Have lesbians ever happened so “embarrassing” things: their own jumping, down the stairs or lifting heavy things as long as the stomach a force, will leak urine? Even laugh, sneeze urine will flow out? The so-called “laughing urine” is actually likely to be stress urinary incontinence in the play Oh. If it is a disease, you can not leave it untreated! Let’s take a look at the following details!
When we mention urinary incontinence, the first response is not the age will be so, in fact, not, stress urinary incontinence can occur at any age and gender, especially the female population and the elderly group. Stress urinary incontinence is a common disease in adult women, epidemiological findings show that the prevalence of the disease varies widely, 23% to 45% of the female population has varying degrees of urinary incontinence, about 7% have obvious symptoms of urinary incontinence, of which about 50% for stress urinary incontinence.
A. What is stress incontinence
Stress urinary incontinence (SUI) refers to the involuntary leakage of urine from the external urethra when the abdominal pressure is increased by sneezing, coughing or exercise.
Symptoms are involuntary leakage of urine during increased abdominal pressure such as coughing, sneezing, or laughing. The sign is the involuntary leakage of urine from the urethra that can be observed during increased abdominal pressure. Urodynamic examination shows involuntary leakage of urine on filling cystometry in the presence of increased abdominal pressure with good stability of the detrusor muscle.
Second, how is stress urinary incontinence caused
1, the more clearly related factors
(1) Age: The prevalence of female urinary incontinence gradually increases with age, with a high incidence at the age of 45 to 55. The correlation between age and urinary incontinence may be related to the relaxation of the pelvic floor, estrogen reduction and degenerative changes in the urethral sphincter that occur with age. Some common diseases of the elderly, such as chronic pulmonary disorders and diabetes mellitus, can also contribute to the progression of urinary incontinence. However, the incidence of stress incontinence in the elderly tends to slow down, which may be related to their lifestyle changes, such as reduced daily activities.
(2) Childbirth: the number of births, age at first birth, mode of delivery, fetal size and incidence of incontinence during pregnancy are significantly correlated with the occurrence of postpartum urinary incontinence; the number of births is positively correlated with the occurrence of urinary incontinence; women whose age at first birth is between 20 and 34 years old have a higher correlation between the occurrence of urinary incontinence and childbirth than other age groups; those who give birth at an older age have a higher likelihood of urinary incontinence Women who give birth vaginally are more likely to have incontinence than those who give birth by cesarean section; women who have a cesarean section are at greater risk of incontinence than women who have not given birth; the use of assisted delivery techniques such as forceps, suction devices, and contractions to speed up labor also increase the likelihood of incontinence; and mothers with large fetuses are at greater risk of incontinence.
(3) Pelvic organ prolapse: pelvic organ prolapse (POP) and stress urinary incontinence seriously affect the health and quality of life of middle-aged and elderly women. Stress urinary incontinence and pelvic organ prolapse are closely related and often accompany each other. The thinning and disorganization of smooth muscle fibers, connective tissue fibrosis and muscle fiber atrophy in the pelvic floor support tissues of patients with pelvic organ prolapse may be associated with the development of stress urinary incontinence.
(4) Obesity: The incidence of stress urinary incontinence is significantly higher in obese women, and weight loss may reduce the incidence of urinary incontinence.
(5) Race and genetic factors: genetic factors have a clear correlation with stress urinary incontinence. The prevalence of stress incontinence is significantly correlated with the prevalence in their immediate family. The prevalence of urinary incontinence is higher in white women than in blacks.
2. Possible associated risk factors
(1) Estrogen: Declining estrogen has long been thought to be associated with stress urinary incontinence in women, and estrogen has been advocated clinically for treatment. However, recent data have questioned the role of estrogen, suggesting that there is no correlation between changes in estrogen levels and the prevalence of stress urinary incontinence.
(2) Hysterectomy: If stress urinary incontinence occurs after hysterectomy, it is usually six months to one year after surgery. Surgical technique and the extent of surgical resection may have a relationship with the occurrence of urinary incontinence. However, there is not enough evidence-based medical evidence to confirm a definite correlation between hysterectomy and the occurrence of stress urinary incontinence.
(3) Smoking: The correlation between smoking and the occurrence of stress urinary incontinence is controversial. Some data suggest that a higher percentage of smokers than nonsmokers experience urinary incontinence, which may be related to smoking-induced chronic cough and reduced collagen fiber synthesis.
(4) Physical activity: High-intensity physical exercise may induce or aggravate urinary incontinence, but there is a lack of sufficient evidence-based medical evidence.
Other possible associated factors are constipation, intestinal dysfunction, caffeine intake and chronic cough.
III. How to determine the severity of urinary incontinence
Stress incontinence can be classified into three degrees according to clinical symptoms: mild: no incontinence during general activities and at night, occasional incontinence when abdominal pressure increases, no need to wear urinary pads. Moderate: frequent urinary incontinence with increased abdominal pressure and rising activities, requiring the wearing of a pad. Severe: urinary incontinence occurs when you get up and move around or when you change your position, which seriously affects the patient’s life and social activities.
Fourth, how to treat stress urinary incontinence
While urinary incontinence in children may be a normal thing, stress incontinence in adults and the elderly is an abnormal phenomenon. After clinical symptoms appear, patients should be treated early. What are the treatment methods for stress urinary incontinence, the following is an introduction.
1.Conservative treatment
(1) pelvic floor muscle training: pelvic floor muscle training (PFMT) on the prevention and treatment of female stress urinary incontinence has been confirmed by numerous meta-analyses and randomized controlled studies. This method is easy to implement, effective and suitable for all types of stress incontinence. The duration of efficacy after cessation of training is unclear.
It is necessary to bring the pelvic floor muscles to a comparable training volume to be effective. The following method can be used: continuous contraction of the pelvic floor muscles (lifting movement) for 2 to 6 seconds, relaxation rest for 2 to 6 seconds, and so on for 10 to 15 repetitions. Training 3 to 8 times a day for more than 8 weeks or longer.
Pelvic floor muscle training can also be implemented by biofeedback using special apparatus and equipment. Compared with simple pelvic floor muscle training, biofeedback is more intuitive and easy to grasp, the efficacy may be better than simple pelvic floor muscle training, and it is possible to maintain a relatively long effective duration.
(2) Weight loss: Obesity is a clear correlate of stress urinary incontinence in women. Weight loss can help prevent the development of stress incontinence. Some studies have shown that obese women with stress urinary incontinence, a weight loss of 5% to 10% will reduce the number of urinary incontinence by more than 50%.
(3) Quit smoking: The evidence linking smoking to urinary incontinence is still insufficient. There is evidence that smoking increases the risk of stress incontinence, but there is no evidence that quitting smoking relieves stress incontinence symptoms.
(4) Dietary changes: There is no clear evidence of a relationship between water consumption, caffeine, or alcohol and the incidence of stress urinary incontinence, but dietary changes may help treat the degree of stress urinary incontinence.
(5) Electrical stimulation therapy: Principle: (1) electric current repeatedly stimulates the pelvic floor muscles to increase the contraction force of the pelvic floor muscles; (2) feedback inhibits sympathetic reflexes and reduces bladder activity.
2.Drug treatment
Midodrine, methoxamine: principle: activation of α1 receptors of urethral smooth muscle as well as somatic motor neurons, increase urethral closure pressure and improve urethral closure function. Side effects: hypertension, palpitations, headache and extremity chills, and in severe cases, stroke. Midodrine has less side effects than methotrexate.
3.Surgical treatment
Stress urinary incontinence is not self-healing and the symptoms worsen with age, so surgery should be chosen when conservative treatment is ineffective. At present, there are many surgical procedures, among which transvaginal tension-free midurethral suspension (TVT) is suitable for patients with all types of stress urinary incontinence, which is less invasive and has a high cure rate, and is currently recognized as one of the procedures with the best long-term outcome.
V. Precautions after stress urinary incontinence surgery
With the growing popularity of minimally invasive sling treatment, more and more patients with stress urinary incontinence will undergo midurethral suspension. Although this procedure is currently the most effective and safe surgical treatment for stress urinary incontinence, long-term postoperative follow-up is still required, as well as the need to pay attention to many daily care issues, the following is a summary of the precautions to take after urethral suspension surgery for stress urinary incontinence.
Usually, the day after surgery, check the patient’s puncture wounds on both sides of the abdomen for blood oozing and whether they have crusted over, and pull out the gauze and urinary catheter filled into the vagina, while the patient should drink more water, and the patient should promptly understand whether there is any difficulty in urination and whether there is any significant thinning of the urine line after the first urination. Postoperative pain at the puncture site is mostly related to local hematoma, and hot compresses can significantly reduce the pain. Weight-bearing exercise and sexual life are prohibited for one month after surgery. Any time there is urinary tract infection, or unexplained hematuria or vaginal blood leakage, prompt medical consultation should be made.
VI. How to prevent stress urinary incontinence
1.Popular education
Stress urinary incontinence is a high incidence in women, so first of all, public awareness should be raised to increase the understanding and awareness of the disease, early detection, early treatment, and minimize its impact on the quality of life of patients. Medical professionals, for their part, should further raise awareness of the disease, widely publicize it and improve diagnosis and treatment. For patients with stress urinary incontinence, attention should also be paid to psychological counseling, explaining to patients and their families the onset of the disease and its main hazards, and relieving their psychological pressure.
2.Avoid risk factors
According to the common risk factors of urinary incontinence, take appropriate preventive measures. For those with a family history of urinary incontinence, obesity, smoking, high-intensity physical exercise and a history of multiple births, the possible correlation between lifestyle habits and the occurrence of urinary incontinence should be evaluated and exposure to susceptible factors should be reduced accordingly.
Pelvic floor muscle training (PFMT) in the postpartum period and during pregnancy
Significance: Pelvic floor muscle training in the postpartum period and during pregnancy is effective in reducing the incidence and severity of stress urinary incontinence.
Timing: From 20 weeks of gestation to 6 months postpartum.
Method: Perform greater than or equal to 28 pelvic floor muscle contractions per day, preferably under the supervision of a physician. Each session includes 2-6 seconds of contraction/2-6 seconds of diastole x 10-15 times.