Urinary incontinence in men: where it comes from and how it is treated. Stress urinary incontinence. Use of urinary incontinence tablets during pregnancy

More than half of women experience urinary incontinence at least once. Sometimes it occurs in young girls after childbirth, sometimes causes inconvenience to older people, and accompanies some for a long time.

Fear of missing urine can lead to psychological and sexual disorders, cause depression and hinder personal and career growth. Incotinence (another name for incontinence) always reduces the quality of life, and therefore requires special attention.

There is even a special international organization for urinary retention, which conducts research and develops all kinds of treatments. Urinary incontinence refers to any involuntary discharge of urine. But depending on the conditions, time of day, circumstances of incontinence, there are several types of incontinence.

Types of urinary incontinence

• stressful
• imperative (urgent)
• mixed
• other types (continuous leakage of urine, bedwetting, unconscious incontinence)
• iatrogenic incontinence (due to medication)

The first three types are most common and are typical for women.

stress urinary incontinence

This type of incontinence accounts for half of all cases of uncontrolled urination. The main cause of this condition is the malfunction of a special muscle - the sphincter of the urethra. The weakening of this muscle, together with a periodic increase in intra-abdominal pressure, leads to leakage of urine or even complete emptying of the bladder.

Symptoms of stress urinary incontinence

• leakage of urine in varying amounts during exercise, laughing, coughing, intercourse, straining
• no irresistible urge to urinate
• sometimes - a combination with gas and fecal incontinence

There are many reasons why stress urinary incontinence can occur.

• Pregnancy

Almost all women in an interesting position experience inconvenience due to the leakage of a small amount of urine. They are forced to plan their walks based on the location of the toilets. Moreover, in the first weeks of pregnancy and shortly before childbirth, the symptoms of incontinence are more pronounced. This is due to the changed hormonal background and the pressure of the uterus on the pelvic organs.

Especially often, incontinence occurs after independent childbirth with a large fetus with a perineal incision and other manipulations. As a result, the muscles and ligaments of the pelvic floor are damaged, intra-abdominal pressure is distributed unevenly, and the sphincter ceases to perform its function. It is after ruptures or inaccurate cuts of the perineum (episiotomy) that gas and fecal incontinence joins urinary incontinence.

• Operations on the pelvic organs

Any interventions related to the uterus, bladder, rectum cause adhesions and changes in pressure in the small pelvis. In addition, operations are sometimes complicated by fistulas between the organs, which also leads to urinary incontinence.

• Age changes

With age, the elasticity of the ligaments and muscle tone decrease, which inevitably leads to sphincter dysfunction. After the onset of menopause, the body is deficient in estrogen, which is the cause of urinary incontinence in older women.

In addition to these main reasons, there are risk factors. They can be a background for the development of urinary incontinence, but their presence does not necessarily lead to this disease.

Risk factors

• caucasian race
• heredity (in the presence of the disease in the next of kin or cases of enuresis in childhood, the risk of incontinence is greater)
• obesity (especially in combination with diabetes)
• neurological diseases (stroke, heart attack, parkinsonism, spinal injury)
• urinary tract infection
• digestive disorders
• taking certain medications
• anemia

Stress urinary incontinence causes a lot of trouble for women. Refusal to play sports, fear of missing urine in public, constant nervous tension adversely affect health. Therefore, it is important not to be shy and not to hush up this topic, but to consult a doctor in time.

urge incontinence

Normally, the urge to urinate appears after the accumulation of a certain amount of urine in the bladder. Feeling this urge, a woman can successfully restrain him to the nearest toilet room. With increased reactivity of the bladder, even a small amount of urine is enough to cause a strong, unbearable urge. And if by a lucky chance there is no toilet nearby, then there is a risk of missing urine.

The cause of this disease is believed to be an overactive bladder. Due to the special mobility of the psyche and the speed of nerve impulses, the muscles of the sphincter and bladder react to the slightest irritation. Therefore, urine can be missed with a small accumulation of it in the bladder, especially if there is any external stimulus (bright light, sound of pouring water, etc.)

The main symptoms of urge incontinence

• frequent urge to urinate
• urges are almost always sudden
• irresistible desire to urinate
• the occurrence of urges is often provoked by external circumstances

The risk factors for urges are exactly the same as those for stress incontinence because the two types often coexist.

Differential diagnosis of urinary incontinence

Iatrogenic incontinence

Some drugs in the list of their side effects have a violation of urination:

• adrenomimetics (pseudoephedrine) can cause urinary retention with subsequent incontinence, are used to treat bronchial diseases;
• all diuretics;
• colchicine (to treat gout);
• some drugs with estrogens;
• sedatives and

After the end of taking these drugs, unpleasant symptoms go away by themselves.

Other types of incontinence

Rarer causes of urination are usually associated with organic pathology. This can be damage to the brain and spinal cord as a result of tumor processes, injuries, strokes, multiple sclerosis.

Only a doctor can determine the exact cause of the problem. Usually, with incontinence, women turn to gynecologists and urologists. Recently, a narrow specialty has appeared - urogynecology, which deals with issues of the female genitourinary sphere.

Examination for urinary incontinence

Detailed description of complaints to the doctor

Factors that provoke incontinence, the time of onset of symptoms, their severity, additional complaints are important. In addition, you need to ask your mother, grandmother, sisters about similar symptoms in order to identify a hereditary predisposition. Be sure to note if in childhood there were cases of chronic nocturnal enuresis.

You can fill out a questionnaire designed specifically for people with incontinence problems. Incontinence Symptom Questionnaire, ISQ (Incontinence Symptom Questionnaire):
1. How long have you been experiencing symptoms of incontinence?
2. Has the volume of urine passed changed since the onset of the disease?
3. How has the incidence of urinary incontinence changed since its onset?
4. Indicate how often the following actions result in incontinence (never, sometimes, often).

• physical exercise, including running, sports
• sneezing
• cough
• weight lifting
• change in body position: transition from a sitting to an upright position
• the sight or sound of rushing water
• psycho-emotional stress
• hypothermia

5. Do you have an irresistible urge to urinate?
6. How long can you hold on to urine when you have an urge?
7. How often do you lose urine?
8. When is urinary incontinence most common?
9. Do you feel your laundry getting wet without the urge to urinate?
10. Do you wake up at night to urinate?
11. Please indicate how much urine you normally lose.
12. Rate on a 5-point scale the degree of influence of urinary incontinence on your daily life: _____ (0 - no effect, 5 - significant effect).

Keeping a urinary diary

Detailed records of urination and urinary incontinence will help the doctor make the correct diagnosis and prescribe treatment.

PAD test

Often the concepts of "a lot" and "little" differ from woman to woman, so it is difficult to assess the degree of the disease. Here, the pad test, or PAD test, comes to the aid of doctors. This method is used to obtain objective data on the amount of urine lost.

For research, a woman needs to wear urological pads, weighing them before and after use. The duration of the test can vary from 20 minutes to two days, more often - about 2 hours. When performing a short test, it is recommended to drink half a liter of still water.

Vaginal examination

Examination of the genital organs with the help of gynecological mirrors is necessary to exclude other diseases. During the examination, the doctor may find:

• atrophy of the vaginal mucosa. After menopause, genital dryness associated with estrogen deficiency may exacerbate urinary incontinence.
• prolapse or prolapse of the pelvic organs (see)
• large fistulas

On examination, a cough test is performed: when coughing, you can notice the release of urine from the urethra.

Analysis of urine

Very often, with inflammatory changes in the organs of the genitourinary system, incontinence of small portions of urine occurs. Therefore, the detection of white blood cells, red blood cells or bacteria in the urine gives rise to examination for infections. To get an accurate result, you need to know the basic rules for collecting urine:

• use the first, "morning" urine
• collect an average portion of urine
• perform thorough toileting of the vagina before urinating
• during collection, cover the vagina with a clean cloth

Imaging (ultrasound, MRI)
Urodynamic studies (to determine the type of incontinence)

Urinary incontinence treatment

Depending on the cause of urinary incontinence in women, treatment is carried out by gynecologists, urologists in a clinic or surgeons in a hospital.

• general treatments
• stress incontinence treatment
• urge incontinence treatment
  

Therapy of any type of urinary incontinence should begin with the simplest and most affordable methods. These methods include lifestyle modification and special exercises. This is a lifestyle change:

Kegel exercises

The essence of such gymnastics is as simple as possible. First you need to "find" the right muscles of the pelvic floor: perivaginal and periurethral. To this end, you need to imagine the urge to urinate while sitting and try to keep this imaginary stream of urine. The muscles involved in this process need to be exercised regularly.

Three times a day, produce their contraction and relaxation, gradually increasing the duration of contractions from a few seconds to 2-3 minutes. This process will be invisible to others, so you can do it not only at home, but also at work, driving in a traffic jam and in any free time.

After establishing control over the muscles at rest, you can complicate the task: try to reduce them when coughing, sneezing, and other provoking factors. You can diversify and manipulate the muscles to achieve a better effect.

• slow compressions
• quick cuts
• pushing out (similar to the pushing period of childbirth)
• jet retention during actual urination

Biofeedback training

The main disadvantage of simple Kegel exercises is the inability to control their implementation. Sometimes women, along with the necessary muscles, strain others, which increase intra-abdominal pressure. This not only negates the entire workout, but can also exacerbate the problem.

A set of exercises with biofeedback (BFB) includes a special apparatus for recording muscle tone. With its help, you can control the correct execution of contractions, and, if necessary, produce electrical stimulation. BFB training has been proven to improve muscle tone and urinary control.

Contraindications to biofeedback training:

• inflammatory diseases in the acute phase
• severe diseases of the heart, kidneys, liver

Use of special simulators

For training, many compact devices have been created that allow you to strengthen the muscles of the pelvic floor with maximum efficiency and perform all the exercises necessary for urinary incontinence in women.

One of these simulators is the PelvicToner. This device, based on the properties of a spring, allows you to gradually and correctly increase the load on the intimate muscles, strengthening them. It is easy to use and care, and the effect of it is confirmed by clinical trials.

Psychological training

With a strong urge to urinate, you can try to distract yourself from thinking about it. Everyone has their own ways: think about plans for the day, read an interesting book, take a nap. The main task is to make the brain forget about going to the toilet, at least for a short period.

Treatment of stress incontinence

In addition to the general methods of incontinence management described above, the treatment of stress incontinence requires the intervention of a doctor. Conservative treatment with drugs is not very popular, as it helps only in a small number of cases.

Medical treatment:

With a mild degree of stress incontinence, when the anatomical structures have retained their integrity, sometimes use:

• Adrenomimetics (Gutron) increase the tone of the sphincter and urethra, but at the same time act on vascular tone. They are used extremely rarely due to low efficiency and side effects (increased blood pressure)
• Anticholinesterase drugs (Ubretide) also increase muscle tone. It is recommended for women who, according to the results of examinations, have hypotonia of the bladder.
• Antidepressant duloxetine (Cymbalta), effective in half the cases, but with side effects on the digestive system.

Treatment of stress incontinence with pills is very rare due to frequent relapses and side effects.

Surgical treatment

For stress urinary incontinence in women, surgery is the treatment of choice. There are several surgical manipulations, differing in complexity of execution. The preference for this or that operation is given depending on the degree of incontinence and the anatomical features of the woman's urethra.

Contraindications to all types of surgical treatment are:

• malignant neoplasms
• inflammatory diseases of the pelvic organs in the acute phase
• diabetes mellitus in the decompensation phase
• diseases of the blood coagulation system

Sling operations (TVT and TVT-O)

These interventions are minimally invasive, last about 30 minutes, and are performed under local anesthesia. The essence of the intervention is extremely simple: the introduction of a special synthetic mesh in the form of a loop under the neck of the bladder or urethra.

This loop holds the urethra in a physiological position, preventing urine from flowing out when intra-abdominal pressure rises.

To introduce this mesh, one or more small incisions are made in the vagina or inguinal folds; they do not form a cosmetic defect. Over time, the mesh seems to grow into the connective tissue, firmly fixing the urethra.

Recovery after such operations occurs very quickly, the effect is felt almost immediately. Despite the attractiveness of sling operations, the likelihood of relapse still remains. In addition, with detrusor instability and anatomical defects in the urethra, this surgical intervention may be ineffective.

Despite the difficulties described above, minimally invasive loop surgery is the gold standard in the treatment of stress incontinence.

Injections of bulk-forming drugs

During the procedure, under the control of a cystoscope, a special substance is injected into the submucosa of the urethra. Most often it is a synthetic material that does not cause allergies.

As a result, the missing soft tissues are compensated and the urethra is fixed in the desired position. The procedure is less traumatic, performed on an outpatient basis under local anesthesia, but also does not exclude relapses.

Burch laparoscopic colposuspension

The operation is performed under general anesthesia, often laparoscopically. The tissues located around the urethra are, as it were, suspended from the inguinal ligaments. These ligaments are very strong, so the long-term results of the operation are very convincing.

But due to the type of anesthesia and the complexity of the procedure, colposuspension has more contraindications and complications than sling operations. Typically, such an intervention is carried out after an unsuccessful loop procedure or in case of violations of the anatomical structure of the genitourinary apparatus.

Colporrhaphy

Sewing of the vagina with special absorbable threads, used for prolapse of the pelvic organs. The operation has a number of complications (tissue scarring, for example) and loses its effect after a few years.

Urgent incontinence treatment

Unlike stress incontinence, surgical treatment is ineffective for urgency. It is recommended that all women with this problem first of all try general methods of treatment (non-drug). Only when they are ineffective, you can think about drug therapy.

Medical treatment

In the treatment of urge urinary incontinence in women, tablets are very effective. There are several classes of drugs whose main task is to restore the normal nervous regulation of urination.

• Drugs that reduce the tone of the bladder wall, reduce the strength and frequency of its contractions. The most common drugs are: Driptan, Detrusitol, Spasmex, Vesikar.
• Drugs that relax the bladder in the filling phase and improve its blood circulation: Dalfaz, Kaldura, Omnik.
• With incontinence in menopausal women, when there is a deficiency of estrogen, hormone replacement therapy or special ointments are used. An example of such an ointment is Ovestin, a cream containing an estrogen component. Its use can reduce dryness and itching of the mucous membranes, reducing the frequency of urinary incontinence.

Treatment of urinary incontinence in women is a complex task that requires an integrated approach and strict implementation of all the recommendations of a specialist. A few simple rules will help to avoid or delay the manifestation of this disease as much as possible.

Prevention of urinary incontinence

• Maintain the body's water balance. To do this, you need to drink 1.5-2 liters of non-carbonated water per day. Excessive and insufficient drinking can be harmful to health.
• Try to create your own urination regimen. It is quite possible to accustom yourself to empty your bladder at a certain time. For example, in the morning before getting ready for work, during the lunch break, immediately after coming home, go to the toilet and reinforce this habit.
• Fight excess weight (on your own or with the help of a specialist)
• To refuse from bad habits
• Reduce consumption of caffeinated foods and salty foods
• Fight constipation, if any. To do this, you can eat foods rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, drink half a glass of kefir at night. For chronic constipation, herbal laxatives can be used (after consulting a doctor (see)
• Engage in strengthening the muscles of the pelvic floor before planning pregnancy, which will avoid perineal tears during childbirth
• Enjoy life and stay positive

Main conclusions:

• Urinary incontinence is a very common problem among women.
• Without treatment, urinary problems are unlikely to go away on their own.
• To determine the type of incontinence, you need to undergo an examination, including filling out a questionnaire and keeping a urination diary.
• Stress incontinence is treated with surgery, while urge incontinence is treated with medication.
• You can independently engage in the prevention of incontinence by leading a healthy lifestyle and strengthening the muscles of the pelvic floor

Urinary incontinence is a serious problem that needs to be treated. It is better to spend a little time going to the doctor and eliminating it than to be embarrassed and tormented all your life.

Worldwide, there are more than 200 million women who complain that they do not hold urine in various situations. That is, its arbitrary leakage is noted. Such a situation brings a lot of not only physical discomfort (wet, irritation in the perineum, etc.), but also psychological problems such as fear of an unpleasant smell from the body, eternal worries about the urge to go to the toilet, searching for him on the way, etc. Often women with leaking urine are forced to leave work, refuse to travel on vacation or even just hikes within the city. What to do in such a situation and whether it is possible to overcome the problem, we understand below.

Urinary incontinence: general information

It is worth knowing that urine leakage is more common in women due to the structural features of the pelvic organs and the urinary system. In women, the urethra is much shorter, and its location near the anus is a provocateur of the spread of infections, which may be one of the causes of incontinence.

Note that urine leakage threatens a woman not only with physical and psychological problems. If the disease is not treated, over time it can turn into colpitis, vulvitis and other gynecological problems.

In total, there are three types of incontinence, depending on the causes and nature of the manifestation of the pathology:

• stress incontinence;
• urgent;
• Mixed.

Patients at risk

Urinary incontinence is most affected by women of the following categories:

• Those who gave birth (at the same time, more than once, and a large baby, at least one of them);
• Women injured during childbirth;
• Patients who at the time of delivery had an infection of the genital tract, which aggravated the area of ​​​​the gap and made it difficult for tissue to heal;
• Women who constantly experience heavy physical exertion (lifting weights in particular);
• Patients with constipation;
• Female paratroopers, whose urogenital organs are slightly displaced during landing;
• Overweight patients;
• Ladies suffering from asthma (any treatment for uncontrolled cough will not give a long-term result);
• Patients in the age group 40+. Here the problem is due to the lack of the hormone estrogen, which invariably declines by the time menopause occurs. Namely, that hormone is responsible for the work of the muscular organs of the small pelvis, and in particular on their blood vessels.

Important: most often, these patients are offered hormone replacement therapy based on estrogen.

stress incontinence

This type of problem does not lie in the fullness of the bladder and in the urge to go to the toilet, but rather in the anatomical features of the structure and tone of the pelvic floor muscles. That is, in this case, a woman may not feel the urge to urinate, but with sudden exertion (coughing, sneezing, running, lifting weights), she has urine leakage. This is stress incontinence.

The reasons for this phenomenon may be:

• An injury received during childbirth, in which the tissues were sewn incorrectly;
• A torn wound of the urethral muscle during childbirth, which led to the non-closure of the walls of the urethra;
• Weak pelvic floor muscles (in a simple way, weak abdominal muscles).

In most cases, doctors prescribe gymnastic exercises to tone all the muscles. Swimming is also good in this case. However, in some cases, an operation is still indicated to eliminate tissues that are incorrectly stitched after childbirth.

Kegel gymnastics

Almost every woman has heard of her. These simple exercises can not only strengthen the muscles of the pelvic floor, but also make sex brighter. The execution technique is to not involve any other muscles except the muscles of the perineum. It is very easy to find and feel them. To do this, it is enough to start urination and, in the middle of the act, try to stop the stream with the muscles without the help of the legs. What you feel is the right muscles. They need to be trained. The set of exercises looks like this:

• Compression. Here it is enough to periodically squeeze the muscles of the perineum, counting up to 3-5. Then slowly loosen them. Later, when the muscles are a little trained, you can hold the tension up to 20-30 seconds.
• Elevator. In this case, compression is also performed, but in stages, as if lifting the elevator up with the muscles. That is, at first they squeeze the muscle a little and hold it in that position. Then, without relaxing the position, they squeeze the muscle even higher and hold it again. And finally, raise the tension even higher. The reverse position of the muscles also needs to be taken in stages, lingering for 2-3 seconds on each "floor".
• Sharp cuts. Here you need to learn how to sharply contract and relax the muscles of the perineum 15-20 times.
• Ejection. This exercise must be performed in the opposite direction, as if you want to go to the toilet in a big way. But do not overdo it. 10 gentle pushes are enough.

Important: the whole complex must be performed 3-5 times a day, 10 exercises each. As soon as you cope with all the exercises without a hitch, you can add 5 more times to each exercise. During gymnastics, you need to breathe evenly and normally. After a month of such exercises, the muscles will be in good shape, and to maintain them, it will be possible to do gymnastics 1-2 times a day.

Urgent incontinence

In this case, the cause of urine leakage is not in the anatomical features of the muscles of the pelvic floor and perineum, but in the features of the muscles of the bladder itself. That is, under the influence of a number of factors, its walls can involuntarily contract, which provokes a sharp urge and leakage. In this case, the bladder muscles contract very strongly and sharply. Such an urgent contraction can be caused by various stressful situations:

• Sharp fright;
• Bad memory;
• Fear.

It is worth knowing that in most cases, urge incontinence is associated with the psycho-emotional background of a woman and often with a lack of the hormone estrogen. That is why this type of leakage is often treated conservatively with drugs from the group of antidepressants, estrogen hormones and M-anticholinergics.

Often women refuse hormone therapy for fear of overfeeding the body with hormones. However, today there are tricky drugs that contain estriol. This is the same hormone estrogen (inactive), but it affects only the receptors of the lower genital and urinary tract. Treatment with such drugs is as safe as possible for the patient and can be used even against the background of therapy with other drugs.

Mixed type of incontinence

The most complex, and at the same time the most common type of pathology. So, a specialist against the background of a lowered bladder and a torn vaginal wall during childbirth can prescribe an operative method of treatment. But the insidiousness lies here in the fact that not only anatomical causes can cause incontinence. It is possible that the provoking factor is still a urological disease. That is why it is so important to send a woman first for a comprehensive examination, so as not to make a medical mistake.

So, against the background of the existing anatomical features in a woman, leakage can be triggered by such factors:

• Stone in the ureter, which may not give renal colic.
• Chronic cystitis.
• Oncology of the bladder.
• Interstitial cystitis, characterized by the localization of infection in the wall of the bladder. From this, the bladder becomes smaller in volume, which means it holds less urine. At the same time, there is no characteristic burning sensation and soreness with such cystitis.

Important: it is better to refuse a specialist who offers an operation to restore the pelvic floor muscles without examining the patient's urodynamics. Since the treatment of incontinence includes a mandatory diagnosis of all systems included in the process. Only a phased examination of the patient will help to establish the true cause of urine leakage.

The compulsory examination program includes:

• Ultrasound of the genitourinary system;
• Urologist consultation;
• Consultation with a gynecologist;
• Consultation with a neurologist (since sometimes the problem may lie in diseases of the spinal column);
• Performing uroflometry (studying the process of urination);
• Performing cystometry (analysis of the filling of the bladder and the formation of pressure in it);
• Performing profilometry (the study of pressure in the urethra).

Important: only on the basis of the results obtained, the specialist has the right to name the final cause of incontinence and prescribe the type of treatment or surgical intervention.

For information: in Moscow, patients with the problem of urine leakage can contact the following treatment centers:

• Scientific Center for Obstetrics, Gynecology and Perinatology. Kulakov;
• Research Institute of Urology of Rosmedtekhnologii;
• Moscow Regional Research Institute of Obstetrics and Gynecology;
• Urological clinic of MGMSU at City Clinical Hospital No. 50;
• Center for Family Planning and Reproduction;
• City Clinical Hospital No. 23.

It is always worth remembering that a timely appeal to competent specialists allows you to solve the problem quickly and efficiently. Within a month, the patient will be able to return to her usual way of life.

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine. Unfortunately, patients are afraid to discuss this problem with the doctor, although today there are many ways to treat this symptom. Urinary incontinence is usually associated with overactive bladder or weakness of the muscle (sphincter) that holds urine. Other causes include a urinary tract infection, an enlarged prostate, and certain medications. Urinary incontinence can occur at any age in both men and women, although it often increases with age and women are more commonly affected.

What are the types of incontinence?

stress urinary incontinence or incontinence of effort. It is often caused by weakened pelvic muscles, sphincter weakness, or problems with the urethra. All this allows urine to flow out with an increase in intraperitoneal pressure - when laughing, coughing, sneezing, lifting weights, playing sports. The main factor in the development of this incontinence is damage to the pelvic muscles during pregnancy and childbirth, in men after prostate surgery.

Urgent (imperative) urinary incontinence associated with overactive bladder (OAB), when the latter is reduced beyond the control of a person. This may manifest as an irresistible urge to go to the toilet when patients are unable to control the involuntary leakage of urine. Often the cause of such symptoms can be various disorders in the nervous regulation of the bladder: after strokes, spinal cord injuries, diseases of the nervous system. However, the exact reason is not completely clear. When making a diagnosis, a number of diseases with similar symptoms, such as bladder cancer, prostate adenoma, and urinary tract infections, must be excluded. Substances that irritate the bladder can contribute to incontinence - coffee, tea, cola, chocolate, acidic fruit juices. Observations have shown that people with depression, anxiety, attention deficit disorder are more susceptible to OAB than the rest of the population.

Mixed incontinence - combination of signs and causes of urge and stress urinary incontinence.

What is an overactive bladder (OAB)?

If the patient has a sudden and acute desire to go to the toilet, which he must satisfy immediately and may not even have time to reach the toilet, in this case we are talking about an overactive bladder. Usually these urges are accompanied by frequent daytime and nighttime urination.

An overactive bladder is a common condition and according to statistics, every fifth person in the world over 40 suffers from OAB symptoms. For most people suffering from symptoms of OAB, this disease is a real problem that causes them discomfort and has a serious impact on the quality of life. And because of false shame, patients often do not seek medical help.

What are the symptoms of GMP?

Imperative urge (sudden, irresistible, hard-to-control urge to urinate). Frequent urination (more than 8 times a day). Urgent urinary incontinence (urinary incontinence due to an imperative urge). Nocturia (needing to wake up one or more times during the night to urinate)

How is the diagnosis made?

One of the first steps in diagnosing urinary disorders is keeping a diary of fluid intake and excretion. A urine and blood test is taken to detect signs of infection, diabetes mellitus. Sometimes a more detailed examination of urine is performed for the presence of specific cells, bacteria and an examination of the inner walls of the bladder. The volume of residual urine is measured. Also, sometimes a special complex of urodynamic research is used, which allows analyzing the parameters of urine movement.

Urinary incontinence treatment

In the treatment of GMP, it is necessary to use:

• behavioral therapy (pelvic muscle training);
• physiotherapy (electrostimulation, amplipulse therapy, electrophoresis), acupuncture;
• lifestyle changes (normalization of fluid intake, reduction of caffeine intake, weight loss, smoking cessation)
• medication (treatment with antimuscarinic drugs that reduce symptoms)
• surgery (sacral nerve stimulation, intestinal plasty, urinary diversion)
• in the presence of urinary incontinence in women in menopause, treatment is carried out after consultation with a gynecologist, hormone replacement therapy.

Tips for keeping your bladder healthy.

• undergo a full medical examination annually;
• consult a doctor when the first symptoms appear;
• quit smoking and get rid of excess weight;
• eat more vegetables and fruits;
• do not delay urination for a long time;
• do not rush while urinating;
• do not abuse the amount of liquid (usually 4-6 glasses per day);
• exclude from the diet foods that have a diuretic effect (coffee, alcohol, grapefruit juice);
• fight constipation;
• urinate after having sex;
• perform exercises to train the muscles of the pelvis.

Kegel exercises

1. Slow contractions (tighten the muscles, as to stop urination, slowly count to three, relax).
2. Contractions (tighten and relax these same muscles as quickly as possible).
3. Pushing out (squeezing, as in a chair or childbirth), this exercise causes tension in the perineal and some abdominal muscles.

You need to start training with ten slow compressions, ten contractions and ten push-ups five times a day. After a week, add five exercises to each. Add five at a time until there are thirty of them.

Exercises to Strengthen the Pelvic Floor Muscles

1. The muscles of the abdomen, buttocks and legs are relaxed, several times to make a compressive movement of the muscles around the anus, as if preventing the emptying of the intestines. Perform several times a day at every opportunity.
2. During urination, you should hold the stream, and start again.
3. Relax first and then slowly contract the pelvic floor muscles. One cycle of the exercise is done in four counts. Repeat for 2 minutes at least 3 times a day.

The material was prepared by a urologist-andrologist, physiotherapist, dermatovenereologist Akimov Oleg Viktorovich. Appointment appointment: 8-905-334-55-24.

Urinary incontinence is a fairly common problem. More than half of all representatives of the weaker sex face it at least once in their lives. Incontinence can occur both in young women after childbirth or surgery, and in mature women after menopause. Statistics show that every fifth girl suffers from urinary incontinence in the reproductive age, every third woman faces this problem in the early period of menopause, and after 70 years - every second elderly woman.

Urinary incontinence is a serious problem that significantly impairs the quality of life, leads to disorders in the sexual and psychological sphere, can provoke depression, and becomes an obstacle to the successful building of a personal life and career. Enuresis should be considered from the point of view of not only a hygienic aspect - this disease also has medical and social significance, as it causes a wide variety of problems in women: sexual dysfunctions, neuroses, etc.

You can also come across such a term as incontinence, which also means urinary incontinence, but is more often used by urologists and gynecologists when making a diagnosis. Enuresis is the name given to a urinary incontinence that is accompanied by an inability to control the emptying of the bladder. Leakage volumes can vary from a few drops to almost the entire contents of the organ. The disease is treated by gynecologists, urologists, surgeons and psychotherapists.

The problem of urinary incontinence is so global that even a special international medical organization has been created to study the causes of enuresis and develop new effective methods of treating this disease.

There are the following types of urinary incontinence:

stressful;

Imperative (urgent);

iatrogenic;

mixed;

Other forms, for example, enuresis with overflow of the bladder, continuous leakage of urine, unconscious incontinence, etc.

In women, it is the first three types of urinary incontinence that are most common, so it is worth dwelling on them in more detail.

Stress urinary incontinence is the inability to control the process of emptying the bladder during stress. The word "stress" in this context means "load" or "effort".

Symptoms of stress urinary incontinence:

Urine excretion with laughter, coughing, sneezing, physical exertion, sexual intimacy.

If there is no tension in the abdominal cavity, then urine is not excreted.

Not every cough or sneeze results in the involuntary release of urine. In the early stages of incontinence, this occurs only when the organ is full, and the amount of urine lost is equal to a few drops.

As the disease progresses, even minor physical activity, such as brisk walking, can lead to loss of urine.

Irresistible urge to urinate in a woman is absent.

Together with urine, involuntary excretion of feces and gases from the intestines can occur.

Normally, physical activity, as well as coughing and laughing, should not lead to the release of urine. This is prevented by the pelvic floor muscles and the sphincter. However, when they are weakened, they become unable to fully cope with their function. Urine overcomes their resistance and flows out.

There may be several reasons:

Difficult childbirth. In this regard, childbirth is especially dangerous, accompanied by the release of a large fetus, perineal incisions, the application of forceps and other manipulations. Women with a narrow pelvis are at risk.

Surgical interventions on the pelvic organs. Any intervention on the bladder, rectum, uterus can lead to stress urinary incontinence. Fistulas that form between organs are dangerous, since these defects also lead to urinary incontinence.

Hormonal changes in a woman's body that occur with age. The less estrogen is produced, the worse the elasticity of the ligaments becomes and the lower the muscle tone will be.

In addition to the main causes that lead to stress urinary incontinence, the following risk factors can be additionally identified:

Overweight, especially in combination with diabetes;

Sharp weight loss;

Hard work associated with high physical exertion;

Passage of radiation therapy;

Prolapse and prolapse of the uterus;

Weight lifting;

Burdened heredity;

Belonging to the Caucasian race;

Neurological diseases, including heart attacks, spinal injuries;

Taking certain medications.

Urgent urinary incontinence is characterized by an unbearable urge to empty the bladder. These urges are imperative, and it is almost impossible to restrain them. And they occur when the bladder is only partially filled. While normally, a woman experiences an urge to urinate when a sufficiently impressive amount of urine accumulates in the bladder.

Symptoms of urge urinary incontinence include:

The urge to empty the bladder is very frequent and occurs more than 8 times a day.

They almost always appear suddenly.

The urge to urinate is irresistible.

There are frequent trips to the toilet at night.

The urge to urinate is often dictated by external factors, including, for example, the sound of running water from a tap, a bright light, a loud sound, etc.

When urge urinary incontinence occurs against the background of a prolapsed bladder, a woman may experience pain and discomfort in the lower abdomen.

Urine leakage may be accompanied by the development of dermatitis in the groin area, and urinary infections such as vulvovaginitis, cystitis, etc. may occur.

The cause of urge urinary incontinence in women lies in the violation of neuromuscular transmission in the detrusor of the bladder (muscular frame), which leads to its increased activity. Therefore, even when a small amount of urine accumulates in the cavity of the organ, the woman experiences the urge to urinate. As for the risk factors that can lead to the development of urge urinary incontinence, they are similar to the risk factors for stress incontinence. Often these two types of incontinence are combined with each other.

Iatrogenic urinary incontinence is incontinence that develops while taking medications. As a rule, enuresis becomes a side effect of a particular medication.

You should be aware that medications such as:

Adrenomimetics (Pseudoephedrine), which are used to treat bronchial diseases. First, such drugs provoke urinary retention, and then cause incontinence.

Any diuretic drugs.

Adrenoblockers.

Hormonal preparations containing estrogen in their composition.

Colchicine, which is used in therapy.

Antidepressants.

Sedative medicines.

When the course of treatment with the listed drugs is completed, urinary incontinence will pass on its own and will not require any therapeutic measures.

Diagnosis of urinary incontinence should begin with keeping a diary. You need to fix the data in it for several days. At this time, a woman should write down how much liquid she drinks, how many times she goes to urinate. It is important to measure the volume of urine released, as well as display in the diary all episodes of urinary incontinence and what she was doing at that time. To understand exactly how much urine goes into episodes of incontinence, you can use the so-called PAD test. For a certain time, the patient wears urological pads, weighing them before and after use.

A conversation in the doctor's office is of no small importance. It allows you to find out the symptoms of the disease, the time of its manifestation.

A woman must visit a gynecologist. During the examination on the chair, the doctor assesses the condition of the muscles and tissues of the pelvic floor, the presence or absence of prolapse of the vaginal walls and uterus.

A cough test is performed in the gynecologist's office. The woman is asked to cough while her bladder is full. If urine is expelled during exertion, stress urinary incontinence may be suspected.

As a rule, the diagnosis is not difficult in most cases. However, additional tests may be required, such as:

Cystoscopy. This study involves examining the bladder from the inside. For this purpose, a thin cystoscope is inserted inside through the urethra. The procedure for a woman is painless, for which the doctor uses a special anesthetic gel. Cystoscopy makes it possible to assess the condition of the bladder, to exclude the presence of tumor formations.

Urodynamic examination evaluates the process of filling and emptying the bladder. To carry it out, special sensors are inserted into the bladder itself and into the vagina, which provide the information necessary for the doctor.

Ultrasound of the pelvic organs. This examination allows you to assess the state of the organs of the female reproductive system, which makes it possible to determine the further therapeutic tactics.

As for laboratory research methods, a woman is prescribed a general and bacterial analysis of urine, a microscopic examination of a smear. Thanks to the above methods of examination, the doctor will be able to make the most accurate diagnosis and prescribe the necessary treatment.

Most often, in older women over the age of 50, a mixed form of urinary incontinence predominates, that is, there is both a stress and an urgent component.

There can be many reasons that lead to the disease, so the doctor during the examination must find out the following points:

Does the woman suffer from neurological pathologies.

Does she have mental disorders?

Does the woman suffer from diabetes?

Does she have problems with being overweight.

Whether there are herniated discs or other degenerative diseases of the spinal cord that can affect the functioning of the bladder.

Did the woman have a history of surgery on the pelvic organs. If there were any, then it is important to find out if they provoked the formation of adhesions and fistulas.

All these diseases can be the cause of urinary incontinence, as in one way or another they can affect the functionality of the bladder. It is possible that the woman has “overfilling incontinence”, that is, due to the reduced sensitivity of the organ, the signal to empty it is transmitted to the brain too weakly, or not at all.

It is important to find out which medications a woman is taking. Particular attention is paid to sedative and antihypertensive drugs, diuretics.

In elderly patients diagnosed with stress incontinence in 30% of cases, pelvic organ prolapse is detected, namely, prolapse of the bladder. Therefore, the approach to both diagnosing an existing problem and treating older women must necessarily be individualized. We should also not lose sight of the fact that urinary incontinence can develop against the background of relative health due to a lack of estrogen production in the postmenopausal period.

A comprehensive urodynamic examination for elderly women complaining of urinary incontinence is prescribed without fail.

Therapeutic tactics largely depend on what exactly caused the urinary incontinence and how far the problem has gone. The disease is treated by gynecologists, urologists and surgeons (if surgery is required).

Treatment of any type of urinary incontinence should be started according to the principle “from simple to complex”.

First, you should definitely try the most accessible methods, including:

Getting rid of excess weight in the presence of obesity. The fact is that excess body weight affects the state of internal organs, which are subjected to excessive pressure. As a result, their location is disturbed, functioning suffers, which leads to problems with urination. Obesity can be treated with diet, medication, psychotherapy, or gastric surgery.

Any drinks that contain caffeine should be limited. This primarily applies to coffee and tea. The ban on caffeine is due to its diuretic effect on the body. With excessive intake of this substance, the risk of urinary incontinence increases significantly. As for the use of ordinary clean water, it cannot be limited, otherwise the situation can be aggravated.

Refusal of cigarettes. So far, no clear relationship has been established between tobacco smoking and the problem of urinary incontinence. However, it has been proven that women suffering from smoker's bronchitis are many times more likely to develop stress urinary incontinence. In general, any diseases of the respiratory system must be treated in a timely manner.

Imperative urinary incontinence is perfectly treated when the patient manages to correct the urination regimen. The essence of this method boils down to the fact that you need to accustom your body to urinate by the hour. The initial interval can be set to 30 minutes and then increased to an hour or more.

In order to increase the tone of the pelvic floor muscles, you should exercise regularly. Special exercises will allow you to correct the work of the sphincter and the walls of the bladder.

All chronic diseases must be treated in a timely manner in order to prevent their exacerbation.

It is equally effective to create a psychological attitude that distracts from the desire to empty the bladder.

Kegel exercises are a gymnastic complex that is very easy to implement. First, a woman must decide what the pelvic floor muscles are and where they are located. To do this, you need to imagine the process of emptying the bladder and try to stop it with muscle power. It is these muscles that should be involved during training.

Three times a day you need to strain and relax the muscles of the pelvic floor. The tension time ranges from a few seconds at the initial stages of training to 3 minutes later. Kegel exercises can be performed almost anywhere and anytime, as they are completely invisible to others.

When the muscles are sufficiently trained, you can try to strain them during coughing and sneezing, during physical exertion. The more varied the exercises, the higher their effectiveness.

You can use techniques such as fast and slow contractions, pushing out like pushing during childbirth, holding the jet during emptying of the bladder.

biofeedback therapy

Exercises with biofeedback (BFB) are superior to Kegel exercises in that they allow you to strain only the right muscles. To implement the complex, specialized equipment is required. It is designed not only to control the process of muscle tension, but also to additionally stimulate them with the help of electrical impulses.

It has been proven that biofeedback training allows you to achieve control over urination in a fairly short time. However, exercises are prohibited for implementation in the presence of malignant tumors, inflammatory diseases in the acute stage, pathologies of the heart, liver and kidneys.

The use of simulators for the treatment of urinary incontinence

There are a lot of devices that allow you to train the muscles of the pelvic floor. Many of them are very compact and easy to use. For example, the PelvicToner simulator allows you to competently increase the load on the muscles, gradually strengthening them. The device is very easy to use, and its effectiveness has been proven in clinical studies.

Psychotechnics

When you have the urge to urinate, you can try to distract yourself from them by moving your thoughts in a different direction. For example, think about upcoming plans for life, read interesting literature, etc. The main task that a woman faces is to delay urination, at least for a short time.

Medications

Vitafon for urinary incontinence

The Vitafon device is a vibroacoustic device that allows you to strengthen muscles and rejuvenate the body. Treatment with Vitafon refers to physiotherapeutic methods of exposure that can be used at home. The device is a housing block connected to the mains. Attached to it are two round diaphragms that emit acoustic vibration in several programmable ranges. It is these membranes that need to be applied to problem areas to provide a therapeutic effect.

Mechanism of action. Phonation with Vitafon allows you to massage the desired area, and the effect is carried out at the cellular level, which improves the nutrition of tissues, both muscle and nerve.

In case of urinary incontinence, phonation of the following zones is carried out:

Perineum area - 10 minutes;

The area of ​​the muscular sphincter of the bladder (slightly above the pubis) - 10 minutes;

Kidney area - 10-30 minutes;

Liver area - up to 15 minutes;

Lumbo-sacral zone - 5 minutes.

Each zone is treated 1-3 times a day. The course of treatment continues until a stable result is obtained.

Vitafon can be used by women who have gone through a difficult labor that has led to urinary incontinence. Physiotherapy with its use will allow you to recover faster, accelerate the healing of injuries.

Vitafon is used to treat enuresis in children.

Contraindications:

Malignant neoplasms in the affected area.

Infectious diseases in the acute stage.

Pregnancy.

Reviews. Doctors speak of the Vitafon device as an effective device that allows you to get rid of urinary incontinence. However, you should not expect a miracle, so before you start using the device for the treatment of enuresis, you should consult a doctor and find out the causes of incontinence. Reviews of people who have used the device for the treatment of urinary incontinence are mostly positive. Often it is used to get rid of this problem in all family members.

If a woman suffers from stress urinary incontinence, then consultation and medical assistance will be necessary for her. The fact is that with the help of conservative methods, it is most often not possible to achieve an effect in this type of disease.

Treatment with drugs is indicated when stress incontinence is mild, and the muscles and ligaments have not lost their integrity. Medical correction is possible with the following drugs:

Gutron (adrenomimetic). The drug increases the tone of the urethra and sphincter. It is prescribed quite rarely, as it has a negative effect on the state of the vascular wall and contributes to an increase in blood pressure.

Ubretide (anticholinesterase drug). The drug increases muscle tone. It is indicated for those patients who suffer from hypotension of the bladder.

Duloxetine or Cymbalta (antidepressant). The drug helps in 50% of cases, however, it has a negative effect on the digestive tract.

In general, drugs for the treatment of stress urinary incontinence are prescribed infrequently, as they have low efficacy, but a sufficient number of side effects.

Operations are indicated in the case when it is not possible to achieve an effect by other methods of correction of urinary incontinence. The choice of a specific surgical technique depends on the characteristics of the female body, as well as on the degree of enuresis.

However, there are general contraindications to any type of operation, including:

Identified malignant tumor.

Inflammation in the pelvic organs, which is in the acute stage.

Blood clotting disorders.

The following operations are possible:

Sling operations (TVT,TVT-O). These operations are less traumatic and quite effective. During their conduct, a special loop is carried out under the neck of the bladder, which is fixed in the desired position. This loop supports the urethra and prevents urine from flowing out. After such an intervention, the woman recovers very quickly, however, the risk of relapse remains.

Bulk injections. This method of treatment boils down to the fact that a special substance is injected into the urethra, which is designed to fill the deficit of missing soft tissues and maintain the urethra in the desired position. The operation is performed in an outpatient setting and does not require general anesthesia. However, the risk of relapse remains.

Colporrhaphy. This method boils down to the fact that the vagina is sutured with special threads. The procedure is indicated for prolapse of the pelvic organs and has a number of complications. It is possible that a relapse will occur after a few years.

Laparoscopic colposuspension according toBurch. This operation aims to suspend the tissues around the urethra from the inguinal ligaments. The procedure requires the introduction of general anesthesia, has many contraindications and more complications than sling operations. Therefore, colposuspension according to Birch is implemented only when the operation using the loop did not bring the desired effect.

Clover plowed. An herb called plowed clover can be used to treat urinary incontinence. It should be brewed like tea and drunk as a weak solution. This herb can be purchased at a pharmacy.

Honey water. Honey has the ability to retain water. Therefore, traditional healers use it to treat enuresis. To get rid of urinary incontinence, before going to bed, you should drink half a glass of warm water, in which a teaspoon of honey is first diluted. The course of treatment is 3 days. Alternatively, you can drink 30 ml of honey water three times a day.

Dill seeds for enuresis in children. To save a child from enuresis, you can use the seeds. You will need to take a tablespoon of seeds and pour them with a glass of boiling water, insist for an hour, strain. Use this infusion on an empty stomach. Children under 10 years old are given 1/2 cup, and children over 10 years old are given a whole glass of drink.

3 effective exercises for urinary incontinence

The following exercises can be used to treat urinary incontinence and should be done every day:

You need to squat down and connect your palms with each other at chest level. The back should be straight. Stay motionless in this position for at least 30 seconds.

It is necessary to lie on your back, spread your knees to the sides, while connecting the feet together. The arms are stretched along the body with palms up. In this position, you need to hold out for a minute.

You need to kneel and lower your buttocks to your feet. Stretch your arms forward, your face should look down. In this position, stretch the spine for a minute.

What to do if you suffer from urinary incontinence?

Drink at least 1.5-2 liters of water without gas per day.

It is important to create your own urination routine. You need to accustom your body to defecate at the same time, for example, in the morning, before leaving the house, at lunchtime and in the evening, upon returning home.

Obesity is not allowed.

All bad habits should be abandoned.

Constipation must not be allowed. To prevent them, you should eat right, consume enough fiber and fluids. Before going to bed, it is recommended to drink a sour-milk drink.

Training the pelvic floor muscles should begin at the stage of pregnancy planning. This will avoid breaks.

You should always try to stay in high spirits and enjoy life.

Education: A diploma in the specialty "Andrology" was obtained after completing residency at the Department of Endoscopic Urology of the RMAPO at the Urological Center of the Central Clinical Hospital No. 1 of Russian Railways (2007). Postgraduate studies were completed here in 2010.

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The problem of urinary incontinence worries up to 20% of women of different ages. It has serious consequences in the form of inflammatory diseases, neuroses, and forces a woman to give up interesting work and sexual life.

For the treatment of urinary incontinence in women in modern urology, sufficient experience has been accumulated in combining physical exercises, regimen, dietary restrictions, drugs and folk remedies.

The use of tablets for urinary incontinence in women may be limited by concomitant diseases, serious contraindications. Therefore, you should not try to choose your own medicines. A specific drug, its dosage can only be prescribed by a specialist.

Read about the features of general therapy depending on the forms of the disease in this article.

Medical treatment is one of the means of choice. It depends primarily on the type of incontinence.

Recall that stress incontinence accounts for half of all cases among the female population. It is characterized by involuntary "leakage" when coughing, sneezing, laughing, exercising. Some scientists in the field of urology advocate the view that this is the initial stage of a general disease, followed by an urgent form.

It is necessary to treat the stressful variant with drugs that reduce the increased tone of the bladder and sphincter. In a woman's body, the level of α-agonists should increase. Therefore, you can achieve the result:

• artificially blocking the destruction of these substances;
• stimulating synthesis by hormonal action.

Medicines for urinary incontinence with the desired properties are the following drugs.

Norepinephrine and serotonin inhibitors - from the group of antidepressants (Duloxetine Canon, produced in Russia, Simbalta, supplied from Switzerland, are suitable). Duloxetine is available in tablets and capsules, Cymbalta only in capsules.

The increase in the concentration of neurotransmitters in the spinal cord reaches its maximum level within 2 hours after ingestion. They activate the communication of nerve centers and pathways with the bladder, the detrusor tone decreases, and the sphincter increases.

Duloxetine has many negative effects. Patients taking the drug complain of:

• insomnia, followed by drowsiness;
• dizziness;
• blurred vision;
• nausea;
• hand tremor;
• loss of appetite;
• unmotivated fatigue;
• persistent dry mouth;
• prolonged constipation or diarrhea.

In case of overdose, epileptic convulsions appear.

• hypertension;
• glaucoma;
• pregnancy and lactation;
• up to 18 years of age;
• renal and hepatic insufficiency, including patients using hemodialysis.

The drug should not be stopped immediately, a withdrawal syndrome occurs. It consists in the appearance:

• headaches;
• severe dizziness;
• increased blood pressure;
• pain in the heart, tachycardia.

A representative of the class of adrenergic agonists is Midodrine (Gutron). Can be bought in drops or tablets. It acts by increasing the tone of the sympathetic division of the nervous system. There is a good strengthening of the sphincter of the urethra with urinary incontinence in women, in pediatric practice. The use is limited due to a large list of undesirable effects, therefore it is contraindicated in:

• arterial hypertension;
• suspected pheochromocytoma;
• obliterating endarteritis;
• spasm of peripheral arteries;
• glaucoma;
• mechanical blockage of the urinary tract by a stone or tumor;
• thyrotoxicosis;
• arrhythmias;
• renal and liver failure.

In the treatment of pregnant and lactating women, it is applicable only for strict neurological indications, and not for the treatment of urinary incontinence.

Hormonal drugs that increase the level of lost estrogens are prescribed mainly by gynecologists. But in urological practice, vaginal suppositories or Ovestin cream are also used. Their use does not affect what changes the gynecologist finds in the uterus or appendages.

Soft trophic effect on the mucous membrane of the urethra and urinary tract, improves its nutrition in women of the older age group. Slowing down the process of atrophy helps control urination.

What is the treatment for urgency incontinence?

For the treatment of imperative (urgent) urinary incontinence, there is a much greater choice of drugs. The basis of the pathology is an increased tone of the detrusor, with which a person is not able to cope. Urination occurs at any time, suddenly. Bedwetting (enuresis) accompanies overactive bladder.

Various organs, including the bladder, have cholinergic receptors in the muscle wall, which are “platforms” to which the nerve impulse is transmitted using the acetylcholine enzyme. You can block this process by:

• suppression of the cholinergic receptor apparatus;
• destruction of the cholinesterase enzyme necessary for the synthesis of acetylcholine.

As a result, the volume of the bladder increases, while its ability to retain urine increases. The main drugs for urinary incontinence of this pharmacological group include:

• Novitropan, Driptan - active substance oxybutynin chloride;
• Roliten, Detrusitol, Uroflex, Urotol - containing tolterodine.

The drugs of the first subgroup are indicated for the treatment of enuresis in children older than five years. Can cause:

• dizziness,
• drowsiness,
• headache,
• diarrhea.

You can not drink pills to people who are driving. Contraindications apply to:

• old age;
• pregnant and lactating women;
• renal dysfunction.

• neurocirculatory dystonia;
• thyrotoxicosis;
• glaucoma;
• heart disease with myocardial ischemia, arrhythmias, heart failure;
• hypertension;
• reflux esophagitis;
• the presence of postoperative ileo- or colostomy (removal of the intestinal loop into the abdomen).

Drugs of the second subgroup are more easily tolerated, since their effect is less common on internal organs. Their use is limited by high cost.

What modern drugs have the least side effects?
More modern means of treating urge incontinence include anticholinergics with a targeted effect on the detrusor. Relaxation is caused by:

• Spasmex - the active ingredient is trospium chloride;
• Vesicar - solifenacin;
• Enablex - darifenacin;
• Toviaz - fesoterodine.

Spasmex is considered the most effective. However, it is not recommended to prescribe:

• bedridden patients;
• children under 14 years old.

It is used very carefully in the elderly with concomitant cardiac pathology.

The drugs are incompatible with the intake of alcohol. Due to the possible inhibition of nervous reactions, transport cannot be controlled. Negative effects are rare. Some remedies (Vesicar) can be taken once a day.

Contraindications include:

• severe stage of renal and hepatic insufficiency;
• myasthenia gravis;
• glaucoma;
• diseases of the stomach and intestines at the time of exacerbation.

Mirabegron or Begminga is considered a new generation drug. Its mechanism of action is based on the stimulation of β3-adrenergic receptors located in the bladder wall in smooth muscle fibers. This allows you to increase the reservoir for the accumulation of urine.

When prescribing, the doctor should take into account the interaction with other drugs. Cardiac glycosides are recognized as clinically significant (need to reduce the dosage). Some aspects of the use of the drug continue to be studied in animals and volunteers.

Approved for the treatment of the elderly. The Japanese pharmaceutical company Astellas is working on improving its drug.

Mirbetric is another newer drug from the same company, already approved by the US Quality Control Authority. It contributes to the complete expulsion of the entire volume of urine and the restoration of the strength of the sphincter.

The course of treatment for urinary incontinence in women usually lasts up to three months. Re-appointment is not ruled out. The doctor requires adherence to a diet, drinking regime, the use of special exercises. In the absence of effect, an operative method for eliminating the pathology is proposed.

Given the many negative effects of drugs, the attending physician is responsible for their appointment. Self-medication can cause serious harm and be hazardous to health. Any side effects should be reported to the doctor and temporarily discontinued until further action is clarified.

Urinary incontinence is a serious problem faced by both men and women. It affects not only children, but also adults. Especially often urinary incontinence is observed in women, which is explained by the physiological characteristics of their body, as well as complications during labor. Self-medication does not bring the desired results, since the treatment of urinary incontinence requires an integrated approach. It is very difficult to manage without medical help. Only a doctor can find out the exact causes of urinary incontinence and prescribe drugs that will help to cope with the problem.

Medicines for urinary incontinence are selected based on the etiology of the disease. Therefore, consultation with a specialist is mandatory. In medical practice, stress and imperative urinary incontinence is most common. In the first case, urine flows out of the bladder due to weakness of the pelvic muscles and sphincter, and in the second case, the cause of its incontinence is the hyperactivity of the organ. Each condition requires correction with various drugs.

Table of essential drugs for urinary incontinence

Promotes the development of a "watchdog" reflex

Adults: 1-2 tablets 30 minutes after a meal.

Children 1/2-1 tablet after meals.

The drug is taken 3 times a day.

Course of admission: 3 months.

Contributes to the normalization of the brain.

It has a sedative effect, eliminates depression, normalizes sleep.

The tablet is placed under the tongue and sucked until completely dissolved. You can take the drug 1-2 times a day. The course of treatment is 14-30 days.

Relieves nervous tension;

Allows you to maintain the sensitivity of sleep, which makes it possible to wake up after filling the bladder.

Improves metabolic processes in the cerebral cortex, normalizes sleep.

The course of treatment is from a week to 10 days. Take 1 tablet per day. If the drug is prescribed to children, then the dose is calculated individually.

The drug helps to reduce anxiety, which improves the quality of sleep.

Allows you to make sleep less sensitive, increases the volume of the bladder, improves the functioning of the sphincter.

1 tablet 3 times a day, regardless of food intake. The minimum course of treatment is 14 days.

The walls of the bladder will be relaxed, which, in turn, prevents the outflow of urine. Sleep will be full, but sensitive.

The drug eliminates muscle spasm, contributes to the normalization of night rest

1 tablet 30 minutes before bedtime.

Children are prescribed 1/2 tablet.

Normalization of the muscle tone of the bladder;

An increase in the volume of the organ.

Removes hypersensitivity from the bladder, relaxes its walls, helps to reduce the number of organ contractions.

1 tablet, 2-3 times a day (the last dose of the drug should be before going to bed).

Children are prescribed 1/2 tablet 2 times a day.

Taking the drug helps prevent nighttime urination by relaxing the bladder wall.

The tone of the sphincter increases, the tone of the bladder weakens.

1 tablet, 2-3 times a day before meals. The course of treatment is 3 months.

Antidiuretic hormone analogues of synthetic origin:

Helps reduce the amount of urine produced during the night.

The course of treatment is 2-3 months. The dose of the drug is selected individually, but it should not exceed 10 tablets per day.

The bladder does not fill up with urine at night.

It affects the functioning of the kidneys, prevents them from producing a large amount of urine.

The drug is taken at bedtime, once. The course of treatment is no more than 3 months.

During a night's rest, the bladder does not fill with urine.

Ovestin suppositories for urinary incontinence

pharmacological properties. Ovestin suppositories contain the hormone estriol, so they are prescribed for the treatment of muscle atrophy of the genitourinary tract, which occurs against the background of hormonal imbalance (estrogen deficiency). The pharmacological effect of the drug is achieved due to the female hormone estriol, which restores the normal epithelium of the urethra and vagina, preventing the development of atrophic changes in the tissues. Most often, such disorders occur in women during menopause and after it.

Method of administration. Candles are administered intravaginally, before a night's rest, in the supine position. For urinary incontinence, 1 suppository per day is prescribed for the first few weeks. The duration of use of the drug is determined by the doctor on an individual basis. Then the dose is reduced and administered 1 suppository 2 times a week.

Pain, hypersensitivity reactions - all these symptoms are observed when using impressive doses of the drug.

Neoplasia (malignant and benign).

Purpura of hemorrhagic type.

Important! Candles are not prescribed for the treatment of women who have a suspicion of breast cancer, and they should not be used if the patient had a history of breast cancer. It is worth paying attention to such contraindications to the use of the drug, such as: diabetes mellitus, heart attack, angina pectoris, vein thrombosis, endometrial hyperplasia, exacerbation of kidney disease.

Reviews. Most women who have used Ovestin suppositories for urinary incontinence note their high effectiveness. The most common side effects they call the occurrence of a burning sensation in the vaginal area.

So, Ovestin suppositories can be used in the complex treatment of urinary incontinence, which is caused by a lack of estrogen in the body. However, the drug has many contraindications and side effects, so you can use it only after medical consultation.

Mechanism of action. The drug Minirin has proven itself in the fight against enuresis in children. The composition of the drug contains a synthetic analogue of the hormone, which is produced by the back of the pituitary gland. The effect occurs already 15 minutes after taking the drug and lasts for 10 hours.

Important! Minirin cannot be administered independently. It is used only on the recommendation of a doctor. There is no single dosage of the drug, the doctor selects the dose on an individual basis.

Polydipsia (congenital and psychogenic).

Features of treatment with Minirin:

If there is no effect from the treatment, then the dose should be increased.

The course of treatment, on average, is 3 months.

The course, if necessary, can be repeated, taking a break of 7 days.

Tablets are not washed down with water, do not drink liquid after taking the drug.

Reviews. Reviews about the use of the drug are most often positive. Parents call one of the advantages of the drug that children do not refuse to take the drug (it needs to be dissolved under the tongue), since the tablet has no taste. In addition, Minirin allows you to get rid of urinary incontinence even in cases where other drugs have been ineffective.

Separately, it is worth noting the high cost of the drug, but it is justified by the fact that the drug really works and eliminates an unwanted symptom. The effect is observed after a few days from the start of treatment. Parents indicate that relapses in children after a course of treatment do not occur.

As for side effects, they appear extremely rarely. Among the adverse events noted: headaches, abdominal pain, nausea. As a rule, Minirin is well tolerated.

Driptan is a drug that comes in the form of tablets. The therapeutic effect is achieved due to the main active substance called "oxybutynin hydrochloride".

Mechanism of action. The drug relaxes the detrusor of the bladder, thereby increasing its capacity. In parallel, the frequency of contraction of the walls of the organ decreases, the spasm is removed, due to which the person does not have the urge to urinate with an incomplete bladder. The effect can be felt already 45 minutes after taking the drug.

Driptan is prescribed for the treatment of urge urinary incontinence in adults against the background of an overactive bladder, for the treatment of incontinence with cystitis, after undergoing bladder surgery. You can use Driptan for the treatment of enuresis in children against the background of unstable bladder function, with nocturnal enuresis, with idiopathic organ dysfunction.

Contraindications to the use of the drug:

Age up to 5 years.

Increased body temperature.

Obstruction of the urinary tract.

Pregnancy and lactation.

Diseases of the colon, colostomy, ielostomy, intestinal obstruction.

Since the drug has contraindications for use, it can not be prescribed independently. Take the drug only on the recommendation of a doctor who individually determines the dose for a particular patient. Average dosage: 1 tablet, 2-3 times a day for adults and 1/2 tablet 2 times a day for children.

Side effects. Possible disorders of the digestive system (vomiting, dry mouth, nausea), abdominal pain, disorders of the central nervous system (drowsiness, headache, etc.), visual disturbances, dysuria, urinary retention, tachycardia, arrhythmia, allergic reactions .

Reviews. If we consider the reviews, Driptan is fairly well tolerated by both adults and children. However, it must be used correctly, without exceeding the dosage.

Patients treated with Driptan indicate its effectiveness in urinary incontinence. Some people have noted the appearance of pain in the abdomen, which disappear after discontinuation of the drug.

The mechanism of influence. Picamilon is prescribed for the treatment of urinary incontinence in children and adults. It has a positive effect on the functioning of the bladder, as it reduces detrusor hypoxia. Therefore, it is often prescribed in complex therapy for neurogenic bladder, with violations of the urodynamics of the urinary tract according to the hyperreflex type. Taking Picamilon improves the storage function of the bladder.

In addition, the effect of the drug is based on its ability to expand the vessels of the brain, to have an antioxidant, tranquilizing and psychostimulating effect. Due to the normalization of the functioning of the nervous system, it becomes easier for a person to restrain urges. Sleep will be better, but sensitive, which helps to avoid nighttime urine leaks.

It is forbidden to treat children under the age of 3 years with Picamilon, it is not prescribed for lactating and pregnant women, as well as against the background of kidney disease.

Side effects are very rare in both children and adults. Among them, allergic reactions, nausea, headaches, overexcitation, increased irritability are noted.

Reviews. Most of the reviews about this drug are positive. However, its effect on urinary incontinence is not always sufficient.

Duloxetine

Mechanism of influence. Duloxetine is an antidepressant drug. It is recommended to use it with frequent urge to urinate, as it has a sedative effect and has a positive effect on the nervous regulation of the bladder. Also, the drug helps to relax the muscles of the organ, but the contraction of the muscle of its sphincter.

Side effects and contraindications:

Vision problems.

It is important to pay attention to contraindications to the use of this drug, including: glaucoma, breastfeeding, pregnancy, age under 18 years, renal and hepatic insufficiency, high blood pressure.

It should be taken into account that the abrupt withdrawal of the drug threatens with the occurrence of headaches, jumps in blood pressure, tachycardia and dizziness attacks.

Melipramine

Mechanism of action. Melipramine is an antidepressant that is also used as an antidiuretic. Its mechanism of action is based on a decrease in the depth of sleep, which makes it more responsive and enables a person to wake up when the bladder is full. The drug is available in injections for intramuscular injection, in capsules and tablets. For the treatment of enuresis, most often it is the tablet form of the drug that is prescribed.

Treatment of urinary incontinence with Melipramin can be started in children from 6 years of age. The duration of taking the drug is strictly limited by medical recommendations. Children under 6 years of age are not prescribed Melipramin.

How the drug is taken. The dosage is selected by the doctor. It is recommended to start therapy with minimal doses, increasing it if the desired effect is absent. Average dose: 1 tablet 1 time per day 30 minutes before bedtime. To calculate the dose more correctly, you need to know the patient's weight. The calculation is based on the scheme: 1 mg of active ingredient per 1 kg of weight. The average duration of treatment is 2 months.

Side effects and contraindications. Melipramin is not prescribed for people with diabetes mellitus, liver and kidney diseases, against the background of exacerbation of infectious diseases, with tuberculosis and heart pathologies.

As for side effects, the appearance of such undesirable manifestations as:

Reviews. Most people who took Melipramine for urinary incontinence were satisfied with its effect. It will be noticeable after a few days from the start of therapy. However, it is important that the drug is prescribed by a doctor, since its independent use can only aggravate the existing problem. The price of Melipramine is very affordable, which is its undoubted advantage.

Pantocalcin

Mechanism of action. Pantocalcin is a nootropic drug that has a wide spectrum of action. It is an antagonist of GABA receptors, helps to eliminate autonomic disorders, increases the volume of the bladder, reduces the amount of urination, and eliminates imperative urges.

Dosage for urinary incontinence. Depending on the age of the patient, 25-50 mg of the drug is prescribed, 3 times a day. You need to take it in the morning and evening hours. The course of treatment is 60 days.

Side effects and contraindications. Side effects of the drug are extremely rare. At the same time, a positive trend is observed in most people suffering from urinary incontinence.

As for contraindications, Pantocalcin is not recommended for children under the age of 3 years, since it is available exclusively in the form of tablets. Other contraindications are pronounced disorders in the liver and kidneys.

Reviews. Reviews about the treatment with Pantocalcin are mostly only positive. A properly selected therapeutic course allows you to achieve a stable remission, or complete relief from urinary incontinence. If we consider the negative consequences of taking the drug, then among them we can distinguish increased irritability and excessive absent-mindedness. Although it has not been established that these effects were provoked by the intake of Pantocalcin.

The mechanism of action on the body. Pantogam is a nootropic drug that is prescribed in the treatment of urge urinary incontinence. The drug has a moderate sedative effect, stimulates the metabolism in neurons. The positive therapeutic effect of Pantogam in the treatment of secondary enuresis is explained by its vegetotropic activity, as well as the ability to influence the functions of the bladder sphincter. The conducted research allowed to establish that Pantogam allows to effectively correct the neurotic conditions that often accompany enuresis in childhood.

The dose of the drug is gradually increased over 10-20 days.

Then the dose is gradually reduced over 10-20 days until completely canceled.

The course can be repeated 2-3 times a year.

The drug is prescribed for the treatment of urinary incontinence in children, adults and elderly patients. The average dose for an adult is 3 tablets per day. The drug is taken after meals. For children, there is such a dosage form as syrup, which is very convenient.

Contraindications and side effects. The drug is not prescribed during the first trimester of pregnancy, as well as people suffering from severe kidney disease. As for side effects, they occur extremely rarely and come down to allergic skin rashes, rhinitis and conjunctivitis.

Funds for urgent form

To eliminate bladder hyperactivity, anticholinergic drugs are prescribed, including: Novitropan, Driptan, Roliten, Uroflex, Urotol, Detruzitol. They act on the bladder detrusor. However, side effects after taking these drugs can be called such conditions of the body as: constipation, drowsiness and dizziness.

Such new generation drugs have a relaxing effect on the detrusor, such as:

Spasmex (trospium chloride).

Mirobegron (Begming). This drug has a minimal set of side effects and can significantly increase bladder reserves.

Self-treatment of the urgent form of urinary incontinence with any drugs is unacceptable. During the passage of the therapeutic course, you should stop drinking alcohol.

More than half of women experience urinary incontinence at least once. Sometimes it occurs in young girls after childbirth, sometimes causes inconvenience to older people, and accompanies some for a long time.

Fear of missing urine can lead to psychological and sexual disorders, cause depression and hinder personal and career growth. Incotinence (another name for incontinence) always reduces the quality of life, and therefore requires special attention.

There is even a special international organization for urinary retention, which conducts research and develops all kinds of treatments. Urinary incontinence refers to any involuntary discharge of urine. But depending on the conditions, time of day, circumstances of incontinence, there are several types of incontinence.

Types of urinary incontinence

• stressful
• imperative (urgent)
• mixed
• other types (continuous leakage of urine, bedwetting, unconscious incontinence)
• iatrogenic incontinence (due to medication)

The first three types are most common and are typical for women.

stress urinary incontinence

This type of incontinence accounts for half of all cases of uncontrolled urination. The main cause of this condition is the malfunction of a special muscle - the sphincter of the urethra. The weakening of this muscle, together with a periodic increase in intra-abdominal pressure, leads to leakage of urine or even complete emptying of the bladder.

Symptoms of stress urinary incontinence

• leakage of urine in varying amounts during exercise, laughing, coughing, intercourse, straining
• no irresistible urge to urinate
• sometimes - a combination with gas and fecal incontinence

There are many reasons why stress urinary incontinence can occur.

• Pregnancy

Almost all women in an interesting position experience inconvenience due to the leakage of a small amount of urine. They are forced to plan their walks based on the location of the toilets. Moreover, in the first weeks of pregnancy and shortly before childbirth, the symptoms of incontinence are more pronounced. This is due to the changed hormonal background and the pressure of the uterus on the pelvic organs.

Especially often, incontinence occurs after independent childbirth with a large fetus with a perineal incision and other manipulations. As a result, the muscles and ligaments of the pelvic floor are damaged, intra-abdominal pressure is distributed unevenly, and the sphincter ceases to perform its function. It is after ruptures or inaccurate cuts of the perineum (episiotomy) that gas and fecal incontinence joins urinary incontinence.

• Operations on the pelvic organs

Any interventions related to the uterus, bladder, rectum cause adhesions and changes in pressure in the small pelvis. In addition, operations are sometimes complicated by fistulas between the organs, which also leads to urinary incontinence.

With age, the elasticity of the ligaments and muscle tone decrease, which inevitably leads to sphincter dysfunction. After the onset of menopause, the body is deficient in estrogen, which is the cause of urinary incontinence in older women.

In addition to these main reasons, there are risk factors. They can be a background for the development of urinary incontinence, but their presence does not necessarily lead to this disease.

Risk factors

• caucasian race
• heredity (in the presence of the disease in the next of kin or cases of enuresis in childhood, the risk of incontinence is greater)
• obesity (especially in combination with diabetes)
• neurological diseases (stroke, heart attack, parkinsonism, spinal injury)
• urinary tract infection
• digestive disorders
• taking certain medications
• anemia

Stress urinary incontinence causes a lot of trouble for women. Refusal to play sports, fear of missing urine in public, constant nervous tension adversely affect health. Therefore, it is important not to be shy and not to hush up this topic, but to consult a doctor in time.

urge incontinence

Normally, the urge to urinate appears after the accumulation of a certain amount of urine in the bladder. Feeling this urge, a woman can successfully restrain him to the nearest toilet room. With increased reactivity of the bladder, even a small amount of urine is enough to cause a strong, unbearable urge. And if by a lucky chance there is no toilet nearby, then there is a risk of missing urine.

The cause of this disease is believed to be an overactive bladder. Due to the special mobility of the psyche and the speed of nerve impulses, the muscles of the sphincter and bladder react to the slightest irritation. Therefore, urine can be missed with a small accumulation of it in the bladder, especially if there is any external stimulus (bright light, sound of pouring water, etc.)

The main symptoms of urge incontinence

• frequent urge to urinate
• urges are almost always sudden
• irresistible desire to urinate
• the occurrence of urges is often provoked by external circumstances

The risk factors for urges are exactly the same as those for stress incontinence because the two types often coexist.

Differential diagnosis of urinary incontinence

Iatrogenic incontinence

Some drugs in the list of their side effects have a violation of urination:

• adrenomimetics (pseudoephedrine) can cause urinary retention with subsequent incontinence, are used to treat bronchial diseases;
• all diuretics;
• colchicine (to treat gout);
• some drugs with estrogens;
• sedatives and antidepressants

After the end of taking these drugs, unpleasant symptoms go away by themselves.

Other types of incontinence

Rarer causes of urination are usually associated with organic pathology. This can be damage to the brain and spinal cord as a result of tumor processes, injuries, strokes, multiple sclerosis.

Only a doctor can determine the exact cause of the problem. Usually, with incontinence, women turn to gynecologists and urologists. Recently, a narrow specialty has appeared - urogynecology, which deals with issues of the female genitourinary sphere.

Examination for urinary incontinence

Detailed description of complaints to the doctor

Factors that provoke incontinence, the time of onset of symptoms, their severity, additional complaints are important. In addition, you need to ask your mother, grandmother, sisters about similar symptoms in order to identify a hereditary predisposition. Be sure to note if in childhood there were cases of chronic nocturnal enuresis.

You can fill out a questionnaire designed specifically for people with incontinence problems. Incontinence Symptom Questionnaire, ISQ (Incontinence Symptom Questionnaire):
1. How long have you been experiencing symptoms of incontinence?
2. Has the volume of urine passed changed since the onset of the disease?
3. How has the incidence of urinary incontinence changed since its onset?
4. Indicate how often the following actions result in incontinence (never, sometimes, often).

• physical exercise, including running, sports
• sneezing
• cough
• weight lifting
• change in body position: transition from a sitting to an upright position
• the sight or sound of rushing water
• psycho-emotional stress
• hypothermia

5. Do you have an irresistible urge to urinate?
6. How long can you hold on to urine when you have an urge?
7. How often do you lose urine?
8. When is urinary incontinence most common?
9. Do you feel your laundry getting wet without the urge to urinate?
10. Do you wake up at night to urinate?
11. Please indicate how much urine you normally lose.
12. Rate on a 5-point scale the degree of influence of urinary incontinence on your daily life: _____ (0 - no effect, 5 - significant effect).

Keeping a urinary diary

Detailed records of urination and urinary incontinence will help the doctor make the correct diagnosis and prescribe treatment.

Often the concepts of "a lot" and "little" differ from woman to woman, so it is difficult to assess the degree of the disease. Here, the pad test, or PAD test, comes to the aid of doctors. This method is used to obtain objective data on the amount of urine lost.

For research, a woman needs to wear urological pads, weighing them before and after use. The duration of the test can vary from 20 minutes to two days, more often - about 2 hours. When performing a short test, it is recommended to drink half a liter of still water.

Vaginal examination

Examination of the genital organs with the help of gynecological mirrors is necessary to exclude other diseases. During the examination, the doctor may find:

• atrophy of the vaginal mucosa. After menopause, genital dryness associated with estrogen deficiency may exacerbate urinary incontinence.
• pelvic prolapse or prolapse (see symptoms of uterine prolapse)
• large fistulas

On examination, a cough test is performed: when coughing, you can notice the release of urine from the urethra.

Analysis of urine

Very often, with inflammatory changes in the organs of the genitourinary system, incontinence of small portions of urine occurs. Therefore, the detection of white blood cells, red blood cells or bacteria in the urine gives rise to examination for infections. To get an accurate result, you need to know the basic rules for collecting urine:

• use the first, "morning" urine
• collect an average portion of urine
• perform thorough toileting of the vagina before urinating
• during collection, cover the vagina with a clean cloth

Imaging (ultrasound, MRI)
Urodynamic studies (to determine the type of incontinence)

Urinary incontinence treatment

Depending on the cause of urinary incontinence in women, treatment is carried out by gynecologists, urologists in a clinic or surgeons in a hospital.

• general treatments
• stress incontinence treatment
• urge incontinence treatment
  

Therapy of any type of urinary incontinence should begin with the simplest and most affordable methods. These methods include lifestyle modification and special exercises. This is a lifestyle change:

• Weight control in obesity

• Decreased consumption of coffee, tea and other caffeinated drinks

• To give up smoking

• Establishing a urinary regimen

• Pelvic floor training

• Treatment of chronic respiratory diseases
• Psychological setting to distract from the desire to urinate

Kegel exercises

The essence of such gymnastics is as simple as possible. First you need to "find" the right muscles of the pelvic floor: perivaginal and periurethral. To this end, you need to imagine the urge to urinate while sitting and try to keep this imaginary stream of urine. The muscles involved in this process need to be exercised regularly.

Three times a day, produce their contraction and relaxation, gradually increasing the duration of contractions from a few seconds to 2-3 minutes. This process will be invisible to others, so you can do it not only at home, but also at work, driving in a traffic jam and in any free time.

After establishing control over the muscles at rest, you can complicate the task: try to reduce them when coughing, sneezing, and other provoking factors. You can diversify and manipulate the muscles to achieve a better effect.

• slow compressions
• quick cuts
• pushing out (similar to the pushing period of childbirth)
• jet retention during actual urination

Biofeedback training

The main disadvantage of simple Kegel exercises is the inability to control their implementation. Sometimes women, along with the necessary muscles, strain others, which increase intra-abdominal pressure. This not only negates the entire workout, but can also exacerbate the problem.

A set of exercises with biofeedback (BFB) includes a special apparatus for recording muscle tone. With its help, you can control the correct execution of contractions, and, if necessary, produce electrical stimulation. BFB training has been proven to improve muscle tone and urinary control.

Contraindications to biofeedback training:

• inflammatory diseases in the acute phase
• severe diseases of the heart, kidneys, liver

Use of special simulators

For training, many compact devices have been created that allow you to strengthen the muscles of the pelvic floor with maximum efficiency and perform all the exercises necessary for urinary incontinence in women.

One of these simulators is the PelvicToner. This device, based on the properties of a spring, allows you to gradually and correctly increase the load on the intimate muscles, strengthening them. It is easy to use and care, and the effect of it is confirmed by clinical trials.

Psychological training

With a strong urge to urinate, you can try to distract yourself from thinking about it. Everyone has their own ways: think about plans for the day, read an interesting book, take a nap. The main task is to make the brain forget about going to the toilet, at least for a short period.

Treatment of stress incontinence

In addition to the general methods of incontinence management described above, the treatment of stress incontinence requires the intervention of a doctor. Conservative treatment with drugs is not very popular, as it helps only in a small number of cases.

With a mild degree of stress incontinence, when the anatomical structures have retained their integrity, sometimes use:

• Adrenomimetics (Gutron) increase the tone of the sphincter and urethra, but at the same time act on vascular tone. They are used extremely rarely due to low efficiency and side effects (increased blood pressure)
• Anticholinesterase drugs (Ubretide) also increase muscle tone. It is recommended for women who, according to the results of examinations, have hypotonia of the bladder.
• Antidepressant duloxetine (Cymbalta), effective in half the cases, but with side effects on the digestive system.

Treatment of stress incontinence with pills is very rare due to frequent relapses and side effects.

Surgical treatment

For stress urinary incontinence in women, surgery is the treatment of choice. There are several surgical manipulations, differing in complexity of execution. The preference for this or that operation is given depending on the degree of incontinence and the anatomical features of the woman's urethra.

Contraindications to all types of surgical treatment are:

• malignant neoplasms
• inflammatory diseases of the pelvic organs in the acute phase
• diabetes mellitus in the decompensation phase
• diseases of the blood coagulation system

Sling operations (TVT and TVT-O)

These interventions are minimally invasive, last about 30 minutes, and are performed under local anesthesia. The essence of the intervention is extremely simple: the introduction of a special synthetic mesh in the form of a loop under the neck of the bladder or urethra.

This loop holds the urethra in a physiological position, preventing urine from flowing out when intra-abdominal pressure rises.

To introduce this mesh, one or more small incisions are made in the vagina or inguinal folds; they do not form a cosmetic defect. Over time, the mesh seems to grow into the connective tissue, firmly fixing the urethra.

Recovery after such operations occurs very quickly, the effect is felt almost immediately. Despite the attractiveness of sling operations, the likelihood of relapse still remains. In addition, with detrusor instability and anatomical defects in the urethra, this surgical intervention may be ineffective.

Despite the difficulties described above, minimally invasive loop surgery is the gold standard in the treatment of stress incontinence.

Injections of bulk-forming drugs

During the procedure, under the control of a cystoscope, a special substance is injected into the submucosa of the urethra. Most often it is a synthetic material that does not cause allergies.

As a result, the missing soft tissues are compensated and the urethra is fixed in the desired position. The procedure is less traumatic, performed on an outpatient basis under local anesthesia, but also does not exclude relapses.

Burch laparoscopic colposuspension

The operation is performed under general anesthesia, often laparoscopically. The tissues located around the urethra are, as it were, suspended from the inguinal ligaments. These ligaments are very strong, so the long-term results of the operation are very convincing.

But due to the type of anesthesia and the complexity of the procedure, colposuspension has more contraindications and complications than sling operations. Typically, such an intervention is carried out after an unsuccessful loop procedure or in case of violations of the anatomical structure of the genitourinary apparatus.

Colporrhaphy

Sewing of the vagina with special absorbable threads, used for prolapse of the pelvic organs. The operation has a number of complications (tissue scarring, for example) and loses its effect after a few years.

Urgent incontinence treatment

Unlike stress incontinence, surgical treatment is ineffective for urgency. It is recommended that all women with this problem first of all try general methods of treatment (non-drug). Only when they are ineffective, you can think about drug therapy.

In the treatment of urge urinary incontinence in women, tablets are very effective. There are several classes of drugs whose main task is to restore the normal nervous regulation of urination.

• Drugs that reduce the tone of the bladder wall, reduce the strength and frequency of its contractions. The most common drugs are: Driptan, Detrusitol, Spasmex, Vesikar.
• Drugs that relax the bladder in the filling phase and improve its blood circulation: Dalfaz, Kaldura, Omnik.
• With incontinence in menopausal women, when there is a deficiency of estrogen, hormone replacement therapy or special ointments are used. An example of such an ointment is Ovestin, a cream containing an estrogen component. Its use can reduce dryness and itching of the mucous membranes, reducing the frequency of urinary incontinence.

Treatment of urinary incontinence in women is a complex task that requires an integrated approach and strict implementation of all the recommendations of a specialist. A few simple rules will help to avoid or delay the manifestation of this disease as much as possible.

Prevention of urinary incontinence

• Maintain the body's water balance. To do this, you need to drink 1.5-2 liters of non-carbonated water per day. Excessive and insufficient drinking can be harmful to health.
• Try to create your own urination regimen. It is quite possible to accustom yourself to empty your bladder at a certain time. For example, in the morning before getting ready for work, during the lunch break, immediately after coming home, go to the toilet and reinforce this habit.
• Fight excess weight (on your own or with the help of a specialist)
• To refuse from bad habits
• Reduce consumption of caffeinated foods and salty foods
• Fight constipation, if any. To do this, you can eat foods rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, drink half a glass of kefir at night. For chronic constipation, herbal laxatives can be used (after consulting a doctor (see laxatives for constipation)
• Engage in strengthening the muscles of the pelvic floor before planning pregnancy, which will avoid perineal tears during childbirth
• Enjoy life and stay positive

Main conclusions:

• Urinary incontinence is a very common problem among women.
• Without treatment, urinary problems are unlikely to go away on their own.
• To determine the type of incontinence, you need to undergo an examination, including filling out a questionnaire and keeping a urination diary.
• Stress incontinence is treated with surgery, while urge incontinence is treated with medication.
• You can independently engage in the prevention of incontinence by leading a healthy lifestyle and strengthening the muscles of the pelvic floor

Urinary incontinence is a serious problem that needs to be treated. It is better to spend a little time going to the doctor and eliminating it than to be embarrassed and tormented all your life.

Urinary incontinence is a serious problem that affects not only young children but also some adults. Most often, this pathology is diagnosed in women. Many are embarrassed to contact a specialist and try to solve this problem on their own, but it is recommended that you immediately consult a doctor who will help you choose effective urinary incontinence pills in your case.

ATX code

Indications for the use of tablets from urinary incontinence

First of all, it is necessary to understand that urinary incontinence develops after a complete or partial loss of control over the urethral sphincter. It is thanks to him that urine remains in the bladder. There are many factors that lead to this problem:

1. Increased activity of the bladder.
2. Deficiency of estrogen in the body.
3. Failure of the musculoskeletal apparatus that support the bladder and urethra.
4. Removal of the uterus by surgery.
5. Infectious diseases of the genitourinary system.
6. A prolapsed uterus or anterior wall of the vagina.
7. Depression and stress.
8. Injuries in the pelvic area.

Statistics show that the most common cause of urinary incontinence is an overactive bladder. In order to get rid of it, specialists prescribe special medications.

Release form

Today, there are quite a few drugs that help overcome such an unpleasant problem as urinary incontinence. The most popular among them are:

1. Driptan.
2. Spasmex.
3. Vesicar.
4. Betmiga.
5. Vitaprost Forte.
6. Detrusitol.
7. Pantogam.
8. Pantocalcin.
9. Urotol.
10. Imipramine.

Which medicine should be taken in your particular case, only a doctor can say with accuracy. Therefore, be sure to pass all the necessary examinations.

A drug based on the active ingredient oxybutin hydrochloride, which helps to reduce the tone of the muscles of the bladder. Differs in antispasmodic action.

If the patient has been diagnosed with angle-closure glaucoma, intestinal atony, colitis, myasthenia gravis, obstructive uropathy, colon expansion, bleeding, it is forbidden to use Driptan tablets. Do not use for therapy during lactation and pregnancy.

Taking this medicine can cause constipation, nausea, dry mouth, diarrhea, insomnia or drowsiness, headaches, dizziness, weakness throughout the body, mydriasis, increased pressure inside the eye, arrhythmias, urinary retention, impotence and allergies.

A medicine based on the active ingredient trospium chloride helps to relax the muscles of the bladder. Differs in antispasmodic and ganglionic blocking properties.

The drug is allowed to be taken from the age of 14. The dosage and duration of therapy are individual and are established only by the attending physician. Tablets are taken before meals with a sufficient amount of liquid.

Spasmex tablets are available in different dosages. It depends on the number of daily applications of this drug. When using a 5 mg medication, it is recommended to take up to three tablets 2-3 times a day. The interval between doses should be at least 8 hours.

If the patient has been found to have renal insufficiency, the daily dose should not exceed 15 mg. On average, therapy lasts up to three months.

For patients with tachyarrhythmia, angle-closure glaucoma, urinary retention, myasthenia gravis, lactose intolerance or trospium chloride, Spasmex tablets are prohibited. The use of this drug can cause the development of pain in the chest, tachycardia, tachyarrhythmia, fainting, hypertensive crisis, shortness of breath, dyspepsia, dry mouth, nausea, diarrhea, gastritis, hallucinations, acute necrosis of skeletal muscles, disturbance of accommodation, urinary retention and allergies.

A drug based on the active component of solifenacin succinate, which reduces the tone of the muscles of the urinary tract. It has an antispasmodic effect. The maximum result from the use of this drug occurs only on the fourth week of admission, but lasts up to 12 months.

You can take the drug from the age of 18. The standard dosage is as follows: 5 mg of the drug 1 time per day. If there is such a need, the attending physician may increase the dosage to 10 mg. You can use it regardless of food.

If the patient has been diagnosed with severe intestinal or gastric diseases, urinary retention, myasthenia gravis, abnormal liver function, angle-closure glaucoma, sensitivity to solifenacin succinate, it is forbidden to take the remedy. For the treatment of pregnant women is prescribed with caution. If there is a need to use Vesicar tablets during lactation, breastfeeding should be stopped.

Taking this medicine can lead to the development of constipation, nausea, diarrhea, dry mouth, dyspepsia, coprostasis, vomiting, dysgeusia, drowsiness, dry eyes and nose, erythema multiforme, rash, allergies, swelling of the legs, exfoliative dermatitis.

A medicine based on the active ingredient Mirabegton, which helps to cope with urinary incontinence. It has a prolonged and antispasmodic effect.

You can take Betmiga tablets from the age of 18. The standard dosage of this drug is as follows: 50 mg once a day. Drink plenty of water. For elderly patients, dose adjustment is not necessary.

If the patient has been diagnosed with sensitivity to Mirabenton, renal failure in the terminal stage, abnormal functioning of the liver and kidneys, it is forbidden to take Betmig tablets. During pregnancy - contraindicated.

Taking Betmig can cause the development of tachycardia, infectious diseases of the genitourinary system, swelling of the eyelids, cystitis, gastritis, dyspepsia, inflammation of the joints, allergies, vulvovaginal itching, increased pressure.

Vitaprost Forte

A medicine based on a special powder, which is obtained from the prostate tissue of bulls that have already reached puberty.

Patients with intolerance to the active ingredient Vitaprost Forte, lactose deficiency are prohibited from taking tablets. In some cases, this medicine may cause allergies.

Detrusitol

A drug based on the active ingredient tolterodine hydrochloride, which helps to reduce the tone of the muscles of the bladder. It has antispasmodic properties.

It is recommended to take Detrusitol regardless of meals, 4 mg of the drug once a day. If necessary, the dose can be reduced to 2 mg per day if the patient is diagnosed with intolerance to the drug. If the patient simultaneously uses ketoconazole, the daily dosage should not exceed 2 mg of the drug.

If the patient has been diagnosed with angle-closure glaucoma, urinary retention, myasthenia gravis, colitis, megacolon, fructose intolerance, sensitivity to tolterodine hydrochloride, it is forbidden to take Detrusitol tablets. For the treatment of children are not used. It is recommended that women of childbearing age use reliable contraception while taking this drug.

Taking Detrusitol tablets can cause sinusitis, allergies, headaches, dizziness, confusion, xerophthalmia, constipation, abdominal pain, flatulence, diarrhea, fatigue, drowsiness, anaphylactic reactions.

A drug based on the active component of the calcium salt of hopantenic acid, which has an anticonvulsant effect.

It is recommended to take Pantogam tablets 15 minutes after a meal. Can be used to treat children from 3 years of age (for infants and children under 3 years of age, syrup is used). For adult patients, the recommended dose is 1 g of the drug 3 times a day. Children can take from 0.5 g 3 times a day. Therapy continues up to six months. If necessary, the course can be repeated after 3-4 months.

Patients who have been diagnosed with phenylketonuria, abnormal kidney function, intolerance to hopantenic acid, should not take this remedy. Not used for therapy during pregnancy.

The use of Pantogam tablets can cause the development of rhinitis, skin rashes, conjunctivitis, drowsiness, sleep disturbances, noise in the head.

Pantocalcin

A medicine based on the active component of calcium hopantenate. It has a nootropic and anticonvulsant effect.

It is recommended to take Pantocalcin 15 minutes after a meal. Adult patients can use up to 1 g of the drug at a time. For children, a single dosage is reduced to 500 mg. These tablets are taken up to 3 times a day. Therapy lasts 2 weeks, but if necessary, the duration of the course can be increased up to 3 months.

Patients who have been diagnosed with acute renal failure should not use the drug. Not used for treatment in the first trimester of pregnancy. In some cases, taking Pantocalcin causes allergies.

A drug based on the active ingredient tolterodine hydrotartrate, which is used to reduce the tone of the smooth muscles of the bladder. Differs in antispasmodic action.

It is recommended to take this medication 2 mg 2 times a day. In case of intolerance to tolterodine, the doctor may reduce the daily dose to 2 mg 1 time per day. If the patient is simultaneously taking ketoconazole, Urotol should be taken at a dosage of 1 mg 2 times a day.

If the patient has been diagnosed with angle-closure glaucoma, urinary retention, ulcerative colitis, myasthenia gravis, megacolon and sensitivity to tolterodine hydrotartrate, it is forbidden to take Urotol tablets. Not used for therapy during pregnancy and in childhood.

The use of this medication can cause the development of angioedema, allergic reactions, headaches, nervousness, drowsiness, tachycardia, arrhythmia, dry skin, urinary retention, bronchitis, pain in the chest area.

A medicine based on imipramine, which helps to get rid of urinary incontinence during the day and at night. Differs in antidiuretic action.

Taking Imipramine tablets is set by the attending physician, depending on the patient's condition. The standard dosage for adult patients is 50 mg of the drug 3-4 times a day. For children from six to twelve years old, the dosage is 30 mg of the drug 2 times a day. For the treatment of nocturnal urinary incontinence, the following dosage is used: 75 mg of the drug one hour before bedtime.

Patients who have been diagnosed with heart failure, improper functioning of the kidneys and liver, impaired function of the hematopoietic organs, angle-closure glaucoma, are prohibited from taking Imipramine tablets. Do not use during pregnancy and lactation.

The use of this medicine may cause tremor, fear, restlessness, sleep disturbance, convulsions, arrhythmias, tachycardia, cholestatic jaundice, photosensitivity, allergies, galactorrhea, constipation, nausea.

Pharmacodynamics

Consider the pharmacodynamics and pharmacokinetics of tablets for urinary incontinence on the example of the drug "Driptan".

This medicine is an antispasmodic, so it has antispasmodic, m-anticholinergic and myotropic effects. It helps to increase the capacity of the bladder, relax the detrusor, reduce the frequency of its contractions, thereby restraining the urge to urinate.

Pharmacokinetics

After ingestion, the highest level of concentration of the active component oxybutynin hydrochloride is reached after 45 minutes. Excreted by the kidneys 2 hours after ingestion.

Use of urinary incontinence tablets during pregnancy

Many women develop urinary incontinence during pregnancy. This can be explained by a rapid increase in body weight, hormonal changes, an increase in the uterus, which begins to put pressure on the bladder. In addition, in a pregnant woman, the natural load on the small pelvis increases.

It should be understood that not all pills can be taken by pregnant women. Therefore, if you notice an unpleasant problem in yourself, you should immediately contact your doctor. He will be able to select the appropriate and safe treatment for you.

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