Urinary Incontinence In Women - Treatment, Symptoms And Causes

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-11 07:35

Urinary incontinence in women

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

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

You can also find such a term as incontinence, which also means urinary incontinence, but is more often used by urologists and gynecologists precisely when making a diagnosis. Experts call enuresis a violation of urination, which is accompanied by the inability to regulate the emptying of the bladder. Leakage volumes can range from a few drops to almost complete organ contents. The disease is treated by gynecologists, urologists, surgeons and psychotherapists.

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

Content:

• Causes and symptoms of urinary incontinence in women
• Diagnosis of urinary incontinence in women
• Urinary incontinence in older women after 50 years
• Treatment of urinary incontinence in women
• Vitafon for urinary incontinence
• Treating stress urinary incontinence
• Operative treatment
• 3 effective exercises for urinary incontinence
• What to do if you suffer from urinary incontinence?

Causes and symptoms of urinary incontinence in women

There are the following types of urinary incontinence:

• Stressful;
• Imperative (urgent);
• Iatrogenic;
• Mixed;
• Other forms, for example, enuresis with overflow of the bladder, continuous urinary leakage, unconscious incontinence, etc.

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

Stress urinary incontinence

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

Symptoms of stress urinary incontinence:

• Excretion of urine during laughing, coughing, sneezing, physical exertion, sexual intercourse.
• If there is no tension in the abdominal cavity, then urine is not excreted.
• Not every cough or sneeze results in an involuntary flow of urine. In the early stages of incontinence, this occurs only when the organ is overcrowded, and the volume of urine lost is equivalent to a few drops.
• As the disease progresses, even mild physical activity, such as brisk walking, can lead to loss of urine.
• An irresistible urge to urinate in a woman is absent.
• Involuntary discharge of feces and gases from the intestines can occur with urine.

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

There may be several reasons:

• Difficult childbirth. In this regard, childbirth is especially dangerous, accompanied by the release of a large fetus, perineal incisions, the imposition of forceps and other manipulations. Women with a narrow pelvis are at risk.
• Surgical interventions on the pelvic organs. Any interventions on the bladder, rectum, uterus can lead to stress urinary incontinence. Fistulas that form between organs are dangerous, since these defects also lead to urinary incontinence.
• Hormonal changes in a woman's body that occur with age. The less estrogen is produced, the worse the elasticity of the ligaments becomes and the lower the muscle tone will be.

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

• Overweight, especially in combination with diabetes mellitus;
• Dramatic weight loss;
• Hard work associated with high physical activity;
• Undergoing radiation therapy;
• Prolapse and prolapse of the uterus;
• Frequent cystitis and urethritis;
• Lifting weights;
• Weighed down heredity;
• Belonging to the Caucasian race;
• Neurological diseases, including heart attacks, strokes, spinal injuries;
• Bronchial asthma, obstructive pulmonary disease;
• Chronic constipation

• Anemia;
• Taking certain medications.

Urgent urinary incontinence

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

The symptoms of urge incontinence are as follows:

• The urge to empty the bladder is very frequent and occurs more than 8 times a day.
• They almost always appear suddenly.
• The urge to urinate is uncontrollable.
• Frequent trips to the toilet are observed at night.
• The urge to urinate is often dictated by external factors, including, for example, the sound of water pouring from the tap, bright light, loud sound, etc.
• When imperative urinary incontinence occurs against the background of a prolapsed bladder, a woman may experience pain and discomfort in the lower abdomen.
• Leakage of urine may be accompanied by the development of dermatitis in the groin area, the occurrence of such genitourinary infections as vulvitis, vulvovaginitis, pyelonephritis, cystitis, etc.

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

Learn More: Urgent Urinary Incontinence

Iatrogenic urinary incontinence

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

You should be aware that medications such as the following can lead to urinary incontinence:

• Adrenomimetics (Pseudoephedrine), which are used to treat bronchial diseases. First, such drugs provoke urinary retention, and then cause urinary incontinence.
• Any diuretic drugs.
• Adrenergic blockers.
• Hormonal preparations containing estrogen.
• Colchicine, which is used in the treatment of gout.
• Antidepressants.
• Sedative medicines.

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

Diagnosis of urinary incontinence in women

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

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

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

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

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

1. Cystoscopy. This test involves examining the inside of the bladder. For this purpose, a thin cystoscope is inserted inside through the urethra. The procedure for a woman is painless, for which the doctor uses a special anesthetic gel. Cystoscopy makes it possible to assess the condition of the bladder, to exclude the presence of tumor formations.
2. The urodynamic examination evaluates the filling and emptying of the bladder. To conduct it, special sensors are inserted into the bladder itself and into the vagina, which provide the information the doctor needs.
3. Ultrasound of the pelvic organs. This examination makes it possible to assess the state of the organs of the female reproductive system, which makes it possible to determine further therapeutic tactics.

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

Urinary incontinence in older women after 50 years

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

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

• Does the woman suffer from neurological pathologies.
• Does she have mental disorders.
• Does the woman have signs of Parkinson's disease?
• Does the woman suffer from diabetes.
• Does she have problems with being overweight?
• Are there herniated discs or other degenerative diseases of the spinal cord that can affect the functioning of the bladder?
• Did the woman have a history of previous operations on the pelvic organs. If there were any, then it is important to find out whether they provoked the formation of adhesions and fistulas.

All of these diseases can be the cause of urinary incontinence, since in one way or another they can affect the functionality of the bladder. It is possible that the woman has "overflow incontinence", that is, due to the reduced sensitivity of the organ, the signal to empty it is transmitted to the brain too weakly, or is completely absent.

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

In elderly patients with diagnosed stress incontinence, pelvic organ prolapse is found in 30% of cases, namely, prolapse of the bladder. Therefore, the approach to both the diagnosis of the existing problem and the treatment of older women must be individual. Also, one should not lose sight of the fact that urinary incontinence can develop against the background of relative health due to a lack of estrogen production in the postmenopausal period.

Comprehensive urodynamic examination for elderly women who complain of urinary incontinence is prescribed without fail.

Treatment of urinary incontinence in women

Therapeutic tactics largely depend on what exactly caused the urinary incontinence and how far the problem has gone. Gynecologists, urologists and surgeons are involved in the treatment of the disease (if surgery is required).

Treatment of any type of urinary incontinence should be initiated on a “simple to complex” basis.

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

• Weight loss in the presence of obesity. The fact is that excess body weight affects the state of the internal organs, which are exposed to excess pressure. As a result, their location is disrupted, functioning suffers, which leads to problems with urination. Obesity can be treated with diet, medication, psychotherapy, or stomach surgery.
• Any drinks that contain caffeine should be limited. This primarily concerns coffee and tea. The ban on caffeine is due to its diuretic effect on the body. With an excess intake of this substance, the risk of urinary incontinence increases significantly. As for the use of ordinary pure water, it cannot be limited, otherwise the situation can be aggravated.
• Refusal from cigarettes. There is still no clear relationship between tobacco smoking and the problem of urinary incontinence. However, it has been proven that women suffering from “smoker's” bronchitis have a many times higher risk of developing stress urinary incontinence. In general, any diseases of the respiratory system must be treated in a timely manner.
• Urinary incontinence is excellently treated when the patient is able to correct the urination regimen. The essence of this method boils down to the fact that you need to accustom your body to urinate for hours. The initial interval can be set at 30 minutes with its subsequent increase to an hour or more.
• In order to tone the muscles of the pelvic floor, you should exercise regularly. Special exercises will allow you to correct the work of the sphincter and the walls of the bladder.
• All chronic diseases must be promptly treated in order to prevent their exacerbation.
• It is no less effective to create a psychological attitude for yourself that distracts from the desire to empty the bladder.

Kegel exercises

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

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

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

You can use such techniques as fast and slow contractions, pushing out as pushing during labor, delaying the stream while emptying the bladder.

Read more: Kegel exercises for urinary incontinence: how to do it at home?

Biofeedback therapy

Exercises with biofeedback (BFB) are superior in effectiveness to Kegel exercises, since they allow you to strain only the necessary muscles. For the implementation of the complex, specialized equipment is required. It is designed not only to control the process of muscle tension, but also to further stimulate them using electrical impulses.

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

Use of simulators for urinary incontinence

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

Psychotechnics

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

Medicines

• Table of Essential Medicines for Urinary Incontinence
• Ovestin candles
• Minirin
• Driptan
• Picamilon
• Duloxetine
• Melipramine
• Pantocalcin
• Pantogam

Vitafon for urinary incontinence

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

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

In case of urinary incontinence, vibroacoustic therapy of the following zones is performed:

• Perineal area - 10 minutes;
• The area of the muscular sphincter of the bladder (slightly above the pubis) - 10 minutes;
• Kidney area - 10-30 minutes;
• Liver area - up to 15 minutes;
• Lumbosacral area - 5 minutes.

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

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

Vitafon is used to treat enuresis in children.

Contraindications:

• Increased body temperature.
• Malignant neoplasms in the affected area.
• Atherosclerosis.
• Thrombophlebitis.
• Infectious diseases in the acute stage.
• Pregnancy.

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

Treating stress urinary incontinence

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

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

• Gutron (adrenergic agonist). The drug increases the tone of the urethra and sphincter. It is rarely prescribed, as it has a negative effect on the state of the vascular wall and increases blood pressure.
• Ubretide (an anticholinesterase drug). The drug increases muscle tone. It is indicated for those patients who suffer from bladder hypotension.
• Duloxetine or Simbalta (antidepressant). The drug helps in 50% of cases, however, it has a negative effect on the digestive tract.

In general, drugs for the treatment of stress urinary incontinence are rarely prescribed because they have low efficacy but have a fair amount of side effects.

Find out more: stress urinary incontinence

Operative treatment

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

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

• Revealed malignant tumor.
• Inflammation in the pelvic area, which is in the acute stage.
• Decompensated diabetes mellitus.
• Blood clotting disorders.

The following operations are possible:

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

  Read more: TVT sling operation

• Bulking agents injections. This method of treatment boils down to the fact that a special substance is injected into the urethra region, which is designed to compensate for the deficiency of missing soft tissues and maintain the urethra in the desired position. The operation is performed in an outpatient clinic and does not require general anesthesia. However, the risk of recurrence remains.

  Read more: Periurethral bulking agents

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

  More: anterior colporrhaphy

• Laparoscopic colposuspension according to Burch. This operation aims to suspend tissue around the urethra from the inguinal ligaments. The procedure requires the introduction of general anesthesia, has many contraindications and more complications than sling operations. Therefore, Birch colposuspension is performed only when the operation with the use of a loop did not bring the desired effect.

  More: Burch Laparoscopic Colposuspension

Treatment of urinary incontinence with folk remedies

• Plowed clover. An herb called plow clover can be used to treat urinary incontinence. It should be brewed like tea and drunk as a weak solution. This herb can be purchased at a pharmacy.
• Honey water. Honey has the ability to retain water. Therefore, traditional healers use it to treat enuresis. To get rid of urinary incontinence, before going to bed, you should drink half a glass of warm water, in which a teaspoon of honey is previously diluted. The course of treatment is 3 days. Alternatively, you can drink 30 ml of honey water three times a day.
• Dill seeds for enuresis in children. To relieve a child of bedwetting, you can use dill seeds. You will need to take a tablespoon of seeds and pour them with a glass of boiling water, insist for an hour, strain. They use this infusion on an empty stomach. Children under 10 are given 1/2 cup each, and children over 10 are given a whole glass of drink.

3 effective exercises for urinary incontinence

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

1. You need to squat down and connect your palms to each other at chest level. The back should be straight. Remain motionless in this position for at least 30 seconds.
2. You need to lie on your back, spread your knees to the sides, while connecting your feet together. Hands are extended along the body, palms up. In this position, you need to hold out for a minute.
3. You need to kneel down and lower your buttocks to your feet. Stretch your arms forward, face down. In this position, you should stretch the spine for a minute.

What to do if you suffer from urinary incontinence?

• You should drink at least 1.5-2 liters of still water a day.
• It's important to create your own urination regimen. You need to accustom your body to relieve itself at the same time, for example, in the morning, before leaving the house, at lunchtime and in the evening, upon returning home.
• Obesity should not be allowed.
• All bad habits should be abandoned.
• Products containing caffeine and high amounts of salt should be kept to a minimum in your menu.
• Constipation should not be allowed. To prevent them, you should eat right, consume a sufficient amount of fiber and fluid. Before going to bed, it is recommended to drink a fermented milk drink.
• You need to start training your pelvic floor muscles at the planning stage of pregnancy. This will avoid tearing.
• You should always try to stay in high spirits and enjoy life.

Author of the article: Lebedev Andrey Sergeevich | Urologist

Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.