In urology clinics, we often encounter some female patients who are particularly embarrassed to mention that they have uncontrollable urinary leakage when they cough hard or run and jump rope, and in serious cases, they even need to wear diapers, which obviously affects their quality of life, and because they are ashamed to talk about it, many of them are embarrassed to seek medical attention and are very distressed. We as urologists will first think that they may have stress urinary incontinence, in fact, they do not understand that urinary incontinence is a common disease and high incidence in women, according to global statistics, the prevalence is close to 50% of the female population, about half of the stress urinary incontinence.
What is stress incontinence
Stress incontinence is the involuntary leakage of urine from the external urethra when the abdominal pressure is increased, such as when sneezing, coughing or exercising. The symptoms are involuntary leakage of urine during increased abdominal pressure such as coughing, sneezing, or laughing. To put it simply, unlike normal urination where the brain commands the bladder muscles to contract and the urethral muscles to relax to allow urine to flow out, in patients with stress urinary incontinence, there is no willingness to urinate, the bladder muscles do not contract and the urethral muscles do not actively relax, but the pressure in the bladder exceeds the pressure in the urethra due to external pressure on the bladder and urine flows out of the urethra uncontrollably.
What factors may cause stress urinary incontinence
(1) Age: The prevalence of urinary incontinence in women increases with age, with a high incidence at 45 to 55 years of age. The correlation between age and urinary incontinence may be related to the relaxation of the pelvic floor with age, the decrease in estrogen and degenerative changes in the urethral sphincter. Some common diseases of old age, such as chronic lung disorders and diabetes, can also contribute to the progression of urinary incontinence.
(2) childbirth: the number of births, age at first birth, mode of delivery, size of the fetus and the incidence of urinary incontinence during pregnancy are significantly associated with the occurrence of postpartum incontinence. The higher the number of births, the greater the chance of incontinence; women who deliver vaginally are more likely to have incontinence than those who deliver by cesarean section; women who have a cesarean section are at greater risk of incontinence than women who have not given birth; and mothers of large fetuses are at greater risk of incontinence.
(3) Pelvic organ prolapse: stress urinary incontinence and uterovaginal prolapse are closely related, and they often exist together.
(4) Obesity: Obese women are significantly more likely to develop stress urinary incontinence.
(5) Ethnic and genetic factors: Genetic factors have a clear correlation with stress urinary incontinence. Other possible correlates include smoking, constipation, bowel dysfunction, caffeine intake, and chronic cough.
How to simply determine the degree of stress incontinence based on symptoms
Mild: general activity and nocturnal incontinence, occasional incontinence when abdominal pressure increases, no need to wear a pad.
Moderate: frequent urinary incontinence with increased abdominal pressure and standing activities, need to wear a pad to live.
Severe: Urinary incontinence occurs upon rising and moving or when the position of the patient changes, which seriously affects the patient’s life and social activities.
How to treat stress urinary incontinence
1, pelvic floor muscle training (anal training) pelvic floor muscle training on the prevention and treatment of female stress urinary incontinence role is very positive. This method is convenient, easy to use, effective and applicable to all types of stress incontinence. The point is that the pelvic floor muscles must be trained to a significant amount in order to be effective. Can be implemented with reference to the following method: continuous contraction of the pelvic floor muscle (lifting movement) for 2 to 6 seconds, relaxation rest for 2 to 6 seconds, and so on for 10 to 15 times. Training 3 to 8 times a day for more than 8 weeks or longer. Some comrades may not feel good to grasp the operating principles, there is a simple trick to tell you, is to repeatedly experience the process of normal urination, conscious control of urine flow, stop urination, just remember to stop urination when the action essentials, in the usual rest contraction, relaxation interval of 5 seconds each training, 20 times each time, every day morning and evening interval open, more training, as long as you can hold on, more can be effective The results can be achieved.
2, Chinese medicine treatment traditional Chinese medicine treatment of this disease, think with the spleen and kidney deficiency, more use of supplemental gas, warm kidney, solid astringent for the method. I observed a large number of patients in the clinic through treatment, are tired or after the afternoon symptoms are obvious, that the disease is mostly due to the spleen and stomach Qi subsidence, the spleen and gastric gasification is not enough to affect the bladder gasification failure and the onset of the disease, so the emphasis on restoring the spleen and stomach and related organs gasification function is the key to treatment. For clinical mild to moderate patients, the following commonly used formula is recommended.
Roasted Astragalus membranaceus 30g Radix Codonopsis pilosulae 10g Rhizoma Atractylodes Macrocephalae 10g Chen Pi 10g Radix Angelicae Sinensis 10g Sheng Ma 5g Radix Bupleurum Chinense 5g Raspberry 15g Radix Platycodon grandiflorum 10g Almond 5g Decoction in water, one dose per day, divided into morning and evening, can be used with anal lifting training.
3.Surgical treatment After systematic examination and treatment by professional urologists, some patients may need to choose surgical treatment. At present, the common clinical use is tension-free urethral midsection sling surgery, short-term efficacy are above 90%, the advantages are stable efficacy, less damage, less complications.
Prevention recommendations to avoid risk factors: According to the common risk factors for urinary incontinence, appropriate preventive measures should be taken. The possible correlation between personal habits and the occurrence of urinary incontinence should be assessed and exposure to susceptible factors should be reduced accordingly.
1. Weight loss is recommended: obesity is a clear correlate of stress urinary incontinence in women. Weight loss can help prevent the occurrence of stress incontinence. Obese women with stress urinary incontinence who lose 5% to 10% of their body weight will reduce the number of incontinence by more than 50%.
2, it is recommended to quit smoking: there is evidence that smoking can increase the risk of stress urinary incontinence, although there is no evidence that smoking cessation can relieve the symptoms of stress urinary incontinence.
3, pay proper attention to exercise to enhance resistance and reduce the chance of cold and cough.