When urine comes out of the collecting tubules, it collects in the renal pelvis. Due to the so-called peristaltic movements of the ureter, portions of urine continue to travel as far as the bladder. When this is full and stretched, irritation of the receptors causes a signal to be sent to the brain that responds by initiating contraction and relaxation of the smooth muscles of the sphincter. This is approximately how urine passes out of our body properly. Unfortunately, very often, especially in the case of women and the elderly, this mechanism fails. If the problem becomes chronic and you have trouble controlling your bladder, you most likely suffer from incontinence, commonly known as urinary incontinence.
What kind of illness is that?
Most often, it is defined as the involuntary partial or complete emptying of the bladder. Although urinary incontinence happens to people of all ages, after the age of 65 it affects 35% of the population, and after the age of 80 it affects 60–80%. Especially in women, urinary incontinence is becoming a social problem. According to estimated data, it affects about 3 to 5 million patients in Poland alone. In the group of women in their thirties, this percentage may increase to 30%, and in their 60s – to almost XNUMX%, which is related to the menopause and the decline in estrogen levels. To make matters worse, the ailment is progressive and, if left untreated, it does not regress on its own. That is why it is so important in incontinence to break down the shame and go to the doctor for advice early. Chronic urinary incontinence leads to a significant reduction in physical activity due to the unpleasant odor associated with leaking urine during exercise and the occurrence of complications such as urinary tract inflammation, inflammation of the genital tract and perineal eczema.
- Do you have urinary incontinence problems? Take advantage of a gynecological consultation
The reasons
Urinary incontinence is an extremely common condition and there is no single cause for its occurrence. It is usually the result of a number of parallel factors overlapping. In general, urinary incontinence can be associated with urological, neurological, internal or gynecological diseases. It happens that it also occurs after injuries, in neoplastic diseases and in birth defects. Due to the main cause of bladder dysfunction, this disease can be divided into three categories:
- exercise incontinence – when weakening of the pelvic muscles causes involuntary urination, e.g. when laughing, coughing or lifting heavy objects
- urge incontinence – associated with overactive bladder even with a small amount of fluid
- mixed incontinence – combining both of the above-described forms
In addition, there are reflex urinary incontinence due to damage to the nervous system, overflow incontinence related to urethral stricture, and extra-urethral (or fistula) urinary incontinence caused by faulty connection of the urinary tract.
The most common cause of urinary incontinence in the elderly and infants is unintentional stimulation of the sacral center of the spinal cord. While in children this problem passes with age, when the brain develops mechanisms responsible for controlling urination, in the elderly degenerative changes in the body can be difficult to reverse, and often have a neurological basis. Nevertheless, the most common cause of incontinence is detrusor instability, which is the presence of involuntary bladder contractions, sometimes severe enough to cause uncontrolled leakage of urine. Stress urinary incontinence is associated with weakening of the sphincters, pelvic floor muscles or excessive mobility of the bladder neck. In this case, involuntary urination is closely associated with physical exertion, coughing, sneezing, sudden movements or laughing. Typical for functional incontinence is the inability to make it to the toilet in time. In most cases, however, no pathological changes in the urinary system are found.
- Do you have urinary incontinence problems? Take advantage of a gynecological consultation
Treatment
Due to the aforementioned causes of incontinence, a thorough medical history and examinations are necessary before starting the treatment. In order to diagnose, among others, general examination, urine culture, serum creatinine and urea concentration, ultrasound, as well as specialist urodynamic and radiological examinations. In addition to the usual physical examination, the doctor may also perform a gynecological examination on a woman and a prostate examination with a finger on a man. Before the appropriate treatment, adapted to the type and severity of urinary incontinence, it is always best to remove the immediate cause. If it is possible, the first thing we should do is get rid of cystitis, discontinue any diuretic drugs, and treat prostate disease. Regardless of the type of urinary incontinence, a simple lifestyle change can often help. Let’s reduce the consumption of alcohol and caffeine, try to lose weight, and plan to consume fluids carefully when we want to avoid problems with incontinence during social meetings.
Of course, there are some helpful medications that can be used when traditional methods, such as sphincter exercises, are insufficient. Medicines (e.g. oxybutynin) can, however, have serious side effects and must be used under medical supervision. Other treatments (e.g., stimulation of the sacral nerves, injection of botulinum toxin into the bladder muscles, surgery) are only used after bladder training and medications have failed. Hormonal drugs are recommended in pharmacotherapy. In the case of overactive bladder, anticholinergic drugs are also recommended, but they should be handled with caution because they contain strong psychoactive substances. Physical therapy includes, among others. bladder electrostimulation and magnetic field treatments. Currently, it is possible to purchase hearing aids for home use.
Exercises and surgery
As for exercise, the recommended ones are those aimed at strengthening the pelvic muscles. It is especially important to strengthen the pelvic floor muscles after delivery, which can prevent stress urinary incontinence in many women later in life. In the case of urinary incontinence, kinesiotherapy, i.e. comprehensive treatment with movement and physical exercise, includes, among others. Kegel exercise, which involves tightening the vaginal and rectal muscles for about 8-10 seconds and repeating this action at short intervals for at least 20 minutes. Strengthened and more flexible muscles prevent stress urinary incontinence, but also increase the sexual satisfaction of both partners. After acquiring the ability to tighten the muscles, specialists choose an individual set of exercises depending on the type and severity of the disease. Properly chosen treatment and systematic and correct exercise of the recommended exercises mean that in many cases urinary incontinence disappears and almost always its symptoms alleviate.
- Do you have urinary incontinence problems? Take advantage of a gynecological consultation
However, if traditional methods of combating urinary incontinence prove ineffective, surgical methods always remain. The most effective are the so-called bladder neck suspension and loop surgery. Where there are indications for surgical treatment, it is best to perform a minimally invasive “sling” procedure. In short, it consists in inserting a special tape that lifts and permanently supports the urethra under the urethra and joins it with the urinary bladder. According to the latest scientific reports, these treatments are very effective (about 80-90% of patients do not lose urine for 5 years after the procedure). Fortunately, conducting them does not involve any serious interference with the body. In practice, 1,5 cm incision of the vaginal mucosa below the external opening of the urethra is sufficient, and conduction anesthesia allows avoiding anesthesia. In some cases (if urinary incontinence is accompanied by the lowering or prolapse of the uterus and vaginal walls), the procedure may be extended to plastic surgery of the perineum and vaginal walls under the same anesthesia.