Persistent urinary incontinence in women. Urinary incontinence in women - causes and treatment

Urinary incontinence is the spontaneous release of urine, that is, uncontrolled by volitional efforts. In most cases, it is acquired, that is, it develops as a result of previous diseases and conditions.

Involuntary urination even in minimal volumes is a big problem for women

Urinary incontinence in women is 10 times more common than in the male population; and this is due to childbirth, gynecological diseases and susceptibility to diseases of the urinary system, in particular cystitis. What types of incontinence are there, and why the average woman needs to understand this, will be discussed below.

Why do women suffer from this pathology?

The following are the causes of urinary incontinence in women:

1. Menopause. As a result of estrogen deficiency, the tone of the vagina and adjacent structures, which at a young age provided additional support to the bladder in maintaining its volume, decreases.
2. Old age: the cervical muscles of the bladder lose tone and cease to “cope” with urinary retention.
3. Childbirth through natural means, especially if there was a clinically narrow pelvis - a condition when the size of the baby's head is larger than the openings of the pelvis.
4. Injuries to the perineum, as a result of which the nerves of the pelvic floor muscles responsible for urinary control were damaged.
5. Surgeries on the pelvic organs with damage to the nerve trunks leading to the bladder or pelvic floor.
6. Uterus removal.
7. Inflammation, injury and tumors of the spinal cord, when the “central command” of the bladder and pelvic muscles is disrupted.
8. Heavy physical work or sports that lead to prolapse of the uterus and prolapse of the pelvic floor.
9. Obesity.
10. Chronic cough as a result of occupational hazards, bronchial asthma or smoking. When you cough, the pressure in the abdominal cavity increases, which leads to urine being squeezed out of the bladder.
11. Diabetes mellitus: as a result of this pathology, the blood supply and innervation of the structures that retain urine are disrupted.
12. Constipation, when when trying to defecate, the pressure in the abdomen and pelvis increases significantly.
13. Nervous system diseases: Alzheimer's disease, multiple sclerosis, parkinsonism, stroke.
14. Chronic cystitis.
15. Fistulas (passages) between the bladder and the intestines or vagina.
16. Stones localized in the bladder.

In some cases, urinary incontinence in women is caused by congenital anomalies of the genitourinary system:

• ectopia of the ureter, when the ureter (one, both or double the number of them) does not flow into the bladder, but into its diverticulum, its neck, urethra, vagina or septum between the bladder or vagina;
• exstrophy of the bladder, in which its mucous membrane is “turned” outward.

Increase the chance of involuntary urine loss:

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

Classification of the disease

The disease is classified as follows:

1. Stress incontinence, which develops when intra-abdominal pressure increases during coughing, laughing, sneezing, straining, and physical activity. It develops due to weakening of the ligamentous apparatus, sphincters along the path of urine or the pelvic floor muscles.
2. Urge incontinence (also called overactive bladder): uncontrollable urges occur with the sound of water, a change from warm to cold, or other irritants; for a few seconds the woman cannot control him.
3. The mixed type develops as a result of a combination of urge and stress incontinence. It is the most common type of disease.
4. Reflex incontinence (neurogenic bladder): urine is involuntarily released due to “inappropriate” stimulation of the bladder from the spinal cord.
5. Incontinence due to overflow, when the outflow from the bladder is difficult (the exit point of the urethra is not completely blocked by a tumor, stone, inflammatory edema), its walls are overstretched. As a result, urine can be released at any time.
6. Extraurethral incontinence: with ectopic ureter or fistulas between the bladder and genitals.

Mechanism of stress urinary incontinence

There are also types of incontinence such as:

• nocturnal (enuresis). It develops most often after 45 years of age as a consequence of a decrease in the elasticity of the walls of the bladder and loss of tone of the sphincter muscle, located “at the exit” of this organ;
• constant incontinence;
• other types: for example, during orgasm or sexual intercourse.

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

Bedwetting in women is the loss of the ability to feel the urge to urinate during night sleep. It has been proven that it is not related to the depth of sleep, but develops as a result of:

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

Spontaneous urination in a woman during sleep indicates illness

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

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

After hysterectomy

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

Incontinence and cystitis

Urinary incontinence with cystitis is imperative: a woman experiences a frequent and pronounced urge to urinate, which occurs when the inflamed bladder is minimally filled. There are other symptoms that indicate this particular disease:

• change in the color and odor of urine;
• pain in the suprapubic region and no urge to urinate;
• When a woman urinates, the pain above the pubis, in the urethra or perineum becomes unbearable.

A deterioration in general condition and a rise in temperature may also occur, but this indicates that the infection from the bladder is spreading to the ureters and kidneys.

How does pathology manifest itself?

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

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

With urge incontinence, a woman becomes a hostage to her reflexes

Diagnostics

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

The initial diagnosis of incontinence is carried out by a urologist. He prescribes an ultrasound of the kidneys and pelvic organs, a general urinalysis, cystography (x-ray method) and cystoscopy (endoscopic method). Infections and abnormalities of the urinary tract can be detected using these methods.

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

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

Incontinence, or urinary incontinence, is a pathology that affects children and adults. The disease not only causes inconvenience, but also causes instability of the psycho-emotional background. The person becomes irritable, withdrawn, and complexes arise. After 40 years, urinary incontinence is more common in women than in men. To get rid of the pathology, the cause that led to the occurrence of incontinence is determined. Only after this the doctor prescribes appropriate therapy.

Urinary incontinence is the involuntary loss of urine that cannot be prevented by force of will. A person loses sensitivity, as a result of which the patient cannot control the process of urination. All aspects of life suffer from this - social, business and personal. The patient cannot work fully, communicate with loved ones and live a normal family life.

Urinary incontinence is a symptom of another pathology, and treatment is based on the nature of the underlying disease.

Condition classification

Experts classify incontinence as follows.

1. Stress incontinence. Sudden urination occurs during excessive physical exertion or strong tension, which occurs in the case of reflexes such as coughing, sneezing and others.
2. Urge incontinence, or overactive bladder, is a problem with urination that occurs due to pathology of the organ itself or a disorder of the nervous system. Urination occurs during rest, without physical stress. Associated symptoms include frequent urge to go to the toilet more than eight times a day and once at night.
3. Neurogenic bladder. Impaired bladder activity due to a malfunction of the nervous system.
4. Infravesical obstruction, or subvesical blockage of the urinary tract. Involuntary urination due to weakening of the bladder walls when it is filled.
5. Extraurethral incontinence. Urination occurs due to pathological communication between the organs of the reproductive and urinary systems or a congenital anomaly of the ureters. At the same time, the woman has an urge to go to the toilet, but she is unable to stop urinating.
6. Enuresis. In women, this condition occurs during night rest. Urine is released suddenly, without the urge to go to the toilet.
7. Mixed look. It combines stress and urge incontinence. It usually occurs in women after the birth of a baby, when mechanical damage to the pelvic organs or muscles occurs during labor. Symptoms include urine leakage during the urge to go to the toilet or during physical exertion.
8. Undermining. After visiting the toilet, urine accumulates in the urethra and when leaving the bathroom, a residual discharge occurs.

Causes of the disorder and predisposing factors

Involuntary urination in women occurs for several reasons. Typically, the appearance of incontinence occurs due to pathologies and age-related changes in the body.

Climax

During menopause, there is a deficiency of female hormones - estrogen. This leads to atrophic changes in the membranes of the urinary and genital organs, muscles and ligaments located in the pelvis.

During pregnancy and after childbirth

Pregnancy and labor provoke the appearance of this problem. During childbirth, an increased load is created on the pelvic organs and when the baby is born, they are injured and muscle damage occurs. As a result, incontinence occurs.

Elderly age

The occurrence of sudden urination is influenced by age. This problem occurs in women after 60 years of age. The pelvic muscles lose their elasticity and no longer properly support the internal organs. With age, there is also a lack of female hormones, which also affects the occurrence of urinary incontinence.

Diseases and injuries

Diseases and injuries that cause incontinence:

• urolithiasis pathology of the bladder;
• chronic cough;
• sclerosis;
• pathologies of the gastrointestinal tract;
• gynecological pathologies;
• abnormal structure of the urinary or genital organs;
• diabetes mellitus of any type;
• infections that are constantly present in the bladder;
• Parkinson's or Alzheimer's pathologies;
• prolapse of organs located in the pelvis;
• oncological pathologies of the bladder.

Other reasons

Other causes of urinary incontinence in women:

• surgical intervention on the pelvic organs;
• unstable emotional background;
• radiation exposure;
• large body weight;
• harmful addictions – smoking and alcohol abuse;
• taking certain medications;
• excessive consumption of coffee, sweet carbonated drinks;
• poor nutrition.

Incontinence manifests itself as follows:

• urine leakage;
• unexpected urge to urinate;
• the desire to visit the toilet occurs during night rest hours;
• after urination there is no relief, and there is a feeling that the bladder is full;
• feeling that there is a foreign body in the vagina;
• there is often an urge to go to the toilet.

Diagnostics

Before prescribing treatment for urinary incontinence, a diagnosis is performed. To determine the cause of the condition, the doctor prescribes:

• urine test to determine the presence or absence of infections in the genitourinary system;
• PAD test to determine the amount of urine leaking suddenly;
• vaginal examination with a cough test to determine the presence or absence of gynecological pathologies;
• KUDI.

Before the tests, the doctor interviews the patient and sometimes asks her to compile a diary of sudden urine output.

How to treat urinary incontinence in women? There are several effective therapeutic methods, which can only be prescribed by a doctor after diagnosis, subject to the pathology that provoked the development of the disease. If involuntary urination occurs due to a disease, then its therapy is carried out.

With proper treatment, incontinence goes away on its own.

The use of medications is possible if there is no anomaly in the structure of the organs of the urinary system. This is the main method of treating pathology. Medications are prescribed depending on the cause that led to incontinence.

1. Drugs whose main active ingredient is estrogen. The doctor prescribes such medications when the level of the female hormone is low.
2. Sympathomimetics. Improves contraction of muscles involved in urination. The drug that is commonly prescribed is Ephedrine.
3. Antidepressants. The doctor prescribes them if incontinence develops due to an unstable emotional background.
4. Anticholinergic drugs. Helps relax and increase bladder volume. The doctor usually prescribes Tolteradine, Driptan, Oxybutin.
5. Desmopressin. The doctor prescribes this drug for temporary incontinence. The product reduces the amount of urine.

Operative method

Surgical intervention is resorted to if conservative methods of therapy have proven ineffective. There are several methods for solving the problem quickly.

1. Sling method. The duration of the operation is half an hour. General anesthesia is not used during the procedure. Local anesthesia is sufficient. The essence of the operation is the introduction of a special mesh, which has the shape of a loop, under the urethra or bladder neck. It prevents involuntary urination when pressure in the abdominal cavity increases.
2. Injections of volume-forming agents. The essence of the procedure is the introduction of a special substance into the urethra using a cystoscope. After such manipulation, the urethra is established in the correct position.
3. Laparoscopic calposuspension. Before surgery, the patient is given general anesthesia. The essence of the procedure is that the tissues that surround the urethra are fixed to the inguinal ligaments. This prevents involuntary urination.

The essence of the exercises comes down to daily tension of the pelvic muscles.

Manipulations are carried out in the morning, afternoon and evening. The duration of the procedure is 10 seconds. Muscle contraction should be followed by relaxation. The muscles also relax for 10 seconds, and then contract again. Only under this condition can you count on a positive effect from the procedure. Some time after the start of gymnastics, the time of muscle tension and relaxation increases.

The total duration of one session should be 20 seconds.

Folk remedies

Treatment of urinary incontinence in women can be carried out using traditional methods. But even in this case, consultation with a doctor is necessary.

Infusion of dill seeds

To prepare this effective homemade recipe, you will need:

• dill seeds - 1 large heaped spoon;
• water – 1 glass.

The water is brought to a boil and dill seeds are poured into it. The container in which the product is prepared is insulated and left to infuse for three hours. When the time is up, the product is filtered. The drink is consumed at one time.

The duration of therapy is not limited. It is recommended to stop taking the drug after achieving a positive result. The product is used at any age. With positive reception, according to anecdotal evidence, patients get rid of involuntary urination.

Yarrow-based decoction

Required components:

• dried yarrow herb – 10 g;
• water – 1 glass.

The medicinal plant is filled with water. The container is placed on the fire and the product is brought to a boil. After this, the drink is brewed for another 10 minutes. The container with the broth is removed from the stove, insulated and left to infuse for 60 minutes. The product is filtered. Frequency of administration: 0.5 cups in the morning, afternoon and evening.

Corn silk infusion

To prepare the product you will need:

• corn silk - 1 large spoon;
• water – 1 glass.

The medicinal plant is poured with the specified amount of boiling water. The container is insulated and left for half an hour to infuse. The product is consumed half a glass in the morning and evening hours.

Medicinal mixture

Ingredients:

• honey – 1 large spoon;
• natural applesauce – 1 tablespoon;
• chopped onion until mushy - 1 large spoon.

All products are combined and mixed. The resulting product is used in the morning, afternoon and evening.

An infusion prepared from sage is also used for therapy.

Any remedy is used only as prescribed by a doctor to avoid complications.

Prevention

To prevent the occurrence of urinary incontinence, it is recommended to adhere to the following preventive measures:

• regular visits to a therapist, endocrinologist, gynecologist;
• regular ;
• proper nutrition;
• giving up a sedentary lifestyle;
• maintaining normal weight;
• visiting the toilet immediately after the urge to urinate;
• giving up harmful addictions.

Conclusion

If the first symptoms of a condition such as urinary incontinence in women occur, you should consult a doctor. Timely therapy will help avoid the progression of pathology and the development of complications. You should not self-medicate, as unexpected consequences may occur.

Urinary incontinence (incontinence) is a disease that most affects the female half of the population. Both older and younger women can experience involuntary urination; every third woman in the world faces a similar problem.

This disease causes feelings of insecurity and uncertainty. It brings not only physical inconvenience, but also psychological problems.

What is urinary incontinence?

Urinary incontinence is divided into stress and urgency.

1. Stress incotinence– involuntary urination, which occurs with a sharp increase in pressure in the abdominal cavity. This can happen during physical activity, heavy lifting, sneezing, or coughing. In this case, the woman does not feel the urge to urinate;
2. Urgent incotinence– involuntary release of urine, accompanied by a strong urge to urinate. A woman's bladder may not be full. In such cases, the woman is unable to stop urinating. With urgent incontinence, you may simply not have time to run to the toilet.

Causes of the disease

Incontinence in women can be caused by many factors. These include traumatic birth, surgical interventions, lack of the hormone estrogen, stroke, etc. In old age, changes may occur in the areas of the brain responsible for urination.

Incontinence is a side effect of some medications (it goes away when you stop taking the medication).

The main causes of urinary incontinence in women:

Symptoms and diagnosis

Symptoms of incotinence:

• urine leakage during physical activity, changing position, laughing, coughing, sneezing;
• strong and uncontrollable urge to urinate;
• urination at night;
• constant leakage of urine;
• dribbling of urine after urination;
• sensation of the presence of a foreign object in the vagina;
• involuntary release of gases and feces.

To establish the causes of incontinence, it is necessary to conduct a comprehensive diagnosis of the body. Before consulting a doctor, it is advisable to remember or ask relatives if anyone else has had similar problems (heredity factor).

It is necessary to keep a diary in which you indicate the nature of incontinence (in what cases it occurs, at what time of day, frequency, amount of discharge).

Be sure to inform the doctor about the presence of chronic diseases, the number of births, and tell about surgical interventions.

The doctor may prescribe an examination for sexually transmitted infections, an ultrasound examination of the kidneys, bladder, and other examinations as necessary.

Doctors tell you everything about incontinence, watch the video:

Treatment

Treatment of incontinence in women depends on the causes of incontinence. In cases of urge incontinence, drug treatment is most often used. Correctly selected treatment will help to quickly cope with the problem.

For stress incontinence, treatment methods can be non-surgical, non-drug, medicinal, or surgical.

Non-surgical, non-drug treatments for incontinence

• exercises for intimate areas;
• bladder training;
• physiotherapeutic treatment.

Exercises for the pelvic muscles are effective both for combating incontinence and for its prevention. The most popular technique is Kegel exercises. These exercises help keep muscles toned and put internal organs in their place.

Before performing the exercises, you need to find the muscles that will be targeted. To do this, you need to stop urinating for a while while urinating. You should have the same feeling when doing exercises.

The essence of Kegel exercises

The bladder is empty.

1. Starting position on your back, legs bent at the knees, apart. One hand under the head, the other under the buttocks;
2. Starting position on your stomach, legs straight, apart, hands under your head. There is a small pillow under the pelvis.

Exercises:

1. Squeeze the pelvic muscles and pull up – 10 seconds;
2. Relax – 10 seconds;
3. Repeat 10 times in the morning, afternoon, evening.

When performing exercises, breathing should be even. It is forbidden to suck in your stomach.

Bladder training involves gradually increasing the time between urinations. You need to make a plan for going to the toilet, while increasing the interval between them. This way the woman will learn to control the urge to urinate.

Training can be combined with taking medications.

Physiotherapy for incontinence is carried out by a specialist. This can be: electrophoresis, electromyostimulation, galvanic current. Electrical stimulation of the vagina may be used.

Drug treatments for incontinence

Drug treatment is most effective for urge incontinence. Most often, antidepressants, antispasmodics, and hormonal therapy are prescribed.

Surgical treatment of incontinence

Surgical treatment for incontinence is mainly used in cases of stress urinary incontinence. The effectiveness of this method is up to 97%.

The most common are minimally invasive surgical methods. A special synthetic loop is placed in the urethra, which helps the pelvic organs retain urine. The return of the disease is practically impossible.

Local anesthesia is used. After surgery, you need to protect yourself from hypothermia. Sexual activity can be resumed within a couple of weeks.

Traditional methods of treatment

There are traditional methods for treating incontinence. Before using them, you should consult your doctor.

It is important to pay attention to the absence of allergies or intolerances to the components of the products used.

In folk medicine, herbal medicine has a special place in the treatment of incontinence. To prepare herbal teas, all ingredients are mixed.

Herbal tea with nettle

Steam two tablespoons of the collection with ½ liter of boiling water for 6-8 hours (it is better to use a thermos or container with a lid, wrapped in a towel). Strain and take little by little throughout the day. Take the collection until the incontinence goes away.

Herbal mixture with chicory

• 100 g – chicory root;
• 100 g – yarrow root;
• 100 g – centaury root.

Steam two tablespoons of the collection with ½ liter of boiling water, leave for 1 hour (covered). Take half a glass up to 6 times a day.

Decoction of plantain leaves

Steam fresh plantain leaves with boiling water and leave for 1 hour. Strain, drink half a glass 4 times a day before meals for 2 weeks.

St. John's wort decoction

• 50 g – St. John's wort herb.

Steam the herb with 1 liter of hot boiled water and leave for 4 hours. Drink like water, without restrictions.

Lifestyle and prevention of incontinence

If you have urinary incontinence, to prevent the disease you need to avoid negative factors and follow the recommendations:

Incotinence is a disease that prevents you from living fully. It is important to understand its causes in time; do not delay your visit to the doctor.

Modern means of treatment will allow you to get rid of the problem of incontinence in the shortest possible time. There is no need to be ashamed and hide your problem, it is better to start solving it.

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

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

There is even a special international organization for urinary continence that conducts research and develops all kinds of treatment methods. Experts call urinary incontinence any involuntary release of urine. But depending on the conditions, time of day, and circumstances of incontinence, several types of incontinence are distinguished.

Types of urinary incontinence

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

The first three types are the most common and are characteristic of women.

Stress urinary incontinence

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

Symptoms of stress urinary incontinence

• leakage of urine in varying amounts during physical activity, laughing, coughing, sexual intercourse, straining
• no irresistible urge to urinate
• sometimes – combination with incontinence of gases and feces

There are many reasons why stress urinary incontinence can occur.

• Pregnancy

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

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

• Surgeries on the pelvic organs

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

• Age-related changes

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

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

Risk factors

• Caucasian
• heredity (if there is a disease in close relatives or cases of enuresis in childhood, the risk of incontinence is greater)
• obesity (especially in combination with diabetes)
• neurological diseases (stroke, heart attack, parkinsonism, spinal injuries)
• urinary tract infection
• digestive disorders
• taking certain medications
• anemia

Stress urinary incontinence causes a lot of trouble for women. Refusal to play sports, fear of leaking urine in public, constant nervous tension have a negative impact on health. Therefore, it is important not to be embarrassed or hush up this topic, but to consult a doctor in a timely manner.

Urge incontinence

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

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

Main symptoms of urge incontinence

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

The risk factors for urgency are the same as for stress incontinence because the two types are often combined.

Differential diagnosis of urinary incontinence

Iatrogenic incontinence

Some medications have urinary disturbances in their list of side effects:

• adrenergic agonists (pseudoephedrine) can cause urinary retention followed by incontinence; they are used to treat bronchial diseases;
• all diuretics;
• colchicine (to treat gout);
• some drugs with estrogens;
• sedatives and

After stopping taking these medications, the unpleasant symptoms go away on their own.

Other types of incontinence

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

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

Urinary incontinence examination

Detailed story to the doctor about your complaints

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

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

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

5. Do you have an irresistible urge to urinate?
6. How long can you hold urine when you feel the urge?
7. How often do you lose urine?
8. When does urinary incontinence occur most often?
9. Do you feel your underwear getting wet without the urge to urinate?
10. Do you wake up at night to urinate?
11. Please indicate how much urine you usually lose.
12. On a 5-point scale, rate the degree of influence of urinary incontinence on your daily life: _____ (0 - does not affect, 5 - significantly affects).

Keeping a urine diary

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

Time	What liquid did you take and in what quantity? (water, coffee, juice, beer, etc.)	How many times did you urinate in one hour?	How much urine? (a little, medium, a lot) or indicate in ml	Experienced Do you have an unbearable urge to urinate?	Have you ever had an episode of involuntary leakage of urine?	How much urine was passed during this episode? (a little, medium, a lot) or indicate in ml	What were you doing during the involuntary leakage of urine?
7:00 -8:00	Tea, 200ml	1	A little	—	—	—	—
8:00 -9:00	—	1	A little	Yes	Yes	A little	I went for a morning jog
9:00 –10:00
10:00 -11:00

PAD test

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

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

Vaginal examination

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

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

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

Analysis of urine

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

• use the first, “morning” urine
• collect a medium urine sample
• thoroughly toilet the vagina before urinating
• cover the vagina with a clean cloth during collection

Imaging (ultrasound, MRI)
Urodynamic studies (allow you to determine 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 surgeons in a hospital.

• general treatments
• treatment of stress incontinence
• treatment of urge incontinence
  

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

Weight control for obesity	a necessary step in the treatment of all types of urinary incontinence. Extra pounds constantly increase intra-abdominal pressure, disrupt the normal arrangement of organs, causing urination problems. Depending on the degree of obesity, psychological, medicinal or surgical treatment is used.
Reduce consumption of coffee, tea and other caffeinated drinks	Caffeine-containing drinks provoke increased urination, so the risk of losing urine increases significantly. But excessive restriction of fluid intake is also undesirable: this will not reduce incontinence, but will have a negative effect on overall well-being.
To give up smoking	A huge number of studies have been conducted to identify a direct connection between smoking and incontinence, but the topic still remains unexplored. We can only say with certainty that chronic nicotine bronchitis with stress urinary incontinence is a huge problem, since with every coughing movement a woman loses urine. This point also includes the treatment of chronic respiratory diseases.
Establishing a urination routine	This method gives very good results for urge incontinence. Its essence is to visit the toilet at strictly defined hours, regardless of the strength of the urge. At first, the intervals between urinations do not exceed 30-60 minutes, but over time you can develop a more convenient regime.
Pelvic floor muscle training	The main goal of such training is to tone the muscles, restore sphincter function and regulate the phases of filling and urination. With the help of special exercises and devices, a woman can completely take control of the sphincter muscles, eliminating the sudden loss of urine.
Treatment of chronic respiratory diseases Psychological setting to distract from the desire to urinate

Kegel exercises

The essence of such gymnastics is as simple as possible. First you need to “find” the necessary pelvic floor muscles: perivaginal and periurethral. To do this, you need to sit while imagining the urge to urinate and try to hold back this imaginary stream of urine. The muscles involved in this process need to be trained regularly.

Contract and relax them three times a day, gradually increasing the time of contraction from a few seconds to 2-3 minutes. This process will be invisible to others, so you can practice not only at home, but also at work, while driving in a traffic jam and in any free time.

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

• slow compressions
• fast contractions
• pushing out (similar to the pushing period of childbirth)
• retention of stream during actual urination

Biofeedback training

The main disadvantage of simple Kegel exercises is the inability to control their implementation. Sometimes women, along with the necessary muscles, also tense others, increasing intra-abdominal pressure. Not only does this ruin your entire workout, but it can also make the problem worse.

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

Contraindications to biofeedback training:

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

Use of special simulators

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

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

Psychological training

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

Treatment of stress incontinence

In addition to the general incontinence treatments described above, treatment for stress incontinence requires the intervention of a physician. Conservative treatment with medications is not very popular, as it helps only in a small number of cases.

Drug treatment:

For mild stress incontinence, when the anatomical structures have retained their integrity, the following is sometimes used:

• Adrenergic agonists (Gutron) increase the tone of the sphincter and urethra, but also affect vascular tone. Used extremely rarely due to low effectiveness and side effects (increased blood pressure)
• Anticholinesterase drugs (Ubretide) also increase muscle tone. Recommended for women whose examination results have revealed bladder hypotension.
• The antidepressant Duloxetine (Cymbalta), effective in half of the cases, but has side effects on the digestive system.

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

Surgical treatment

For stress urinary incontinence in women, surgery is the treatment of choice. There are several surgical procedures that vary in complexity. Preference for one operation or another is given depending on the degree of incontinence and the anatomical features of the woman’s urethra.

Contraindications to all types of surgical treatment are:

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

Sling operations (TVT and TVT-O)

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

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

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

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

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

Injections of volume-forming drugs

During the procedure, under the control of a cystoscope, a special substance is injected 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 replaced and the urethra is fixed in the desired position. The procedure is low-traumatic, performed on an outpatient basis under local anesthesia, but also does not exclude relapses.

Laparoscopic colposuspension according to Burch

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

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

Colporrhaphy

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

Treatment of urge incontinence

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

Drug treatment

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

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

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

Prevention of urinary incontinence

• Maintain the body's water balance. To do this, you need to drink 1.5-2 liters of still water per day. Drinking too much and not drinking enough can be harmful to your health.
• Try to create your own urination routine. It is quite possible to train yourself to empty your bladder at a certain time. For example, in the morning before getting ready for work, during the lunch break, immediately upon arriving home, visit the toilet and consolidate this habit.
• Fight excess weight (on your own or with the help of a specialist)
• To refuse from bad habits
• Reduce consumption of caffeine-containing foods and salty foods
• Fight constipation, if any. To do this, you can eat foods rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, and drink half a glass of kefir at night. For chronic constipation, you can use herbal laxatives (after consulting a doctor (see)
• Strengthen the pelvic floor muscles before planning pregnancy, which will help avoid perineal ruptures during childbirth
• Enjoy life and maintain a positive attitude

Main conclusions:

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

Urinary incontinence is a serious problem that requires treatment. It’s better to spend a little time going to the doctor and getting it fixed than to be embarrassed and tormented all your life.

Urinary incontinence (or incontinence) is perceived by many as a typical pathology of old age. Indeed, this disease affects more than half of women after 70-80 years. However, this problem occurs not only in older women, but also after childbirth, in late pregnancy, after some operations and even in stressful situations.

The problem causes many inconveniences and restrictions in everyday life, leads to self-doubt, depression, isolation, and disturbances in sexual relationships. Unfortunately, not all women decide to seek medical help in a timely manner, keeping silent about the illness or looking for dubious traditional medicine. Pathology can be overcome only with the help of competent treatment.

Causes of the disease

There are many factors that can provoke incontinence. Among them there are several main reasons:

• the period of pregnancy and after the birth of a child, when an enlarged uterus puts increased pressure on the pelvic organs;
• long-term stressful conditions;
• age-related changes that cause a decrease in the elasticity of ligaments and muscle tone;
• surgical operations on the pelvic organs (uterus, bladder, rectum), complicated by the appearance of fistulas or.

It is worth noting a number of diseases in which urinary incontinence is one of the symptoms. These are diabetes mellitus, the presence of bladder stones, multiple sclerosis, and stroke. The pathological condition can be provoked by certain medications (for example, diuretics), abuse of strong tea, coffee and alcoholic beverages, smoking, and excess weight. Even in healthy women, high estrogen medications or antidepressants can cause problems with holding back the urge to urinate. After discontinuation of these drugs, this condition goes away without treatment.

In women over 50 years of age, urinary incontinence may be hereditary. The presence of enuresis in childhood may also be a predisposing factor for senile incontinence years later.

Types of pathology

In modern medicine, there are several types of urinary disorders. Their classification reflects the characteristics of various cases that make it impossible for the patient to control the process.

• Stress urinary incontinence

This condition is one of the most common. Uncontrollable discharge occurs during even minor physical activity, when coughing and sneezing, when jumping and running, lifting weights, and laughing. The main reason is weakening of the pelvic floor muscles.

• Urgent incontinence

Or urgent - may be caused by an overactive bladder. Its nerve endings instantly react to the slightest external stimuli: the sound of water, bright light. The desire to urinate occurs suddenly when a woman cannot keep the process under control. Incontinence can be caused by brain diseases, hormonal disorders, and inflammatory processes in the bladder.

• Bedwetting (enuresis)

It is more common among young children suffering from excessive nervous excitability. But there are frequent cases of the development of pathology in women in old age, as well as in younger representatives of the fairer sex.

Mild urinary incontinence that occurs at night can be caused by changes in hormonal levels, psychological trauma, and diseases of the urinary system. Enuresis can occur after childbirth when giving birth to twins or a large baby.

The inability to control the process of urination does not always indicate a full bladder. A small amount of urine may stream or drip out.

• Mixed incontinence

Occurs in about a third of cases of pathology. This type of disorder combines the symptoms of exercise incontinence and an urgent urge to urinate. Characterized by a more frequent urge to urinate - more than 8-10 times during the day and more than once at night. This pathology often appears after childbirth or after suffering traumatic injuries to the pelvic organs.

• Permanent incontinence

With this type of incontinence, the flow of several drops (leaking) occurs with short breaks during the day, regardless of physical stress.

Manifestation of the disease during menopause

Surgical treatment

What to do if conservative treatment does not produce effective results? In these cases, sling operations are prescribed. The main indicators for surgical intervention are urgency and stress incontinence. A number of contraindications should be taken into account. The operation is not performed on pregnant women, in the presence of inflammatory processes in the organs of the urinary system, or on patients taking medications to thin the blood.

After preliminary consultation with a urologist and therapist, sling surgery is performed under local anesthesia. A loop is installed on the anterior wall of the vagina that will support the bladder in the correct position. The procedure lasts no more than 30 minutes. To control the process of urination, a catheter is installed, which is removed a day or two after the procedure. After removing the catheter, a number of women experience minor painful sensations, which can be easily eliminated with painkillers.

The recovery period lasts from two weeks to a month. A woman should be in a state of physical and sexual rest, avoid lifting heavy objects, intense sports, and driving a car. Sexual life is allowed no earlier than a month later.

Sometimes complications may occur:

• bladder injuries;
• bleeding;
• development of the inflammatory process, for its prevention a course of antibiotics is prescribed;
• problems with urination immediately after surgery;
• intestinal dysfunction.

Carrying out the operation in a medical institution with a good reputation eliminates the risk of complications and makes surgery absolutely safe for health.

Laser therapy

Laser exposure is one of the most effective methods for normalizing urination. Using pulses, the walls of the vagina and urethra are treated. Laser treatment for urinary incontinence tightens the bladder walls, making them more elastic. The method has many advantages. It is painless, safe for the patient, and does not require a long recovery period.

According to statistics, more than 90% of patients report positive results after laser therapy sessions. The laser is not used in cases of severe vaginal prolapse, uterine prolapse, or in the presence of malignant tumors and bleeding in the body. One of the contraindications is age over 60 years.

Traditional medicine

You can combat the problem of urinary incontinence using folk remedies. Using common medicinal herbs, it is easy to prepare decoctions and infusions that will help reduce the activity of symptoms without the use of medication.

Folk remedies will be effective for urinary incontinence if they are used regularly and following dietary rules. However, it should be borne in mind that the use of infusions and decoctions is not effective for urge incontinence that occurs during menopause, age-related changes or the presence of inflammatory processes.

• Dill seeds

Two tablespoons of seeds are poured into 0.5 liters of hot water and left to infuse overnight. In the morning, the resulting infusion is filtered and drunk before eating. Duration of treatment – ​​10 days. After a ten-day break, the treatment is repeated.

• Cowberry

To prepare the medicine, take dry berries and leaves of the plant. They are crushed, the same amount of St. John's wort is added, poured with boiling water and kept in a water bath for 10-15 minutes. You should take a glass of the decoction three times a day.

• Elecampane

The root of the plant is poured with boiling water, kept on low heat for at least a quarter of an hour, infused in a dark place for several hours, and a small amount of honey is added. The resulting mixture is drunk before bedtime 2-3 times a day.

• Corn silk

2-3 teaspoons of corn silk are poured with boiling water, left for a quarter of an hour or more, and filtered. Take the resulting decoction several times a day, about half a glass with the addition of a teaspoon of honey.

• Shepherd's Purse

Infuse two tablespoons of chopped herbs in a glass of cool boiled water and filter. Take a tablespoon several times a day. This remedy is effective for bedwetting.

Many patients also note the effectiveness of the following home remedies:

• cold decoction prepared from the bark of viburnum, elm, ash;
• taking a glass of fresh carrot juice before breakfast;
• eating a pinch of crushed dill seeds several times a day;
• inclusion in the menu of tea made from young twigs of cherries or sweet cherries.

Treatment with folk remedies has proven its effectiveness for many years. However, if a woman does not see significant improvement after completing the course, she should consult a doctor to prescribe more effective methods or surgical treatment. Self-medication over a long period of time can be hazardous to health.

Lifestyle changes and prevention

When such a problem arises, a woman has to make certain adjustments to her lifestyle. First of all, you need to pay attention to personal hygiene. To avoid skin irritation and infection, after a shower you should treat the affected areas with moisturizing anti-inflammatory creams or medications. It's good if they contain petroleum jelly, lanolin or cocoa butter. When taking a shower, you should use warm, but not hot water.

Many women have to give up some of the pleasures of life due to fears of leakage and odor. To protect and eliminate these problems, absorbent protective pads are used. You can also buy special underwear in pharmacies. It should be changed and washed regularly.

Prevention of urinary incontinence involves taking the following measures:

1. It is strictly forbidden to lift weights exceeding 5 kg; this causes excessive tension in the muscles of the pelvic area and serves as a provoking factor in the development of pathology.
2. Under any circumstances, ensure that the bladder is completely emptied and do not put off the process “for later.”
3. Watch your diet and avoid overeating.
4. Timely identify and treat inflammatory diseases of the urinary system.
5. Be active, follow a daily routine that includes playing sports, going to the pool, walking.
6. Monitor timely bowel movements and combat constipation.
7. Provide yourself with a favorable emotional atmosphere, avoid stressful situations, chronic lack of sleep, increased physical and psychological stress.
8. Control the amount of fluid you drink (1.5-2 liters per day).
9. Make sure to empty your bladder before going to bed.
10. Do not abuse sweet carbonated drinks, packaged juices, strong tea, coffee and alcohol.
11. Visit a urologist regularly.
12. Perform for prevention.

Particular attention to the listed preventive measures should be paid to expectant mothers and women experiencing menopause. An emotional positive attitude is of great importance.

Urinary incontinence is a disease that requires careful long-term treatment. Only complex therapy, together with changes in daily routine and nutrition, will eliminate the pathology and restore the ability to lead a normal lifestyle.