Women can still control urination in normal times due to relaxation of the inter-vaginal bladder fascia, flattening of the posterior angle of the urethra, and relaxation of the bladder neck after childbirth or menopause, but urinary incontinence occurs when there is a sudden increase in abdominal pressure, such as coughing, sneezing, laughing, running and so on. Severe cases can only control urination when lying down or sitting, this situation is medically called stress urinary incontinence, is a common disease of middle-aged and elderly women, according to the consultation survey, its incidence is about 10% to 25%, but according to statistical data, there are still many women with light urinary leakage symptoms are ashamed to admit that they suffer from urinary incontinence, and did not go to the hospital for help, so the actual prevalence is estimated to be about 30%! In Europe and the United States, the incidence of stress incontinence in women over 65 years of age is as high as 35%, 40% in Shanghai and 57% in Hong Kong. Therefore, urinary incontinence is a more common problem for middle-aged and elderly women. A. What is stress urinary incontinence Stress urinary incontinence (SUI) is when the abdominal pressure suddenly increases, such as coughing, sneezing, laughing, force or position change, etc., the urine lost control of involuntary escape. If it occurs occasionally, it is not pathological, but if it occurs frequently, it is pathological. According to the latest research data, about 30% of women will suffer from varying degrees of urinary incontinence throughout their lives, and stress incontinence accounts for about 40% to 50% of female incontinence, so this is the most common type of incontinence in women. Second, the impact of urinary incontinence on the patient The symptoms are mild, occasionally a small amount of urine leakage is not embarrassing, the patient may be ashamed to say and not necessarily to seek medical advice; but severe incontinence, although not dangerous or life-threatening, but people have to use diapers / bags all day, patients due to fear of leakage, fear of others to smell the smell of urine on their own body and be discriminated against, thus avoiding participation in normal social and daily activities. To avoid being in an embarrassing, embarrassing situation, so it is a psychologically unpleasant, annoying, easy to produce low self-esteem disease, although urinary incontinence is not a direct life-threatening serious disease, but may seriously affect the patient’s quality of life. With the advent of an aging society in China, there will be an increasing number of such patients. Stress urinary incontinence in middle-aged and elderly women is not only a personal hygiene and health problem, but also a problem that cannot be ignored by families and society, and should be taken seriously and concerned. Third, the causes of urinary incontinence Although there are many reasons for stress incontinence, but it boils down to two main points: (1) because of childbirth, obesity, constipation and other factors make the pelvic floor support structure is destroyed and relaxed, the urethra appears to move down, in this case when the cough and other abdominal pressure rises, the elevated pressure only on the bladder, can not act on the urethra through normal conduction, resulting in the total pressure in the bladder may exceed The total pressure in the bladder may exceed the urethral closure pressure, resulting in urinary outflow. (2) Due to low estrogen levels or other reasons (such as surgery, radiotherapy, etc.) resulting in atrophy of the urethral mucosa, the ability of the urethra to “water seal” itself decreases, making it easy for urinary incontinence to occur. If you are suffering from urinary incontinence, even if the symptoms are mild, but affects your daily life, you should actively seek treatment, and should promptly and actively go to the hospital urologist to seek advice and guidance from a professional doctor to distinguish the cause of the disease You should not be afraid of treatment. Doctors in the process of diagnosis and treatment, must find out what the problem is, usually need to understand the patient how long the symptoms of urinary leakage, the severity of urinary leakage, the cause of the onset, the patient’s needs and treatment wishes, etc., because the symptoms of urinary incontinence, a variety of types, based on symptoms alone is not easy to accurately distinguish, it is necessary to carry out some of the necessary tests, such as simple urinary diary, urine pad test, professional doctors may further choose to urinary The main purpose is to understand the severity of incontinence and identify stress incontinence due to bladder neck malfunction and urge incontinence caused by an unstable bladder, and to determine the correct diagnosis in order to decide the best treatment plan. V. Treatment methods for urinary incontinence There are various treatment methods for stress urinary incontinence, mainly including physical therapy, medication and surgery. Patients with urinary incontinence should also promptly treat diseases that increase abdominal pressure, such as constipation, chronic cough and other diseases. Your doctor will choose the appropriate treatment plan for you based on the cause, the degree of incontinence, and the patient’s needs and desires. (1) For patients with mild to moderate incontinence, you can take medication and behavioral therapy. Behavioral therapy: Kegel exercises by tightening the anus for a period of more than 3 seconds and then relaxing. Do this continuously for 15 to 30 minutes, 2 to 3 times a day. Or 150 to 200 times a day for 6 to 8 weeks as a course of treatment. The purpose is to enhance the support of the pelvic floor muscle groups and reset the posteriorly inverted or prolapsed bladder, thus restoring the normal angle between the bladder and urethra. (2) Drug therapy. Alpha agonists act on the bladder neck and urethral initiation to increase its tension and enhance urethral closure pressure; estrogenic drugs can be used orally or locally to improve the atrophy of the urethral mucosa and increase the “water seal” effect. Pharmacological treatment is suitable for mild to moderate patients; however, for those who are ineffective after non-surgical treatment or have a high degree of incontinence, active surgical treatment should be considered. In fact, surgical treatment is also the most effective method of stress urinary incontinence. (3) Surgical treatment, which includes two modalities: a) a minimally invasive intracavitary surgical approach with paraurethral injections to artificially increase the “water seal” mechanism; and b) a minimally invasive surgical approach with bladder neck and urethral suspension to correct the lax pelvic floor structure. Surgical treatment is generally suitable for patients with moderate to severe cases or those who have failed other treatments. Sixth, the new minimally invasive treatment technology Transvaginal – closed-hole urethral tension-free sling (TVT-O) is currently the world’s new “gold standard” for the treatment of female urinary incontinence, only a small incision of 1 cm between the urethra and the vagina, a biomaterial sling placed under the urethra, through the closed hole through the The procedure is simple and has long-term safety and efficacy. There is no need for cystoscopic observation, and there are no complications such as bladder injury or perforation, sling rejection or wound infection, vaginal perforation and postoperative urinary difficulties.