Stress urinary incontinence
Stress urinary incontinence is a common problem for many women that is not usually talked about out loud. However, it can significantly impair the quality of life. Women with this pathology experience physical and psychological discomfort, however, for a number of reasons, they do not go to the doctor. It has been established that about 40% of women in Europe suffer from stress urinary incontinence. It is a urological, gynecological and neurological problem at the same time. Moreover, she begins to bother women even in reproductive age, and by the age of 70 every second representative of the weaker sex will suffer from urinary incontinence.
In Russia, the problem of stress urinary incontinence is also colossal. According to the chief urologist of the Ministry of Health of the Russian Federation, in the country more than 40% of women over the age of forty suffer from it. Although this problem has existed for a long time, until the middle of the last century, medicine did not consider it as a disease. Therefore, most women still consider stress urinary incontinence to be a natural aging process in the body and do not take any measures to combat it. However, this approach is fundamentally wrong.
So, stress urinary incontinence is an involuntary discharge of urine, which may be associated with a failure of the function of the urethral sphincter, or with weakness of the pelvic floor muscles. As a result, urine flows out even with a slight tension of the peritoneum: with laughter, with coughing, sneezing, intercourse, a sharp rise from a place and physical exertion. The word "stress" in this case is used in the context of "effort, load".
- Causes of stress urinary incontinence
- Symptoms of stress urinary incontinence
- Diagnosis of stress urinary incontinence
- Treating stress urinary incontinence
- Prevention of urinary incontinence
Causes of stress urinary incontinence
In more than 60% of cases, stress urinary incontinence is associated with a weakened sphincter function. This can occur after a difficult birth, or after a gynecological operation. Moreover, it is not the number of births that matters, but their course. In this regard, the danger is the birth of a large child, a narrow pelvis of a woman, ruptures of the pelvic floor muscles, the use of forceps, episiotomy, etc. After childbirth, the restoration of tissues and ligaments can take place on their own, but it will not be complete. As for operations, interventions such as hysterectomy, oophorectomy, etc. can affect.
- In 15% of cases, violations occur due to pronounced physical exertion. That is, the woman was engaged in hard physical labor, which led to a weakening of the pelvic floor muscles and changed the position of internal organs.
- In 7% of cases, stress incontinence is caused by hormonal disorders in the body that occur against the background of menopause. Age-related estrogen deficiency affects, leading to atrophic changes. This is especially noticeable in the condition of the skin, which becomes dry and flabby. Not only the skin becomes decrepit, but also the ligaments that are responsible for keeping urine in the bladder.
- Prerequisites for the development of stress incontinence can be factors such as: obesity, frequent constipation, radiation therapy.
- The risk of stress urinary incontinence is increased in women who suffer from chronic cystitis or urethritis.
- Do not overlook diseases such as COPD and bronchial asthma in the pathogenesis of stress urinary incontinence. These pathologies are characterized by frequent episodes of increased intra-abdominal pressure, which over time calls for overstretching of the ligaments around the urethra.
So, it is wrong to consider stress urinary incontinence solely as a consequence of aging.
Symptoms of stress urinary incontinence
The main symptom of stress urinary incontinence is involuntary urine leakage that occurs without any urge to empty the bladder. Incontinence occurs due to physical exertion.
If urine leakage is ignored, then the pathology will progress. The amount of urine lost increases from a few drops to the full volume of the bladder.
There are three degrees of stress urinary incontinence, each characterized by the following symptoms:
Easy degree. The output of urine occurs when sneezing, coughing, physical exertion. If the woman does not cough or laugh, the urine will not leak. At first, it is released only when the bladder is sufficiently full.
Average degree. Urine starts to leak during a sudden rise from a place, while running.
Severe degree. Urine comes out of the bladder even when walking and at rest.
Urology doctors use a classification based on the number of pads a woman uses per day. First degree - one pad per day, second degree - two to four pads per day, third degree - more than four pads per day.
Diagnosis of stress urinary incontinence
Diagnostics of urinary incontinence should begin with filling out a diary, which must be kept for several days. The woman needs to record the volume of fluid she drinks, the number of urinations and portions of urine excreted in milliliters, as well as the frequency of incontinence episodes. It is important to note what exactly the woman was doing at the moment when the involuntary release of urine occurred.
Every patient with urinary incontinence should visit a gynecologist, who will assess the condition of the tissues and muscles, determine the possible prolapse of the walls of the vagina and uterus. A cough test is also performed in the gynecologist's office. A woman with a full bladder should cough several times. If urine is leaking at this time, the test is considered positive. Based on these examinations, a diagnosis is made.
In some cases, it may be necessary to implement the following diagnostic procedures, such as:
- Ultrasound of the pelvic organs;
The doctor simultaneously evaluates the condition of the skin of the perineum, reveals the presence of urogenital fistulas. As for laboratory methods of examination, urine culture, general urine analysis, smear microscopy are shown.
Treating stress urinary incontinence
Treatment of stress urinary incontinence in the early stages is not difficult at all. If a woman seeks medical help in a timely manner, then surgery can be avoided and conservative methods of therapy can be dispensed with.
If the disease has only recently manifested itself, the doctor will select exercises for the woman that are aimed at strengthening the muscles of the pelvic floor. As a rule, this is possible at stages 1-2 of the development of incontinence. Kegel exercises, which are reduced to alternating tension and relaxation of the pelvic floor muscles, have proven themselves well.
It is possible to use special devices that are inserted into the vagina and stimulate it from the inside with electrical impulses.
Another progressive non-surgical method of treating stress incontinence is biofeedback (biofeedback) therapy. This method resembles a computer game, when a woman, looking at a monitor, learns to control the muscles of the pelvic floor. She alternately strains and relaxes the muscles of the perineum. At this time, sensors are connected to her body, which detect muscle contractions and display them on the screen in the form of a swimming fish. If you combine biofeedback therapy with other exercises, you can achieve good results: normalize the work of the bladder, sphincters, improve blood circulation in the pelvic organs, get rid of stress urine leakage.
You can also train your pelvic floor muscles using special cone weights that are placed in the vagina and held by the strength of its muscles. With training, the weight of the weights increases, which leads to the development of self-control skills during urination. As a rule, the effect can be felt already after 1-1.5 months after the start of such classes.
It is equally important to normalize weight, quit smoking, which provokes a cough. It is important to exclude such a factor as hard work.
With regard to medical correction, it is possible to prescribe antidepressants, estrogens and systemic HRT. When incontinence develops against the background of menopause, hormonal drugs have proven themselves quite well.
In the later stages of the development of urinary incontinence, the choice of therapeutic tactics depends on what exactly caused the pathological condition.
In some cases, it is impossible to do without surgical intervention. Today, incontinence can be managed with a synthetic prolene loop (sling surgery). The loop is inserted into the body and placed under the middle part of the urethra, pulling it in the right way. The loop is adjusted by the surgeon, after which it is fixed and left in the woman's body. The operation can be performed under local anesthesia. Recurrence of stress urinary incontinence in women develops in 10-20% of cases.
Another modern technique for treating incontinence is the introduction of hydrogels into the sphincter area. They support weakened muscles, providing a locking effect. However, this method has a number of disadvantages, including: a low degree of biocompatibility of drugs, their rapid resorption and migration in tissues. In this regard, it is preferable to inject an artificial polymer, the use of which can be considered as safe as possible.
Depending on the indications, such operations can be applied as: anterior colporrhaphy, implantation of an artificial sphincter, urethrocystopexy, etc. In general, there are more than 200 methods of surgery for urinary incontinence. Many of them have long been abandoned, since they are very traumatic, for example, the Goebel-Stäckel operation, while others are not effective enough, for example, anterior colporrhaphy.
Prevention of urinary incontinence
It is necessary to give up bad habits.
- You should maintain normal body weight.
- It is important to strengthen the pelvic floor muscles, to control timely bowel movements.
- Neurological and urogenital diseases must be treated promptly.
When urinary incontinence is detected, women should put aside false shame and turn to a doctor with their problem. The sooner treatment is started, the better the results will be. When qualified assistance is provided at the early stages of the development of the pathological process, it is almost always possible to avoid surgical intervention.
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.