Incontinence in women: causes and treatment

Urinary incontinence is one of the most common urological problems that significantly reduces the quality of life. This condition is a symptom of the pathological process, and not an independent ailment.

The reasons for its appearance are many. It causes stress, urogenital diseases, hormonal disorders and allergic reactions, menopause, uterine prolapse, and much more. Contrary to popular belief, this problem is not the concern of older women. Urinary incontinence can occur in girls.

Diagnosis of urinary incontinence in women

Depending on the cause of the problem, such doctors as a gynecologist, urologist and neurologist can help in the fight against it. You need to start the examination with a visit to the first specialist from this list. Before visiting the doctor, a diary should be kept for at least two days, recording the frequency and intensity of urination, the number of episodes. This is the first thing to do with urinary incontinence.

Admission will include a survey of the patient in order to find out the details of the symptom, its duration, frequency, severity. In addition to the conversation, a mandatory diagnostic point is a vaginal examination, during which a violation of the location of the uterus and vagina, inflammatory processes are revealed. Additionally, palpation of the lower abdomen is performed. After which the specialist will give directions for examinations, which may include the following types:

  • laboratory diagnostics
  • instrumental diagnostics
  • urodynamic tests.

Laboratory diagnostics involves a general urine test to identify inflammatory processes and culture on microflora. If incontinence is caused by the presence of a tumor, a histological and cytological examination of the material obtained from it is performed.

How to treat urinary incontinence in a woman and what to do if the use of drugs and physiotherapy did not work, it is impossible to establish without instrumental diagnostics. It has many varieties. It includes:

  • Pelvic ultrasound. This study aims to diagnose inflammatory processes and tumors.
  • Retrograde cystometry. With its help, the reservoir function of the bladder is evaluated.
  • Cystography and cystourethrogram. They are an x-ray using a contrast medium.
  • Uroflowmetry. Allows you to evaluate the contractile function of the pelvic floor muscles and urinary tract patency.
  • Electromyography. It allows you to evaluate the contractility of the muscles of the sphincters and pelvic floor.
  • Urethrocystoscopy It consists in an endoscopic examination of the bladder cavity.

It is important to determine the frequency of leaks and their volume. To do this, use a one-hour cushioning test or a stop test with a tampon-applicator.

General information

Urinary incontinence in women is the involuntary and uncontrolled allocation of urine from the urethra, due to violations of various mechanisms of regulation of mycosis. According to available data, one in five women faces involuntary urine production during reproductive age, every third in perimenopausal and early menopausal women, and every second in the elderly (after 70 years).

The problem of urinary incontinence is most relevant for women giving 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 effect on the quality of life, accompanied by a forced decrease in physical activity, neurosis, depression, sexual dysfunction. The medical aspects of this violation are examined by specialists in the field of theoretical and clinical urology, gynecology, and psychotherapy.

Disease classification

Distribution received 2 types of classification. Both of them not only reflect why urinary incontinence occurs in women, but also characterize the course of the disease. There are such forms as:

  • Stressful. It is considered the most common type, due to the weakening of the pelvic floor. Leakage occurs with an increase in intra-abdominal pressure, for example, when lifting weights. The treatment of stress urinary incontinence is reduced primarily to strengthening the muscles responsible for controlling urination.
  • Imperative. It consists in a strong urge that a person can not restrain. Caused by increased bladder activity.
  • Mixed. Most patients have a combination of several types of incontinence. The combination of a stressful and imperative form is most characteristic of older people.
  • Transient. Most often it is caused by inflammation, so it goes away after it is eliminated.

There are forms such as persistent incontinence, instillation, reflex incontinence. But they are less common than those discussed above.

What is urinary incontinence in women?

Incontinence is a process of involuntary urination or urination that a person cannot stop.

Urination is a complex physiological process in which not only the organs of urination are involved, but also the brain and spinal cord. Normally, urine is held in the bladder due to the fact that the pressure in the urethra (urethra) is higher than the pressure in the bladder. After the situation changes to the opposite, and the pressure in the urethra decreases, and in the bladder it rises, an act of urination occurs.

Women are more likely than men to be affected by this syndrome. This is due to structural features of the female genitourinary organs. Women have a very short and wide urethra compared to men. Therefore, the female urethra, more precisely, the muscles surrounding it, is more difficult to restrain pressure from the bladder.

Urinary incontinence (incontinence) has the following main forms:

  • urgent (imperative),
  • stressful
  • mixed (urgent and stressful),
  • temporary
  • enuresis,
  • leakage.

Types of incontinence and their features

Urinary incontinence, or incontinence, as doctors call this condition, is divided into three types according to symptoms:

  • Stress urinary incontinence: incontinence occurs only with increased intra-abdominal pressure, which can cause weight lifting, exercise, sexual intercourse, and even minor stresses such as sneezing, coughing or laughing.
  • Urgent urinary incontinence: characterized by an intolerable urge to urinate, sometimes a woman may not have time to react. What is most strange, while the bladder can be filled very slightly.
  • A mixed form of incontinence, which combines the symptoms of the first and second forms of incontinence.

Whatever type of incontinence is observed, this is always an additional experience for a woman, and stress is one of the main causes of pathology. You can walk in this vicious circle for a very long time.

Causes

Prerequisites for stress urinary incontinence in women can be obesity, constipation, sudden weight loss, hard physical labor, radiation therapy. It is known that women who give birth more often suffer from the disease, while the number of births is not as important as their course. The birth of a large fetus, a narrow pelvis, episiotomy, ruptures of the muscles of the pelvic floor, the use of obstetric forceps - these and other factors are decisive for the subsequent development of incontinence.

Involuntary urination is usually observed in patients of menopausal age, which is associated with age-related deficiency of estrogen and other sex steroids and atrophic changes in the genitourinary system that occur against this background. Operations on the organs of the small pelvis (oophorectomy, adnexectomy, hysterectomy, panhisterectomy, endourethral interventions), prolapse and prolapse of the uterus, chronic cystitis and urethritis make their contribution.

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

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

Treatment methods

Cure urinary incontinence in women can be both conservative and surgical methods. Conservative treatment is divided into drug and non-drug. They usually begin it by performing Kegel exercises that help strengthen the pelvic floor. With insufficient effect, alternative or pharmacological drugs are connected. In addition to them, you should adhere to such recommendations as:

  • the exclusion of caffeine,
  • weight loss,
  • refusal of alcohol and nicotine,
  • scheduled emptying.

If conservative methods of treatment do not give the desired result, surgical intervention can be applied aimed at correcting the position of the urinary system. Often this is the optimal answer to the question of how to get rid of urinary incontinence in women aged. The most common types of operations are:

  • Sling. Conducted under local anesthesia, are minimally invasive. They consist in throwing a loop of synthetic material on the urethra or neck of the bladder.
  • Laparoscopic colposuspension. It is carried out under general anesthesia. It consists in attaching the tissues surrounding the urethra to the inguinal ligaments.
  • Injections for volume formation. They consist in filling the urethral membrane with synthetic material that provides replacement of the missing tissues, due to this, it is fixed in the correct position.

What happens and what are the signs?

The causes of urinary incontinence in women can be different. Incontinence may occur:

  • after the development of infectious diseases of the female genitourinary system (inflammation of the bladder, endometritis, urethritis),
  • as a result of a tumor,
  • due to weakness of the muscles of the bladder and sphincters of the urethra,
  • after displacement of the urethra,
  • due to neurological disorders.

The most common form of stress is urinary incontinence in women. The reasons for its development are weakening of the ligaments of the pelvic floor and the malfunction of the urethral sphincters, which cannot withstand even a slight increase in pressure from the bladder. Risk factors for the development of the condition - smoking, menopause.

Urgent form is the second most common form of incontinence. Its most common cause is overactive bladder. In this condition, the bladder reacts with urge to urinate even with minor irritations and sends impulses to the sphincters of the urethra, which should not be normal. The reasons that provoke this condition are alcohol consumption, nervous excitement, temperature changes, even the sound of pouring water.

Temporary (transient) incontinence is a transient form that develops after exposure to alcohol, due to acute infections of the bladder and genitals, with constipation. After eliminating the incontinence factor, urination returns to normal.

Less common is reflex incontinence. It occurs as a result of damage to the brain or spinal cord due to encephalitis, Parkinson's and Alzheimer's diseases, stroke, multiple sclerosis, injuries.

A factor contributing to the development of the condition in adulthood is a complex history of childbirth. These are births that lead to rupture or stretching of the muscles of the pelvic day, birth with the help of obstetric forceps.

Another definite reason is menopause. After its onset, the production of estrogen in the woman’s body decreases, which leads to atrophy of the mucous membrane of the urethra, weakening of the muscles and ligaments in the perineum.

Also, damage to the muscles of the perineum can be observed in women engaged in heavy physical work, weight lifting. The acceleration of degenerative processes is also affected by old age. Under the influence of adverse factors, there is a dislocation of the genitals and the bladder with the urethra.

Other causes of incontinence:

  • operations on the pelvic organs (oophorectomy, adnexectomy, hysterectomy),
  • inflammatory diseases of the urethra and bladder,
  • excess weight,
  • diabetes,
  • smoking,
  • Alzheimer's syndrome
  • Parkinson's disease,
  • stroke,
  • atherosclerosis,
  • chronic cough
  • taking diuretics or drugs that have a relaxing effect on the muscles of the urethra,
  • heredity,
  • bladder stones
  • constipation
  • radiation therapy.

Incontinence enhancing products:

Pathogenesis

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

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

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

Means of treatment

Since urinary incontinence is a symptom manifested in various diseases, the range of drugs used to combat it is very wide. The following types of drugs can be used:

  • antidepressants used to treat incontinence due to psychological reasons,
  • sympathomimetics that promote muscle contraction,
  • anticholinergic, allowing you to regain control over the urge,
  • estrogens are used for incontinence caused by menopause.

Traditional medicine practitioners will also have a number of recommendations on how to treat urinary incontinence. The most popular recipes are infusions:

It is important not to get involved in self-medication with folk remedies, but to consult a competent specialist in time, as urinary incontinence can be a symptom of incipient pyelonephritis and other serious diseases.

In addition to medicines, modern physiotherapy methods are used, as well as exposure using devices operating on the basis of the principles of biological feedback, biofeedback stimulants.

Methods and treatments for incontinence

Treatment of incontinence should be carried out after the exact determination of its causes - it can be not only hormonal disruptions or complications after childbirth, but also commonplace urinary tract infections or tumor diseases. It is clear that in this case, charging for the muscles of the pelvic floor will not give a special effect.

Manifestations

The set of symptoms largely depends on the type of pathology. In many cases, a woman feels that the bladder is not completely empty, or that a foreign body is in the vagina.

Urgent incontinence is determined by symptoms such as strong and unbearable urge to urinate. The bladder is far from full. Moreover, in most cases, a woman does not have time to get to the toilet. Up to 8-10 urges per day can be observed.

With stressful incontinence, urine is released involuntarily during exercise, laughing, running or walking fast, coughing, etc. At the same time, there is no urge to urinate.

A mixed form of urinary incontinence may also be observed. Such patients have signs of both urgent and stressful forms.

Enuresis is a form of the disease in which urination occurs completely involuntarily, without connection with a specific provoking factor. This form is more common (in 99% of cases) in children.

Leakage of urine is a form of the syndrome in which urine located in the urethra flows out after emptying the bladder.

How pathological changes are classified

How is urine excreted normally? This fluid is produced by the kidneys, after which it passes into the bladder, gradually accumulating and stretching the walls of the organ. At the same time, the muscle that allows urine to stand out and is called the “detrusor” is relaxed. However, as the organ fills, the receptors located in its shell become excited, which makes them want to urinate. The detrusor at this moment strains, while the sphincter of the bubble relaxes. At that moment, when the pressure in the urethral channel becomes less than this value in the detrusor, urination occurs.

Spontaneous urination can not be attributed to independent diseases, this is a symptom that indicates certain problems. Accordingly, in order to get rid of urinary incontinence, it is necessary to determine under the influence of what factors normal processes are disturbed, then to eliminate them. When classifying emit:

  • True incontinence. Pathology can manifest itself without the presence of defects that alter the functionality of the urinary system.
  • False incontinence. Involuntary urination occurs under the influence of congenital or acquired defects affecting the bladder, urethral canal or ureters.

Fact. In the absence of pathologies of the urinary system and organ defects in a person, there are no difficulties with regard to controlled urination by tension and relaxation of the sphincter.

There are several types of involuntary urination in women, each of which has certain characteristics. The reason and symptoms are also able to vary, which is clearly enough reflected in the table:

Type of pathologyWhy develops and who can be observedCharacteristic
Stressful.Pathology develops due to an insufficient amount of collagen in the pelvic ligaments, which leads to their weakening. Collagen deficiency can be congenital in nature, although it is more often formed with a small amount of estrogen, which is especially noticeable in women during postmenopausal women or with menopause.

Pathology is especially often diagnosed in women who prefer smoking, on the background of which the amount of vitamin C is reduced, which negatively affects the state of collagen structures.

This condition may be due to excessive mobility of the neck of the bladder, weakness of the sphincter. Due to weak resistance, in the case of increasing intra-abdominal pressure, urine is released uncontrollably. Damage to the sphincter can cause the formation of pathology.This is the name of involuntary urination that occurs with increased intra-abdominal pressure, unexpectedly arising from excessive physical exertion, walking, colds, manifested by coughing or laughing. However, there is no urge to withdraw urine. Urgent.Urgent incontinence often develops in children, who, when accustomed to the pot, were sent to it constantly, regardless of the fullness of the organ. Such a habit, over the years, provokes a decrease in the volume of the bladder and involuntary contractions at the moment when it is just starting to fill up.

Urgent incontinence can be caused by a variety of pathological processes, which include inflammatory processes, neoplasms, urolithiasis and other diseases that interfere with normal urination.

The intake of certain pharmaceuticals, surgical interventions in the pelvic zone may adversely affect

The cause of what may be the excessive consumption of certain foods, drinks.So a woman is called the inability to retain urine when an imperative urge to empty the bubble occurs. The need to urinate is so strong that the process cannot be postponed. However, the fullness of the bubble may be small. Mixed.Considering the symptoms, it can be noted that it is characteristic of both urgent and stress urinary incontinence.The urge to empty the bubble is sharp, and at the same time, digging begins. Paradoxical.Most often manifested in the older generation and in the presence of various diseases of the genitourinary system. The list of such conditions includes the development of oncological processes in the prostate gland, adenoma, stricture of the urethral canal. As a result, it is impossible to empty the organ; it overflows and stretches the walls.It develops in cases where the bladder cannot be completely empty due to pathological changes. Temporary (transitory).Such incontinence occurs when there are digestive system pathologies that occur accompanied by constipation. It also develops in the presence of acute cystitis, with severe alcohol intoxication.Often accompanies other pathological conditions. When eliminating the root cause goes by itself.

Classifying involuntary urination, enuresis is distinguished, which is an uncontrolled process that begins regardless of the circumstances - morning or night involuntary urination is possible. A feature of nocturnal enuresis is its manifestation during sleep. There are other types of incontinence that can occur under the influence of different circumstances. So, in some cases, urine flows involuntarily at the time of intercourse.

Women urinary incontinence

The second, or average degree of enuresis in women is involuntary urination when walking or other physical exertion (weight lifting, running, a sharp change in body position). The causes of this disease can be: a difficult birth, hormonal disorders in the body associated with menopause, overweight, undergone operations on the organs of the genitourinary system, hard physical work. The most effective treatment for enuresis is complex. It includes physical exercises that strengthen the muscles of the lower pelvis - for example, Kegel exercises, the use of traditional methods and medicines of traditional medicine.

Prevention of urinary incontinence in women

Prevention consists in maintaining a healthy lifestyle, giving up bad habits, and controlling weight. An important factor is the strengthening of the muscles of the abs and perineum. The optimal for this purpose is the regular execution of Kegel exercises. Yoga classes are also helpful. This will help prevent women from developing stress urinary incontinence.

In case of neurological or urogenital diseases, you need to immediately consult a doctor, their timely and adequate treatment is very important. No less important is the careful management of childbirth. Ruptures and the use of obstetric forceps can further trigger incontinence.

As with any of the diseases, the treatment started in the early stages will be most effective, and competent prevention will help to avoid this ailment in old age.

Non-surgical non-drug methods

Non-drug treatments for incontinence include:

  • bladder training
  • exercises for strengthening the pelvic floor,
  • physiotherapy.

Training consists in creating a urination plan and its implementation. The implementation of the plan still needs to be learned and trained better under the guidance of a doctor. Intervals between urination should gradually increase. The fact is that women with incontinence develop a certain stereotype of going to the toilet over time: they tend to go there, even if the urge is weak, as if for “prevention” or “in reserve”, so that in no case will there be embarrassment . In fulfilling the plan, a woman must restrain her urge. The interval between urination should be increased by half an hour every week until it reaches a duration of 3-3.5 hours. Thus, a woman changes the old stereotype of behavior and develops a new one. Usually, the training is supported by drug therapy, which is designed for 3 months, as well as the training program.

Also, no less attention should be paid to training the muscles of the pelvic floor. For most women, trained pelvic floor muscles are the key to success in treating and preventing urinary incontinence. However, only a few consciously work on the pelvic muscles, but in vain. This is the best prevention of female incontinence. So, for example, “Kegel exercises” are included in the list of exercise exercises for incontinence.

In addition to these exercises and trainings, physiotherapy should not be forgotten. It can strengthen muscles and make the ligaments more elastic, by improving the blood supply to the pelvis. For this purpose, usually used methods of physiotherapy, such as:

  • microcurrents
  • warming up
  • electromagnetic impulses.

Why does incontinence develop in the fairer sex?

Among the main causes of urinary incontinence in women in the reproductive period, both before and after 30 years are complicated or multiple births. But much more often, such problems appear in women aged due to the deteriorating tissue elasticity, malfunctioning of the muscular and ligamentous apparatus of the pelvic floor. The result of those who are already many years old is the deteriorating tone of the urethral canal, which is manifested by urinary incontinence.

Despite the huge number of reasons against which pathological conditions arise, the main part is due to nerve stress and overwork of a physical nature:

  1. Heavy labor with injuries in the process is a common reason why urine leaks, this situation is characteristic of stress incontinence. In this case, trauma is understood not only as perineal tears, but also excessive stretching of the pelvic floor muscle mass.
  2. Periods of leakage of urine can be observed in women and with excessive body weight.
  3. Another reason when urine freely leaves the bladder is gynecological surgery. It implies the elimination of cysts, neoplasms on the ovaries or uterus.
  4. Leakage of urine can be associated with hormonal changes against the background of the onset of menopause. Age-related urinary incontinence, which develops in this case, is closely associated with a markedly decreased elasticity of muscle tissue.
  5. Involuntary urination often occurs against a background of neurological disorders. This is a stroke, and a damaged spinal cord, and Parkinson's disease, as well as multiple sclerosis and other pathologies. The result of such problems is weakened nerve impulses involved in the work of the bladder.

Often, the causes of urinary incontinence in women are in the structural features of their body. It is known that the urethral canal of the weaker sex is three or four centimeters in length, in men it reaches from 24 to 30 cm. Width also varies - in women this value is 6-10 mm, in the opposite sex it does not exceed 4-7 mm Given this structure, the pelvic muscles in the weaker sex should be much stronger than in men, otherwise there is a complete emptying of the bladder, regardless of the patient's desire.

What to do and how to treat?

Incontinence is a problem that worsens not only hygiene, but also the quality of life, causes emotional discomfort, and complicates social relationships. Often a woman is forced to completely change her lifestyle, avoid communicating with people, visiting public places, quit work.

Many ladies do not go to the doctor to find this problem, and try to deal with it on their own. This is especially true for elderly patients who believe that incontinence is a variant of the norm for their age. As a result, the condition only worsens, after which the treatment becomes really complicated.

This problem must be addressed by a urologist or a gynecologist, who will tell you how to treat urinary incontinence in women. Medicine has developed many ways to deal with incontinence. However, it is necessary to treat the condition taking into account the underlying disease that caused it.

Treatment of urinary incontinence in women includes medical, surgical, psychotherapeutic methods, physical exercises, physiotherapy (microcurrents, heating, electromagnetic effects).

Conservative methods are indicated in the initial stages of the disease, with high risks associated with surgery.

Treatment of urinary incontinence in women

The most effective treatment depends on the cause of the woman's urinary incontinence, and even your personal preferences. Therapy is different for every woman and depends on the type of incontinence and how it affects life. After the doctor diagnoses the cause, treatment may include exercises, training on bladder control, medication, or a combination of these methods. Some women may need surgery.

General recommendations for controlling urination:

  • diet with the exception of caffeine (without coffee, strong tea, cola, energy drinks, chocolate),
  • body weight control, the fight against obesity,
  • quitting smoking, alcoholic beverages,
  • bladder emptying by the hour.

Conservative treatment methods are indicated mainly for young women with unexpressed urinary incontinence after birth, as well as in patients with an increased risk of surgical treatment, in elderly patients previously operated on without a positive effect. Urgent urinary incontinence is treated only conservatively. Conservative therapy usually begins with special exercises aimed at strengthening the muscles of the pelvic floor. They also have a stimulating effect on the abdominal muscles and pelvic organs.

Depending on the cause of enuresis in women, various drugs and tablets are prescribed:

  • Sympathomimetics - Ephedrine - helps to reduce the muscles involved in urinating. Bottom line - enuresis stops.
  • Anticholinergics - Oxybutin, Driptan, Tolteradin. They make it possible to relax the bladder, as well as increase its volume. In women with urinary incontinence, these drugs are prescribed to restore urge control.
  • Desmopressin - reduces the amount of urine formed - is prescribed for temporary incontinence.
  • Antidepressants - Duloxitine, Imipramine - are prescribed if stress is the cause of incontinence.
  • Estrogens - drugs in the form of female hormones progestin or estrogen - are prescribed if incontinence occurs due to a lack of female hormones. This happens during menopause.

Incontinence in women can be controlled with medication. But in many cases, treatment is based on a change in behavioral factors, and therefore Kegel exercises are often prescribed. These procedures, combined with medications, can help many women with urinary incontinence.

At night

The cause of night incontinence in adult women is:

  • frequent stresses
  • diabetes,
  • relaxation of the muscles of the bladder,
  • urinary tract infections
  • small capacity of the bladder,
  • decreased elasticity of the walls of the bladder.

Among the methods for treating enuresis, therapy with and without traditional medicine is distinguished. The first option is aimed at strengthening the muscles of the genitourinary system. These include Kegel exercises. Effective drugs for night enuresis are antispasmodics - for example, Spazmeks, Driptan.

Medical methods

Medications have proven particularly effective in case of urgent type of incontinence. To treat this type of urinary incontinence, women are prescribed primarily antispasmodics and antidepressants. Excellent drug for the treatment of urgent urinary incontinence in women is Driptan, which:

  • has a relaxing effect on the muscles of the bladder,
  • dampens impulses for urges from the nervous system.

Thus, under the influence of driptan, the bladder relaxes and grows in volume, peremptory urges, which the woman could not cope with, disappear, respectively, she begins to go to the toilet less often. The effect of taking driptan is fully felt a month after the start of treatment. However, in each case, the doctor should choose the dose of driptan, do not try to take driptan yourself.

Symptoms of urinary incontinence

With the stressful form of the disease, they begin to notice involuntary, without a preliminary urge to urinate, leakage of urine that occurs with any physical exertion. As the pathology progresses, the amount of urine lost increases (from a few drops to almost the entire bladder volume), and exercise tolerance decreases.

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

How is pathology diagnosed

With incontinence, symptoms and treatment are closely related, but even if there are obvious signs of the disease before developing a therapeutic regimen, the doctor needs to make sure the diagnosis is correct by means of certain measures:

  • Gynecological examination in the chair.
  • The patient is invited to keep a special diary - in it for several weeks it is required to note the volume of urine output and record the frequency of visits to the toilet.
  • Ultrasound examinations of the bladder, kidneys.
  • Urodynamic examinations are prescribed, which include uroflowmetry, profilometry, cystometry.
  • In women with urinary incontinence, fibrocystoscopy may be recommended.

Important. Only after receiving all the necessary results is the treatment of the pathology prescribed, which can be conservative or surgical.

Kegel exercises

Kegel exercises can help with any type of urinary incontinence in women. These exercises help strengthen the muscles in your abdomen and pelvis. When performing exercises, patients should strain the pelvic muscles three times a day for three seconds. The effectiveness of pessaries, special intravaginal rubber devices largely depends on the type of incontinence and the individual characteristics of the anatomical structure of the body.

Compress the muscles of the perineum and hold the compression for 3 seconds, then relax them for the same time. Gradually increase the duration of compression-relaxation to 20 s. At the same time, relax gradually. Also use fast contractions and activation of the muscles used in stool and childbirth.

Methods of treatment at home

It is quite possible to cure this trouble on your own, however, if the process began a long time ago and took a chronic form, then a doctor’s consultation is simply necessary. A qualified specialist will select the optimal treatment: prescribe pills, drugs that will act on the problem.

On a note! It is recommended to supplement treatment with folk remedies, it will not become superfluous, the effect, on the contrary, will be better. In some cases, in unreleased conditions, it is home-based procedures that can help get rid of trouble forever.

Surgical intervention

Usually, surgery is resorted to in the case of a stressful form of incontinence, but sometimes surgery is also indicated for the urgent form of incontinence. However, conservative methods can help young patients. At the present stage of the development of surgery, doctors use about 250 different methods of surgical interventions in order to eliminate stress urinary incontinence in women. Many of these methods are used in our country, including minimally invasive methods, such as, for example, looping a loop of synthetic fabric. After such operations, a woman can go home the next day after the operation. 85% of women who underwent such an operation live a full life, the only risk factor for them is cystitis due to hypothermia.

Complications

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

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

Conservative and surgical treatments

Consider what to do when diagnosing incontinence. Conservative methods can be drug or non-drug. It should be noted that any treatment gives the fastest and lasting effect when using certain pharmaceuticals. Consider what can be done with urinary incontinence, how pathology is treated in women. The selection of procedures is carried out by a urologist, based on the degree of development of the disease state and the factors that cause it. May be assigned:

  1. Kegel exercises and other similar techniques that strengthen the muscles of the pelvic floor. Usually they are recommended for a mild form of the disease, when young women experience some malfunctioning of the muscle group that supports the neck and the bladder itself in limbo. Free practice is not recommended; exercises should be carried out regularly. Prevention of urinary incontinence in women should also include such gymnastics in combination with proper nutrition and the prevention of increased physical exertion.
  2. Dietary nutrition. With a mild course of the pathological condition, dietary nutrition will be a good help. Certain foods irritate the bladder, which can aggravate a woman’s pathological condition; therefore, it is advisable to abandon their use. The list includes carbonated drinks, coffee, alcohol, fruits of citrus trees, natural juices squeezed from them, glucose substitutes. Spicy foods should be abandoned, and in order to stop dehydration for 24 hours, you will need to review the drinking regime, the main rule of which is the consumption during this time of at least two liters of purified liquid.
  3. Leakage of urine in women can be prevented by catheterization. This is a temporary measure to eliminate the pathological manifestation against the background of overcrowding of the bubble. For this, a catheter is inserted into the organ through the urethral canal, which allows you to get rid of excess urine. If the procedure is performed by an experienced doctor, it does not cause discomfort.
  4. When treating urinary incontinence in women, behavioral therapy is prescribed in which patients are taught to train the pelvic muscles. To do this, use a tampon with a built-in sensor, placed in the vagina and the sensory plate, which is placed on the stomach. In the case of compression of the desired muscles, a picture comes in to help control the process.
  5. Urological pessaries produced in the form of bowls, rings help to get rid of leakage during enuresis of uncomplicated forms. Their goal is to reduce the pressure exerted on the sphincter, thereby preventing a small involuntary leakage of fluid.
  6. During electrical stimulation, a weak, painless current is passed through the muscles of the bladder and pelvic floor. With stress incontinence, muscle tissue is strengthened, while with imperative, the bladder relaxes and organ contractions become rarer.

In women, the treatment of pathology is carried out with the mandatory use of pharmaceuticals. In this case, the reasons that caused the appearance of leaky urine and the type of pathological process are taken into account. The most effective way to cure urgent incontinence. The following drugs are used - alpha-adrenergic blockers (Tamsulosin or Terazosin), antidepressants, in particular Amitriptyline, anti-suscarinic drugs - Oxybutynin or Tolteradin. If incontinence develops against a background of an overactive bladder, drugs are prescribed to reduce the frequency of urges with an increase in the volume of excreted fluid.

Involuntary urination in women with a lack of estrogen is eliminated by replacement therapy. If urine spontaneously flows due to infection of the urethral canal, antimicrobials are prescribed. If urgent incontinence occurs, take antispasmodics along with antidepressants.

How to treat pathological manifestations if it is not possible to eliminate them using conservative methods? It happens that surgical intervention is necessary, while the following methods are distinguished:

  • The use of implants. Involved in stressful incontinence. There are a lot of clinics doing this minimally invasive operation, the principle is the introduction of collagen and other substances around urine.
  • Colposuspension. Vaginal walls are sutured to suspend the urethra.
  • Doctors recommend - get rid of incontinence with the help of sling operations. The principle of operation is the installation of a synthetic loop, which prevents the fluid from flowing out uncontrollably.

The latter method is most popular because it is minimally invasive and allows the use of various materials, both skin flaps and synthetics.

Normally, muscular tissue of the pelvic floor also lends itself to conscious control. However, some pathological disorders may occur in female urinary incontinence.

Urodynamic tests

Urodynamic tests include:

  • stress test
  • Bonnie test
  • gasket test (daily or hourly).

A stress test is designed to assess the condition of a patient with a stressful form of urinary incontinence. A patient with a full bladder is invited to cough or push. If urine leaks during this test, it means the presence of a stressful form of the syndrome. The Bonnie test differs from the stress test in that the neck of the bladder is lifted using a special device.

In the test of pads, disposable pads are used to assess how often urine flows from the bladder and to what extent. After a certain period, the gaskets are weighed and, based on this value, the volume of the leaked liquid is calculated.

Operation

If devices and medications for urinary incontinence in women do not help, then there is a need for surgical treatment. There are several types of surgery that can help fix this problem:

  1. Sling operations (TVT and TVT-O). These interventions are minimally invasive, lasting about 30 minutes, and are performed under local anesthesia. The essence of the operation 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 keeps the urethra in a physiological position, preventing the urine from flowing out with an increase in intra-abdominal pressure.
  2. Laparoscopic colposuspension according to Burch. The operation is performed under general anesthesia, often laparoscopic access. Tissues located around the urethra are suspended from the inguinal ligaments. These ligaments are very strong, so the long-term results of the operation are very convincing.
  3. Injections of volume-forming preparations. During the procedure, under the control of a cystoscope, a special substance is introduced into the submucous membrane of the urethra. More 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.

Any surgery for urinary incontinence is aimed at restoring the correct position of the urinary system. Surgery for incontinence leads to the fact that leakage of urine during coughing, laughing and sneezing occurs much less frequently. The decision to undergo surgery for women with urinary incontinence should be based on a correctly diagnosed diagnosis, since the absence of this aspect can lead to serious problems.

Incontinence Hygiene

Urological pads facilitate socialization and improve the quality of life of women with urinary incontinence. There is a large selection of high-quality urological pads that reliably absorb liquid and neutralize unpleasant odors.

Basic requirements for urological pads:

  • the ability to absorb and retain excretion,
  • dry surface to prevent skin irritation,
  • anatomical fit
  • bacterial safety.

Many women are embarrassed by their problems and postpone a visit to the doctor, “quietly” using urological pads. This attitude to your health is unreasonable, you should undergo an examination.


Urinary incontinence must be treated the same as any other health problem. There is nothing reprehensible or shameful in this.The reasons are well-known deviations in the structure and functions of some body systems, which can be effectively eliminated in various ways. Women after childbirth must necessarily undergo a consultation with a urologist and gynecologist and pass the necessary tests, even in the absence of urinary incontinence. Urinary incontinence in the elderly should also not be considered a natural manifestation of aging. Regardless of the age of the woman, you can always find an acceptable solution in each case individually. It must be borne in mind that the effectiveness of treatment largely depends on the timeliness of seeking medical help. The sooner treatment is started, the better results can be achieved.

Training

Intense pelvic muscle exercises will be very effective. By the way, this method will not take much of your strength, and you will spend time - nothing at all! A few examples:

  1. Oddly enough, but very well strengthens the muscle control of urination. That is, try to control the delay in visiting the restroom, do not go directly to the toilet, and be patient a little. Thus, you strain the muscles, thereby training them.
  2. Another effective exercise: tighten the vaginal muscles, stay in this state for 10 seconds. You need to repeat the action 6 times - you need to make sure that there is no pain, severe fatigue. It is recommended to repeat the exercises 6-10 times during the day. The retention time of the voltage should be gradually increased to reasonable limits for you.
  3. You can train muscles in this way: take a comfortable position while sitting on a chair, while the feet should rest on the floor, slightly knees apart in different directions. With your elbows resting on your hips, tilt your torso forward. This position will clearly fix the stomach + buttocks. Then, by tensioning the muscles, retract the anal passage for 10 seconds. Relax for 5 seconds. Repeat steps preferably 6-7 times.

Alternative treatment of urinary incontinence in women

Opponents of traditional methods of treatment are probably interested in the question of how to treat urinary incontinence with folk remedies. In this aspect, there are several recipes:

  1. Perfectly help the seeds of dill. 1 tablespoon of seeds is poured with a glass of boiling water and left for 2-3 hours, wrapped up well. Then the resulting infusion is filtered. The entire glass of the product must be drunk 1 time. And do this every day until you get the result. People’s doctors say that with this method you can cure urinary incontinence in people of any age. There are cases of complete recovery.
  2. Infusion of sage herb: it is necessary to use one glass three times a day.
  3. A steamed infusion of yarrow herb should be drunk at least half a glass 3 times a day.
  4. Yarrow is a weed that is found almost everywhere - a real storehouse for folk healers. If you need to get rid of involuntary urination, then take 10 grams of yarrow with flowers in 1 glass of water. Simmer for 10 minutes over low heat. Then leave to insist for 1 hour, not forgetting to wrap your broth. Take half a glass 3 times a day.

In the treatment of folk remedies, it is important not to start the process of urinary incontinence and prevent the development of more serious diseases, the prerequisites of which may be involuntary urination (for example, cystitis, pyelonephritis).

Drug treatment

Of the medications prescribed are estrogens, drugs that reduce the volume of urine, antidepressants, adrenomimetics (ephedrine), anticholinergics (oxybutynin, driptan, tolterodine).

The goal of drug treatment with sympathomimetics is to increase the tone of the sphincter of the bladder. Anticholinergics are more commonly used for overactive bladder syndrome. They allow you to increase the volume of the bladder and relax its muscle walls. Antidepressants (duloxetine, imipramine) are prescribed for the stress form of urinary incontinence.

The effectiveness of drugs, however, is high only when there are no anatomical defects that cause incontinence.

Forecast and Prevention

The prognosis is determined by the causes of development, the severity of the pathology and the timeliness of seeking medical help. Prevention consists in giving up bad habits and addictions, controlling weight, strengthening the press and muscles of the pelvic floor, and controlling bowel movements. An important aspect is the careful management of childbirth, adequate treatment of urogenital and neurological diseases. Women who are faced with such an intimate problem as urinary incontinence need to overcome false shyness and seek specialized help as soon as possible.

Folk remedies

IngredientsCooking + Application
Marshmallow (root) - 100 g

Nettle (leaves) - 100 g

Yarrow (grass) - 80 gMix the components. We make a mixture of herbs (100 g / 500 ml of boiling water) overnight (preferably in a thermos). We filter the solution only in the morning. Accepted during the day dosed (in small portions). Do not stop treatment until the problem disappears Wheatgrass (root) - 100 g

Violet (herb) - 100 g

Yarrow (root) - 80 gWe combine the ingredients, thoroughly mixing with each other. We take 3 tbsp. l mixes of these herbs, place in a thermos, pour 1 liter of boiling water. We insist throughout the night, we separate the liquid from the rain. Take a glass about 5-6 times a day Formulation for pregnant women:

St. John's wort grass - 70 gIt is desirable to grind the components, then turn them into a homogeneous mass. Next 2 tbsp. l pour the mixture with boiling water (500 ml). Cover the container with a lid, leave for 1.5–2 hours. After - the solution is filtered. We administer 100 g 5 times a day Chicory (root) - 100 g Centaury (herb) - 80 g Yarrow (herb) - 100 gMix the components carefully, grind. We place 4 tbsp. l herbs in a container, pour boiling water (1 liter). We insist for no less than 1 hour. Filter, drink 5-7 times Seedlings - 50 g

Red wine (good quality) - 500 gGrind the component (you can use a blender or in a mortar). Pour the resulting powder with wine and hold for 1 week in a warm place (but not in the sun). Having filtered the solution, we drink 1 tbsp. l at least 4 times a day. Unpleasant sensations should decrease noticeably after 14 days of daily intake. If there are changes, the dose can be halved - take 1/2 tbsp. l 4 times

As you can see, all recipes are extremely easy to prepare and use, so home treatment for urinary incontinence will not only be effective, but it will also take a minimal amount of effort, time and material resources. However, any problem must be approached comprehensively, so you should rethink your lifestyle. Perhaps you are doing something wrong, or maybe not?

Surgical treatments

Of surgical methods, the most widely used technique is in which a loop is inserted under the urethra or neck of the bladder that supports the urethra in its natural physiological position. Such operations are called sling operations. They take about half an hour under local anesthesia.

Burch's colposuspension is another common type of surgical treatment. Most often, it is carried out by the laparoscopic method. The essence of the operation is to suspend the urethra to the inguinal ligaments. The operation is performed under general anesthesia.

In total, there are approximately 200 different surgical techniques to eliminate incontinence. Among them are the use of volume-forming agents that fix the urethra in the desired position, vaginoplasty, prosthetics of the urethral sphincter. Surgery is often indicated for the stressful form of urinary incontinence, less often for urgent.

Pills - Driptan

Driptan is an effective antispasmodic in the treatment of enuresis in women. Its principle of action is to reduce the tone of the muscles of the bladder, which increases its capacity. Accordingly, the frequency of urges to urinate is reduced. Taking Driptan for a long time is not addictive. The drug is prescribed 5 mg 2-3 times a day. The daily dose for adults should not exceed 15 mg. Before using the drug, it is important to consult a doctor.

Incontinence in older women

Often, urinary incontinence in older women is associated with a lack of female hormone - estrogen. In this case, hormonal drugs are prescribed that contribute to the restoration of tissues, normal blood circulation, the return of the desired tone to the muscles of the pelvic floor. In other words, they remove or smooth out the effects of hormonal changes caused by menopause. Most often, with such a diagnosis, Ubretid, Simbalta, Gutron is prescribed.

Urgent incontinence is also released when the muscles of the bladder involuntarily contract. In this case, Detruzitol, Driptan, Spazmeks, Vesikar help.

Important! Before using any medications, it is necessary to take tests, identify the cause and consult a doctor.

Recommendations

  1. Limit the use of food that irritates the bladder. The most harmful products: coffee, alcohol, tomatoes, citruses, spicy seasonings, milk, chocolate products.
  2. Smoking - worsens the overall health of the body, tobacco tar - an irritant of the walls of the bladder, they destroy the mucous membrane, which performs a protective function. This also affects problems with the bladder - enuresis appears.
  3. Suffer from chronic constipation? We’ll also have to adjust the condition of the intestine - the gathering feces presses on the walls of the bladder, reducing its tone. Normalize the intestines, for example, with the help of products (prunes, beets, apples, dried apricots). They should be consumed daily, you can take turns - not all at once!
  4. Difficulties with the release of urine often arise due to the penetration of bacterial infections into the genitourinary system. Take care of the quality of personal hygiene of the genitals at home, try to wear underwear, which is made of natural material.
  5. A common cause of the problem may be overweight (obesity), which weakens the muscles of the pelvic floor. Obesity should be dealt with immediately. How? There are many ways: do not overeat, consume low-calorie foods, play sports, etc.

For your information! A common mistake in the problem of uncontrolled urine output is a very small intake of fluid (to run less to the toilet). This approach is completely wrong, since dehydration will occur in the body, urine in this case will be too concentrated. This can lead to irritation of the mucous membranes, which will also lead to another problem - vaginitis, urethritis. Drink as much water as you like!

Diet

With incontinence, it is important to follow a proper diet. Products that irritate the bladder are removed from the patient’s diet. First of all, it is spicy, salty, pickled, alcohol, as well as coffee, strong tea, chocolate, carbonated drinks. If the patient is obese, then the diet should be aimed at reducing excess weight.

Lingerie

When choosing clothes for urinary incontinence, it is important to consider several factors: patient preferences, causes and degree of urinary incontinence, physical abilities of a person, and the presence of outside help. Today, many models of both disposable and reusable underpants are produced, which differ in size, shape, and absorption capacity. They are quite comfortable and protect against leaks. Disposable underpants, or diapers for adults, are used in severe cases of the disease, bedwetting, for bedridden patients.

Gaskets

For mild to moderate urinary incontinence, women use regular daily pads or sanitary pads for critical days. However, there are special urological pads for single and multiple use. Disposable - convenient and practical, but are quite expensive. Reusable - a little cheaper, but they need to be washed and dried. They are used with special underpants, to which they are attached. The dimensions of the urological pads are different - depending on the amount of fluid that they absorb.

Yes, the problem of urinary incontinence is unpleasant and difficult, but with some effort and perseverance, it can be overcome. A set of folk methods and means, muscle training and drug treatment will certainly do their job. Be healthy!

Watch the video: Treatment for stress urinary incontinence in women: Mayo Clinic Radio (March 2020).