High incidence of urinary incontinence, low consultation rate
Zhang Zhengwang, deputy chief physician, master’s degree supervisor and associate professor of urology at East China Hospital of Fudan University, said in an interview that urinary incontinence is a common disease, especially among middle-aged and elderly women. According to the survey, the incidence of urinary incontinence in women is higher than 40 percent. The incidence of middle-aged and elderly women is higher, about 50%, especially in urban women, the incidence of incontinence is 15% to 60%. However, the rate of incontinence visits is low compared to the high incidence, with often only one in five people coming forward to visit a formal medical facility.
”Based on clinical experience, I believe that the low rate of incontinence visits may be related to three factors.” Zhang Zhengwang said, first, for a long time the medical community does not have a good treatment for stress incontinence, the revolutionary bladder neck suspension surgery in 1973 greatly improved the effectiveness of about 71%, but the surgery is invasive is its drawback. Second, urinary incontinence belongs to a subspecialty under urology, but for a long time there is a lack of physicians specializing in this subspecialty in China, compared to other common diseases of the urinary system, less patient education is provided, and patients thus lack a proper understanding of the disease they suffer from and do not know where to go to see a doctor. Third, the main group of people suffering from urinary incontinence are middle-aged and elderly women, most of whom have limited ability to actively accept knowledge of the disease from modern media such as the Internet, and are influenced by traditional ideas about the decline in quality of life and do not actively treat it, or choose to suffer in silence for fear of causing trouble for their children.
In 1996, a mid-urethral suspension using a sling made of polymeric synthetic material was introduced, increasing the efficacy to 90%, but the procedure was performed via the posterior toe route, with a greater risk of bladder damage. It is recognized as the gold standard for the treatment of stress urinary incontinence. It utilizes the body’s natural orifice to place a tension-free suspension band in the mid-urethra, which has the advantages of minimal invasiveness, rapid postoperative recovery, and less recurrence after surgery, with an efficacy of more than 95 percent. He called on the face of urinary incontinence, should not be afraid of medical treatment, choose the appropriate specialist consultation, so that the professional physician to develop a personalized response strategy, urinary incontinence is not incurable.
There are many clinical types of urinary incontinence and individualized treatment is needed
”TVT-O surgery is effective, but not all patients with urinary incontinence need to have this surgery.” Zhang Zhengwang said the causes of urinary incontinence are complex and can be divided into many types, commonly including urge incontinence, stress incontinence, mixed incontinence, filling incontinence and true incontinence. Some incontinence is often accompanied or secondary to other urological or female genital disorders, such as overactive bladder, neurogenic bladder, prostatic hyperplasia in men, or pelvic organ prolapse in women. Of these, urinary incontinence in women is mostly closely related to decreased estrogen levels during menopause or after menopause, and is commonly associated with urge, stress and mixed incontinence. Male incontinence is mostly associated with prostate enlargement and damage to the nerve or sphincter muscle after prostate surgery, and is commonly associated with filling and or urge incontinence.
Overall, stress incontinence and urge incontinence are the most common in clinical practice.
Stress incontinence
The main etiology of stress incontinence is that a decrease in estrogen leads to relaxation of supporting tissues such as pelvic floor muscles, fascia and ligaments, which cannot maintain normal urethral position and bladder tone, and a sudden rise in bladder pressure with increased abdominal pressure, resulting in uncontrolled overflow of urine.
Typical symptoms: involuntary leakage of urine under increased abdominal pressure, such as when coughing, laughing, or physical exercise.
Urge incontinence
Urge incontinence is mainly associated with decreased bladder stability due to decreased estrogen, overactive bladder forcing muscles or sensory hypersensitivity.
Typical symptoms: frequent and urgent urination, an urgent desire to urinate as soon as the patient has the urge to urinate, but early urination or overflow of urine occurs because the patient cannot reach the toilet in time.
Treatment is different for different types of urinary incontinence, and individualized treatment must be emphasized. Stress incontinence, for example, relies primarily on surgical treatment, and non-surgical treatments such as pelvic floor muscle training and medication are largely ineffective or do not provide long-term stable results. In the case of urge incontinence, there is no surgical solution and must rely on behavioral therapy in conjunction with medication. Behavioral therapy involves progressive bladder training under the guidance of a physician to gradually expand the effective capacity of the bladder and reduce the frequency of urination by urinating on time or delaying urination; and by taking anticholinergic drugs such as tolterodine or solifenacin orally to relieve overactivity of the bladder’s detrusor muscles and inhibit sensory hypersensitivity of the bladder, thereby effectively controlling the onset of urinary incontinence.
Surgery for patients without surgical indications is counterproductive. Therefore, it is important for patients with urinary incontinence to be diagnosed and staged appropriately.
The “brother” of urinary incontinence – pelvic organ prolapse
In addition to urinary incontinence, middle-aged and elderly women often have lower abdominal discomfort, nocturnal urination, and even vulvar drop with blocks falling out, in fact, these symptoms are the performance of middle-aged and elderly women “pelvic floor disease”. Zhang Zhengwang said, the so-called “pelvic floor disease” refers to the pelvic floor dysfunctional diseases, is the general term for pelvic organ prolapse and stress urinary incontinence, including the front and back wall of the vagina bulge, stress urinary incontinence and uterine prolapse, etc.. With the aging of the population, the incidence of pelvic organ prolapse and stress urinary incontinence is gradually increasing, and according to statistics, more than 50% of women in China have had related experiences. According to statistics, 30% of women with pelvic organ prolapse may have combined urinary incontinence; and if there is urinary incontinence, the likelihood of organ prolapse is more than 50%.
The pelvic floor of women is like a self-regulating hammock, relying on environmental changes to regulate its own tension. After entering middle age, the tension of the hammock is affected by many factors such as pregnancy, childbirth and estrogen decline and becomes relaxed and collapsed, the supporting role of the muscles and ligaments of the pelvic floor gradually weakens, the urethral sphincter relaxes, and the angle between the bladder and urethra changes, resulting in frequent urination, urinary urgency, various types of This leads to frequent urination, urinary urgency, various types of urinary incontinence and prolapse of pelvic organs; in turn, pelvic organ prolapse causes urethral muscle spasm, poor urination and urinary retention, followed by frequent or persistent urinary tract infections.
Urinary incontinence combined with pelvic organ prolapse can be treated by a closed-hole route with simultaneous midurethral suspension + mesh pelvic floor reconstruction in one operation.
Urinary urgency Possible overactive bladder syndrome
”Urinary incontinence is common, but one of the more common phenomena among middle-aged and elderly people is urinary urgency.” Zhang Zhengwang says this condition is usually overactive bladder (OAB), where urge incontinence occurs when symptoms worsen, and is medically called wet OAB. as long as urinary urgency is the main clinical manifestation, accompanied or not by urinary frequency, increased nocturia or even incontinence, and primary disease is ruled out, a medical diagnosis of overactive bladder can be made. However, the symptoms of overactive bladder can appear in many diseases, such as acute cystitis, prostatic hyperplasia or prostatitis, paraplegic patients, bladder lesions due to diabetes mellitus, and even some specific manifestations of bladder tumors.
”Some patients in life are very annoyed because of urinary urgency and frequency, but not to the point of incontinence, that there is no need to see a doctor, or it is useless to see, in fact, this is a one-sided perception.” Zhang Zhengwang said that the country has now developed a standardized OAB diagnosis and treatment guidelines, which can be approached in three main ways –
1. behavioral treatment. With overactive bladder disorder to learn how to hold urine, called “bladder training”, to consciously expand the capacity of the bladder, so that the ability to store urine to strengthen.
2. Drug therapy. The recommended first-line treatment is cholinergic M-blockers.
3. physical therapy, nerve electrical stimulation, to assist in improving muscle contraction in the bladder.
It is not uncommon to misdiagnose overactive bladder disorder as a “urinary tract infection” and there are chronic urinary sensations. To distinguish between the two diseases: 1. whether “urgency” is the core symptom. The core symptom of overactive bladder is “urgency”, while “urinary sensation” is not. 2, urine routine and urine culture. If white blood cells are found in the urine routine, it can be considered a urinary tract infection, but it is important to note that white blood cells can sometimes be found in the urine routine for overactive bladder disease. In addition, a urine culture will show bacteria in urinary tract infections, but not in overactive bladder. 3. If a urinary tract infection does not respond to a period of antibiotic treatment, clinical consideration should be given to overactive bladder.
Health prescriptions for patients with overactive bladder
For middle-aged and elderly people with urinary urgency and frequency, in addition to identifying the cause and treating it symptomatically, you can also start with lifestyle and self-management.
1. Adhere to daily bladder training.
Method 1: Delayed urination, appropriately delaying urination for a short period of time and then slowly extending it, gradually making the volume of urination greater than 300ml each time.
Method 2: Regular urination, establish a regular urination schedule, and gradually make the interval between urination close to 2 hours.
2. insist on daily pelvic floor muscle training.
Doing 50-100 times of anal tightening and anal lifting activities each in the early morning before getting out of bed and in the evening after getting into bed and lying down.
3. insist on keeping a daily diary of urination.
4. Diet: avoid the following foods that tend to cause bladder irritation as much as possible: oranges, grapefruit, pineapple, tomato products (because they are all highly acidic); chocolate, coffee and black tea (because they all contain caffeine); stimulating foods such as chili sauce, peppers and mustard; sugar and honey (sugar tends to irritate the bladder); various alcoholic beverages (including wine, beer and champagne); various energy drinks and carbonated beverages; all kinds of frozen drinks and ice cream. Eat more of the following bladder-friendly fruits and beverages: bananas, apples, pears, cranberry juice, etc.
5. Properly control your water intake. 8 glasses of water (about 1500ml) every 24 hours; reduce fluid intake after 6 pm or 3-4 hours before bedtime. But remember: excessive less water will increase the concentration of urine, stimulating the bladder mucosa and causing urinary tract infections.
6, keep the perineal area and feet warm.
7.Keep your bowels open. Eat more fiber-rich food, constipation relief can effectively reduce the symptoms of frequent and urgent urination.
8, actively treat chronic diseases such as emphysema, asthma, bronchitis, etc.