What causes urinary incontinence: Urinary incontinence – Symptoms and causes
Urinary Incontinence in Older Adults
Urinary incontinence means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. Talk to your healthcare provider about what you can do.
What happens in the body to cause bladder control problems? The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.
Causes of Urinary Incontinence
Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:
- Weak bladder muscles
- Overactive bladder muscles
- Weak pelvic floor muscles
- Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
- Blockage from an enlarged prostate in men
- Diseases such as arthritis that may make it difficult to get to the bathroom in time
- Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.
Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:
- Prostatitis—a painful inflammation of the prostate gland
- Injury, or damage to nerves or muscles from surgery
- An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia (BPH), a condition where the prostate grows as men age.
Diagnosis of Urinary Incontinence
The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:
- Urine and blood tests
- Tests that measure how well you empty your bladder
In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.
Types of Urinary Incontinence
There are different types of incontinence:
- Stress incontinence occurs when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause.
- Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
- Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
- Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.
Treatment for Urinary Incontinence
Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:
- Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer. Learn more about pelvic floor exercises and how to do them.
- Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
- Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
- Lifestyle changes may help with incontinence. Losing weight, quitting smoking, saying “no” to alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation and avoiding lifting heavy objects may help with incontinence. Choosing water instead of other drinks and limiting drinks before bedtime may also help.
For more tips to keep your bladder healthy, visit 13 Tips to Keep Your Bladder Healthy.
Incontinence and Alzheimer’s Disease
People in the later stages of Alzheimer’s disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. To minimize the chance of accidents, the caregiver can:
- Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But don’t limit water.
- Keep pathways clear and the bathroom clutter-free, with a light on at all times.
- Make sure you provide regular bathroom breaks.
- Supply underwear that is easy to get on and off.
- Use absorbent underclothes for trips away from home.
For more ways to deal with incontinence and other common medical problems in someone with Alzheimer’s, visit Alzheimer’s Disease: Common Medical Problems.
Managing Urinary Incontinence
Besides bladder control training, you may want to talk with your doctor about other ways to help manage incontinence:
- Medicines can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage.
- Some women find that using an estrogen vaginal cream may help relieve stress or urge incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
- A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This can reduce stress incontinence in women. This treatment may need to be repeated.
- Some women may be able to use a medical device, such as a urethral insert, a small disposable device inserted into the urethra. A pessary, a stiff ring inserted into the vagina, may help prevent leaking if you have a prolapsed bladder or vagina.
- Nerve stimulation, which sends mild electric current to the nerves around the bladder that help control urination, may be another option.
- Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.
Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including adult diapers, furniture pads, urine deodorizing pills, and special skin cleansers that may make leaking urine bother you a little less.
Visit the National Institute of Diabetes and Digestive and Kidney Diseases for more information on urinary incontinence in men and urinary incontinence in women.
Read about this topic in Spanish. Lea sobre este tema en español.
For More Information on Urinary Incontinence
This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.
May 16, 2017
Urinary incontinence – Causes – NHS
Urinary incontinence is when the normal process of storing and passing urine is disrupted. This can happen for several reasons.
Certain factors may also increase your chance of developing urinary incontinence.
Some of the possible causes lead to short-term urinary incontinence, while others may cause a long-term problem. If the cause can be treated, this may cure your incontinence.
Causes of stress incontinence
Stress incontinence is when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Your urethra is the tube that urine passes through to leave the body.
Any sudden extra pressure on your bladder, such as laughing or sneezing, can cause urine to leak out of your urethra if you have stress incontinence.
Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or if your urethral sphincter – the ring of muscle that keeps the urethra closed – is damaged.
Problems with these muscles may be caused by:
- damage during childbirth – particularly if your baby was born vaginally, rather than by caesarean section
- increased pressure on your tummy – for example, because you are pregnant or obese
- damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy), or removal of the prostate gland
- neurological conditions that affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis
- certain connective tissue disorders such as Ehlers-Danlos syndrome
- certain medicines
Causes of urge incontinence
The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of your bladder.
The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.
Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is known as having an overactive bladder.
The reason your detrusor muscles contract too often may not be clear, but possible causes include:
- drinking too much alcohol or caffeine
- not drinking enough fluids – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
- conditions affecting the lower urinary tract (urethra and bladder) – such as urinary tract infections (UTIs) or tumours in the bladder
- neurological conditions
- certain medicines
Causes of overflow incontinence
Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction affecting your bladder.
Your bladder may fill up as usual, but because of an obstruction, you will not be able to empty it completely, even when you try.
At the same time, pressure from the urine that’s left in your bladder builds up behind the obstruction, causing frequent leaks.
Your bladder can be obstructed by:
Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means your bladder does not completely empty when you urinate. As a result, the bladder becomes stretched.
Your detrusor muscles may not fully contract if:
- there’s damage to your nerves – for example, as a result of surgery to part of your bowel or a spinal cord injury
- you’re taking certain medicines
Causes of total incontinence
Total incontinence is when your bladder cannot store any urine at all. It can mean you either pass large amounts of urine constantly, or you pass urine occasionally with frequent leaking in between.
Total incontinence can be caused by:
- a problem with your bladder from birth
- injury to your spinal cord – this can disrupt the nerve signals between your brain and your bladder
- a bladder fistula – a small, tunnel like hole that can form between the bladder and a nearby area, such as the vagina
Medicines that may cause incontinence
Some medicines can disrupt the normal process of storing and passing urine or increase the amount of urine you produce.
Stopping these medicines, if advised to do so by a doctor, may help resolve your incontinence.
In addition to common causes, some things can increase your risk of developing urinary incontinence without directly being the cause of the problem. These are known as risk factors.
Some of the main risk factors for urinary incontinence include:
- family history – there may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have the problem
- increasing age – urinary incontinence becomes more common in middle age and is very common in people who are 80 or older
- having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra
Page last reviewed: 07 November 2019
Next review due: 07 November 2022
Incontinence (Urinary & Bowel): Types, Causes, Treatments
Urinary incontinence — when you accidentally leak urine — is a problem that affects millions of Americans, most of them women. There are several different types, causes, and treatments.
With this type, urine leaks due to weakened pelvic floor muscles and tissues. It can happen when pressure on your bladder increases — such as when you exercise, laugh, sneeze, or cough.
Pregnancy and childbirth can stretch and weaken a woman’s pelvic floor muscles. Other things that can lead to stress incontinence are being overweight or obese, taking certain medications or, in men, having prostate surgery.
This is also called overactive bladder (OAB). With this type, you have an urgent need to go to the bathroom and may not get there in time.
Causes of overactive bladder include:
- Damage to the bladder’s nerves
- Damage to other parts of the nervous system
- Damage to muscles
Conditions such as multiple sclerosis, Parkinson’s disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Bladder problems, such as infections and bladder stones, and certain medications can also cause it.
If you can’t empty your bladder, you may have overflow incontinence. This means you may dribble urine.
You need to get the condition treated. If your bladder can’t empty, that can lead to infections and other problems.
Mental or physical problems such as dementia or arthritis prevent you from getting to the bathroom in time.
Mixed Urinary Incontinence
This means you have any two types of the condition. Many women have both stress and urge incontinence.
Treatment for Different Types of Urinary Incontinence
Lifestyle changes and treatments can help with symptoms. Your doctor can help you come up with a plan that’s right for you.
For stress incontinence, treatments include:
Pads and Vaginal Inserts.
Pelvic floor exercises. If you’ve had a baby, chances are you’ve been told to do Kegel exercises. These help to strengthen the pelvic floor after childbirth. They also help prevent stress incontinence. Best of all, you can do Kegels anytime, anywhere.
- Squeeze the muscles that you use stop the flow of urine.
- Hold the squeeze for 10 seconds, then rest for 10 seconds.
- Do 3 or 4 sets daily.
Note: You can learn how to do Kegels by stopping your urine, but don’t do this routinely. Stopping the flow of urine can lead to an infection.
Biofeedback. A probe is inserted to monitor when your bladder muscles squeeze. When you’re able to recognize it as it’s happening, you can start to gain control of it. It’s often used in combination with Kegel exercises.
Pessary. For women, doctors may prescribe a device called a pessary that is inserted into the vagina. It repositions the urethra to help reduce leakage.
Injections and surgery. Shots to bulk up your urethral area may help. In more extreme cases, you may need surgery. One procedure pulls the urethra back up to a more normal position, relieving the pressure and leakage. Another surgery involves securing the urethra with a “sling,” a piece of material that holds up the urethra to prevent leakage.
For urge incontinence, treatment options include:
Timed voiding and bladder training. First, you complete a chart of the times you pee and the times you leak. You observe patterns and then plan to empty your bladder before an accident would happen. You can also “retrain” your bladder, gradually increasing the time between bathroom visits. Kegel exercises are also helpful.
Medications, electrical stimulation, or surgery. Doctors sometimes prescribe medicines (or inject Botox in the bladder) that block the contractions of an overactive bladder. Electrical stimulation of the bladder nerves helps in some cases. Surgery is reserved for severe cases. It aims to increase the amount of urine your bladder can store.
For overflow incontinence, treatments include:
Medication or surgery. Meds called alpha-blockers often can help if the problem is caused by an enlarged prostate. If there’s a blockage, you may need surgery.
Catheter. Some people use a catheter to make sure their bladder is emptied. It’s a thin plastic tube that you insert in your urethra. A doctor or nurse can teach you how to insert it for yourself.
It’s important to identify any underlying disease or blockage causing overflow incontinence and treat that.
Talk to Your Doctor
You might feel embarrassed to talk about your urinary incontinence, but it’s worth it. Your doctor can help you figure out what’s causing your problem. That’s the first step to getting help.
Be straightforward. Just tell your doctor you’re having problems. Keep it simple: “I’m having bladder problems.”
Your doctor should ask questions, like how long the leakage has been happening, how bad it is, and how much it upsets your life. They may suggest tests or refer you to an expert in this kind of problem.
Urinary Incontinence in Women | Johns Hopkins Medicine
Urinary Incontinence in Women: What You Need to Know
Urinary incontinence is the accidental loss of urine.
Over 25 million adult Americans experience temporary or chronic urinary incontinence.
This condition can occur at any age, but it is more common in women over the age of 50.
There are four types of urinary incontinence: urgency, stress, functional and overflow incontinence.
Behavioral therapies, medications, nerve stimulation and surgery are some of the treatments available for managing urinary incontinence.
What is urinary incontinence?
Urinary incontinence (UI) is the accidental loss of urine. According to the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. UI can occur at any age, but it is more common among women over 50. Urinary incontinence may be a temporary condition that results from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
What causes urinary incontinence?
Urinary incontinence is not an inevitable result of aging, but it is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after the hormonal changes of menopause.
What are some of the different types of urinary incontinence?
The following are some of the different types of urinary incontinence:
Urgency incontinence: This is the inability to hold urine long enough to reach a restroom. It can be associated with having to urinate often and feeling a strong, sudden urge to urinate. It can be a separate condition, but it may also be an indication of other diseases or conditions that would also warrant medical attention.
Stress incontinence: This is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects or performing other body movements that put pressure on the bladder.
Functional incontinence: This is urine leakage due to a difficulty reaching a restroom in time because of physical conditions, such as arthritis, injury or other disabilities.
Overflow incontinence. Leakage occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it.
What are the symptoms of urinary incontinence?
The following are common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:
Needing to rush to the restroom and/or losing urine if you do not get to the restroom in time
Urine leakage with movements or exercise
Leakage of urine that prevents activities
Urine leakage with coughing, sneezing or laughing
Leakage of urine that began or continued after surgery
Leakage of urine that causes embarrassment
Constant feeling of wetness without sensation of urine leakage
Feeling of incomplete bladder emptying
The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is urinary incontinence diagnosed?
For people with urinary incontinence, it is important to consult a health care provider. In many cases, patients will then be referred to an urogynecologist or urologist, a doctor who specializes in diseases of the urinary tract. Urinary incontinence is diagnosed with a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples.
What is the treatment for urinary incontinence?
Specific treatment for urinary incontinence will be determined by your doctor based on:
Your age, overall health and medical history
Type of incontinence and extent of the disease
Your tolerance for specific medications, procedures or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include:
Bladder training: Teaches people to resist the urge to void and gradually expand the intervals between voiding.
Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.
Diet modifications: Eliminating bladder irritants, such as caffeine, alcohol and citrus fruits.
Pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage):
Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence.
Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles.
Pelvic floor electrical stimulation: Mild electrical pulses stimulate muscle contractions.
Pessary (small rubber device that is worn inside the vagina to prevent leakage)
Consult your doctor with questions regarding the management and treatment of urinary incontinence.
How is urinary incontinence managed?
Many women wear protective pads, shields or diapers to protect their clothing from urine leakage. Alternatively, specifically designed absorbent underclothing, which is similar in appearance to normal underwear, can be worn easily under everyday clothing.
Urinary Incontinence | ACOG
Accidental Bowel Leakage: Involuntary loss of control of the bowels. This condition can lead to leakage of solid stool, liquid stool, mucus, or gas. Also called fecal incontinence.
Antibiotics: Drugs that treat certain types of infections.
Biofeedback: A technique used by physical therapists to help a person control body functions, such as heartbeat or blood pressure.
Bladder: A hollow, muscular organ in which urine is stored.
Bladder Neck: The narrow part of the bladder above the urethra, the tube that empties urine from the bladder.
Diuretic: A drug or substance that increases the production of urine.
Dysuria: Pain during urination.
Frequency: Needing to urinate more than seven times per day, or more often than is usual for you.
Gynecologist: A doctor with special training and education in women’s health.
Kegel Exercises: Pelvic muscle exercises. Doing these exercises helps with bladder and bowel control as well as sexual function.
Nocturia: The number of times sleep is interrupted by the need to urinate.
Nocturnal Enuresis: The involuntary loss of urine at night while asleep.
Pelvic Exam: A physical examination of a woman’s pelvic organs.
Pelvic Floor: A muscular area that supports a woman’s pelvic organs.
Pelvic Floor Disorders: Disorders which affect the muscles and tissues that support the pelvic organs.
Pelvic Organ Prolapse: A condition in which a pelvic organ drops down. This condition is caused by weakening of the muscles and tissues that support the organs in the pelvis, including the vagina, uterus, and bladder.
Pessary: A device that can be inserted into the vagina to support the organs that have dropped down or to help control urine leakage.
Synthetic: Made by a chemical process, usually to imitate a natural material.
Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.
Urgency: A strong desire to urinate that is difficult to control.
Urinary Incontinence: Involuntary loss of urine.
Urinary Tract Infection (UTI): An infection in any part of the urinary system, including the kidneys, bladder, or urethra.
Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.
What Is Urinary Incontinence? – Symptoms
Treatment depends on what’s causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence through strengthening the pelvic muscles. Medicine and surgery are other options.
What are Kegel exercises?
Kegal exercises help strengthen the muscles that control the bladder. They can be done anywhere, any time. Although designed for women, the Kegel exercises can also help men. It may take 3 to 6 months to see an improvement. For more information, see “Kegel Exercises for Your Pelvic Muscles.”
What is bladder training?
Bladder training is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence, or a combination of the 2 types (mixed incontinence).
Bladder training can help in the following ways:
- Lengthen the amount of time between bathroom trips
- Increase the amount of urine your bladder can hold
- Improve your control over the urge to urinate
Some bladder training techniques are explained in “Bladder Training for Urinary Incontinence”.
Are there other ways to treat incontinence?
Yes. Medicines or medical devices can treat some types of urinary incontinence. For example, estrogen cream to put in the vagina can be helpful for some women who have mild stress incontinence. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine through the prostate. Talk to your doctor about possible medicine options for your type of incontinence.
In some cases, surgery may be an option. Treatment depends on what type of urinary incontinence you have and what is causing it.
Urinary Incontinence, Sexual Side Effects of Menopause
Urinary leakage during intercourse is estimated to affect up to a quarter of women with incontinence.
Reduced levels of estrogen starting around menopause can cause thinning of the lining of the urethra, the short tube that passes urine from the bladder out of the body. The surrounding pelvic muscles also may weaken with aging, a process known as “pelvic relaxation.” As a result, women at midlife and beyond are at increased risk for urinary incontinence, or the involuntary leakage of urine. The main risk factors for developing urinary incontinence are vaginal childbirth and increased age.
The most common types of urinary incontinence in women are:
- Stress incontinence, which is caused by weak pelvic floor muscles. The most common symptoms are leakage of urine with coughing, laughing, sneezing, or lifting objects. Stress incontinence is common during perimenopause but typically doesn’t worsen because of menopause.
- Urge incontinence (also called “overactive bladder”), which is caused by overly active or irritated bladder muscles. The most common symptom is the frequent and sudden urge to urinate, with occasional leakage of urine.
Although urinary incontinence is common during perimenopause and beyond, it’s not an inevitable result of aging and should not be considered normal or passively accepted if it proves bothersome.
Sex is one area where urinary incontinence can prove troubling. Urinary leakage during intercourse is estimated to affect up to a quarter of women with incontinence. This can be embarrassing for women and lead them to avoid intercourse or to worry about leakage to the point that they are unable to relax and enjoy sex.
You need not endure problems with urinary incontinence. Exercises to train and strengthen the pelvic floor muscles may help (see the discussion of Kegel exercises later in the program), as may a number of medications and surgical treatments. The simple practice of urinating right before intercourse can also be helpful.
The problem of female urinary incontinence – Clinic of urology MGMSU
Urinary incontinence is the involuntary discharge of urine from the urethra. According to statistics, urinary incontinence in women is twice as common as in the stronger sex. This is due to a large number of provoking factors that affect a woman at different periods of her life.
Of course, this disease does not threaten the patient’s life, but it causes her considerable concern, and is always associated with problems in the social sphere and in the field of personal hygiene.According to the WHO, at the age of 40-60, about 38-44% of women have signs of urinary incontinence. Also, this problem is observed in about 10% of girls.
Urinary incontinence in older women
Patients of age almost always have comorbidities that affect the ability of the bladder to retain fluid. So, urinary incontinence in an elderly woman may be associated with Parkinson’s disease, dementia and other cognitive disorders, taking sedatives, lowering the pressure of diuretics, etc.e. Any pathologies that are characteristic of older age and affect the nervous system can also cause female urinary incontinence. These include, for example, degenerative diseases of the spinal cord or herniated discs.
Endocrinological disorders in the stage of decompensation, in particular, diabetes mellitus, lead to a violation of the water-salt balance in the body. This, in turn, causes bedwetting in older women. Finally, involuntary discharge can be caused by disorders of the musculoskeletal system.Even feeling the urge to urinate, the woman does not have time to reach the restroom.
Postpartum urinary incontinence
According to numerous studies, urinary incontinence in adult women is definitely associated with whether the patient has given birth. At the same time, it is not the number of births that is of key importance, but their nature and complexity. If during labor, injuries to the perineum or ruptures of the pelvic floor muscles were observed, then this can cause urinary incontinence in young girls.
Heavy, prolonged or rapid labor increases the risk of developing the disease.
Urinary incontinence in women: symptoms
Of course, the main manifestation of this pathology is the involuntary discharge of a certain amount of urine and the woman’s inability to control this process.
Also, the symptoms of urinary incontinence can manifest itself as unexpected urge, pain or difficulty in normal urination and an increase in its frequency. Uncontrollable urge occurs mainly in stressful situations.The same conditions often provoke urinary incontinence at night in girls.
Often, the inability to hold urine is associated with coughing, laughing, or increased physical activity. The tension in the abdominal wall in such cases increases the pressure on the bladder, which leads to the release of a certain amount of urine.
Urinary incontinence in women: causes
- Extensive gynecological operations. Surgical intervention in this area is always associated with a high risk of damage to the pelvic nerves, which are responsible for maintaining the tone of the urethral sphincter.
- The onset of symptoms of urinary incontinence in women is most often associated with intrauterine growth disorders. Genetically determined inferiority of the pelvic floor tissues leads to an inability to fully control the process of urination.
- Age-related urinary incontinence in women is largely associated with the onset of menopause and hormonal imbalance in the body. Although the influence of this factor has not yet been proven, it is possible that urine excretion occurs as a result of a weakening of the general muscle tone in old age.
- Any trauma to the perineum, even not associated with labor, also leads to loss of control over urination. Damage to the nerve pathways, as well as a violation of the anatomical integrity of the urinary tract, can lead to the development of urinary incontinence.
- The causes of urinary incontinence may lie in the patient’s increased body weight, bowel dysfunctions, neuropsychiatric diseases, etc.
- Partial loss of the ability to control urination can also result from constant serious physical exertion associated with hard physical labor or engaging in certain sports.
Female urinary incontinence is not only a medical but also a social problem. Many people are embarrassed to talk about it with their doctor. This is a completely wrong approach, since this disease can be successfully treated in the vast majority of patients.
Not Found (# 404)
Choosing a specialist service
Click to select a service
Select date and address
A repeated consultation is considered to be a consultation of one specialist within 30 days from the date of the previous appointment.On the 31st day from the previous visit to a specialist of this profile, the consultation will be primary.
Correction of urinary incontinence | Medical center “Orange” Mytishchi
Urinary incontinence is a common female problem. Sometimes it develops after complex or multiple births, but in most cases, the pathology is associated with age-related changes in hormonal levels.In older women, the elastic tissues of the muscles and ligaments of the pelvic floor gradually weaken. The tone of the urethra worsens, urine begins to leak involuntarily. In gynecology, the treatment of urinary incontinence in women is one of the most frequent medical tasks.
Have you encountered an incontinence problem? This situation is naturally stressful. You start to try to leave the house less, communicate with other people less. The reason for this is the fear that involuntary urination will occur. You can solve this problem.Modern gynecologists and surgeons use different methods of treatment to restore the normal functionality of the urinary system. Sign up for a consultation with a doctor by phone +7 (495) 646-80-03.
Depending on the symptoms, the types of incontinence are distinguished in medicine:
- Stressful. In a calm state, the pathology does not manifest itself in any way, but with increased intra-abdominal pressure, urine flows out, and the woman cannot contain it. Any, even insignificant physical activity can become a “trigger”.For example, lifting heavy things, intercourse, sports, sneezing, laughing, coughing.
- Urgent. Symptoms may resemble cystitis. The patient has a sharp, intolerable desire to empty the bladder. It is important that the degree of fullness of the bladder does not matter. The urge occurs even if there is very little urine.
- Mixed. Combines the symptoms of the first two types.
- Enuresis. So in medicine is called a form of involuntary loss of urine at a certain time of the day, for example, at night during sleep.Very often, enuresis in women develops in old age, as a form of senile incontinence.
- Permanent. With this form, urine leaks all the time. The reason is the weakness of the sphincter. Sometimes the problem can be caused by fistulas, abnormalities in the structure of the ureter.
Incontinence is very often associated with stressful conditions, but in itself it is stress. As a result, you worry, and thus further exacerbate the problem. For any type, a doctor’s consultation and correction of urinary incontinence is necessary.
Stress is only one of the causes of spontaneous urination, but do not forget that most of the other provoking factors are somehow associated with strong nervous tension. Pathology can be provoked by:
- Complicated labor. During childbirth, the female body is exposed to severe stress and can be seriously injured. The most common type of injury is soft tissue tears. A difficult birth can result in overstretching of the pelvic floor muscles, resulting in incontinence.
- Genital surgery. For example, surgical methods are the main ones in the treatment of cysts, tumors of any nature.
- Changes in hormonal levels. Most often – due to the onset of menopause in the elderly. It can develop at a younger age with a sharp change in hormone levels.
Stress incontinence is rare in men. This is due to the structural features of the female urethra:
- Small length – only 3-4 cm.
- Larger than men, width (6-10 mm), as a result of which it is necessary that the muscles of the pelvic floor are strong enough.
Other reasons underlie the development of the urgent form. The main feature of this form is the inability to control not only urination, but also urge. For example, women with other forms of incontinence can restrict fluid intake, thereby reducing the likelihood of involuntary urine leakage. In an urgent form, the urge occurs frequently and regardless of how much liquid you drink.
Risk factors are:
- Neurological problems, stroke.
- Postponed genitourinary infection.
Before treating incontinence, your doctor will order a complete examination. Only by accurately establishing the reasons, it is possible to cope with the problem that has arisen. The doctors of our clinic use different methods of treatment, choosing a program based on the results of diagnostics and the clinical picture. We use:
- Medical methods.Urgent incontinence can be successfully managed with medication. The patient is prescribed antispasmodic drugs. If, during the diagnosis, reasons of a mental nature were identified, antidepressants can be prescribed, but only after consulting a doctor with specialized qualifications. Antispasmodics relax the walls of the urinary bladder, so the urge to urge disappears.
- Surgical methods. Surgical treatment of urinary incontinence in women is used for stressful conditions.Surgery is usually recommended for age-related incontinence. Young patients who have a problem after childbirth are first given conservative therapy. Along with traditional surgery, our clinic uses modern methods, for example, laser correction. Minimally invasive methods can successfully treat incontinence, returning a woman to a normal life.
Treatment of bedwetting in adult women requires a complex action. In most cases, an operation is prescribed, in parallel with it, the doctor will prescribe medications.When correcting any type of incontinence, it is very important not only to relieve symptoms, but also to restore the elasticity of the muscles of the bladder, pelvic day, urethra, and the consistency of the sphincter. For this, the treatment of bedwetting in women is supplemented with physiotherapy methods and special gymnastics.
Treatment of incontinence is paid. The cost of the service in the Apelsin clinic depends on the diagnostic and treatment program chosen by the doctor. Remember, incontinence doesn’t go away on its own.The price of refusing treatment is the inability to lead a normal life, the constant fear of being in an awkward situation, since you could not control the urination process.
You need to take care of your health before problems begin to appear. See your gynecologist at least once a year. A preventive examination is the only way to notice the developing pathology in the early stages. Make an appointment with a gynecologist by phone +7 (495) 646-80-03.
North-West Center for Minimally Invasive Gynecology
Currently, urinary incontinence in women is usually divided into three main forms that have different causes, clinical manifestations and, accordingly, treatment methods:
- stress urinary incontinence (stress urinary incontinence, such as coughing),
- Urgent urinary incontinence (urge incontinence associated with urge to urge),
- mixed urinary incontinence.
The first form of the disease is most common.
Stress urinary incontinence (SUI)
Urinary incontinence during coughing, physical activity, sneezing, laughing and other actions accompanied by an increase in intra-abdominal pressure. A synonym for stress urinary incontinence is stress urinary incontinence – NUI, which more clearly reflects the essence of the phenomenon. The essence of stress urinary incontinence (urinary incontinence when coughing, sneezing, laughing, etc.)is reduced to the fact that an increase in intra-abdominal pressure leads to the “squeezing” of urine from the bladder through the urethra (urethra). In this case, the damaged sphincter (closure) apparatus of the urethra is unable to resist the flow of fluid. The fundamental difference between stress incontinence and other types is the fact that urine loss occurs without the participation of the bladder: the muscular wall of the bladder (detrusor) remains relaxed during urine loss.
The causes of stress urinary incontinence are very diverse, but among them the following are more common:
- urinary incontinence after childbirth (large fetus, protracted / accelerated course, rough obstetric allowance, etc.),
- hereditary defects of connective tissue (urinary incontinence is combined with the formation of hernias of the anterior abdominal wall, varicose veins disease, skin laxity, etc.),
- chronic respiratory diseases with coughing and sneezing (urinary incontinence when coughing),
- chronic constipation,
- weight lifting,
- operations on the pelvic organs (for example, removal of the uterus).
Diagnosis of urinary incontinence
In women, stress usually does not cause difficulties and is based on a thorough clarification of the patient’s complaints and examination data.However, for the correct choice of tactics (and in order to avoid mistakes), it is imperative to perform the following special examination protocol:
- filling out specific questionnaires (the best option is ICIQ-SF, UDI-6),
- urination diary compilation,
- Daily or hourly pad test,
- vaginal examination with cough test,
- Ultrasound of the pelvic organs and kidneys,
- complex urodynamic study (KUDI).
The implementation of such a protocol makes it possible to exclude an urgent form of urinary incontinence, which, according to the patient’s complaints, can be mistakenly interpreted as stressful, and to objectify the indications for surgical treatment.
Treatment of stress urinary incontinence in women can be conservative and surgical
Conservative treatments include:
- Pelvic floor muscle training (Kegel exercises),
- correction of general and local hormonal levels,
- treatment of respiratory diseases, chronic constipation, etc.
Unfortunately, in the vast majority of cases, conservative therapy is ineffective, since stress urinary incontinence in women is caused by an anatomical (structural) defect in the musculo-fascial apparatus of the pelvic floor. The only way to correct this defect is surgery .
Implantation of a synthetic mid-urethral sling (sling operation, TVT, TOT, etc.)
It is the current “gold standard” treatment for stress urinary incontinence in women, with long-term efficacy of up to 85-90%.By now, all the fundamental stages of the sling operation have been worked out to the smallest detail. For the implantation of a synthetic sling, in most cases, regional anesthesia is used (the patient is awake). The tape is installed through an incision on the anterior wall of the vagina no more than 1 cm long and 2 skin punctures (less than 5 mm) in the groin folds or in the suprapubic region. After 2-3 months, even a professional may not find “traces” of the sling operation. The patients are discharged from the hospital on the next day after the manipulation.The return to full activity (including sex life) usually occurs 1 month after sling surgery.
Some differences exist in the methods of implantation of tapes from different manufacturers. Today, implants of various companies are presented on the medical device market: UroSling (Lintex, St. Petersburg), TVT, TVT-O, TVT-Secur (J&J), Monarc, Miniarc (AMS), Aris (Coloplast), etc.
Despite the obvious advantages of sling operations, their prevalence is still insufficient.The main reasons for this are the overly conservative views of clinicians, reluctance to master new technologies and the lack of information about inexpensive domestic implants available to all segments of the population.
Thus, at present, the treatment of stress urinary incontinence is a problem that has an effective and safe solution.
Urinary incontinence in women – GUZ “Tula Regional Clinical Hospital No. 2 named after L.N. Tolstoy “
Stress urinary incontinence in women – TVT surgeries – implantation of a free synthetic loop
Stress urinary incontinence in women is one of the most common and difficult problems in modern medicine.Urinary incontinence causes severe physical and mental suffering. Treatment and rehabilitation of patients with urinary incontinence has not only medical but also social significance. The International Society for Urinary Continence (ICS) has identified urinary incontinence as a major problem requiring further study.
About a third of all women who visit a gynecologist every year indicate symptoms of involuntary urination during exercise. Most often, urinary incontinence occurs in women between the ages of 40 and 50.According to sociological surveys, symptoms of urinary incontinence, manifested in isolated episodes or are of a regular nature, are noted by up to 40% of all women. Unfortunately, only every tenth of these women goes to the doctor because of a sense of false bashfulness and ignorance about the possibility of effective treatment.
The main causes of stress urinary incontinence are:
- severe, prolonged or rapid labor
- gynecological interventions (extirpation of the uterus, removal of interligamentous tumors)
- endourethral operations
- unbearable physical labor
- perineal injury
The disease is manifested by the involuntary flow of urine during physical activity (laughing, coughing, sneezing, running, lifting weights), while the amount of involuntarily excreted urine does not always correspond to the degree of physical exertion.Urinary incontinence can occur at a young or old age.
Speaking about the reasons for the development of urinary incontinence at stress , one cannot but dwell on the mechanism of normal urination. It is carried out as follows: the wall of the bladder (detrusor) contracts, the neck of the bladder opens and the muscle sphincters relax, which then close after emptying the bladder, at which time the detrusor relaxes. Muscle activity peaks before urination and gradually decreases during urination.
Thus, urinary incontinence occurs as a result of dysfunction of the urinary bladder sphincters, in which anatomical hormonal changes occur. According to many researchers, one of the factors in the development of stress urinary incontinence is a decrease in the anatomical length of the urethra (3 centimeters is the critical length of the urethra that allows a woman to retain urine).
For the mechanism of urinary retention, the preservation of the posterior urethrocystic angle is essential.Its value at rest ranges from 130o to 160o, and under tension – from 145o to 180o.
Treatment of stress urinary incontinence using a free synthetic loop (TVT).
With the development of scientific and technological progress, scientists from different countries have used various synthetic materials. At present, polypropylene is widely used in loop operations in the world. The use of synthetic materials makes it possible to minimize surgical intervention, which undoubtedly reduces the invasiveness of the operation.
Loop operations are rightfully the main ones in the surgical treatment of urinary incontinence. The TVT method, or plastic free synthetic loop, has earned the most recognition around the world. Over the past 5 years, more than 200,000 such operations have been performed in Europe, and the discussion of the advantages of this method continues. The method was developed at the University Hospital of Uppsala (Sweden).
Indications for surgery using a free synthetic loop are:
- stress urinary incontinence predominantly, also in combination with cystocele and genital prolapse
- Recurrent stress urinary incontinence
Contraindications to surgery are:
- organic bladder obstruction
- cicatricial changes in the anterior wall of the vagina
- acute inflammatory diseases of the urethra and bladder
- colpitis, sexually transmitted diseases
- severe concomitant diseases
A special tool kit is used for operation TVT .The set is represented by a sterilely packed prolene loop in a polyethylene case – a casing, special needles are fixed to each end of the loop – perforators, with the help of which this loop is passed from the vagina to the suprapubic region. There is also a pusher handle and a Foley catheter guide.
The main advantage of the operation, along with its low trauma, is the ability to control the loop tension, since the operation is performed under local anesthesia, which ensures constant contact with the patient during the operation.
A prolene tape is used as a loop, which does not have fixation, that is, free tension is applied. Prolene does not dissolve, it is encapsulated in tissues without losing its original tensile strength. There are no contraindications to its use. This speaks of the safety of this method. The duration of the operation is about 30 minutes.
Operation using a free synthetic loop is effective in 97% of cases in the treatment of patients suffering from stress urinary incontinence, combined with cystocele and genital prolapse.
Local anesthesia makes it possible to carry out a cough test during the operation, that is, to immediately monitor the results of the operation. The use of prolene inert material reduces the trauma of the operation, turning it into a minimally invasive, almost percutaneous intervention, which is an integral advantage of this manual.
The use of small incisions avoids gross scarring of the anterior vaginal wall and preserves fertility and sexual function.
This technique can be recommended as the operation of choice in patients with urinary incontinence, as well as in the case of a combination of urinary incontinence with genital prolapse and cystocele simultaneously with other vaginal interventions.
Write a comment
- Required fields are marked with * .
90,000 Why incontinence occurs in sexually transmitted infections
A very wide range of conditions can cause urinary incontinence.Not the last place in this list is occupied by sexually transmitted infections (STIs). It is possible to successfully cope with the problem, but the necessary conditions for this will be – complex treatment and adherence to hygiene recommendations.
One of the main dangers of sexually transmitted infections (STIs) is the high risk of complications. This is due to the fact that many people postpone the examination and visit to the doctor, or are not serious about adhering to medical recommendations.
What causes difficulties in STI treatment?
1. Latent flow. Even people who are very attentive to their well-being often cannot notice signs of genital infections at the initial stage of the disease. The fact is that the first stages of diseases caused by papillomavirus infection (the cause of genital warts), cytomegalovirus infection, chlamydia, hepatitis, HIV proceed without pronounced symptoms. A person can continue to lead his usual way of life all this time.As a result, the lack of timely treatment leads to an aggravation of the course of the infection and to its transmission to other people.
2. “Blurred”, “blurred” first symptoms. The first manifestations of some genital infections may not be taken into account, since they do not cause serious discomfort and appear only periodically. Among such symptoms are episodes of fever, pulling pain in the lower abdomen and itching in the genital tract with the appearance of discharge from them. Standard tests (general blood test, smear for flora), which are taken at the clinic during a medical examination, in some cases are not able to detect STIs.
3. Deliberate procrastination with a visit to the doctor. Sometimes people are embarrassed to go to the doctor with delicate problems and try to solve them with self-medication, which usually turns out to be ineffective. As a result, the disease can imperceptibly turn into a chronic form and favorable conditions will be created for reducing the effectiveness of treatment and the appearance of complications.
Urinary incontinence as a complication of STIs
Problem with urination control can occur as one of the complications of most genital infections.Urinary incontinence (incontinence) is not a necessary symptom or consequence of an STI, but it can occur in some people as a result of a complicated course of the disease.
Sexual infections are accompanied by the development of inflammatory processes in the pelvic organs. As a result, disturbances in the sensitivity of the receptors of the organs of the genitourinary system may occur. This makes it difficult to control urination. At first, urinary incontinence may be barely noticeable (just a few drops per day), but with a prolonged course of STIs, incontinence becomes more serious.
Sexually transmitted diseases are most dangerous for pregnant women. When registering with an antenatal clinic, the doctor prescribes a set of studies, including tests for STIs. It is then that some women first learn about the presence of the disease. Due to the limited list of drugs that are safe for the unborn child, the treatment of genital infections during pregnancy is very difficult, but possible and extremely necessary. In addition to this, the expectant mother may face urinary incontinence during this period due to the increasing pressure of the growing baby on the bladder, and genital infections aggravate the incontinence.Therefore, absorbent hygiene products are an indispensable aid for pregnant women, able to restore them a sense of comfort and confidence.
Complications resulting from genital infections may require surgical treatment. After some operations, the problem of urinary incontinence also occurs, especially in men. For example, surgical treatment of prostate problems can lead to a weakening of the bladder sphincter and intermittent urine leakage. Despite the risk of such complications, treatment helps to get rid of more serious problems, preserve health and even life.And special absorbent products help to comfortably solve the problem of incontinence for the entire period of postoperative recovery.
How to reduce the manifestations of urinary incontinence
It can take several weeks to several months to effectively treat STIs and get rid of their consequences. By following simple rules, you can independently minimize the problem of incontinence, making the process of treatment and rehabilitation easier:
1.Adjust the amount of fluid you drink. Try to drink approximately equal, moderate amounts throughout the day to prevent overfilling of your bladder.
2. Limit or exclude diuretic foods (coffee, alcoholic beverages, berries, tea).
3. Try to go to the toilet on time, that is, empty your bladder before it becomes too full and the urge becomes difficult to contain.
4.Tone your pelvic floor muscles. Kegel exercises are optimal for this. After consulting with a specialist, you can use special devices for such activities. With exercise, you can gradually regain control of urination. Exercises for the pelvic floor muscles can be done not only if incontinence occurs, but also to prevent this problem in the future.
5. Normalize your weight. If you are overweight, it can worsen the problem of incontinence.Therefore, it is advisable to get in shape with a balanced diet and physical activity.
Correct hygiene for urinary incontinence
Often in the course of the course of STI treatment, it is necessary to simultaneously solve the problem of incontinence. It is important that in the course of therapy, which can last weeks or months, the person does not lose the opportunity to live a normal life and keep his problem a secret. In this case, proper hygienic care is an important prerequisite for a comfortable treatment.
Special absorbent hygiene products such as urological pads can help you stop worrying about urine leaks and bad odors. When choosing the best option for a product, take a look at the extensive line of hygienic absorbents from the iD brand.
How to choose the right urological pads for your case? If you are not sure that you can tell the exact amount of urine leaking right away, you should start with the medium absorbency iD LIGHT Normal option.If the pad fills up too quickly, select a product with a higher absorbency (iD LIGHT Extra, iD LIGHT Extra Plus or iD LIGHT Maxi). At the final stage of treatment, if minimal drip of urine remains, you can switch to the thinnest iD LIGHT Ultra Mini until incontinence is completely eliminated. A quick and simple test can help you better determine your choice of absorbent product and the degree of urinary incontinence.
Some types of genital infections (gonorrhea, chlamydia, and candidiasis) are accompanied by profuse discharge that conventional sanitary napkins cannot completely cope with.And the iD LIGHT urological pads can solve this delicate problem. Their absorbent layer turns liquid secretions into a gel, which reliably traps moisture and odor inside the product, preventing leakage.
Another frequent companion of genital infections is severe itching and irritation of the skin and mucous membranes of the genital organs. Leaking urine exacerbates these symptoms, which can cause persistent discomfort throughout the day. The iD LIGHT urological pads are formulated with a soft breathable material that is dermatologically proven hypoallergenic to prevent skin irritation.
The iD hygiene products are comfortable even after prolonged use and are not visible under clothing, which allows people undergoing long courses of treatment to stay in the rhythm of their usual lifestyle.
Peculiarities of urination in gynecological patients
I.Yu. ILYINA , Candidate of Medical Sciences, Associate Professor, Yu.E. DOBROKHOTOVA , Doctor of Medical Sciences, Professor, State Budgetary Educational Institution of Higher Professional Education “Russian National Research Medical University named afterN.I. Pirogov “Ministry of Health of Russia, Moscow
The problem of urinary incontinence is one of the most common diseases among women, especially in old age. Some gynecological diseases are characterized by the development of various types of urinary disorders, such as stress urinary incontinence and an overactive bladder. Depending on the reasons that led to the development of urination disorders and the characteristics of the course of this pathology, various types of treatment are recommended.
The problem of urinary incontinence is one of the most common diseases in women, especially in old age [1-3].
The International Society for the Study of Urinary Continence (1974) defined urinary incontinence as a condition in which involuntary loss of urine is a social and hygienic problem and is objectively confirmed [4-6].
Women suffering from various disorders of urination rarely see a specialist because of embarrassment.Many of them believe that this phenomenon is quite natural and that every woman ever notes the symptoms of urinary incontinence. At the same time, some are skeptical about the possibility of treatment by a specialist, since they do not believe in the effectiveness of treatment of this pathology [3, 6, 7].
The interaction of several mechanisms plays a role in urinary retention both at rest and under stress: the resistance of the urethra and bladder closure apparatus, the stability of the urethral anatomical support, and adequate innervation of all of the above components [8–10].
There are many different classifications of this pathology. In gynecological practice, one has to deal mainly with stressful and imperative types of urinary incontinence, as well as their combination:
Stress urinary incontinence is an involuntary discharge of urine with an increase in intravesical pressure over intraurethral pressure, but in the absence of detrusor activity [4, 6, 7]. According to estimates of domestic and foreign literature, the incidence of stress urinary incontinence in women ranges from 5 to 78%.Up to 20% of such patients are found at urological appointments and up to 31% at gynecological appointments [4, 8].
The cause of stress urinary incontinence is a dysfunction of the sphincter apparatus of the bladder and urethra, which occurs when the normal urethrovesical relationship changes [6, 8].
Normally, in a standing woman, the bladder neck and proximal urethra are located in the abdominal cavity above the pelvic floor, so the pressure in the urethra is equal to or greater than the pressure in the bladder.With various violations of the normal anatomical urethrovesical relationship with an increase in intra-abdominal pressure, intravesical pressure exceeds the urethral pressure, which leads to urinary incontinence [4, 5].
The causes of stress urinary incontinence are the same as in genital prolapse. Most often, this is pathological childbirth (rapid or protracted) – in 51.1% of cases, as a result of which traumatic and trophic disorders develop in the walls of the urethra and the bladder neck (hematomas, ischemic areas, muscle fiber tears), later their atrophy occurs and replacement with fibrous tissue, the elastic properties of the urethrovesical segment are impaired [4, 13].Heavy physical exertion (20.6% of cases) associated with a prolonged static increase in intra-abdominal pressure leads to a weakening of the ligamentous apparatus of the pelvic floor, disruption of the anatomical and functional urethrovesical relationships. However, it should be emphasized that physical overstrain on its own rarely leads to urinary incontinence. The disease occurs due to a number of other reasons, and progresses under the influence of physical activity and inflammatory processes in the urogenital organs [4, 8].Hormonal disorders (15.6% of cases) that occur in postmenopausal women lead to a decrease in the synthesis of estrogens, hypotrophy of the epithelium of the bladder triangle and urethra, a decrease in the sensitivity of adrenergic receptors of the bladder neck and tissue turgor due to a decrease in the amount of water in them, as a result of which there is a violation of the closure mechanisms [11, 13]. During operations on the pelvic organs (12.7% of cases), muscle-fascial formations are injured, cicatricial changes develop in the paraurethral tissues, leading to a shortening of the anatomical and functional length of the urethra [4, 12].
Therefore, stress urinary incontinence is a serious medical and social problem that has an extremely negative impact on the psychological state of patients.
Overactive bladder is a clinical syndrome that determines urgency (with or without urge incontinence), which is usually accompanied by frequent urination and nocturia (urination from falling asleep to awakening) .
Urgent (imperative) urinary incontinence – the involuntary flow of urine with a strong urge to urinate.The incidence of urge incontinence in the general population is 30–50% [4, 13]. By the strength of its behavioral influence, urge urination has a stronger psychological effect than stress urination [6, 7].
The cause of frequent and urgent urination in most patients is detrusor overactivity. According to the definition of the last committee for the standardization of terminology of the function of the lower urinary tract (2002), the term “detrusor overactive” refers to involuntary contractions of the detrusor (amplitude greater than 5 cm H2O.Art.), which arise spontaneously or can be caused deliberately (when changing body position, coughing, etc.), despite the fact that a person is trying to suppress these contractions by volitional effort (Abrams P. et al., 2002; Rovner ES, Wein AJ, 2002).
Thus, at present, the term “overactive bladder” (OAB) is a general name for all the above clinical manifestations and violations of the act of urination [13, 14].
Simeonova Z. et al. (1999) found that OAB symptoms are more common in women over the age of 50 compared with women under the age of 50.This fact is confirmed by morphological changes in the bladder wall . Susset J.G. et al. (1978) found an increase with age in the collagen content in the detrusor, which can lead to an increase in the elasticity of the bladder wall and further to symptoms of OAB. Further Bercovich E. et al. (1999) confirmed that in older people the content of collagen in the bladder wall is 20–30% higher than in middle-aged and young people [13, 14]. All authors noted an increase in collagen content, mainly of the 1st and 2nd types.These forms of collagen have strong cross-links, which can help to increase the elasticity of the wall and, as a result, lead to a decrease in the adaptive capacity of the bladder. Additionally, research by Susset J.G. (1983) noted that with age in the detrusor, along with an increased content of collagen, there is also a decrease in the density of nerve fibers.
Clinic of urgent urinary incontinence is associated with damage to the upper motor neuron (above the lumbar spinal urinary center).The sacral parasympathetic center of the bladder is in an overactive state and receives an inhibitory effect from the overlying parts of the spinal cord. The beginning and end of the act of urination is considered as the cessation or resumption of supraspinal inhibition. At the same time, there is no inhibitory effect of the cortical and subcortical centers of urination on the spinal centers and the bladder. In addition to central denervation and out of control of hypermotor spinal centers, the mechanism of hypermotor dysfunctions of the bladder may be associated with peripheral denervation of the bladder wall [4, 7, 14].
Various gynecological operations are often the cause of urgency urinary incontinence [4, 12]. This complication occurs due to the fact that the lower-posterior surface of the bladder is in contact with the body of the uterus. The lateral surfaces of the bladder are adjacent to the wide ligaments of the uterus, where the uterine arteries pass, and its neck corresponds to the middle part of the anterior wall of the vagina. This explains the high incidence of bladder injuries during hysterectomies.Somewhat less often, the bladder is injured during surgical interventions for benign neoplasms of the uterus and appendages. Especially often the bladder is injured with large tumors emanating from the anterior surface of the cervix .
Thus, the process of urinary retention mainly depends on the tone of the pelvic floor muscles, the state of collagen fibers in the ligamentous apparatus of the small pelvis, as well as the detrusor muscles of the bladder. Optimal urethral function is closely related to structures outside the urethra: the pubic-urethral ligaments, the suburethral vaginal wall, the pubococcygeal muscles, and the levator muscles.A very important factor is the state of collagen in these structures. The state of blood supply and trophism of the detrusor muscles, pelvic floor, and collagen fibers to a certain extent depends on the level of estrogen [4, 13]. For an adequate increase in intra-urethral pressure with an increase in intra-abdominal pressure, a full-fledged state of the urothelium, elasticity of collagen, which is part of the connective tissue of the urethra, preserved smooth muscle tone of the urethral wall, and full vascularization of the urethra are necessary.In all of these structures, receptors for estrogens, progesterone and androgens are located, and the conditions of estrogen deficiency determine the rapid development of urogenital atrophy. After menopause, low estrogen levels lead to general cellular, biochemical, bacteriological and anatomical changes in the urinary tract [11, 13].
Urgent urinary incontinence is treated conservatively, and treatment is aimed at suppressing the motor activity of the bladder and increasing its functional capacity.To do this, use pharmacological drugs, hyperthermic manipulations, inhibitory electrical stimulation of the muscles of the perineum, electrical stimulation of the sacral nerves, training of “intimate muscles” according to Kegel, etc. [4, 11, 14]. Most often, physiotherapeutic and physical therapy measures in these patients are not effective, which necessitates the search for new opportunities in their recovery.
Drug therapy is the first and main method of treatment for all forms of overactive bladder.Medicines used to treat OAB belong to different pharmacotherapeutic groups and are distinguished by their mechanism of action .
Among medicines, anticholinergic drugs are the first line of treatment. M-anticholinergics, suppressing M-cholinergic receptors, reduce the contractile function of the bladder (there are two types of muscarinic receptors in the detrusor (M2 and M3) [4, 14]. To date, there are five types of muscarinic receptors that are present in the brain (cortex, hypothalamus), heart, smooth muscles, basal parts of the forebrain, etc.and this is the reason for the appearance of such side effects when using drugs of this group, such as dry eyes, skin, disorders of the gastrointestinal tract, visual impairment, from the side of the central nervous system – dizziness, headache, irritability, drowsiness.
This group of drugs includes atropine sulfate, tolterodine tartrate (Appel R.A. et al., 1997; Jonas U. et al., 1997) . Often used is trospium chloride (Spazmex), which, in addition to anticholinergic, has a moderate ganglion blocking effect.There are indications of a small number of side effects when using it.
All anticholinergic drugs belong to tertiary ammonium compounds and are lipophilic and, accordingly, penetrate the blood-brain barrier. Trospium chloride (Spazmex) is the only quaternary ammonium, due to which it acquires a positive charge, becomes hydrophilic and does not penetrate the blood-brain barrier.
Thus, trospia chloride (Spazmex) is a drug that can be used even in elderly, neurological patients due to the fact that it does not penetrate the BBB, does not cause central side effects, has a local effect on the urothelium, has a direct muscle relaxant effect, there is no metabolism by the cytochrome P450 system and, therefore, there is no hepatic metabolism, which allows you to significantly change the dosage of the drug without fear of toxic effects on the liver.
Since one of the main links in the pathogenesis of the development of urogenital problems is the development of an estrogen-deficient state, it seems logical to prescribe hormone replacement therapy in order to correct them [4, 9, 10, 13, 14].
In the presence of only sensory manifestations of atrophic cystourethritis and vaginitis, ie, with mild manifestations, the use of local therapy is shown mainly . In patients with mild and moderate severity of urogenital disorders, systemic therapy is used to correct both local and systemic manifestations of hypoestrogenism.
1. Alekseeva E.P. Urogenital disorders in women of reproductive age after hysterectomy. Abstract of the thesis. Cand. honey. sciences. M., 2000.28.
2. Pushkar D.Yu., Laurent O.B., Benizri E.V., Korsunskaya I.L., Labazanov G.A. Modified sling surgery for correction of stress urinary incontinence in women. Reconstructive plastic surgery. Collection of scientific papers dedicated to the 70th anniversary of the birth of Professor D.V. Kahn. M., 1998: 22-30.
3. Chapple CR, Bosch R, Hanus T. Female incontinence. EUR. Urol. 2000.38 (4).
4. Zhdanova M.S. Genital prolapse in women with connective tissue dysplasia, management tactics. Abstract of the thesis. Cand. honey. sciences. M., 2009.24.
5. Pereverzev A.S. Clinical urogynecology. Kharkov, 2000: 128-264.
6. Savitsky G.A., Savitsky A.G. Stress urinary incontinence in women. SPb., 2000: 57-122.
7. Pushkar D.Yu.Diagnostics and treatment of complex and combined forms of urinary incontinence in women. Abstract of the thesis. doct. honey. sciences. M., 1996.46.
8. Kahn D.V., Laurent O.B., Eremin B.V. Diagnosis and treatment of stress urinary incontinence in women. Methodical developments of the Moscow State Museum of Modern Art. ON. Semashko. M., 1987.55.
9. Bergnik EW, Kloosterboer HS, Van der Vies H. Estrogen binding proteins in the fetal genital tract. J. Steroid Biochem 1997; 20: 1057-1060.
10. Colleselli K, Stenzl A, Eder R, Strasser H, Poisel S, Bartsch G.