They are referred to as the general term "Dizuriy" (from the ancient Greek words of DYS - "Disorder", URON - "Urine"). One of these disorders is the incontinence of urine - episodic or constant uncontrolled urination or urine leakage. At the representatives of the beautiful gender, it occurs more often than that of a strong half of humanity. More than 30% of women (for the Russian Federation, this figure, according to recent studies, is 38.6% 1) at least once experienced urine incontinence, and up to 20% are regularly faced with this nuisance, seriously worsening the usual quality of life. The "fault" is purely natural causes - the anatomical features of the structure of the urinary tract), as well as the pregnancy, childbirth, climax and menopause by the female organism. What is known urology and gynecology about this disease today?

Diagnosis of urinary incontinence in women

in some cases, urodynamic studies may be required: for example, urofloumometry (assessment of urination indicators), cystometry (measurement of pressure in the bladder during its filling of the liquid through the catheter) and other procedures at the discretion of the doctor necessary according to the testimony.

Stress incontinence of urine in women

The most common type of disease, over 50% of cases. Weakening of a special "locking" muscle ureyeing Canal - sphincter - against the background of a periodic increase in intra-abdominal pressure due to physical activity (even small!) Leads to uncontrolled urination: the leakage of urine or complete emptying of the bladder.

The reasons. Enhance intra-abdominal pressure of such physiological conditions and their consequences, as pregnancy and transferred operations on the organs of a small pelvis - the urinary bubble, the rectum. Also, the cause of stress incontinence of urine is often age-related changes: the organism of the elderly women is experiencing a lack of hormones of estrogen, which leads to a decrease in the elasticity of ligaments and muscle tone, including the tone of the sphincter.

Risk factors, against which it is possible to develop stress incontinence of urine, are heredity, obesity, diabetes, stroke, heart attack, Parkinson's disease, spine injury, infectious diseases of the urine system, anemia and some other disorders.

Symptoms. Patients, as a rule, complain to the doctor on such intertpete sensations as the leakage of urine during sports, the change of body position, laughter, cough, sexual intercourse, lifting weights and the absence of a "control signal" of the body - urges to urine. Less frequently uncontrolled urination is combined with incontinence of gases and feces.

Treatment. With the lightweight form of stress urinary incontinence in women, the pelvic bottom muscles exercise. Most often, in the absence of contraindications, urologists are recommended to a patient a minimally invasive (that is, gentle, small-acting surgical intervention - the introduction of the holding hinge mesh under the neck of the bladder or urethra.

Urgent urinary incontinence in women

The least common type of disease, not more than 15-20% of cases. Implanting occurs with the urgent (imperative, unbearable, uncommon) urge to urination. The bladder is sometimes filled slightly.

The reasons. This type of disorder may be associated with a hyperactive bladder syndrome (GMP). Nervous endings - the receptors - the muscles of the sphincter and the bladder in the syndrome of GMP acutely and almost instantly react to the slightest irritants: for example, bright light, noise of flowing water, - provoking uncontrolled urination.

Symptoms. Urgent urinary incontinence in women is accompanied by frequent urges to urine, while the desire to persevery appears suddenly and is almost uncontrollable. Risk factors for the development of disorder are the same as for the stress form of incontinence.

Treatment. In contrast to the previous form of urine incontinence, in this case, non-drug (physiotherapy, special exercises for the pelvic bottom muscles) and drug methods are coming to the fore in patients therapy. As for drugs, preparations are used that reduce the tone of the bladder wall, which reduces the intensity of its abbreviations, relaxing bladder When filling and improving its blood circulation. To date, these are drugs of two groups: antimuskarin and β3 agonists, allowing to significantly ease the life of women with urgent urinary incontinence. Women of menopausal age can be additionally recommended replacement hormone therapy.

Mixed urinary incontinence in women

This type of disease combines signs - causes and symptoms - the first two disorders and manifests itself in about 30% of cases. The involuntary urine leak occurs both in physical stress and on the background of the urgent urination. Treatment of mixed incontinence shape is carried out both by the operational way and with the help of non-drug therapy and drug reception.

From her first person

Treatment of urinary incontinence in elderly women folk remediesMedicinal preparations

Urinary incontinence in old age in women (synonymous: Inconteption) is a severe negative impact from a medical, personal and social point of view.

The phenomena frequency changes according to conditions and is 5-15% of the entire adult population living at home, 20-30% of the number of hospitalized, up to 70% in the nursing homes. Basically, the problems with incontinence in the female half begin in the opposite of 50-70 years.

Often urinary incontinence is associated with significant medical diseases, including the introduction of a constant catheter in the bladder, in the urinary system organs, and.

Signs and symptoms

• imperative (urgent) urinary incontinence (periodic uncontrolled urine leakage);
• woman with urges can not tolerate to the toilet;
• frequent and unusual motivations to urination.

Types and causes of urinary incontinence in old age

Inconteintion is the inability to control urination.

It may be temporary or constant, it can also be the result of multiple problems in the urinary tract.

Inconteintion is usually divided into four types:

• Stressful type of pathology - arises due to the weakening or improper operation of the urine sphincter and in the case of a stressful situation will be negative symptoms, the emission of urine. In addition to the stressful situation, the development of this type of pathology can also pregnancy, childbirth, operational intervention and age-related changes.
• Imperative type - With excessive bladder reactivity, even the minimum portion of urine can provoke the urge to the toilet and. The reason for the development of this type of incontinence, stress.
• Nonogenic type of pathology- provoke this type of urine incontinence can certain medicines, diuretic drugs, antidepressants and certain hormonal preparations.
• Other types of pathology - provoke them from organic origin root causes, such as oncology, injuries and strokes, certain diseases, for example, or. In each case, the reason establishes a urologist after a complete examination and inspection of a woman. Never be practicing an independent diagnosis.

Provoking factors

Incontinence of urine in women after 50 years can be provoked by the following factors and reasons:

• stretching muscles pelvis due to frequent pregnancy and childbirth; Women with gestation diabetes are at a higher risk;
• weak muscles controlling urination (urethral sphincter and pelvic bottom muscles);
• in which the hormonal restructuring of the body is underway and the level of estrogen decreases;
• certain diseases damaging the nerve paths from the bladder to the brain, for example:
• periodic infections of urinary tract (imp);
• incorrect combination of drugs;
• dysfunction of hip joint;
• unsuccessful transaction for the front hips;
• inflammatory processes affecting the organs and the urinary system itself.

In addition, the reasons for such an unpleasant phenomenon as urinary incontinence can be excessive weight, a certain degree of obesity, since additional pressure on the abdominal press, muscle and pelvic bottom provoking involuntary selection.

None of the factors mentioned directly to the incontinuations, and are considered only supporting factors.

Diagnostics

To set the right diagnosis, a urologist is needed, it appoints a comprehensive examination:

• collecting the course of the disease, the very character and frequency of urine discharge, the intensity and volume, the number of genera, were operational interventions and whether individuals suffer from diseases;
• vaginal (internal) study - At this stage, the doctor carries out the smear for laboratory research of the vagina and cervix;
• make ultrasound ureacher, bladder, kidneys. This is necessary for the doctor to establish the presence and lack of inflammation.

In addition to this, a common intended to identify infections (hematuria and glucosuria) is carried out.

It is important to emphasize that the elderly often suffer from asymptomatic bacteriuria, non-inconsistent and does not require treatment, except for patients who have recently appeared or accompanied by high temperature, burning when urination.

Checking a small pelvis

Women need to check a small pelvis. The following reasons:

• Atrophic vaginitis is the cause or worsen the course of urinary incontinence.
• During the inspection, you need to assess the ability to reduce the muscles of the bottom of the pelvis and, in accordance with this, plan treatment.
• Many older women are frivolous to constant gynecological observation. Checking the pelvic with a smear (smear papanicolau) can eliminate the presence of cervical tumors.
• As part of the inspection, provocative tests are conducted to eliminate urine leakage during tension, including cough and waltasalvy sample. If there is, it is necessary to achieve the omission of the vagina during checking with a finger or with a pessary (a device that is entered into the vagina to maintain the urine, bladder and rectum) to eliminate hidden urine incontinence due to stress.

Estimation of residual urine in the bladder

Assessment of residual urine in the bladder after sufficient emptiness gives information about the efficiency of emptying and risk and infectious damage.

Although it is possible to check with a catheter, a preferred method is an ultrasound study.

It should be remembered that problems such as or can make it difficult to carry out an ultrasound examination.

Imaging check

There is no specific image check in the framework of the patient's examination with urinary incontinence. The choice of a certain diagnostic procedure depends on the clinical state and therapeutic opportunities.

Ultrasonic surveys of the kidneys and urinary tract provide information on the volume of the bladder, the amount of residual urine after emptying the bladder, stones or urinary tumors.

Treatment of urinary incontinence in elderly women

Treatment can help more than 80% of people with a problem.

Exercises and behavioral therapy (one of the leading directions of modern psychotherapy) is most successful.

Also, the incontinence of urine in women after 70 is often treated with drugs.

Medications

• Urotol., Tablets 2 mg with a valid Tolterodine;
• Enablexwith the existing substance Darifenatsin * (Darifenacin *);
• Fesoterodin(Fesoterodin Fumarat).

Homeopathic medicines from urinary incontinence:

• Causticum;
• Parelar;
• Sepia;
• Zinc.

Some of the most common homeopathic agents used in incontinence due to stress are presented.

Attention! According to a recent study, drugs help only about 20-30% of women who take them, and often have significant side effects. Therefore, before taking pills, you need to discuss everything with doctors.

Kegel Exercises

To strengthen the pelvic bottom muscles, compress and hold 10 seconds. Muscles vagina, then relax them.

To find and feel the muscles you need to imagine as if you are trying to stop the urine current, in order not to describe, while especially the buttocks or abdominal cavity.

Keep the muscles intense 10 sec., Then relax for 10-15 seconds, and again. Do this exercise 2 times a day (day and evening) for 20 approaches.

Treatment of urinary incontinence in women by folk remedies

Recipe # 1:

• mix in equal proportions by St. John's wort, the road, the root of Valerian and the bumps of hops - 2 tbsp.
• next, the collection is sealed in a glass of boiled water, insist half an hour and take before eating.

Recipe # 2:

With involuntary and uncontrolled incontinence from the arsenal of folk agents, the following can be applied:

• take in the equal parts of the St. John's wort, a mother-and-stepmother, the gold masculine - 1 tbsp. l.
• next, it is necessary to brew grass in a glass of steep boiling water, insist 30 minutes. And take twice a day.

Other recipes for the treatment of urinary incontinence in women of old age:

• Sage: 50 gr. Sage is sealed in a thermos, 1 l bay. Boiling water, insisted 2 hours - take 3 times a day by half a glass.
• Cherry bark Collected during its flowering, crushed - 2 tbsp. l. Breed in 300 ml. Steep boiling water, boil on the water bath for 10-15 minutes., insist and take over the day like tea.
• Blueberries with blackberry: 0.5 liters of water are added 2 tbsp. l. Blueberries and blackberries boil 20 minutes. On slow fire, they insist an hour and take both tea.
• Recipe from lingonberries: Mix 2 tbsp. l. Leaf and berries Bruscan workers and a hunter in iron containers, pour the decoction of boiling water and put on a slow fire for 8-10 minutes, after allowing the brave half an hour and take 3 times a day on the floor of the glass.
• Yarrow: 1 tbsp. l. Yarrow leaves fervent in boiling water, insist half an hour and drink 100 ml. Three times a day before meals. You can also use St. John's wort - the preparation recipe is the same, and to enhance the positive effect of medicinal plants, you can take in equal parts to collect.
• Effective inxium infusion and seeds: It helps solve the problem of incontinuient quickly and efficiently. Just brew 2 tbsp. l. 300 ml. Boiling water, let's lie down and drink once a day, preferably in the morning.

In addition to treating folk remedies, all women should eliminate strong tea, coffee and foods containing caffeine from the diet.

Acupuncture

Acupuncture can help, depending on what causes incontinence. In one of the American research, women passed 4 weekly treatment with the urinary bubble acupuncture, they have significantly improved symptoms.

Forecast

The prognosis is favorable - it is possible to cure the incontinuations, the main timely to consult a doctor, go through full and comprehensive examination and follow all the recommendations of the physicians, not practicing self-medication. Even with all the effectiveness of folk recipes.

If the state is not treated, patients may suffer from recurrence of urinary tract infections and social isolation.

Interesting

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

The fear of missing urine can lead to psychological, sexual disorders, cause depressive states and impede personal and career growth. Incotinition (another incontinence name) always reduces the quality of life, so requires special attention.

There is even a special international organization for the retention of urine, which conducts research and develops all sorts of treatments. The incontinence of urine specialists call any involuntary allocation. But depending on the conditions, the time of day, the incontinence circumstances allocate several types of its species.

Types of urinary incontinence

• stressful
• imperative (urgent)
• mixed
• other species (continuous urine leakage, night incontinence, unconscious incontinence)
• yatrogenian incontinence (due to drug intake)

The first three species are most often characteristic of women.

Stressing urinary incontinence

This type of incontinence is half of all cases of uncontrolled urination. The main cause of this state is the incorrect operation of a special muscle - the sphincter of the urethra. The weakening of this muscle together with a periodic increase in intra-abdominal pressure lead to urine leakage or even complete emptying of the bladder.

Symptoms of stressful urinary incontinence

• watching urine in various quantities with exercise, laughter, cough, pencil, outraging
• lack of irresistible urges for urination
• sometimes - a combination with incontinence of gases and feces

The reasons for which stress incontinence of urine may occur, a huge set

• Pregnancy

Almost all women in an interesting position are inconvenient due to the leaking 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 stronger. This is due to a changed hormonal background and the pressure of the uterus on the organs of the small pelvis.

Especially often incontinence occurs after independent genera, a large fruit with a crotch incision and other manipulations. As a result, the muscles and bundles of the pelvic bottom are damaged, intra-abdominal pressure is distributed unevenly and the sphincter ceases to perform its function. It is after breaking or non-accurant cuts of the perineum (episiotomy) to incontinence of urine, incontinence of gases and feces is joined.

• Operations on the organs of a small pelvis

Any interventions associated with the urine, the bladder, the rectum, cause the adhesion process and changes in the pressure in a small pelvis. In addition, operations are sometimes complicated by fistulas between the bodies, which also leads to urinary incontinence.

• Age-related changes

With age, the elasticity of bundles and muscle tone decreases, which inevitably leads to the sphincter dysfunction. After the occurrence of Klimaks, the body is experiencing a deficiency of estrogen, which is the cause of urinary incontinence in older women.

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

Risk factors

• caucasoid Race
• heredity (if there is a disease near the nearest relatives or cases of Enurraw in childhood, the risk of incontinence more)
• obesity (especially in combination with diabetes mellitus)
• neurological diseases (stroke, heart attack, parkinsonism, spinal injuries)
• urinary tract infection
• digestion disorders
• receive some medicines
• anemia

Stress incontinence of urine delivers women a lot of trouble. Failure to exercise sports, afraid to miss urine in humans, constant nervous tension adversely affect health. Therefore, it is important not to be shy and not to silence this topic, and in time to contact the doctor.

Imperative incontinence

Normally, urinate appears after accumulation in a bubble of a certain amount of urine. Feeling this urge, a woman can successfully restrain him to the nearest toilet room. With an increased reactivity of the bladder, even a small amount of urine is enough to occur a strong, unbearable urge. And if there is no toilet next to the lucky accident, that is, the risk to miss urine.

The reason for the occurrence of this ailment is considered a hyperreactive bladder. Due to the special mobility of the psyche and the speed of nerve pulses, the muscles of the sphincter and the bladder react to the slightest irritation. Therefore, urine can be missed with a small cluster in the bubble, especially if there is any external stimulus (bright light, the sound of flowing water, etc.).

The main symptoms of imperative incontinence

• frequent urges for urination
• urge almost always sudden
• expendable desire to urinate
• the emergence of urges is often provoked by external circumstances.

The risk factors for the emergence of imperative urges are exactly the same as in stress incontinence, because these kinds are often combined.

Differential diagnosis of urinary incontinence

Yatrogenian incontinence

Some medicinal products The list of their side effects have urination disturbance:

• adrenomimetics (pseudoephedrine) can cause urine delay, followed by its incontinence, are applied to the treatment of bronchial diseases;
• all diuretic products;
• colchicine (for the treatment of gout);
• some drugs with estrogen;
• sedable drugs I.

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

Other types of incontinence

More rare causes of urine omissions are usually associated with organic pathology. These may be damage to the head and spinal cord as a result of tumor processes, injuries, strokes, sclerosis.

Only a doctor can establish the exact cause of the problem. Usually, in incontinence, women turn to gynecologists and urologists. Recently, a narrow specialty appeared - urzhynecology, which is engaged in issues of the feminine urinary sphere.

Urinary incontinence examination

Detailed story doctor about complaints

The factors provoking incontinence are important, the time of symptoms, their severity, additional complaints. In addition, you need to ask mom, grandmother, sisters about similar symptoms to reveal the hereditary predisposition. Be sure to note if in childhood there were cases of chronic night enuresis.

You can fill out a questionnaire created specifically for people with incontinence problem. ISQ incontinence symptoms questionnaire, ISQ (Incontinence Symptom Questionnaire):
1. For what time do you celebrate the symptoms of incontinence?
2. Was the amount of missed urine changed from the moment of the disease?
3. How has the number of cases of urinary incontinence change since their appearance?
4. Specify how often the execution of the following actions leads to incontinence (never, sometimes, often).

• exercise, including Running, Sports
• sneezing
• cough
• lifting weight
• changing body position: transition from sitting in vertical position
• view or sound of the murmur
• psycho-emotional tension
• supercooling

5. Are you worried about insurmountable urge on urination?
6. How long can you keep urine when the appearance of the urge?
7. How often do you lose urine?
8. When urine incontinence occurs more often?
9. Do you feel clothes laundry without urination at urination?
10. Do you wake up at night to urinate?
11. Please indicate how many urine you usually lose.
12. Rate on a 5-point scale the degree of influence of urine incontinence on your daily life: _____ (0 - does not affect, 5 - significantly influences).

Maintaining a diary of urine

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

Time	What fluid have you taken and in what quantity? (water, coffee, juice, beer, etc.)	How many times did you preach in one hour?	What amount of urine? (a little, medium, much) or specify in ml	Tested Are you unbearable to urine-based urine?	Did you have an episode of non-surpassed urine release?	How many urine was meditated during this episode? (a little, medium, much) or specify in ml	What have you been occupied during unprofitable urine release?
7:00 -8:00	Tea, 200ml	1	Little	—	—	—	—
8:00 -9:00	—	1	Little	yes	yes	little	Engaged in the morning jogging
9:00 –10:00
10:00 -11:00

Pad test

Often the concepts of "many" and "little" in different women differ, therefore it is difficult to assess the degree of the disease. There is a test with gaskets, or a pad-test to help doctors. This method is used to obtain objective data on the number of urine omissions.

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

Vaginal research

Inspection of the genital organs with gynecological mirrors are necessary to eliminate other diseases. During the examination, the doctor may detect:

• atrophy of the mucous membrane of the vagina. After menopause, the dryness of the genital organs associated with the deficit of estrogen may aggravate urinary incontinence
• loss or omission of small pelvis organs (see)
• large fistula

When inspection, a cough test is carried out: when driving, you can see the selection of urine from the urethra.

Analysis of urine

Very often, with inflammatory changes in the organs of the urogenital system, incontinence of small portions of urine occurs. Therefore, the detection of leukocytes, erythrocytes or bacteria in the urine gives a reason for the examination for infections. To obtain an accurate result you need to know the basic rules for collecting urine:

• use the first, "Morning" urine
• collect the middle portion of urine
• conduct a thorough toilet of the vagina before urination
• during harvest to cover the vagina with a clean cloth

Visualization (ultrasound, MRI)
Urodynamic studies (allow us to find out the type of incontinence)

Treatment of urinary incontinence

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

• general treatments
• treatment of stress incontinence
• treatment of imperative incontinence
  

Therapy of any kind of urinary incontinence should be started with the easiest and most affordable methods. Such methods include lifestyle correction and special exercises. This is a lifestyle correction:

Weight control in obesity	the necessary stage in the treatment of all types of urinary incontinence. Extra kilograms constantly increase intra-abdominal pressure, disturb the normal arrangement of organs, causing urination disorders. Depending on the degree of obesity, psychological, drug or surgical treatment is used.
Reducing coffee consumption, tea and other beverages containing caffeine	Caffein-containing drinks provoke a rapid urination, so the risk to miss urine increases at times. But the excessive limitation of the use of fluid is also undesirable: incontinence will not reduce it, and on general health will affect negatively.
To give up smoking	In order to identify a direct link between tobacco and incontinence, a huge number of studies have been carried out, but the topic is still unexplored. With accuracy, it can only be said that chronic nicotine bronchitis with stressful urinary incontinence is a huge problem, since every cough movement the woman misses urine. The treatment of chronic respiratory diseases can be attributed to the same item.
Establishing urination regime	This method gives very good results with imperative incontinence. Its essence lies in visiting the toilet in strictly defined hours, regardless of the urge strength. First, the intervals between urine do not exceed 30-60 minutes, but over time you can develop a more convenient mode.
Pelvic DNA Muscle Training	The main goal of such training is to bring muscle tone, restoring the sphincter function and regulation of phases of filling and urination. With the help of special exercises and devices, a woman can completely take control of the muscles of the sphincter, eliminating the sudden misunderstanding of urine.
Treatment of chronic respiratory diseases Psychological installation for distraction from the desire to urinate

Exercises of Kegel

The essence of such gymnastics is as simple as possible. First you need to "find" the desired muscles of the pelvic bottom: perivaginal and perimeral. To this end, you need to sit at the urination and try to keep this imaginary urine stream. Muscles involved in this process must be regularly trained.

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

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

• slow compression
• fast abbreviations
• equalization (by analogy with a waiting period of childbirth)
• route delay during real urination

Training with biological feedback

The main disadvantage of the simple exercise of Kegel is the impossibility of monitoring their implementation. Sometimes women together with the necessary muscles are straining and other, increasing intra-abdominal pressure. It not only negates all the workout, but can aggravate the problem.

Complex of exercises with biological feedback (BOS) includes a special device for registering muscle tone. With it, it is possible to control the correctness of the comprehension, and if necessary, it is electrostimulation. Bos training proves the muscle tone and control over urination.

Contraindications to Bos Training:

• inflammatory diseases in the aggravation phase
• heavy hearts, kidneys, liver disease

Using special simulators

For training, a lot of compact devices have been created, allowing to strengthen the pelvic bottom muscles with maximum efficiency and perform all the necessary urine in women exercise.

To one of these simulators belongs to Pelvictoner. This device based on the properties of the spring allows you to gradually and properly increase the load on intimate muscles, strengthening them. It is easy to use and care, and the effect of it is confirmed by clinical trials.

Psychological training

With strong urges to urine, you can try to distract from thought about it. Everyone will have their own ways: think about the plans for a day, read an interesting book, to rise. The main task is to make the brain forget about the campaign to the toilet at least for a short period.

Treatment of stress incontinence

In addition to the general methods of combating the incontinence described above, the doctor's intervention is required for the treatment of stress incontinence. Conservative treatment with medications is not very popular, as it helps only in a small amount of cases.

Medicia treatment:

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

• Adrenomimetics (GuTron) increase the tone of the sphincter and urethra, but at the same time act on the tone of the vessels. Apply extremely rare due to low efficiency and side effects (an increase in blood pressure)
• Anticholinesterase preparations (ulitid) also increase muscle tone. Recommended by women who, according to the results of the surveys, the bladder hypotension was revealed.
• Antidepressant Duloxetin (Sybalt), effective in half cases, but possessing side effects on the digestive system.

Treatment of stress incontinence with tablets is carried out very rarely due to frequent relapses and side effects.

Operational treatment

With stress incontinence of urine in women, the operation is a method of choice. There are several surgical manipulations that differ in the complexity of execution. The preference for one or another operation is given depending on the degree of incontinence and the anatomical features of the woman's urethra.

Contraindication to all types of surgical treatment are:

• malignant neoplasms
• inflammatory diseases of the small pelvis organs in the exacerbation phase
• sugar diabetes in the decompensation phase
• blood coagulation diseases

Sling operations (TVT and TVT-O)

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

This loop keeps the urethra in a physiological position, not allowing the urine to flow with an increase in intra-abdominal pressure.

To introduce this grid, one or several small cuts in the vagina or inguinal folds, they do not form a cosmetic defect. Over time, the grid seems to grow into a connecting fabric, firmly fixing the urethra.

Recovery after such operations occurs very quickly, the effect is felt almost immediately. Despite the attractiveness of sling operations, the probability of recurrences is still preserved. In addition, with the instability of the Destroyer and the Anatomical Defects of Urethra, this surgical intervention may be unsuccessful.

Despite the difficulties described above, minimally invasive loop operations are the Gold Standard in the treatment of stress incontinence.

Injection of volume-forming drugs

During the procedure under the control of the cystoscope, a special substance is introduced into the submembratus shell of the urethra. It is more often a synthetic material that does not cause allergies.

As a result, the missing soft tissues and the fixation of the urethra in the desired position occurs. The procedure is small-acting, is carried out on outpatient conditions under local anesthesia, but also does not exclude recurrences.

Laparoscopic Colposuspetsia on Burch

The operation is carried out under general anesthesia, more often laparoscopic access. Fabrics located around the urethra, as if hang to inguinal ligaments. These bundles are very durable, so the remote results of the operation are very convincing.

But due to the type of anesthesia and the complexity of the Collaposuspension procedure, there has more contraindications and complications than allen operations. Usually such intervention is carried out after an untenable looping procedure or in violations. anatomical structure urinary apparatus.

Kohlpopia

Cutting the vagina with special absorbable threads used in the prolapse of a small pelvic organs. The operation has a number of complications (scarring of fabric, for example) and loses effect in several years.

Treatment of imperative incontinence

In contrast to stress incontinence, with imperative urges, surgical treatment is inefficient. All women with such a problem are primarily recommended to try common treatments (non-drug). Only with their ineffectiveness can be wondering about drug therapy.

Medicia treatment

In the treatment of imperative urinary incontinence, women pills are very effective. There are several classes of drugs, the main task of which is to restore the normal nervous regulation of urination.

• Preparations that reduce the tone of the bladder wall, reduce the strength and frequency of its abbreviations. The most common medicines: Dipridge, Destrozitol, Spruce, Vescar.
• Preparations, relaxing bladder in the phase of filling and improving its blood circulation: Dalfaz, Collura, Omnik.
• When incontinence in women of menopausal age, when there is a deficiency of estrogen, use substitution hormone therapy or special ointments. An example of such ointments is solidin - cream containing an estrogen component. Its use allows to reduce dryness and itching of mucous, reducing the incontinence rate of urine.

Treatment of urinary incontinence in women is a difficult task that requires an integrated approach and clear execution of all recommendations of a specialist. Several simple rules will allow to avoid or maximize the manifestations of this ailment.

Prevention of urinary incontinence

• Support the water balance of the body. To do this, drink 1.5-2 liters of non-carbonated water per day. Excessive and insufficient drinking can harm health.
• Try to create your own urination regimen. It is quite realistic to teach yourself to empty the bladder at a certain time. For example, in the morning before fees to work, during a lunch break, immediately at the arrival of home to visit the toilet and fasten this habit.
• Fight with overweight (independently or with a specialist)
• To refuse from bad habits
• Reduce the use of caffean-containing products and salinities
• To fight with constipation, if any. To do this, you can use products rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, drink half a cup of kefir at night. In chronic constipation, it is possible to use vegetable women's facilities (after the doctor's consultation (see)
• Engage in strengthening the muscles of the pelvic floor before planning pregnancy, which will avoid cringe breaks in childbirth
• Enjoy life and keep a positive attitude

Main conclusions:

• Urinary incontinence is a very common problem among women.
• Without treating the problem of urination, it is unlikely to be held independently.
• To clarify the type of incontinence, it is necessary to pass the survey, including it is necessary to fill out the questionnaire and keep the diary of urine.
• Stress incontinence is treated with the help of operations, and imperative - by taking drugs.
• You can independently engage in the prevention of incontinence, leading the right lifestyle and strengthening the muscles of the pelvic bottom

Urinary incontinence is a serious problem that requires treatment. It is better to spend a little time going to the doctor and her elimination than all my life is shy and suffer.

This is a violation of urination, accompanied by the inability of arbitrary regulation of the emptying of the bladder. Depending on the form, it is manifested by uncontrolled urine when straining or alone, sudden and uncontrollable urges, unconscious urinary incontinence. As part of the diagnosis of urinary incontinence, women carry out a gynecological examination, ultrasound of the genitourinary system, urodynamic studies, functional tests, urethrocystoscopy. Conservative therapy methods may include special exercises, pharmacotherapy, electrical stimulation. In case of inefficiency, alleged and other operations are performed.

General

Incontinence of urine in women is an involuntary and uncontrolled separation of urine from the urethra due to violations of various mechanisms for the regulation of micake. According to available data, with the involuntary separation of urine in reproductive age Each fifth woman is facing, in a perimenopausal and early menopausal age - each third, and in the elderly (after 70 years) - every second.

The problem of urine incontinence is most relevant for those who have given birth, especially those who have a history of natural childbirth. Urinary incontinence has not only a hygienic, but also a medical and social aspect, since it has a pronounced negative impact on the quality of life, accompanied by a forced decrease in physical activity, neurosis, depression, sexual dysfunction. The medical sides of this violation are considered by experts in the field of theoretical and clinical urology, gynecology, psychotherapy.

The reasons

Prerequisites for stressing urinary incontinence in women can serve obesity, constipation, sharp weight loss, heavy physical work, radiation therapy. It is known that the disease is more likely to have given birth to giving birth, and the amount of birth as their current is not so important. The birth of a large fetus, a narrow pelvis, episiotomy, pelvic bottom muscle breaks, the use of obstetric forceps - these and other factors are predetermining for the subsequent development of the incontinencies.

Incoming urination is usually observed in menopausal age patients, which is associated with the age deficit of estrogen and other genital steroids and arising at this background atrophic changes in the organs of the urogenital system. Operations on small pelvis organs (ooforectomy, adhesomectomy, hysterectomy, phenisterectomy, endoorectural interventions), omission and fallout, chronic cystitis and urethritis are made.

A direct producing factor of stress incontinence is any tension, leading to an increase in intra-abdominal pressure: cough, sneezing, fast walking, running, sharp movements, lifting weight and other physical effort. Background of the emergence of urgent urges are the same as in stress incontinence, and provoking factors can perform various external stimuli (sharp sound, bright light, pouring from water tap).

Reflex incontinence can develop as a result of damage to the head and spinal cord (injuries, tumors, encephalitis, stroke, sclerosis, Alzheimer's disease, Parkinson's disease, etc.). Yatrogenic incontinence arises as a side effect of some drugs (diuretic, sedative, adrenoblockers, antidepressants, colchicine, etc.) and disappears after the cancellation of these funds.

Pathogenesis

The mechanism for the occurrence of stress incontinence of urine in women is associated with insufficiency of urethral or bubble sphincters and / or weakness of the pelvic bottom structures. An important role in the regulation of urination is given to the state of the sphinctering apparatus - with changes in architectonics (the ratio of muscle and connecting components), the reduction and extension of the sphincters is disturbed, as a result of which the latter become unable to regulate urine selection.

Normally, the continentation (retention) of urine is ensured by a positive gradient of the urethral pressure (i.e., the pressure in the urethre is higher than in the bladder). Incoming urine isolated occurs if this gradient changes to negative. An indispensable condition for arbitrary urination is the stable anatomical position of the organs of a small pelvis relative to each other. With the weakening of the myofascial and ligament apparatus, the support-fixing function of the pelvic bottom is disturbed, which may be accompanied by the omission of the bladder and the urethra.

The pathogenesis of the imperative urinary incontinence is associated with a disruption of neuromuscular transmission in a detruding, leading to the hyperactivity of the bladder. In this case, when accumulating even a small amount of urine, a strong, unbearable urging to micakes occurs.

Classification

At the place of allocation of urine, transurethral (true) and extrarateral (false) incontinence are distinguished. With a true form of urine, it is distinguished by intact urethra; With false - from abnormally arranged or damaged urinary tract (from ectopically located ureterals, an ancient bladder, urinary fistulas). In the future, we will discuss exclusively on cases of true infontiences. Women meet the following varieties of transurethral urinary incontinence:

• Stressful- Inspection of urine, associated with the inconsistency of the urethral sphincter or the weakness of the muscles of the pelvic bottom.
• Imperative(Urgent, hyperactive bladder) - unbearable, unstable urges caused by the increased reactivity of the bladder.
• Mixed- combining signs of stressful and imperative incontinence (sudden, unstoppable need to persevery occurs during physically voltage, after what the uncontrolled urination occurs.
• Reflex incontinence (Neurogenic bladder) is a spontaneous separation of urine, due to impaired innervation of the bladder.
• Yatrogenic- The reception of some medicinal substances is caused.
• Other (situational) forms - Enurperse, urinary incontinence from the overflow of the bladder (paradoxical ichuria), with sexual intercourse.

The first three types of pathologies are found in most cases, all other accounts for no more than 5-10%. Stressful incontinative is classified in degrees: with a mild degree, the irrepresentation of urine occurs during physical effort, sneezing, cough; with medium - during a sharp rise, running; With severe - while walking or alone. Sometimes there is a classification based on the number of hygiene gaskets used in york: I degree - no more than one per day; II degree - 2-4; III degree - more than 4 gaskets per day.

Symptoms of urinary incontinence

In the stressful form of the disease, the involuntary, without prior urge to urination, the leakage of urine, which happens with any physical tension occurs. As the pathology progressing, the amount of urine lost increases (from several drops to almost the entire volume of the bladder), and the tolerance of physical exertion decreases.

Urgent incontinence can be accompanied by a number of other symptoms characteristic of a hyperactive bladder: pollakiuria (urination with early 8 times a day), nocuturia, imperative urges. If the incontinuation is combined with the omission of the bladder, discomfort or pain can be occurring at the bottom of the abdomen, the feeling of incomplete emptying, the feeling of the foreign body in the vagina, dyspare.

Complications

Faced with uncontrolled urine leakage, a woman is experiencing not only hygienic problems, but also serious psychological discomfort. The patient is forced to abandon the usual lifestyle, limit its physical activity, avoid the appearance of public places and in the company, to refuse sex.

The constant leakage of urine is fraught with the development of dermatitis in the groin region, recurring urinary infections (vulvovaginitis, cystitis, pyelonephritis), as well as neuropsychiatric disorders - neurosis and depression. However, due to the smallestness or false idea of \u200b\u200burinary incontinence, as an "inevitable age satellite," women are extremely rarely treated with this medical problem, preferring to put up with obvious inconveniences.

Diagnostics

The patient who collided with the problem of urine incontinence must be surveyed by a urologist and gynecologist. This will allow not only to establish the causes and form of incontinencies, but also to choose the optimal correction paths. When analyzing the anamnesis, the doctor is interested in the prescription of incontinence, its connection with the load or other provoking factors, the presence of imperative urges and other dysuric symptoms (burning, cutting, pain). When conversation, risk factors are specified: traumatic childbirth, surgical interventions, neurological pathology, peculiarities of professional activities.

Necessarily inspection on the gynecological chair; This allows you to reveal the prolapse of genitals, urethro, cysto- and recalts, to evaluate the condition of the skin of the crotch, detect urinary fistulas, carry out functional samples (sample with a straightening, coughing sample) provoking involuntary urinations. Prior to repeated reception (for 3-5 days), the patient is proposed to conduct a diary of urination, where the frequency of mixtures is noted, the volume of each dedicated portion of urine, the number of incontinence episodes, the number of gas supplies used, the amount of liquid consumed per day.

To assess the anatomy-topographic relationship between the small pelvis organs, gynecological ultrasound is carried out, ugily bladder ultrasound. From the laboratory examination methods of the greatest interest general analysis urine, urine bakposev on the flora, overview microscopy smear. Methods of urodynamic research include urofloumetrium, cystometry of filling and emptying, intrauterine pressure profilometry - these diagnostic procedures make it possible to estimate the state of sphincters, differentiate stressful and urgent urinary incontinence in women.

If necessary, the functional examination is complemented by the methods of instrumental assessment of the anatomical structure of urinary tract: urethrocystography, urethroscopy and cystoscopy. The result of the survey becomes a conclusion, reflecting the form, degree and cause of incontinence.

Treatment of urinary incontinence in women

If there is no coarse organic pathology due to the incontinencies, treatment is starting with conservative measures. The patient is recommended to normalize weight (in obesity), abandon smoking, provoking chronic cough, eliminate severe physical work, observe an ingenicular diet. On the initial stages Exercises aimed at strengthening the pelvic dna muscles (Kegel gymnastics) can be effective, electrostimulation of the muscles of the perineum, bos therapy. With accompanying neuropsychiatric disorders, it may be necessary to help the psychotherapist.

Pharmacological support for stressful form of incontinuations may include the appointment of antidepressants (duloxetine, imipramine), local estrogen (in the form of vaginal candles or creams) or systemic HRT. For the treatment of imperative incontinence, m-cholinolities are used (tantherodine, oxybutinin, solifenatsin), α-adrenoblays (alfuzosin, tamsulosin, doxazosin), imipramine, replacement hormone therapy. In some cases, intrapaulic injections of botulinium toxin type A can be prescribed to the patient, the perioretral administration of the outbreak, filler.

The surgery of stress incontinence of urine in women has more than 200 different techniques and their modifications. The most common methods of operational correction of stress-incontentation today are Sling operations (one, TVT, TVT-O, TVT-S). Despite the differences in the technique of execution, they are based on one general principle - fixation of the urethra with the help of "loops" from an inert synthetic material and reducing its hypermobility that prevent urine leakage.

However, despite the high efficiency of alignment operations, 10-20% of women develop recurrences. Depending on clinical indications, other types of surgical interventions are possible: urethrocyst drugs, front colophia with the reposition of the bladder, implantation of the artificial sphincter of the bladder, etc.

Prediction and prevention

The forecast is determined by the causes of development, the severity of pathology and the timeliness of appealing for medical care. Prevention consists in refusing to harmful habits and dependencies, weight control, strengthening the press and muscles of the pelvic bottom, controlling defecation. An important aspect is the maintenance of childbirth, adequate treatment of urogenital and neurological diseases. Women who collided with such an intimate problem as urinary incontinence, it is necessary to overcome a false specitude and ask for specialized help as soon as possible.

Urinary incontinence or incontection is an involuntary allocation of urin, which a person is not able to control with a volitional effort. This pathology is distributed not only in Russia, but all over the world. But at the moment, statists cannot provide specific information on the number of cases, since not all people turn to the doctor to take care of urinary incontinence.

Total doctors distinguish 5 forms of the disease: it is stressful, temporary, urgent, paradoxical, mixed. After converting the patient to a specialist, the first thing he should do is find out the direct cause of urine incontinence. Only after examination of the urogenital system can be assigned adequate treatment.

Before treating urinary incontinence, the doctor must pre-talk with the patient and get as much information about the first symptoms of the disease and the duration of their manifestation. Often, the problem is related to the position of the urogenital segment, violation of the structure of the pelvic diaphragm or the omission of the vagina from the front of women.

Also in such cases as possible causes Or girls, it is worth considering the sub-locking of the urinary tract or depring paralysis. If there are such problems, it will lead to ruptures muscular fibers bladder and suppressing the performance of sphincter. Next, healthy areas over time are replaced with the scars, after which the lumen of the bubble and urethral zone will not be able to completely close.

The most common reasons for the occurrence of this problem in men include supercooling, alcohol abuse or excessive physical exercise and exercises provoking urinary incontinence. Also, do not forget about various infectious diseases that are able to cause such a notch. For other reasons, the following can be attributed:

• ptosis of the internal organs. In this case, the treatment of urinary incontinence must be selected taking into account the possible omission of organs such as kidneys, liver or intestines that will squeeze the bladder;
• problems with the functional state of the CNS. Here, the threat of the occurrence of pathology is associated with blood circulation of the brain, atherosclerosis or Parkinson's disease;
• diseases of the urogenital system. This includes such pathology as prostate adenoma, pyelonephritis or cystitis;
• intoxication. It may be a narcotic, alcoholic or diabetic, if the patient has an obvious increase in blood sugar levels.

Which contributes to urinary incontinence in women

For women, stressful incontinence of urine is often characteristic, as well as the same reasons that provoke the occurrence of this deviation in men. Such a problem may occur after severely transferred delivery. Another women should carefully follow overweight, which is able to influence the problems described. Among other common reasons, the following can be distinguished:

1. . If there are such problems, sharp pains will arise during urination, and the Urina will change the color on a saturated yellow with an unpleasant odor;
2. psychological problems. Treatment of stressful urinary incontinence is one of the most frequent practices among women, due to their excessive susceptibility. In this case, problems arise with the weakening of the walls of the bladder, as a result, the reduction occurs at an order of magnitude faster, after which it becomes more difficult to restrain the urge;
3. climax. This problem is characteristic of women older than 40 years. Here incontinence is associated with the weakening of the sphincter due to insufficient muscle elasticity;
4. . Here the woman will constantly suffer from frequent urges, about 10-11 times a day. But when the bladder emptying occurs, it does not feel relieved. This is due to the constant feeling of urine residue inside the organ.

Urinary incontinence in children

If the child is already born with a similar problem, it indicates poor heredity or incorrect development of the urogenital system. To begin the treatment of urinary incontinence in children is only necessary after determining the exact causes of the occurrence of the ailment. They can be associated with the admission of antibacterial agents, the immaturity of the CNS, stressful situations or the presence of fistulas in the urea.

Also, one of the main reasons can include the production of Calcitrol hormone, the abnormal narrowings of the urethra (in girls) and the narrowing of the opening of the extreme flesh in boys. It is advisable to constantly monitor the child so that it swept as far as possible, it will allow it to protect it from jade, and other infections of the urogenital system.

Treatment of urinary incontinence

To get rid of the disease, when urine incontinence, it is advisable to apply various exercises and gymnastics, both for women and for men. But do not forget that, together with this, it is desirable to receive drug treatment on the recommendations of the urologist. It is very important not to launch a disease here, since it is not to get rid of it in particularly difficult cases without.

Physiotherapy

The greatest prevalence among all techniques received when urine incontinence. Almost all therapeutic physical culture is built on muscle training for avoiding pressure on the bladder. You can perform these exercises in any position - standing, lying or sitting, which makes it possible to do absolutely to all people.

Dogel's gymnastics when urine incontinence must be in the morning and in the evening, paying for this at least 10-20 minutes. Special attention should be paid attention to the following exercises:

• Sitting on a chair, legs stand on the width of the pelvis, and the hands are on the hips. Next you need to round the back and direct your head a little forward with the maximum stomach. In such a state, it is necessary to be about 20 seconds, then repeat the exercise for another 9 times.
• In a set of exercises when urinary incontinence, women and men include the adoption of the situation of Löse on the floor face to the ceiling with his legs raised, and then with their hands and head alternately. In such a state, it is necessary to be up to 1 minute, but breathing only the nose.
• In the position lying the legs bend in the knees and then bred on the sides, closed in the footsteps. Now it is necessary to raise your head over the floor and fix it for about 30 seconds. You need to repeat the exercise 10 times.
• In the standing position, the legs are bred on the sides, and the body leans forward to transfer weight. Next you need to connect your hands, crosant fingers, and put the head. From this posture, you can only go out after 30 seconds.

Note! All exercises in urinary incontinence in women or men are desirable to perform in special groups or after watching the training video.

It is very difficult to understand how to perform the pose needed for recovery.

Treatment of urinary incontinence with surgical intervention

This method is extremely rare and, mostly, only for patients aged. In this case, it is very important that the victim does not find inflammatory processes or infection in the organs of the urogenital system. Operation itself will take about 40 minutes under local anesthesia. Before this, the disease can not be drunk and is there for 5 hours. This technique is also called TVT.

As for women, the essence of treatment will be to attach a mesh ribbon to the urethra through 2 small cuts into the vagina. For its tension, it is necessary to carry out a cough stress test. This is necessary for maximum adjustment to avoid uncontrolled allocating urin. After such surgical intervention, the woman can return home the next day, and the recovery period takes no more than 3 days.

Folk Methods

Another effective treatment of urinary incontinence is associated with the use of dill seeds. To do this, they should be dried, pour boiling water and not enough for at least 3 hours. After the liquid cools, it needs to be distributed on a dose of 50 ml and take 1 time per day for 3 days. Before use, the main thing is not to forget to strain the tincture.