through natural routes, especially if there was a clinically narrow pelvis - a condition where the size of the baby's head is larger than the exit holes from the pelvis.
Injuries to the perineum, as a result of which the nerves of the muscles of the pelvic floor, which are responsible for controlling urination, were damaged.
Operations on the pelvic organs with damage to the nerve trunks leading to the bladder or pelvic floor.
Uterus removal.
Inflammation, trauma and tumors of the spinal cord, when the "central command" of the bladder and pelvic muscles is disrupted.
Heavy physical work or sports that lead to prolapse of the uterus and prolapse of the pelvic floor.
Obesity.
Chronic cough as a result of occupational hazards, bronchial asthma or smoking. Coughing increases the pressure in the abdomen, causing urine to be squeezed out of the bladder.
Diabetes mellitus: as a result of this pathology, the blood supply and innervation of the structures that hold urine are disturbed.
Constipation, when, when trying to defecate, the pressure in the abdomen and pelvis increases significantly.
Diseases of the nervous system: Alzheimer's disease, multiple sclerosis, parkinsonism, stroke.
Chronic cystitis.
Fistulas (moves) between the bladder and the intestines or vagina.
Stones located in the bladder.

In some cases, urinary incontinence in women is due to congenital anomalies in the development of the genitourinary system:

ectopia of the ureter, when the ureter (one, both, or doubled) does not flow into the bladder, but into its diverticulum, its neck, urethra, vagina, or septum between the bladder or vagina;
exstrophy of the bladder, in which its mucosa is "turned out" outward.

Increase the chance of involuntary separation of urine:

diuretic drugs;
alcohol;
carbonated drinks containing CO2;
coffee and other caffeinated drinks;
drugs used to treat pancreatitis or peptic ulcers, the side effect of which is the relaxation of the muscles of the bladder;
smoking: it leads to oxygen starvation of all tissues, including the bladder and perineal muscles.

Disease classification

The disease is classified as follows:

Stress incontinence, which develops with an increase in intra-abdominal pressure when coughing, laughing, sneezing, straining, physical activity. It develops due to the weakening of the ligamentous apparatus, sphincters in the path of urine or the muscles of the pelvic floor.
Urgent incontinence (also called overactive bladder): uncontrollable urges occur when the sound of water, the transition from heat to cold, or other stimuli; for a few seconds the woman cannot control him.
Mixed type develops as a result of a combination of imperative and stress incontinence. It is the most common type of disease.
Reflex incontinence (neurogenic bladder): urine is involuntarily released due to "wrong" stimulation of the bladder from the spinal cord.
Incontinence due to overflow, when the outflow from the bladder is difficult (the exit site of the urethra is not completely blocked by a tumor, stone, inflammatory edema), its walls are overstretched. As a result, urine can be released at any time.
Extraurethral incontinence: with ectopic ureter or fistula between the bladder and the genitals.

There are other types of incontinence such as:

nighttime urinary incontinence in women (enuresis). It develops most often after 45 years as a result of a decrease in the elasticity of the walls of the bladder and loss of tone of the sphincter muscle located "at the exit" of this organ;
persistent incontinence;
other types: for example, during orgasm or sexual intercourse.

Warning! Depending on the above types of incontinence, the urologist chooses a treatment and diagnostic tactics for this disease.

Enuresis

Bedwetting in women is the loss of the ability to feel the urge to urinate during a night's sleep. It has been proven that it is not associated with the depth of sleep, but develops due to:

perineal injury;
bladder tumors;
spinal injuries;
difficult childbirth;
gynecological operations;
diseases of the pelvic organs.

Very rarely, pathology can become a continuation of childhood enuresis, which has not been adequately cured.

Warning! At risk for the development of enuresis are overweight women and those who suffer from diabetes.

After hysterectomy

Urinary incontinence after removal of the uterus develops because the ligamentous apparatus common with the bladder is damaged (it was previously held by the uterus). In addition, the pelvic floor muscles, which also had common connections with the uterus, become flabby, the sphincter responsible for closing the bladder weakens.

Incontinence and cystitis

Urinary incontinence with cystitis is imperative: a woman experiences frequent and pronounced urge to urinate, which occurs with minimal filling of the inflamed bladder. There are other symptoms that indicate precisely this disease:

change in color and smell of urine;
pain in the suprapubic region and in the absence of the urge to urinate;
when a woman urinates, the pain above the pubis, in the urethra or perineum becomes unbearable.

There may be a deterioration in the general condition, and a rise in temperature, but this suggests that the infection from the bladder is spreading to the ureters and kidneys.

How pathology manifests itself

Symptoms of urinary incontinence in women depend on the type of pathology:

In the stress type, laughing, coughing, lifting weights, sneezing, and even running cause some amount of urine to pass.
The imperative (urgent) type is provoked by the sound of water, a sharp transition to the cold, or changing clothes outside in the cold season. At the same time, the woman feels such a strong urge to urinate that she is forced to urgently look for a toilet. In some women, a certain amount of urine is released, while others are able to hold it. Urgent incontinence does not depend on how much urine was in the bladder at the time the reflex was "turned on".
If the type of incontinence is mixed, then with a strong urge to urinate, involuntary leakage of urine is noted.
In case of damage or diseases of the central nervous system organs (spinal cord or brain), the urge to urinate does not always occur. More often, a woman already after the fact feels that her underwear is wet.

Diagnostics

Advice! Without determining the exact cause of the pathology, adequate treatment of urinary incontinence in women is impossible.

The initial diagnosis of incontinence is handled by a urologist. He prescribes ultrasound of the kidneys and pelvic organs, general urinalysis, cystography (X-ray method) and cystoscopy (endoscopic method). In this way, infections and anomalies in the development of the urinary tract can be detected.

If incontinence was caused by removal of the uterus, trauma to the perineum, or developed as a result of menopause, then after excluding cystitis, the gynecologist begins treatment.

If the woman is young, incontinence was not caused by an infectious lesion of the reproductive or urinary organs, she is referred for a consultation with a neurologist who conducts an examination. If he suspects diseases of the nervous system, he may prescribe additional studies: MRI of the brain or spinal cord, dopplerography of the vessels of the head and neck, electromyography.

A special case is urinary incontinence in pregnant women. Everything about this pathology, its causes, types and treatment can be found in the article: Why does it develop and how to cope with urinary incontinence during pregnancy?

But perhaps it is more correct to treat not the consequence, but the cause?

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Causes of the disease

The main factors affecting the failure in the body:

age, aging of the body;
lack of estrogen;
diseases of the cranial and spinal nerves;
diseases of the central nervous system;
the result of injury to the nerve trunks that regulate urination;
sports loads;
work associated with hard physical labor;
big weight;
spinal cord injury;
the presence of diseases (diabetes mellitus, bladder cancer, stroke, chronic cough).

Important! Exacerbates this disease malnutrition, drinking alcohol, antidepressants.

Which doctor treats

A large percentage of the fair sex suffers from this disease. Some are embarrassed to talk about it, do not know which doctor to contact. In the event of involuntary urination, a narrow-profile specialist urologist-andrologist is needed. This doctor will help in the diagnosis and treatment of the problem.

situations

There are various situations or factors in which women may experience involuntary bladder spasms and urination. Let's take a look at the common ones.

stress urinary incontinence

Urinary incontinence caused by stress is the most common cause of the disease. From drug treatment, drugs are isolated that will help solve the current problem:

alpha-adrenergic - increase muscle tone;
Duloxetine is an antidepressant that increases muscle contraction. Often used not for treatment, but to relieve symptoms. The best effect can be obtained in combination with exercises;
Estrogens - hormones, often used in age-related atrophic vaginitis. Until the end of an unexplored drug.

When coughing

Sometimes even a normal cough can cause urination. In this case, it is necessary to undergo a course of treatment. Involuntary excretion of urine when coughing is treated as follows:

Kegel gymnastics - a conservative method of treatment, specially designed exercises to strengthen the pelvic muscles;
steep-free therapy is the use of weights;
magnetic stimulation of the pelvic organs and pelvic floor, strengthening muscles;
the use of drugs (anti-inflammatory, antibacterial, hormonal);
in rare cases, surgery (“sling” surgery, surgery to relieve pain and urge to urinary excretion).

Urinary incontinence at night

Often, during sleep, when the muscles are weakened, involuntary urination occurs. To get rid of enuresis, treatment is carried out in three main ways:

conservative - regular performance of a number of exercises aimed at training the walls of the bladder, pelvic muscles;
medication - taking medications to improve blood circulation in the bladder, reduce the amount of urine produced;
surgical - an operation to create a special loop, relieve pain and relieve urges.

How to treat incontinence after childbirth

Weakened muscles after childbirth should recover after a while. If this pathology has not gone away on its own, then treatment is necessary, which includes:

weight retention therapy;
Kegel exercises, bladder training;
physiotherapy to strengthen the pelvic muscles;
medical treatment.

In rare cases, after contacting a specialist, he may prescribe drastic measures:

loop operation;
gel operation;
surgery to strengthen the pubic-vesical ligaments.

How to treat in old age

To begin with, ladies of advanced years are prescribed a set of exercises and a diet that can strengthen the muscles of the pelvis:

Kegel exercises, a special ring for the uterus;
exclusion of tea, alcoholic beverages, caffeinated drinks and foods;
use of pads, diapers.

Spontaneous excretion of urine from the body at the age of 50 can occur due to stress, increased bladder activity, incomplete urination, and the influence of external mechanisms. For treatment, the influencing factor must be taken into account and complex treatment is used:

prescribe antibiotics;
drugs that restore the ability to control urination, delay the release of urine;
recommend a special set of exercises;
visiting physiotherapy;
surgical treatment;
folk remedies (common option).

An alternative medicine recipe that will help you quickly get rid of the problem:

1 st. l. dill seeds pour 250 ml of boiling water, put in a warm place for 2 hours and cover with a blanket.
After the time has passed, drink the infusion.

Treatment with folk remedies

There are conservative methods of treatment of the described problem. Traditional medicine did not stand aside. If urinary incontinence occurs due to menopause, pathological childbirth, or for another reason, you need to pay attention to folk ways to fix the problem.

Herbs

Herbs to treat urinary incontinence in women:

sage infusion (traditionally, a tablespoon of dry grass is brewed in a glass of boiling water) is taken 250 ml three times a day;
steam yarrow leaves, brew in boiling water. Infusion drink 100 ml three times a day;
drink a glass of fresh carrot juice on an empty stomach;
make an infusion of St. John's wort, be sure to filter. Drink throughout the day instead of tea and other drinks in unlimited quantities;
make a decoction based on fresh or dried blueberries. Drink 50 ml up to four times a day;
make a tincture of dill seeds and strain. The infusion helps to quickly and effectively cope with the problem of urinary incontinence. You need to drink 300 ml per day, at a time (do not stretch over several doses).

Special exercises

Urinary incontinence occurs due to the inability to control the muscles of the pelvic floor. Therefore, you need to strengthen the muscles. For this, special Kegel exercises have been developed to help women in the fight against the described problem.

Important! Kegel exercises, in order for them to show effectiveness, must be performed regularly. They will contribute to recovery, strengthen the health of the entire genitourinary system.

Doing the exercises is quite simple: you need to squeeze and unclench the muscles of the vagina up to 100 times during the day. You can do lying down, sitting, while walking. Movements are not noticeable to those around you, so you can find time for Kegel exercises even at work.

What should be done:

normalize weight;
determine the types of food that irritates the bladder mucosa: citrus fruits and chocolate, tomatoes and vinegar, dairy products, spices. Harmful for urinary incontinence, alcohol in any form, coffee.

How to train a bubble

You should learn to go to the toilet on a strict schedule, even if there is no urge to urinate in the allotted time. It is necessary to stimulate urination by various methods in order to be able to control the urge in the future.

Medication treatment

Drugs for incontinence, which are used for this disease:

Anticholinergic drugs. Medications help relax the bladder, increase volume.
Antidepressants. They help a person to calm down, accept the problem and begin to actively deal with it without fears and tantrums.

Tablets

Therapy of this kind of pathology takes place with the help of various drugs, which are prescribed based on the cause:

Imipramine, Tofranil, Duloxetine (antidepressants);
Ditropan, Ditrol, Oxytrol (anticholinergic drugs);
Trospium, Darifenacin, Solifenacin, Resilifetaroxin, Caspaicin, Botulinum toxin A (selective anticholinergics).

Most drugs have contraindications and side effects. The effectiveness of some under certain factors may exclude the effect in other cases. Recommends to use as directed by a doctor.

Driptan

Driptan is an antispasmodic with positive reviews. It is noted that it relieves discomfort in a short time, is easily excreted from the body within two hours and has indications for any age category. Its only drawback is drowsiness. Among the side effects, the following factors can be distinguished:

long-term use of tablets can lead to caries (women with dentures should not worry);
headaches, nausea;
blurred vision, increased eye pressure;
arrhythmia;
allergy.

Apply 5 mg 2 times a day.

Of the contraindications are:

some diseases of the gastrointestinal tract (intestinal atony, ulcerative colitis);
children under 5 years old and individual intolerance;
angle-closure glaucoma or bleeding.

Spasmex

Positive feedback from many women who suffer from involuntary excretion of urine testifies to the effectiveness of Spasmex. The drug helps to reduce the tone of the muscles of the urinary tract. Treatment with these tablets is determined by the doctor, the duration of the course is up to three months.

The drug has contraindications and side effects. It is forbidden to take with:

tachyarrhetmias;
myasthenia gravis;
urinary retention;
glaucoma;
during lactation;
during pregnancy;
children under 14 years old.

oxybutynin

Oxybutynin is an antispasmodic used for cystitis, enuresis, bladder weakness. The drug relieves spasm, makes the muscles more elastic, controls the urge to urinate, reduces their number. It has a significant number of contraindications and side effects, it is used as prescribed by a doctor.

Using a pessary

A special medical device made from rubber. It is inserted into the vagina up to the very cervix to create additional pressure on the walls of the urethra, to support the muscular wall.

The device helps to maintain the urethra in a closed position, which means that the fluid in the bladder is retained during exercise. Devices of this type should be used constantly.

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The phenomenon of urinary incontinence for people is becoming a social and hygienic problem. This problem is common throughout the world among all segments of the population. There are many causes that cause this pathology and, accordingly, several ways to treat this unpleasant condition. Mechanical means have been developed for urinary continence and training of the pelvic floor muscles, as well as hygienic supplies that can facilitate the care of patients with this disorder.

general information

Urinary incontinence (incontinence) is uncontrolled urination, which manifests itself both externally (urethral incontinence) and internal outflow of urine (intraurethral). The disease can occur at any age, more often in women. This pathology does not lead to serious disturbances in the functioning of the body, but because of it, a person is not able to lead a normal life, it is not possible to stay in a public place for a long time or take long walks. This situation also causes discomfort to loved ones. But patients rarely ask for help, because they consider this condition to be irreversible or temporary. Some are simply embarrassed to go to the doctor, and in fact the provision of assistance at the beginning has a positive effect on the outcome of the disease.

Classification

There are two types of incontinence: urethral and intraurethral. Urethral incontinence or emptying naturally is more common. Intraurethral incontinence involves the leakage of urine in an unnatural way within the body. Since involuntary urination can be caused by many factors, the classification of this phenomenon is extensive. Depending on the causes, these types of urinary incontinence are distinguished:

imperative;
extraurethral (drip urinary incontinence);
stressful;
functional;
leakage after emptying;
enuresis (bedwetting);
mixed urinary incontinence.

The severity of urinary incontinence is classified into 4 clinical stages. At the 1st stage, the release of fluid is 2 ml / day. Stage 2 is characterized by a loss of up to 10 ml/day. Stage 3 - up to 50 ml, and stage 4 - more than 50 ml / day. The degree of urinary incontinence in women is distinguished by the number of necessary hygiene products. For example, if 2 pads are enough per day, then this is a mild degree, 2-4 pads - medium, and more than 5 pads - a severe degree. Urinary incontinence during the day more than 400 ml is the basis to issue a disability.

stress incontinence

An increase in intrauterine pressure provoked by coughing, laughing, heavy breathing, heavy lifting and strong physical exertion can cause urinary incontinence. Pathology develops due to a disorder in the work of the muscles of the urinary system and the urethral sphincter. In this case, the bladder is not able to control incontinence, therefore, with stressful urination, there is no urge to empty.

Sphincter dysfunction can be acquired or congenital. In men, the violation in most cases is provoked by prostatectomy (radical surgery for prostate cancer). In a woman, a violation of the sphincter function is associated with a rupture or inaccurate incision of the perineum during childbirth. Common to both sexes and a common cause of stress incontinence is the loss of elasticity and weakening of muscle tone with age.

functional incontinence

Unlike stress incontinence, with functional incontinence, a person, due to mental or physical disorders, is not able to refrain from emptying. This type includes enuresis in adults and imperative urinary incontinence. Enuresis is characterized by urinary incontinence during sleep (mainly at night). Less commonly, urine output occurs in the morning. The disease is often observed in children, depending on the psychosomatics of the child. People who had bedwetting as children often develop urinary problems in adulthood.

Mixed pathology

Observation of two or more types of incontinence in a patient is called mixed. This type of incontinence mostly affects older women. Men suffer from overflow incontinence due to dysfunction of the prostate gland, that is, a lot of urine accumulates in the bladder due to impaired outflow, which causes severe distension and uncontrolled emptying.

Causes and symptoms of incontinence

Why do these crashes happen? The causes of urinary incontinence are diverse, and psychosomatics plays an important role in the occurrence, along with neurological disorders and anomalies in the structure of organs. Urinary incontinence can be caused by injuries, changes in the structure of the ureters and urethra, inflammatory diseases, age-related changes, tumors and other factors.

Symptoms of urethral incontinence are manifested by involuntary leakage or urination, a feeling of incomplete emptying of the bladder, urinary incontinence during sleep. Intrauritary incontinence occurs with an abnormal anatomical structure, trauma, including during operations or endoscopic procedures. The condition is manifested by a feeling of fullness in the abdominal cavity, swelling and urine from the vagina.

Risk factors

Women, people with neurological diseases or anomalies of the anatomical structure, engaged in heavy physical labor are more likely to develop incontinence. Involuntary urination can be caused by operations on the organs of the urinary system, radiation exposure, damage to the nerve endings and muscles of the pelvic floor. Contributing factors include:

advanced age;
overweight;
psychological deviations;
menopause;
stroke;
prostatitis;
alcoholism;
taking certain medications.

Complications

The main complication of spontaneous urination is negative changes in lifestyle. With such a pathology, the possibilities for choosing a job are limited, and in severe cases, one has to give up work. Self-restraint in the social sphere can lead to emotional breakdowns and depression. There is a risk of infection of the lower urinary tract.

In some people, along with incontinence, involuntary emptying of the rectum occurs. In bedridden patients, such a violation provokes the appearance of bedsores. Care of patients with urinary and fecal incontinence includes multiple hygiene procedures, diaper changes and gymnastics for the anal and urethral sphincter.

Diagnostics

The main issue in the diagnosis of incontinence is the confirmation of incontinence, the identification of contributing factors, the establishment of the type and cause of occurrence. When examining a patient, an active questioning tactic is used, during which they find out when incontinence began, whether there is urination in a dream. What contributes to the leakage of urine, or emptying occurs uncontrollably, at what time of the day in the morning or at night. Find out pain, dysfunction of the intestines, the amount of fluid consumed and the presence of enuresis in the past. The patient is asked to complete a urinary diary and keep it for at least 3 days. The diary is a list that indicates the time of emptying. In women, the condition of the pelvic floor organs is carefully studied. An ultrasound device checks for the presence and volume of residual urine. Laboratory tests are also carried out, including urine and blood tests.

What can help with urinary incontinence?

We eliminate general incontinence during inflammation with folk methods. For treatment, a decoction of St. John's wort is used, they drink it in the morning on an empty stomach for a month. Brewed dill seeds are considered an effective remedy for incontinence. Before determining the method of treatment, it is necessary to eliminate the factors that contribute to and provoke the onset of the disease. The answer to the question of how to treat urinary incontinence is simple. Sometimes for this it is enough to give up bad habits, revise the diet or reduce physical activity. Often, inflammation and infections need to be treated, for which antibiotics are used. Estrogen levels may need to be adjusted. Urinary disorders are treated in the following ways:

drug treatment;
surgical treatment;
psychotherapy;
non-drug therapy (physiotherapy).

Medical therapy and medications

When an infection is diagnosed, a course of antibiotics is prescribed. They are able to quickly cure cystitis and eliminate harmful bacteria in the intestines that cause leakage. Basically, an antibiotic is prescribed that does not have a systemic effect, such drugs include Norfloxacin. Treatment of urinary incontinence with medications is a common and priority method that eliminates urgent incontinence. Urinary incontinence drugs increase the capacity of the bladder, reduce the frequency of urination, especially at night, and stop involuntary contractions of the detrusor. All these qualities are possessed by anticholinergic drugs. These include medicines such as Driptan and Detruzitol.

These drugs act on the nervous system and affect the muscle fiber and, like all such drugs, have side effects. Persons with diseases of the gastrointestinal tract and the cardiovascular system need to be very careful when taking these drugs. The dose and the drugs themselves for urinary incontinence are prescribed only by the doctor after all the necessary examinations and tests, taking into account the individual characteristics of the patient's body.

Psychotherapy

This hypnotic technique is mainly used for enuresis. Its essence lies in suggesting to the patient that he will definitely feel the need to empty himself in a dream and wake up. In order for the patient to remember this information well on a subconscious level, medical staff or relatives are recommended to wake him up at the same time at night. Self-hypnosis methods are used when the patient himself convinces himself of the ability to carry out controlled urination.

Surgical treatment

Operative methods of treatment are used in severe forms. There are such types of surgery: suspension, sling and plastic. Suspension operations are used for prolapse of the pelvic organs, they are returned to their normal position and in this way they help to retain urine. Women undergo plastic surgery to strengthen the walls of the vagina. Sling surgeries are performed on women with stress urinary incontinence. It consists in holding and fixing a belt made of synthetic or own fibers under the urethra, which results in an increase in intraurethral pressure. For men, during such an operation, an artificial urethral sphincter is installed.

Physiotherapy and exercise

Auxiliary physiotherapeutic methods include drug electrophoresis, relaxing the muscles of the urea, paraffin therapy, ultrasound therapy. Phys. exercises are used for all types of urinary incontinence and consists in training the muscles of the pelvic floor. There are several ways to strengthen muscles, but the Kegel technique is the most effective.

The Kegel technique is to train the muscles of the anal sphincter and vagina. The patient squeezes the anal sphincter 10 times in 30 seconds or hold for 15-20 seconds. The same gymnastics can help to strengthen the muscles of the vagina. Women can complicate gymnastics with the help of original simulators - vaginal cones - oval or round weights made of medical silicone, different in weight. With their help, the muscles of the pelvic floor are quickly restored, stress incontinence is eliminated. Suitable for postpartum.

A combination of Kegel exercises and bladder training

With incontinence, a combination of Kegel exercises with the use of therapeutic drugs and bladder training is shown. This combination suggests conservative treatment.

Bladder training consists in observing the urination regimen and in an effort to bring it to a healthy rate, when urination occurs no more than 8 times a day. The regimen is determined by the doctor in consultation with the patient. The patient should keep a diary, and gradually increase the time interval between urination by several minutes. A urethral obturator (a special mechanical tool) can help women in this technique and stop involuntary urination in everyday life.

Prevention

The problem of involuntary urination can be prevented by adhering to the right lifestyle and avoiding the abuse of alcohol and smoking. It is necessary to monitor the state of health and consult a doctor in time. It is important for women not to lift weights, to visit a gynecologist regularly. Do Kegel exercises to train the sphincter muscles. People who are prone to incontinence are not recommended to overexert themselves, constantly drink tea, coffee, and use diuretics with caution.

Lack of complete control over your body causes discomfort and insecurity. This especially affects girls and women who, at the slightest physical exertion - coughing, experience such embarrassment as involuntary urination. This can happen to every person. But, unfortunately, pathology is observed more often in women and there are reasons for that.

Levels of dysfunction

Violation of voluntary urination can come from improper functioning of the central nervous system namely the sympathetic and parasympathetic nervous systems. Vegetation ensures the functioning of processes that are brought to automatism.

Another reason is the weakening of the pelvic floor muscles. With this pathology weakens the external and internal sphincters. And it’s worth a little strain, as they open and urination occurs. Cough, just included in the number of light physical exertion.

With such actions, there is a sharp increase in intra-abdominal pressure, followed by a rapid attenuation, the bladder experiences a certain pressure. At this moment, the weakness of the sphincters makes itself felt, and the urine can freely go out into the environment.

Why does it feel like an uncontrolled act? This is due to the fact that we cannot control the internal sphincter and it is normal. It opens and closes according to time and bladder filling. And we control the external sphincter, and therefore decide when exactly to go to the toilet. With pelvic floor insufficiency, not everyone can be controlled. Then this feeling arises.

Types of urination disorders

At the mental level, imperative urination and stressful urination are distinguished..

Imperative urination is overbearing. That is, a focus is formed in the mind of a person, which takes all the attention. In doing so, we feel an urgent urge to go to the bathroom, which happens over the next few seconds. This pathology can be observed in any half.

stress incontinence more common in women. It occurs when coughing, sneezing, laughing. Another may be light physical activity.

This disruption can happen anywhere. And the joint pathology brings the greatest inconvenience. That is, a woman has both imperative urges and stressful urination. Then life becomes unbearable. Going to work, to the store, any attempt to leave the house seems like torture.

Causes of the manifestation of the disease

With involuntary urination in women, the causes can be detected at various levels of the body:

weakness of the pelvic floor in muscle diseases;
physical wear of the pelvic floor muscles;
neurogenic causes;
psychogenic reasons.

Various systemic diseases can lead to a weakening of the work of sphincters and the tone of the muscles of the perineum. Examples are scleroderma, dermatomyositis. This pathology causes the aggression of its own body against muscle proteins. They are destroyed due to the negative effects of their own immune complexes. It also includes urinary tract infections. In this case, the body tries to communicate that not all is well with the genitourinary system.

A physical defect in the pelvic floor muscles may appear after some conditions:

surgical interventions and nonunion of muscles on the scar;
perineal injury;
pregnancy and childbirth - this process greatly weakens the strength of the muscles of the perineum and is the main and main cause of urinary incontinence in women;
menopause - hormonal changes adversely affect the described link;
stricture (narrowing) of the urethra - a violation of the normal outflow and work of the sphincters due to the pathology of the urethral wall;
a stone in the urethra with urolithiasis - prevents the closure of the sphincters, therefore drip incontinence is observed.

Neurogenic causes can occur with any violation of the nerve link. A prerequisite for such a genesis of incontinence will be a disorder in the functioning of the cauda equina of the human spinal cord. Injury may be the cause of his disruption. The injury can be obtained during surgery on the spinal cord, unsuccessful epidural anesthesia, when they got into the epidural space, which is located between the membranes of the spinal cord, and the process of the nerves was touched into the canal itself. Also fractures of the spine with a violation of the integrity of the nerves of the cauda equina.

If the lumbar spinal cord is affected, then weakness of all sphincters will be added to involuntary urination. Then a person cannot control any of the emptying processes.

Psychogenic causes arise against the background of former complexes, which are developed to a pathological state. Excessive shyness, fear of showing oneself, one's presence, strong excitement lead to relaxation of the sphincters. This is due to the increased work of the sympathetic nervous system in such situations.

This type of autonomic nervous system is responsible for relaxing the sphincter muscles and contracting the smooth muscles. That is, at the most exciting moment, sympathy contracts the detrusor - the muscle of the bladder, and relaxes the external and internal sphincters.

Diagnosis and treatment

To get rid of this trouble, you need to find the root cause. The doctor will help with this. He will conduct a comprehensive diagnosis. To do this, you will need a consultation with a urologist to determine the pathology of the urinary system and the normal functioning of the pelvic floor muscles. Consultation a rheumatologist will help to exclude or identify systemic diseases, which were described above. A neurosurgeon or neurologist will determine the pathology of the innervation of the organs of interest or a violation of the integrity of the cauda equina. And the psychiatrist must exclude or confirm the psychogenic factor.

After establishing the cause, the doctor selects an adequate treatment. It will eradicate the problem or alleviate the ailment.

If the cause is mental disorders, sessions of autopsychotherapy are held, work with a psychologist, sometimes hypnosis is used. The neurogenic cause must be eliminated only surgically. If this is a small defect, then it is possible to reduce the production of urine in tablets, improve the contractility of sphincters and synaptic transmission of impulses with sympathomimetics.

With weakness of the pelvic floor, surgical interventions are also used, but a woman can help herself if she exercise perineum muscles every day. This will strengthen the walls of the uterus and the sphincters of the urethra. If the reason is menopause, then the doctor prescribes progesterone-containing drugs that compensate for the lack of female hormones and eliminate the cause.

An effective method that has already proven itself is the installation of a vaginal pessary. He is an assistant to the external sphincter.

Also, a woman with such a disease needs to change her lifestyle:

go to the toilet more often. This can be done at any time of desire, if the toilet is at hand;

Urinary incontinence in women is one of the most common urogynecological diseases, according to urologists, more than 200 million women on earth suffer from this disease. Although the disease is not fatal, it significantly reduces the quality of life, causing severe moral and physical suffering.

Urinary incontinence disease - this is an involuntary release that is not subject to volitional control. Involuntary excretion can occur during physical activities such as coughing, lifting weights, walking, running, sexual intercourse. With a mild form of urinary incontinence, a woman loses a few drops (2-3 milliliters), in this case it is much easier to cure the disease than with a significant discharge.

It is very easy to calculate excretion using a certain test, for this study, a regular sanitary napkin should be weighed, after which it is used during the day and re-weighed, the difference in weight will be equal to the amount of urine lost. If the test showed a loss of more than 4 milliliters per day, then this indicates the presence of an ailment.

The risk group for the disease primarily includes women after menopause, as well as those with hormonal disorders. One of the main causes of the disease is a decrease in the contractile activity of the pelvic floor muscles and the elasticity of the ligaments, which leads to disruption of the closure apparatus of the bladder. The vessels also include overweight women, due to high intravesical pressure, which leads to loss of urine. The second risk group can include those women who have undergone difficult childbirth or gynecological operations that have violated the state of the musculoskeletal apparatus of the pelvic floor. This also includes women who are engaged in heavy physical labor.

Treatment of urinary incontinence should be carried out in a complex, in several directions. Since the disease begins mainly due to dysfunction of the ligamentous and muscular apparatus, a good result in the treatment of the disease can be achieved with the help of physiotherapy exercises. Good exercises to strengthen the muscles of the perineum and abdominals are "scissors", "birch", "bicycle".

One of the best intensive physical programs to strengthen the muscles of the pelvic floor was developed by the German scientist Arnold Kegel back in the 20th century.

First exercise

To start this physical procedure, you should determine the location of the pubococcygeal muscle, arbitrarily interrupt urination and you will feel it. After the muscle has been determined, you should lie on the bed in a comfortable position and consistently strain and relax it. You can start with ten contractions, gradually increasing them up to 50 times. After mastering the exercise, it can be performed in any convenient place, even when doing housework.

Second exercise

The same as the first exercise, but the contraction and relaxation of the pubococcygeal muscle should be done in an accelerated mode, try to do contractile movements at high speed.

Third exercise

It remains the same, but it is the most difficult, you should contract the muscle very, well, very slowly, you may not be able to do it right the first time, but do not be upset, patience, and you will succeed.

Regarding drug treatment, drugs are used that suppress involuntary contraction and cause relaxation of the detrusor muscle of the bladder walls, drugs that expel urine are also used: tolterodine, oxybutynin, solifenacin.

Elderly postmenopausal women are recommended hormone replacement therapy with the use of estrogenic drugs: ovestin, estracad. Duloxetine gives good results in the treatment of urine, but since it belongs to the class of antidepressants, it should be prescribed only under strict medical supervision.

Traditional medicine in its piggy bank also has many recipes for the treatment of urinary incontinence:

Drinking tea from young sweet cherry or cherry branches 30 minutes before meals has a positive effect on frequent urge to urinate

Plantain leaves (1 tablespoon) pour boiling water (200 mg), wrap with a warm cloth and insist for 1 hour. Strain the finished tincture and take a tablespoon 3 times a day.

St. John's wort (50g.) Pour a liter of boiling water and leave for 4 hours. Strain and consume as much as your heart desires.

A decoction of fresh or dried blueberries in many cases gives a very positive result, you should use half a glass 4 times a day. It should be brewed like a simple berry compote.

Mix together a teaspoon of St. John's wort and centaury, pour two glasses of boiling water, leave for 40 minutes, strain, drink two glasses a day in the morning and evening before meals for three weeks.

But in any case, before starting treatment, you need to consult with doctors!

This is a violation of urination, accompanied by the impossibility of arbitrary regulation of bladder emptying. Depending on the form, it is manifested by uncontrolled leakage of urine during exertion or at rest, sudden and uncontrollable urge to urinate, unconscious urinary incontinence. As part of the diagnosis of urinary incontinence in women, a gynecological examination, ultrasound of the genitourinary system, urodynamic studies, functional tests, and urethrocystoscopy are performed. Methods of conservative therapy may include special exercises, pharmacotherapy, electrical stimulation. In case of inefficiency, sling and other operations are performed.

The direct producing factor of stress incontinence is any tension that leads to an increase in intra-abdominal pressure: coughing, sneezing, brisk walking, running, sudden movements, heavy lifting and other physical effort. The prerequisites for the occurrence of urgent urges are the same as with stress incontinence, and various external stimuli (sharp sound, bright light, water pouring from a tap) can act as provoking factors.

Reflex incontinence can develop as a result of damage to the brain and spinal cord (trauma, tumors, encephalitis, stroke, multiple sclerosis, Alzheimer's disease, Parkinson's disease, etc.). Iatrogenic incontinence occurs as a side effect of certain drugs (diuretics, sedatives, blockers, antidepressants, colchicine, etc.) and disappears after the abolition of these drugs.

Pathogenesis

The mechanism of occurrence of stress urinary incontinence in women is associated with insufficiency of the urethral or vesical sphincters and / or weakness of the pelvic floor structures. An important role in the regulation of urination is given to the state of the sphincter apparatus - with changes in architectonics (the ratio of muscle and connective tissue components), the contractility and extensibility of the sphincters are disturbed, as a result of which the latter become unable to regulate urine output.

Normally, the continence (retention) of urine is provided by a positive urethral pressure gradient (i.e., the pressure in the urethra is higher than in the bladder). Involuntary excretion of urine occurs if this gradient changes to negative. An indispensable condition for voluntary urination is a stable anatomical position of the pelvic organs relative to each other. With the weakening of the myofascial and ligamentous apparatus, the support-fixation function of the pelvic floor is disturbed, which may be accompanied by prolapse of the bladder and urethra.

The pathogenesis of urge urinary incontinence is associated with impaired neuromuscular transmission in the detrusor, leading to overactive bladder. In this case, with the accumulation of even a small amount of urine, there is a strong, unbearable urge to urinate.

Classification

According to the place of urine excretion, transurethral (true) and extraurethral (false) incontinence are distinguished. In the true form, urine is excreted through the intact urethra; with false - from abnormally located or damaged urinary tract (from ectopically located ureters, exstrophy bladder, urinary fistulas). In the following, we will deal exclusively with cases of true incontinence. In women, the following types of transurethral urinary incontinence occur:

stressful- involuntary excretion of urine associated with the failure of the urethral sphincter or weakness of the muscles of the pelvic floor.
imperative(urgent, overactive bladder) - unbearable, uncontrollable urges due to increased reactivity of the bladder.
mixed- combining signs of stress and imperative incontinence (a sudden, uncontrollable need to urinate occurs during physical exertion, followed by uncontrolled urination.
Reflex incontinence(neurogenic bladder) - spontaneous excretion of urine due to a violation of the innervation of the bladder.
iatrogenic- caused by the intake of certain drugs.
Other (situational) forms- enuresis, urinary incontinence from overflow of the bladder (paradoxical ischuria), during sexual intercourse.

The first three types of pathology occur in most cases, all the rest account for no more than 5-10%. Stress incontinence is classified according to degrees: with a mild degree, urinary incontinence occurs with physical effort, sneezing, coughing; with an average - during a sharp rise, running; in severe - while walking or at rest. Sometimes in urogynecology a classification is used based on the number of sanitary pads used: I degree - no more than one per day; II degree - 2–4; III degree - more than 4 pads per day.

Symptoms of Urinary Incontinence

In the stress form of the disease, involuntary, without a preliminary urge to urinate, urine leakage, which occurs with any physical exertion, begins to be noticed. As the pathology progresses, the amount of urine lost increases (from a few drops to almost the entire volume of the bladder), and exercise tolerance decreases.

Urge incontinence can be accompanied by a number of other symptoms characteristic of an overactive bladder: pollakiuria (increased urination more than 8 times a day), nocturia, imperative urges. If incontinence is combined with bladder prolapse, there may be discomfort or pain in the lower abdomen, a feeling of incomplete emptying, sensation of a foreign body in the vagina, dyspareunia.

Complications

Faced with uncontrolled leakage of urine, a woman experiences not only hygienic problems, but also serious psychological discomfort. The patient is forced to give up her usual way of life, limit her physical activity, avoid appearance in public places and in company, refuse sex.

Constant leakage of urine is fraught with the development of dermatitis in the inguinal region, recurrent genitourinary infections (vulvovaginitis, cystitis, pyelonephritis), as well as neuropsychiatric disorders - neurosis and depression. However, due to shame or a false idea of urinary incontinence as an "inevitable companion of age", women rarely seek medical help with this problem, preferring to put up with obvious inconveniences.

Diagnostics

A patient with urinary incontinence should be examined by a urologist and gynecologist. This will allow not only to establish the causes and form of incontinence, but also to choose the best ways of correction. When collecting an anamnesis, the doctor is interested in the duration of the onset of incontinence, its relationship with stress or other provoking factors, the presence of imperative urges and other dysuric symptoms (burning, pain, pain). During the conversation, risk factors are specified: traumatic childbirth, surgical interventions, neurological pathology, features of professional activity.

Be sure to conduct an examination on the gynecological chair; this allows you to identify prolapse of the genitals, urethro-, cysto- and rectocele, assess the condition of the skin of the perineum, detect genitourinary fistulas, conduct functional tests (test with straining, cough test) that provoke involuntary urination. Before re-admission (within 3-5 days), the patient is asked to keep a diary of urination, which notes the frequency of micturition, the volume of each allocated portion of urine, the number of episodes of incontinence, the number of pads used, the volume of fluid consumed per day.

To assess the anatomical and topographic relationships of the pelvic organs, gynecological ultrasound, ultrasound of the bladder is performed. Of the laboratory examination methods, the most interesting are the general urinalysis, urine culture for flora, and survey smear microscopy. Urodynamic research methods include uroflowmetry, filling and emptying cystometry, intraurethral pressure profilometry - these diagnostic procedures allow assessing the state of sphincters, differentiating stress and urgency urinary incontinence in women.

If necessary, a functional examination is supplemented by methods of instrumental assessment of the anatomical structure of the urinary tract: urethrocystography, ureteroscopy and cystoscopy. The result of the examination is a conclusion reflecting the form, degree and causes of incontinence.

Treatment of urinary incontinence in women

If there is no gross organic pathology causing incontinence, treatment begins with conservative measures. The patient is recommended to normalize weight (in case of obesity), quit smoking, which provokes chronic cough, eliminate heavy physical labor, and follow a caffeine-free diet. In the initial stages, exercises aimed at strengthening the muscles of the pelvic floor (Kegel gymnastics), electrical stimulation of the muscles of the perineum, biofeedback therapy can be effective. With concomitant neuropsychiatric disorders, the help of a psychotherapist may be required.

Pharmacological support for stress incontinence may include the appointment of antidepressants (duloxetine, imipramine), topical estrogen (in the form of vaginal suppositories or cream) or systemic HRT. For the treatment of imperative incontinence, M-cholinolytics (tolterodine, oxybutynin, solifenacin), α-blockers (alfuzosin, tamsulosin, doxazosin), imipramine, hormone replacement therapy are used. In some cases, the patient may be prescribed intravesical injections of botulinum toxin type A, periurethral injection of autofat, fillers.

Surgery for stress urinary incontinence in women includes more than 200 different techniques and their modifications. Sling operations (TOT, TVT, TVT-O, TVT-S) are the most common methods of operative correction of stress incontinence today. Despite the differences in execution technique, they are based on a single general principle - fixing the urethra with the help of a "loop" made of an inert synthetic material and reducing its hypermobility, preventing urine leakage.

However, despite the high efficiency of sling operations, 10-20% of women develop relapses. 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.

Forecast and prevention

The prognosis is determined by the causes of development, the severity of the pathology and the timeliness of seeking medical help. Prevention consists in giving up bad habits and addictions, weight control, strengthening the press and muscles of the pelvic floor, and controlling bowel movements. 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 need to overcome false modesty and seek specialized help as soon as possible.