Urine incontience (inkontinention) – an involuntary effluence of urine which cannot be controlled by strong-willed effort. Pathology is widespread around the world. The incontiences of urine given about prevalence are contradictory that speaks as distinctions in the choice of the studied populations, and the fact that only a small part of the patients suffering from various forms of an incontience of urine to medical institutions. Allocate the stressful, urgentny, mixed, paradoxical, temporary incontience of urine. Diagnostics consists in inspection of urinogenital system and identification of the reason of an incontience of urine according to which the choice of medical tactics is carried out.
Urine incontience (inkontinention) – an involuntary effluence of urine which cannot be controlled by strong-willed effort. Pathology is widespread around the world. The incontiences of urine given about prevalence are contradictory that speaks as distinctions in the choice of the studied populations, and the fact that only a small part of the patients suffering from various forms of an incontience of urine to medical institutions.
Average data say that from an urine incontience in this or that form about 20% of the population of all globe suffer. The Russian researchers in the field of urology claim that the incontience of urine is observed at 12-70% of children and 15-40% of adults. With age the frequency of an incontience of urine increases both at men, and at women. In group of people is younger than forty years the incontience meets at women more often. In the senior age group the share of men increases because of age changes of a prostate.
The urine incontience sharply worsens quality of life of patients, leads to development of psychoemotional frustration, professional, social, family and household disadaptation. The incontience of urine is not an independent disease, and only manifestation of pathological processes of various genesis. Approach to treatment of an incontience of urine has to be defined with the main disease.Please Help us - click on the advertisement
Classification of an incontience of urine
Allocate a false and true incontience of urine.False incontience of urine.
False incontience of urine is called the involuntary effluence of urine at congenital (a total epispadiya of an urethra, a bladder ekstrofiya, an ektopiya of the mouth of a mochetochnik with an exit in a vagina or an urethra etc.) or acquired (uric fistula after a trauma) defects of an urethra, a mochetochnik or a bladder.
True incontience of urine. If the incontience of urine develops in the absence of listed and similar it rough defects, it is called true.Please Help us - click on the advertisement
Urine incontience reasons
Anatomic violations and local violations of sensitivity. The repeated or complicated childbirth, obesity, chronic inflammatory diseases of bodies of a small pelvis, operation on bodies of a small pelvis, occupation weightlifting and some other sports can change normal anatomic interposition of pelvic bodies and influence a threshold of sensitivity of nervous receptors. The urine incontience becomes a consequence of changes in the urinary channel, a bladder, sheaves and fastion of a pelvic bottom.
Hormonal reasons of an incontience of urine. Deficiency of estrogen at a climax leads to development of atrophic changes in covers urinogenital bodies, sheaves and muscles of a pelvic bottom that, in turn, becomes the urine incontience reason.
Injuries and diseases of the central and peripheral system. The incontience of urine can develop at blood circulation violation, inflammatory diseases, injuries and tumors back and a brain, diabetes, multiple sclerosis and some malformations of the central and peripheral nervous system.Please Help us - click on the advertisement
Urine incontience types
For a start we will consider process of a normal urination. Urine is produced by kidneys, comes to a bladder, collects and stretches its walls. Detruzor (the muscle expelling urine) is in process of filling of a bubble in the weakened state. With a certain pressure receptors are excited in a wall of a bladder. There is a desire on an urination. Detruzor strains, the sphincter of a bladder relaxes. The urination occurs when pressure in a detruzor exceeds pressure in an urethra. Normal the person can control an urination, straining and relaxing a sphincter and muscles of a pelvic bottom.
Stressful incontience of urine
The urine incontience arising at a state which is followed by increase in intra belly pressure (intensive physical activity, cough, laughter) is called stressful. Desires on an urination at the same time are absent.
The stressful incontience of urine arises owing to weakening of a pelvic bottom at the lowered content of collagen in pelvic sheaves. Decrease in level of collagen happens congenital, but develops at a lack of estrogen of menopausal and post-menopausal age more often.
The stressful incontience develops at the smoking women more often. Smoking leads to lowering of the level of vitamin C in an organism. As decrease in level of vitamin C influences durability of collagenic structures, some researchers believe that also deficiency of collagen is the reason of a stressful incontience of urine at the smoking women.
One of the reasons of a stressful incontience of urine is development of excessive mobility of a neck of a bladder or insolvency of a press (sphincter) of a bladder. The neck at these states is stretched or displaced. The sphincter cannot fully be reduced. Lack of sufficient resistance at increase in intra belly pressure becomes the urine incontience reason.
Direct injury of a sphincter (at a fracture of pelvic bones, injury of an external sphincter at men during prostate gland operation etc.) becomes the reason of a stressful incontience of urine in certain cases.
Urgentny incontience of urine
Urgentny is called the urine incontience arising at an imperative (imperative) desire on an urination. The patient feels the need to urinate immediately and cannot postpone an urination even for very short period. In certain cases an urgentny incontience of urine the desire is not expressed or poorly expressed.
Detruzor tension in a filling phase (a bladder hyperactivity) is norm at children aged up to 2-3 years. Then the tone of a detruzor changes. However, approximately at 10-15% of people the hyperactivity of a bladder remains during all life. The urine incontience at the same time appears if pressure in a bladder exceeds pressure in an urethra.
In certain cases the hyperactivity of a bladder develops at pathological processes in the central and peripheral nervous system. External irritants can act as a provocative factor at an urgentny incontience (nervous excitement, reception of alcoholic beverages, a sound of the current water, an exit from the warm placement on cold). The importance of control over an urination in some cases becomes the reason of neurotic "binding" of an urgentny incontience of urine to certain events (for example – emergence in public).
The mixed urine incontience
At the mixed incontience the combination of symptoms of an urgentny and stressful incontience of urine is observed.
Paradoxical incontience of urine (overflow incontience)
Develops at the elderly patients having diseases of urinogenital bodies (is more often - prostate adenoma, is more rare – a striktury urethra of various etiology and a prostate cancer). It is connected with refilling and restretching of a bladder because of it is long the existing obstacles to urine outflow.
Temporary (tranzitorny) incontience of urine
In some cases the incontience of urine develops at influence of a number of external factors (sharp cystitis at elderly people, strong alcoholic intoxication, locks) and disappears after elimination of these factors.Please Help us - click on the advertisement
Diagnostics of an incontience of urine
Diagnostics begins with definition of the reasons and expressiveness of an incontience of urine. Collect complaints of patients, the detailed anamnesis of development of an incontience. The patient fills in the diary of urinations in which the volume and frequency of urinations is reflected. At an urine incontience from women great diagnostic value is gained by consultation of the gynecologist with carrying out gynecologic survey during which comes to light to a tsistotsela, omission of a uterus and vagina. The kashlevy test is carried out (at the expressed omission of a uterus and a forward wall of a vagina the test sometimes happens negative; the possible latent form of an incontience of urine is in that case supposed). For exact definition of losses of urine the pro-masonry test is carried out.
The anatomic condition of a pelvic bottom, accumulative and evakuatorny functions of a bladder are investigated by means of ultrasonography of a bladder or an uretrotsistografiya. The laboratory research of urine is conducted, crops of urine on microflora are carried out.Please Help us - click on the advertisement
Treatment of an incontience of urine
Presently the incontience of urine is treated as it is conservative (medicamentous and non-drug therapy), and quickly. The therapeutic technique is selected the urologist individually after detailed inspection of the patient, definition of the reasons and degree of an incontience of urine. The indication to surgical treatment of an incontience of urine is inefficiency or insufficient effect of conservative therapy.
Non-drug therapy of an incontience of urine
Bladder trainings are shown to all patients with an incontience of urine. To patients recommend to carry out exercises for pelvic muscles. The general events (normalization of physical activity, the diet promoting weight reduction) are held.
The training of a bladder consists of three stages: training, scheduling of urinations and implementation of this plan. At the patient for a long time suffering from an urine incontience the special stereotype of an urination is developed. The patient is afraid that the urination can occur in improper time therefore tries to empty a bladder beforehand, at emergence of the first weak desire.
The training of a bladder is held gradually to increase a time interval between urinations. For the patient the individual plan of urinations is formed. If desires on an urination appear at an inopportune time, the patient has to constrain them, intensively reducing an anal sphincter. In the beginning the minimum interval between urinations is established. Every 2-3 week this interval is increased for 30 minutes until it does not reach 3-3,5 hours.
As a rule, the training of a bladder is held along with a course of medicamentous therapy. Treatment continues about three months. After this period of time at the patient the new stereotype of urinations is usually formed. At successful treatment cancellation of medicines should not cause increase of urinations or lead to an urine incontience.
The special technique of a training of a bladder for patients with heavy intellectual violations – so-called "urinations according to the hint" is created. Training is carried out in three steps. In the beginning the patient is learned to define when he dry and when – wet after an urination. Then train to distinguish a desire and to report about it to people around. At the last stage try to obtain complete control of the patient over an urination.
Medicamentous therapy of an incontience of urine
Medicines are applied at treatment of all forms of an incontience of urine. The greatest effect of medicamentous therapy is observed at patients with an urgentny incontience. Medicines are appointed to increase the functional capacity of a bladder and to reduce its sokratitelny activity.
Choice medicines at treatment of an urgentny incontience of urine are spazmolitik and antidepressants. One of the most effective medicines which is applied at therapy of an incontience of urine – . Medicine interrupts the irregular irritating impulses from TsNS and weakens a detruzor. The dosage is selected individually. Duration of a course of drug treatment at an urine incontience, as a rule, does not exceed 3 months. The effect of therapy usually remains within several months, sometimes longer. At renewal of an incontience of urine repeated courses of medicamentous therapy are conducted.
Surgical treatment of an incontience of urine
In most cases the good result at treatment of an incontience of urine manages to be achieved by conservative methods. At insufficient efficiency or lack of effect of medicamentous and non-drug therapy expeditious treatment of an incontience of urine is carried out. Operational tactics is defined depending on a form of an incontience of urine and results of the previous conservative treatment. Operation is required to patients with a stressful and paradoxical incontience of urine more often, is more rare – the patient suffering from an urgentny incontience of urine.
There are low-invasive methods of treatment of an incontience of urine. To the patient carry out injections of collagen, the homogenized autozhir, teflon paste, etc. Given a technique it is applied at a stressful incontience of urine at women if there are no neurogenetic frustration of an urination (a neurogenetic bladder). Treatment is not shown at the expressed omission of a bladder and walls of a vagina.
At surgical treatment of an incontience of urine loopback (slang) operations are widely applied. Apply synthetic materials (TVT, TVT-O, TOT set), a rag from a forward wall of a vagina to formation of a free loop, musculo or a skin rag. The greatest efficiency (90-96%) is reached when using synthetic materials.Please Help us - click on the advertisement
Problems of treatment and prevention of an incontience of urine
Despite prevalence of an incontience of urine, only small percent of patients sees doctors. Prejudices or false shame become an obstacle quite often. People of advanced and senile age sometimes perceive an urine incontience as natural age change. The long suffering leads to development of psychoemotional frustration, deterioration of life and actual invalidization of patients.
Meanwhile, the urine incontience, regardless of its etiology, is not natural manifestation, is caused by deviations of structure or function of some bodies and in most cases is eliminated at selection of the corresponding methods of treatment. It is necessary to consider that efficiency of therapeutic actions at an incontience of urine increases in a case of the early address of the patient.