Incontinence in women: causes, symptoms and treatment of a delicate problem

Incontinence in women is a condition in which involuntary flow of urine occurs. Urinary incontinence is divided into overflow incontinence, anatomic incontinence, functional incontinence and total incontinence.

In 20% of women, involuntary discharge of urine is observed at the age from 20 to 55 years, in 15% of women - up to 35 years, in 28% - after 55 years.

Symptoms and causes of urinary incontinence in women

There are two main causes of urinary incontinence. Urinary incontinence may occur when pressure is applied to the bladder at the time of laughter, sneezing, coughing, and other actions. Urinary incontinence caused by stress is not manifested in sleep and when changing the position of the body.

The cause of urinary incontinence in women can be an uncontrollable urge to urinate, which occurs when involuntary contraction of the muscles of the bladder.

Incontinence may be due to pelvic floor insufficiency. After an injury to the pelvic floor, the uterus, bladder and walls of the vagina descend, changing their natural location. Urinary incontinence can be triggered by hereditary factors, various anatomical disorders (acquired and congenital), surgical interventions, hard labor, urinary infections, taking certain medications, being overweight.

This disease can gradually develop with bladder stones, pelvic organ prolapse, diabetes mellitus, Alzheimer's disease or Parkinson’s disease, multiple sclerosis, bladder cancer, stroke, spinal cord injury, and after suffering a hysterectomy (removal of the uterus) and chronic cough associated with smoking or a long course of bronchitis.

Urinary incontinence can develop during smoking, with insufficient fluid intake and caffeine abuse.

Incontinence symptoms

In women with urinary incontinence, the urge to urinate is not constant. Symptoms of impulses may vary depending on the specific situation and lifestyle. However, for all the symptoms, there is always an unstoppable desire to urinate. Increased urination occurs at night. With increased urination, the patient's condition worsens, as the bladder no longer holds a large volume of urine.

The urge to urinate with urinary incontinence may occur even with an almost empty bladder. A small amount of urine flows in a stream, in a strong stream or in drops. Excretion of urine occurs when running, walking, in bed, at the sound of water pouring from the tap. Neurogenous incontinence is manifested when the bladder is over-stretched. When the bladder is completely filled, the fluid pressure overcomes the resistance of the sphincter, and urine leaks out of the bladder. With this type of violation, women are usually not able to urinate with a strong even stream.

Methods of diagnosis and treatment of urinary incontinence in women

To clarify the diagnosis of urinary incontinence in women, the doctor specifies the details of the development of the disease and conducts a medical examination. The presence of infection in the bladder helps to determine the culture for sterility, urinalysis, and urine culture. To conduct a stress test for the bladder, the doctor injects fluid into the bladder and asks for coughing. And in Bonnie's test, lifting (tightening) the bladder neck occurs with a tool or a finger inserted into the vagina. The pads test helps determine how often and how much urine leakage occurs during the day.

In addition, during incontinence, the doctor may prescribe cystometry to cystometry, uroflowmetry - a series of tests to determine the pressure in the bladder at different fullness. In cystometry, the leakage pressure and the maximum force of the urethra are determined. The method of ultrasound diagnostics and X-ray diffraction helps to determine the residual amount of fluid in the bladder after urination. They help determine the position of the urethra and bladder during tension, coughing and urination.

Individual patients are prescribed cystoscopy - a method of studying the internal structure of the bladder and urethra using a thin endoscope. Physical defects of the urinary system help cytourethrogram. In this method, iodine-containing contrast is used to obtain an X-ray of the inner walls of the urethra and bladder.

There are many approaches to treating urinary incontinence in women. The best methods of treatment are based on combating the cause of urinary incontinence. And depending on the cause of the violation, physiotherapy, physical exercise, hormone therapy, drug therapy, psychotherapy or surgical therapy are used. Health can be improved by replacing one drug for urinary incontinence in women with another, while eliminating the pathological condition underlying the disorder.

Kegel exercises can help with any type of urinary incontinence in women. These exercises help to strengthen the muscles of the abdominal cavity and pelvis. When performing exercises, patients should strain pelvic muscles three times a day for three seconds. The effectiveness of the use of a pessary, special intravaginal rubber devices largely depends on the type of incontinence and the individual characteristics of the anatomical structure of the body.

It is quite possible to strengthen the pelvic muscles with extracorporeal magnetic stimulation. During this procedure, the magnetic field acts on the nerve endings of the body.

Urinary incontinence during physical exertion, but without weakening the muscles of the pelvic floor, vaginal atrophy is treated with various drugs (for example, decongestant and decongestant Zyudfed). It is believed that some urinary incontinence drugs in women are capable of providing a lifelong therapeutic effect.

If urinary incontinence is caused by a prolapse or prolapse of the uterus, then surgery is not necessary. Incontinence surgery in women can also eliminate fistulas, which can cause incontinence.

Incontinence operations in women are performed either by intravaginal or abdominal access under general anesthesia. In extremely severe cases, incontinence is treated by enlarging the bladder or urine.

Medical expert articles

Quite often, prolapse of the genital organs is accompanied by stress urinary incontinence (NMPN) and cystocele. The main cause of the cystocele is the weakening of the pubocervical fascia, the divergence of the cardinal ligaments, and the defect of the detrusor muscle itself. The formation of the cystocele is accompanied by the omission of the anterior wall of the vagina, the urethro-vesicular segment and, accordingly, the violation of urination.

Urinary incontinence is a pathological condition in which volitional control over the act of urination is lost, a complaint of any involuntary leakage of urine.

Epidemiology

Shyness and the attitude of women to the problem as an integral sign of aging leads to the fact that the figures do not reflect the prevalence of the disease, but it should be noted that 50% of women aged 45 to 60 years have ever experienced involuntary incontinence. In a study conducted in the USA, out of 2,000 women over the age of 65, urgent urination occurred in 36% of respondents. According to D.Yu. Pushkar (1996), the incidence of urinary incontinence among women is 36.8%, according to I.A. Apolikhina (2006) - 33.6%.

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Causes of urinary incontinence in women

Births are considered the leading cause of urinary incontinence: stress urinary incontinence is observed in 21% of women after spontaneous i labor and in 34% after the application of pathological obstetric forceps.

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At present, it has been proven that the main role in the development of this disease is played by pathological births. Involuntary discharge of urine often occurs after difficult childbirth, worn protracted or accompanied by obstetric operations. A constant companion of pathological labor is trauma to the perineum and pelvic floor. However, the occurrence of urinary incontinence in unborn women and not even sexually active, was forced to reconsider the issues of pathogenesis. Numerous studies have shown that in case of urinary incontinence there is a pronounced disturbance of the closing apparatus of the bladder neck, changes in its shape, mobility, axis “bladder-urethra”. S. Raz believes that urinary incontinence should be divided into two main types:

  • a disease associated with the dislocation and weakening of the ligamentous apparatus of the unchanged urethra and urethrovesical segment, which is attributed to anatomical incontinence,
  • disease associated with changes in the urethra and sphincter apparatus, leading to dysfunction of the switching device.

Stress urinary incontinence combined with prolapse of the genitals in 82% of cases, mixed - in 100%.

The condition for the retention of urine is considered a positive gradient of urethral pressure (pressure in the urethra exceeds intravesical pressure). When urination is disturbed and urinary incontinence, this gradient becomes negative.

The disease progresses under the influence of physical exertion and hormonal disorders (a decrease in the concentration of estrogens in menopause, and in women of reproductive age a significant role is played by fluctuations in the ratio of sex and glucocorticoid hormones and their indirect effect on α and β adrenoreceptors). An important role is played by connective tissue dysplasia.

In the genesis of genital prolapse and urinary incontinence, the decisive role belongs not only to the total number of genera, but also to the peculiarities of their course. So, even after uncomplicated childbirth, 20% of women show a slowdown in distal conduction in the sensory nerves (in 15% of cases, a transient one). This suggests that the lumbosacral plexus is damaged in childbirth, as a result of which the paralysis of the obturator, femoral and sciatic nerves develops, and as a consequence, urinary and feces incotinence. Moreover, incontinence of urine and feces after normal labor is due to stretching of the muscles or damage to the tissues of the perineum due to a violation of the innervation of the pelvic floor sphincter muscles.

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J. G. stronglaivas and E. J. McGuire in 1988 developed a classification that later underwent numerous additions and changes. This classification is recommended for use by the International Urine Retention Society (1CS) and is generally accepted.

International Classification of Incontinence

  • Type 0. At rest, the bottom of the bladder is above the symphysis joint. When coughing while standing, a slight turn and dislocation of the urethra and the bottom of the bladder are determined. When you open his neck spontaneous urine is not observed.
  • Type 1. At rest, the bottom of the bladder is above the symphysis joint. When straining occurs, the bottom of the bladder descends approximately 1 cm, while opening the bladder neck and urethra, an involuntary discharge of urine. Cystocele may not be detected.
  • Type 2a. At rest, the bottom of the bladder is at the level of the upper edge of the symphysis. When coughing occurs, a significant pubescence of the bladder and urethra occurs below the pubic symphysis. At wide opening of an urethra spontaneous release of urine is noted. Determined by cystocele.
  • Type 26. At rest, the bottom of the bladder is below the pubic joint. When coughing is determined by a significant omission of the bladder and urethra, which is accompanied by a pronounced spontaneous discharge of urine. Determined by cystotourtrocele.
  • Type 3. At rest, the bottom of the bladder is slightly below the upper edge of the pubic symphysis. The bladder neck and proximal urethra are open at rest in the absence of detrusor contractions. Spontaneous urine excretion is observed due to a slight increase in intravesical pressure. Urinary incontinence occurs with the loss of the anatomical configuration of the posterior vesicourethral angle.

As can be seen from the above classification, during urinary incontinence of types 0, 1 and 2, the normal urethrovesical segment and the proximal part of the urethra dislocate, which is often accompanied by the development of the cystocele or is a consequence of it. These types of urinary incontinence are called anatomic incontinence.

In the case of incontinence of type 3, the urethra and bladder neck do not function any more, like the sphincter and are more often represented by a rigid tube and a scar-modified urethrovesical segment.

The use of this classification allows you to standardize approaches to such patients and optimize the choice of treatment tactics. Patients with urinary incontinence type 3 need to form additional support for the urethra and bladder neck, as well as to create a passive retention of urine by compressing the urethra, since the sphincter function in these patients is completely lost.

Urinary incontinence is divided into true and false.

  • False urinary incontinence - involuntary urination without urging to urinate, may be associated with congenital or acquired defects of the ureter, urethra and bladder (bladder exstrophy, absence of its anterior wall, total episode of the urethra, etc.).
  • The classification of true urinary incontinence, as defined by the International Urine Retention Society ICS (2002), is as follows.
    • Stress urinary incontinence, or stress urinary incontinence (NMPN), is a complaint of involuntary urine leakage in tension, sneezing or coughing.
    • Urge incontinence is an involuntary leakage of urine that occurs immediately after a sudden sharp urge to urinate.
    • Mixed urinary incontinence is a combination of stress and urgent urinary incontinence.
    • Enuresis is any involuntary loss of urine.
    • Night enuresis - complaints of loss of urine during sleep.
    • Incontinence of urine from overflow (paradoxical ischuria).
    • Extraurethral urinary incontinence - urinary excretion in addition to the urethra (typical of various urinary fistulas).

Overactive bladder (GMF) is a clinical syndrome characterized by a number of symptoms: frequent urination (more often 8 times a day), imperative urges with (or without) imperative urinary incontinence, nocturia. Urge incontinence refers to the manifestation of an overactive bladder.

Urge incontinence is an involuntary leakage of urine, due to a sudden sharp urge to urinate, due to an involuntary contraction of the detrusor during the bladder filling phase. Detrusor hyperactivity may be due to neurogenic and idiopathic causes when neurogenic pathology is not established, as well as their combination.

  • Idiopathic causes include age-related changes in the detrusor, myogenic and sensory disturbances, as well as anatomical changes in the position of the urethra and bladder.
  • Neurogenic causes are the result of suprasacral and supraspinal injuries: the consequences of circulatory disorders and injuries to the brain and spinal cord, Parkinson's disease, multiple sclerosis, and other neurological diseases that lead to impaired detrusor innervation.

The classifications considering the symptoms of urgency from the point of view of a doctor and a patient proposed by A. Woowden and R. Freeman in 2003.

The scale for assessing the severity of clinical manifestations of imperative symptoms:

  • 0 - no urgency,
  • 1 - mild
  • 2 - the average degree
  • 3 - severe.

R. Freeman classification:

  • usually can not hold urine
  • I hold urine if I go to the toilet immediately,
  • I can "finish" and go to the toilet.

This scale is actively used to assess the symptoms of detrusor hyperactivity. Symptoms of overactive bladder and urgent incontinence must be differentiated from stress urinary incontinence, urolithiasis, bladder cancer, interstitial cystitis.

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General information

Incontinence of urine in women is an involuntary and uncontrolled urine excretion from the urethra, due to violations of various mechanisms of regulation of miccia. According to the available data, every fifth woman encounters involuntary urine release in reproductive age, every third woman in perimenopausal and early menopausal age, and every second in elderly (after 70 years).

The problem of urinary incontinence is most relevant for women who have given birth, especially those with a history of natural childbirth. Urinary incontinence has not only hygienic, but also medical and social aspects, since it has a pronounced negative effect on the quality of life, accompanied by a forced decrease in physical activity, neurosis, depression, sexual dysfunction. The medical aspects of this disorder are considered by experts in the field of theoretical and clinical urology, gynecology, and psychotherapy.

Prerequisites for stress urinary incontinence in women can be obesity, constipation, drastic weight loss, heavy physical labor, radiation therapy. It is known that women giving birth often suffer from the disease, and the number of births is not as important as their course. The birth of a large fetus, narrow pelvis, episiotomy, breaks in the muscles of the pelvic floor, the use of obstetric forceps - these and other factors are determinant for the subsequent development of incontinence.

Involuntary urination is usually noted in patients of menopausal age, which is associated with an age deficiency of estrogen and other sex steroids and the resulting atrophic changes in the organs of the genitourinary system. Operations on the pelvic organs (oophorectomy, adnexectomy, hysterectomy, panhysterectomy, endourethral interventions), prolapse and prolapse of the uterus, chronic cystitis and urethritis make their contribution.

The direct producing factor for stress incontinence is any tension that leads to an increase in intra-abdominal pressure: coughing, sneezing, brisk walking, jogging, sudden movements, lifting weights, and other physical effort. The prerequisites for the emergence of urgent urges are the same as in stress incontinence, and various external stimuli can act as provoking factors (sharp sound, bright light, water pouring from the tap).

Reflex-incontinence can develop as a result of injuries of the brain and spinal cord (injuries, tumors, encephalitis, stroke, multiple sclerosis, Alzheimer's disease, Parkinson's disease, etc.). Iatrogenic incontinence occurs as a side effect of certain drugs (diuretic, sedatives, adrenergic blockers, antidepressants, colchicine, etc.) and disappears after the withdrawal of these funds.

The mechanism of stress urinary incontinence in women is associated with insufficiency of the urethral or cystic sphincters and / or weakness of the pelvic floor structures. An important role in the regulation of urination is assigned to the state of the sphincter apparatus - when the architectonics changes (the ratio of muscle and connective tissue components), the contractility and extensibility of the sphincters is disturbed, as a result of which the latter become unable to regulate urine excretion.

Normally, the continent (retention) of urine is provided by a positive gradient of urethral pressure (that is, the pressure in the urethra is higher than in the bladder). Involuntary urine excretion occurs when this gradient changes to negative. An indispensable condition for voluntary urination is a stable anatomical position of the pelvic organs relative to each other. When the myofascial and ligamentous apparatus is weakened, the support-fixation function of the pelvic floor is disturbed, which may be accompanied by a prolapse of the bladder and urethra.

The pathogenesis of imperative urinary incontinence is associated with impaired neuromuscular transmission in the detrusor, leading to bladder hyperactivity. In this case, the accumulation of even a small amount of urine gives rise to a strong, unbearable urge to miccate.

Classification

According to the place of urine excretion, transurethral (true) and extraurethral (false) incontinence are distinguished. In the true form, the urine is excreted in the intact urethra, in the false urine - from abnormally located or damaged urinary tracts (from ectopically located ureters, extroverted bladder, urinary fistulas). In the future, we will focus exclusively on cases of true incontinence. Women have the following types of transurethral incontinence:

  • Stressful - involuntary urine, associated with failure of the urethral sphincter or weakness of the pelvic floor musculature.
  • Imperative (urgent, hyperactive bladder) - intolerable, unrestrained urges due to increased reactivity of the bladder.
  • Mixed - combining signs of stress and imperative incontinence (a sudden, unstoppable need to urinate occurs during physical exertion, followed by uncontrolled urination.
  • Incontinence reflex (neurogenic bladder) - spontaneous urine, caused by a violation of the innervation of the bladder.
  • Iatrogenic - caused by taking certain drugs.
  • Other (situational) forms - enuresis, urinary incontinence from bladder overflow (paradoxical ischuria), during intercourse.

The first three types of pathology are found in most cases, all the rest do not exceed 5-10%. Stress incontinence is classified according to degrees: with a slight degree, urine incontinence occurs with physical exertion, sneezing, coughing, with moderate exertion during abrupt rising, running, with severe excretion while walking or at rest. Sometimes, a classification based on the number of sanitary pads used is used in urogynecology: Grade I - no more than one per day, Grade II - 2–4, Grade III - more than 4 pads per day.

Complications

Faced with uncontrolled urine leakage, the woman is experiencing not only hygienic problems, but also serious psychological discomfort. The patient is forced to abandon the usual way of life, to limit their physical activity, to avoid appearing in public places and in the company, to refuse sex.

Constant leakage of urine is fraught with the development of dermatitis in the groin area, recurrent urinary infections (vulvovaginitis, cystitis, pyelonephritis), as well as neuropsychiatric disorders - neuroses and depression. However, due to shyness or misconception about incontinence, as the “inevitable companion of age”, women rarely turn to this problem for medical help, preferring to put up with obvious inconveniences.

Diagnostics

A patient who is confronted with a problem of urinary incontinence should be examined by a urologist and gynecologist. This will allow not only to establish the causes and form of incontinence, but also to choose the optimal path of correction. When collecting a doctor's history, the prescription of incontinence, its connection with stress or other provoking factors, the presence of imperative desires and other dysuric symptoms (burning, cutting, pain) are of interest. When talking, the risk factors are clarified: traumatic labor, surgical interventions, neurological pathology, features of professional activity.

A gynecological examination is obligatory, it allows to detect genital prolapse, urethro, cyst and rectocele, assess the condition of the perineal skin, detect urinary fistulas, carry out functional tests (straining test, cough test), causing involuntary urine. Before re-admission (within 3-5 days), the patient is asked to keep a urination diary, where the frequency of micci is noted, the volume of each selected urine portion, the number of incontinence episodes, the number of pads used, the volume of fluid consumed per day.

To assess the anatomical and topographic relationships of the pelvic organs, gynecological ultrasound and bladder ultrasound are performed. Of the laboratory methods of examination of the greatest interest are the general analysis of urine, urine bakposev on flora, smear microscopy. Urodynamic research methods include uroflowmetry, filling and emptying cystometry, intraurethral pressure profilometry - these diagnostic procedures allow to evaluate the state of sphincters, to differentiate stress and urge incontinence in women.

If necessary, functional examination is supplemented by the methods of instrumental assessment of the anatomical structure of the urinary tract: urethrocystography, urethroscopy and cystoscopy. The result of the survey is a conclusion reflecting the form, degree and cause of incontinence.

Female urinary incontinence treatment

If there is no coarse organic pathology that causes incontinence, treatment begins with conservative measures. The patient is recommended to normalize weight (with obesity), quit smoking, provoking a chronic cough, eliminate heavy physical labor, follow a caffeine-free diet. In the initial stages, exercises aimed at strengthening the pelvic floor muscles (Kegel exercises), electrical stimulation of the perineal muscles, and BOS-therapy can be effective. In case of comorbid neuropsychiatric disorders, the help of a psychotherapist may be required.

Pharmacological support in the stress form of incontinence may include the administration of antidepressants (duloxetine, imipramine), topical estrogens (as vaginal suppositories or creams) or systemic HRT. M-cholinolytics (tolterodine, oxybutynin, solifenacin), α-blockers (alfuzosin, tamsulosin, doxazosin), imipramine, hormone replacement therapy are used to treat imperative incontinence. In some cases, the patient may be administered intravesical injections of botulinum toxin type A, periurethral administration of autofat, fillers.

Surgery of stress urinary incontinence in women has more than 200 different methods and their modifications. The most common methods of operational correction of stress incontinence today are sling operations (TOT, TVT, TVT-O, TVT-S). Despite the differences in the technique of execution, they are based on a single general principle - fixation of the urethra with the help of a “loop” of inert synthetic material and reduction of its hyper-mobility, preventing urine leakage.

However, despite the high efficiency of sling operations, 10-20% of women develop relapses. Depending on the clinical indications, it is possible to perform other types of surgical interventions: urethrocystopexy, anterior colporrhaphy with bladder reposition, implantation of an artificial bladder sphincter, etc.

Prognosis and prevention

The prognosis is determined by the causes of development, the severity of the pathology and the timeliness of seeking medical help. Prevention consists in rejecting bad habits and addictions, controlling weight, strengthening the abdominal muscles and pelvic floor, and controlling defecation. An important aspect is the careful management of childbirth, adequate treatment of urogenital and neurological diseases. Women who are faced with such an intimate problem as urinary incontinence, must overcome false modesty and seek specialized help as early as possible.

What is urinary incontinence?

Urinary incontinence is the involuntary separation of urine, which cannot be prevented by willpower. In humans, the sensitivity disappears, so that the patient can not control the process of urination. All aspects of life suffer from this - social, business and personal. The patient cannot fully work, contact with relatives and live a normal family life.

Causes of the violation and suggestive factors

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

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

Diseases and injuries

Incontinence diseases and injuries:

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

Other reasons

Other causes of urinary incontinence in women:

  • surgery on the pelvic organs,
  • unstable emotional background,
  • radiation exposure
  • large body mass
  • harmful addictions - smoking and alcohol abuse,
  • taking certain medications
  • excessive consumption of coffee, sugary carbonated drinks,
  • improper nutrition.

Drug therapy

The use of drugs is possible if there is no abnormality of the structure of the organs of the urinary system. This is the main way to treat pathology. Medication prescribed depending on the cause, which led to the occurrence of incontinence.

  1. Drugs, the main active component of which is estrogen. The doctor prescribes such medications with a low level of the female hormone.
  2. Sympathomimetics. Improve the contraction of muscles involved in urination. The drug that is usually prescribed is Ephedrine.
  3. Antidepressants. The doctor prescribes them if incontinence develops due to an unstable emotional background.
  4. Anticholinergic drugs. Promote relaxation and increase the volume of the bladder. The doctor usually prescribes Tolteradin, Driptan, Oksibutin.
  5. Desmopressin. The doctor prescribes such a drug for temporary incontinence. The tool reduces the amount of urine.

Operational method

  1. Sling method. The duration of the operation is half an hour. During the procedure, general anesthesia is not used. Enough local anesthesia. The essence of the operation - the introduction of a special mesh, which has the form of a loop, under the urethra or neck of the bladder. It prevents involuntary urination with increasing pressure in the abdominal cavity.
  2. Injection volume forming agents. The essence of the procedure is the introduction of a special substance into the urethra using a cystoscope. After this manipulation, the urethra is placed in the correct position.
  3. Laparoscopic kalposuspenziya.Before surgery, the patient is general anesthesia. The essence of the procedure - the tissues that surround the urethra, are fixed on the inguinal ligaments. This prevents involuntary urination.

Physical exercise

Specialists recommend Keel exercises to do women, no matter what type of incontinence is observed. Classes are aimed at improving the condition of the muscles located in the pelvis.

Manipulations are carried out in the morning, in the afternoon and in the evening. The duration of the procedure is 10 seconds. After muscle contraction, relaxation should follow. The muscles also relax for 10 seconds, and then shrink again. Only under this condition can we expect a positive effect from the procedure. Some time after the start of gymnastics, the time for tension and muscle relaxation increases.

The total duration of one session should be 20 seconds.

Along with these exercises, it is also recommended to wear a small ball during the day, which is clamped between the legs. The higher its location, the better the effect.

Infusion on the seeds of dill

To prepare this effective homemade recipe, you will need:

  • fennel seeds - 1 big spoon with a hill,
  • water - 1 cup.

The water is brought to a boil, and dill seeds are poured over it. The container in which the preparation is prepared is insulated and left to insist for three hours. When the time is up, the medium is filtered. Drink consumed at a time.

Broth based on yarrow

  • dried yarrow herb - 10 g,
  • water - 1 cup.

Medicinal plant is filled with water. The container is set on fire and the medium is brought to a boil. After that, the drink is brewed for another 10 minutes. Capacity with broth is removed from the stove, insulated and left to insist for 60 minutes. The tool is filtered. The frequency of admission - in the morning, noon and evening 0.5 cups.

Infusion based on corn stigmas

For cooking means will be required:

  • corn silk - 1 big spoon,
  • water - 1 cup.

The medicinal plant is poured with the specified amount of boiling water. Capacity is insulated and left for half an hour to insist. The tool is used for half a cup in the morning and evening hours.

Therapeutic mixture

  • honey - 1 big spoon,
  • natural apple puree - 1 tablespoon,
  • chopped to a mushy onion - 1 large spoon.

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

For therapy also use infusion prepared on the basis of sage.

Prevention

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

  • regular visits to the therapist, endocrinologist, gynecologist,
  • Kegel regular exercises
  • proper nutrition
  • avoiding a sedentary lifestyle,
  • maintaining weight in good condition
  • toilet immediately after the urge to urinate,
  • rejection of addictions.

Conclusion

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

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Frequent types of urinary incontinence and their causes

Urinary incontinence is a pathology characterized by an uncontrolled process of urine excretion. This disease affects millions of women worldwide. What is incontinence? Various factors can trigger the development of this pathological condition. Urinary incontinence occurs due to the weakening of the pelvic floor muscles and / or small pelvis, disorders in the urethral sphincter. These problems can be provoked by the following diseases and conditions:

  • childbirth and childbirth,
  • overweight, obesity,
  • advanced age
  • bladder stones
  • abnormal structure of the genitourinary system,
  • chronic bladder infections,
  • chronic cough,
  • diabetes,
  • Alzheimer's, Parkinson’s,
  • sclerosis,
  • bladder cancer,
  • stroke,
  • prolapse of the pelvic organs,
  • chronic cough.

Some drugs and foods may increase incontinence. For example, medications with a diuretic effect or a relaxing effect on the bladder (antidepressants) can increase urinary incontinence in women. The use of alcohol, tobacco, tea, coffee, soda, a diet based on products that irritate the bladder will increase the manifestation of incontinence. Depending on the characteristics, circumstances, occurrence of urinary incontinence, experts divide this disease into the following types:

  • imperative
  • stressful
  • mixed
  • iatrogenic,
  • reflex,
  • enuresis,
  • involuntary leakage of urine,
  • urine leakage after the bladder emptying process.

Stress incontinence

The cause of this type of disorder of the urogenital system is a malfunction of the urethral sphincter. When intra-abdominal pressure occurs, the weakened muscles of this organ are not able to prevent the leakage of urine or the complete emptying of the bladder. Symptoms of stress urinary incontinence include: urine excretion during running, laughing, physical exertion, coughing, sex and lack of urge to use the toilet.

There are factors that create the soil for the development of incontinence stress species. These include: heredity, obesity, neurological diseases, infectious diseases of the urogenital system, medication of a specific action. But the main reasons that provoke the development of this type of disorder of the urogenital system are the following conditions:

  • Pregnancy. During childbirth, urinary incontinence is caused by a change in the hormonal levels in the body and the pressure of the growing uterus on the urogenital system. In pregnant women, this urination disorder occurs in half the cases.
  • Childbirth. Problems with uncontrolled urination can occur after childbirth, if the woman gave birth to a large child, and at the same time the doctors had to undergo a perineal incision or other manipulations. Because of these factors, the ligaments and muscles of the pelvic floor are damaged, there is an uneven distribution of pressure in the peritoneum, which subsequently causes disruption of the sphincter.
  • Undergone operations on the pelvic organs. Surgical manipulations with the bladder, uterus often lead to the formation of adhesions, fistulas, changes in pressure in the pelvic area, which leads to problems with urinary incontinence.
  • Age changes. Climax, reduced elasticity of the ligaments, muscle tone - the causes that cause urinary incontinence in women.

Imperative Incontinence

With the normal functioning of the bladder urge to urinate occurs after its filling. At the same time, the person calmly restrains him until the next visit to the toilet. If a woman suffers from imperative incontinence, even with a small filling of the bladder with urine, there can be insurmountable urges to urinate, which cannot be restrained. In case of this condition, external stimuli can provoke incontinence: flowing water, bright light or other. What is the cause of this disorder?

The main reason for this is the overactive bladder, which instantly reacts even to slight irritation due to the unusual speed of the sphincter nerve impulses. The factors leading to the emergence of imperative incontinence are older age, childbirth, hormonal changes, injuries, infectious diseases, inflammation, and swelling. This pathology is almost always characterized by sudden urge to urinate, arising up to 8-10 times a day.

Bedwetting

Involuntary urination during sleep is called bedwetting. Older women often suffer from them due to hormonal changes in their bodies, which lead to a decrease in estrogen and a weakening of the muscles of the perineum, the condition of the mucous membrane of the urethra and the urogenital diaphragm. At a young age, incontinence at night appears as a result of stretching the muscles of the pelvic organs, which is triggered by childbirth with tears or dissection of the perineum. Inflammatory processes in the bladder lead to exacerbation.

Permanent

In case of involuntary discharge of urine during the day, permanent incontinence occurs. Often the cause is age-related changes in the body, nervous disorders and dysfunction of the urinary tract. In older women, spontaneous reduction of the detrusor, physical stress (for example, coughing) becomes a frequent cause of this phenomenon. To correct the situation with incontinence in mild or moderate disease, special exercises for training the pelvic floor will help.

Other species

Medication with a diuretic, sedative or estrogen drugs often leads to the development of iatrogenic incontinence. As a rule, in this case, after medication, urination problems cease. More than 1/3 of women aged 30-70 suffer from mixed incontinence, in which there is a combination of signs of a stressful and imperative course of the disease.

Symptoms and signs of urinary incontinence

Women more often than men face the problem of urinary incontinence. This is due to the structural features of their urogenital system. In women, incontinence is expressed by the following symptoms: urine leakage, sudden uncontrollable urge to go to the toilet, the sensation of an incompletely emptied bladder, the sensation of the presence of a foreign body in the vagina.

What to do and how to treat urinary incontinence

How to fix incontinence problem? If you find a qualified urologist, then he will be able to help the woman do everything possible to get rid of the problems with urination. When talking with the doctor, the patient must be frank about his symptoms of urinary incontinence. If necessary, the doctor will prescribe a woman to undergo additional studies to determine the exact diagnosis. Often, doctors refer these patients to the following examinations:

  • urinalysis to identify / eliminate the presence of infection in the urogenital system,
  • vaginal examination to clarify the presence / absence of gynecological diseases,
  • A PAD test that gives information about the amount of urine being missed,

After examination, the doctor will give recommendations on what methods and preparations to use to eliminate problems with urination. There are two types of urinary incontinence treatment: conservative and surgical. The first of them includes performing special exercises, training the muscles of the pelvis using special devices, physiotherapy, and medications. Treatment in a conservative manner continues throughout the year.

Drug treatment

How to treat uncontrolled urination? The use of tablets and other drugs to get rid of urinary incontinence is effective in the stress type of the disease only when the anatomy of the urinary organs is not disturbed. Sometimes for drug treatment used adrenomimetics and anticholinesterase drugs to improve the tone of the sphincter, duloxetine. In case of incontinence of imperative nature, a number of drugs give a positive result (Driptan, Spazmeks, Vesicard, Detruzitol, hormonal drugs, antibiotics for inflammation).

Kegel exercises

Training the pelvic muscular system leads to the elimination of urinary incontinence. Tension and relaxation of the periurethral and perivaginal muscles will help establish control over the process of urination. How to do Kegel exercises for women with incontinence? To do this, in a sitting position, imagine the arising urge to go to the toilet and try to hold an imaginary stream of urine.

Those muscles that are involved in this case, you need to regularly train 3 times a day to eliminate incontinence. It is easy to do imperceptibly, not only at home, but also in the car, at work and in another place. In this case, the time of muscle contraction must be increased from a couple of seconds to 3 minutes. The effectiveness of the Kegel exercises increases with the use of a biofeedback apparatus, which helps to see whether those muscles are involved during exercise and the correctness of the contractions. Kegel exercises can be performed in this style:

  • quickly contract muscles
  • slow down to squeeze the muscles
  • perform extrusions similar to attempts during childbirth,
  • produce retention jet during real urination.

Medical devices

Effectively helps to prevent involuntary urination pessary. It is a rubber device that is inserted into the vagina at the cervix to support the urethra in the closed position and to keep the urine in the bladder. This device is well suited for comfortable jogging and other physical activities. Many types of pessaries are intended for permanent use, but there is a possibility of urinary infections.

Treatment of folk remedies

There are many recipes for the treatment of urinary incontinence folk remedies. They help eliminate inflammation in the urogenital system and normalize the bladder. The basis of these recipes are herbal ingredients that do not cause side effects when used correctly. Often these methods are used to treat urinary incontinence in older women. To get rid of urination problems, you must apply the following folk remedies:

  • with nightly uncontrolled urination, weekly intake of a mixture of honey (1 tablespoon), grated apple (1 tablespoon), grated onions (1 tablespoon), helps 3 times a day.
  • drink plantain juice (1st. l.) 3 times a day,
  • drink plantain tincture (1 tablespoon of leaves of the plant per 1 tablespoon boiling water) 4 times a day for a glass,
  • use 2 times a day for a glass of tincture of 1 tbsp. l corn silk, filled with 1 cup of boiling water and infused for 30 minutes.

Surgical treatment of urinary incontinence

If a conservative method of treatment did not give a positive result, then the doctor will recommend surgery to eliminate problems with urination. It can not be used for people with cancer, diabetes, with exacerbation of inflammatory processes. There are several types of surgical methods for getting rid of incontinence:

  • Loopback or sling operations. During surgery, a mesh is inserted under the urethra in a loop.
  • Injection into the mucous membrane of the urethra-forming drugs. As a result, missing tissues are compensated, and the urethra is fixed in the correct position.
  • Burch laparoscopic colposuspension.
  • Colporrhaphy (vaginal closure).

Video: gymnastics for women

Although it is widely believed that urinary incontinence is incurable, there are effective ways to treat this urination problem. One of them is physical exercises aimed at strengthening the muscles of the small pelvis. How to perform this gym look at the video.Regular classes will help to forget about the problem with the uncontrolled leakage of urine and enjoy life again, confidently communicating with people.

Elena, 36 years old, Omsk: After the birth of my second child, I noticed that when I cough, sneeze, I excrete urine. It is especially inconvenient when such confusions occur during physical exertion outside the home. At first I was treated with eggshell, warming up, but to no avail. The doctor, after the examination, said that surgery was needed to stop urinary incontinence. I was afraid, but decided to do it. After surgery, the problem disappeared.

Tatiana, 50 years old, Moscow: For more than 10 years she didn’t tell anyone about her illness, but experienced painful experiences. But once tired of constantly wearing pads when incontinence, and decided that something needs to be done. I went to the doctor, he recommended surgery. After the operation, I again felt like a full-fledged person.

Zinaida, 30 years old, Voronezh: After the birth of my first child, I got pregnant six months later. After a cold at the 6th month of pregnancy, I noticed that I had urinary incontinence when I cough. When I told the gynecologist about this, he recommended doing Kegel exercises. After 2 weeks of this charge, this problem disappeared.

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