» Urinary incontinence in women, Causes, diagnosis and treatment
Urinary incontinence in women, Causes, diagnosis and treatment
Urinary incontinence in women, Causes, diagnosis and treatment
Urinary incontinence in women (Incontinentia) - is the involuntary leakage of urine, is not amenable to willpower. This is a fairly common condition that is accompanied by psycho-emotional disorders. Due to the constant wear pads, odor disrupted social adaptation of patients and significantly worse quality of life. Sometimes it makes it impossible to leave the house. In a world of more than 200 million women suffering from urinary incontinence.
Causes of urinary incontinence in women varied. Usually, incontinence occurs because of the wholeClimax complex of reasons:
Climax. Occurring during the hormonal changes of menopause. This gives rise to hormonal changes, causing the aging of tissues, atrophy and thinning of the membranes of the urinary organs, muscles, ligaments, pelvic floor, contributing to incontinence.
Changes in the central or peripheral nervous system, accompanied by dysfunction of the pelvic organs (spinal cord injury, circulatory disorders in the spinal cord, inflammatory diseases of the spinal cord, multiple sclerosis, diabetes, tumors, malformations).
Violation of the anatomical relationships of the pelvic organs (bladder, urethra, with the other organs of the pelvic floor) or a violation of the sensitivity of nerve receptors. These conditions occur after complications or multiple births, operations on the pelvic organs, classes weightlifting and other sports, obesity, chronic inflammatory processes. The normal urinary bladder and provide urine channel, their muscular system, as well as fascia and ligaments that hold the bladder and pelvic floor muscles.
The urine collects in the bladder, and stretches its walls. Receptors located in the bladder wall are excited and there is an urge to urinate, which people can control at will, squeezing sphincter (pulp) of the bladder and pelvic floor muscles. The muscle of the bladder, casting out the urine, called the detrusor. Normally, she relaxed during filling of the bladder. During the emptying of the bladder is shrinking, forcing urine. If, during the filling of the bladder detrusor is reduced, so called overactive bladder. Urinary incontinence in this case occurs when the bladder pressure is greater than the pressure in the urethra. This is in violation of the nervous regulation of the bladder, as in diseases of the central brain and spinal cord and peripheral diseases of the peripheral nerve fibers. This incontinence is urgent. There is a strong urge to urinate and urine withhold the sudden urge.
Urinary incontinence that occurs when the urinary sphincter insufficiency, excessive mobility of the bladder neck is stressful and is due to pelvic prolapse, the vaginal walls. In this neck of the bladder is stretched, or displaced position and the muscle sphincter of the bladder can not contract fully. Sphincter thus does not provide sufficient resistance to pressure of urine in the bladder. This incontinence occurs when a small increase in pressure in the bladder, which in turn increases with an increase in intra-abdominal pressure when laughing, coughing, exertion, sneezing, running. Insufficiency of the sphincter of the bladder occurs after operations on the pelvic organs, after radiotherapy, can also be a consequence of age-related degenerative changes in muscles of the sphincter and pelvic floor. Urinary incontinence can be caused by these two mechanisms at once, then it is called mixed.
Diagnosis of urinary incontinence in women. An examination of the patient with urinary incontinence primarily determine the cause of the problem arises of its occurrence and type of urinary incontinence. The patient is recommended to keep a diary bladder, where it should mark the time and volume of each urination, urination is accompanied by pain, etc. Must be appointed general blood and urine tests, counseling gynecologist. Cystoscopy is performed to examine the walls of the bladder, ultrasound scan to rule out other diseases of urinary system. Perform ascending cystography. Spend uroflowmetry, which allows to evaluate the functional state of the bladder and urinary tract. The most objective way the survey is combined urodynamic study. It includes uroflowmetry, cystometry, pressure profilometry in the urethra, the definition of the threshold of abdominal pressure. This method allows to determine the type of incontinence and the dominant component, if the form of mixed incontinence. Produced and electromyographic study, which provides information on the status of the pelvic floor muscles.
Treatment of urinary incontinence in women. Treatment for incontinence depends on its type. Treatment of urge incontinence of urine is carried out mostly conservative. Appointed by drugs that suppress the involuntary contraction and relaxation of muscles causing expelling urine - the detrusor. Sometimes assigned to antidepressants, which also relax the bladder. To reduce age-related atrophic changes in the mucous membranes are appointed by estrogen. To reduce the amount of urine from time to time assigned desmopressin (an analogue of vasopressin). Always be appointed and non-pharmacological treatment of urinary incontinence. They are:
Bladder training. Its purpose the establishment of compulsory rate of urination and urinary control. Training is conducted by a special technique with biofeedback.
Physiotherapy. Electrical stimulation and electromagnetic stimulation, with the introduction of a sinusoidal or diadynamic currents and ultrasound of various drugs that reduce the hyperactivity of the muscles expelling urine.
The most effective combination of treatments. Operative treatment of urgent (emergency has arisen), urinary incontinence is rare. Commonly used plastic surgery - expanding plastic bladder (augmentation). In the wall of the bladder sewn graft taken from the ileum. In this case, increasing bladder capacity and decreases the strength of its contractions, and therefore reduced pressure and urine. The results of surgery are good, but the operation is complicated, there may be complications. Treatment of stress urinary incontinence is mainly surgical. Only patients younger age at onset is assigned physiotherapy, exercises designed to strengthen the pelvic floor muscles, electrical stimulation of the muscles. There are over 250 methods of surgical treatment of stress urinary incontinence. Carry a plastic patch sphincter of the bladder, the strengthening of the bladder neck.
Types of surgical treatment of urinary incontinence in women:
bladder and suspensory sling (loop) operation.
plastic walls of the vagina. - Transplantation of an artificial urinary sphincter
injection of bulking agents.
The success of these operations from 70 to 90%.
Urinary incontinence in women, causes of urinary incontinence in women, diagnosis of urinary incontinence in women, treatment of urinary incontinence in women