Women will inevitably experience the symptoms of “frequent, urgent and painful urination” one or more times in their lives, which will not only bring inconvenience to their lives but will also have a great impact on their psychology. Because of its complex etiology and the difficulty of prevention and treatment, it adds to the psychological burden of patients. The author has combined decades of clinical experience to summarize the most common causes of this condition and its prevention and treatment methods as follows.
Clinically, the group of symptoms “urinary frequency, urinary urgency, and urinary pain” is usually defined as bladder irritation, which is now basically collectively called lower urinary tract irritation (Luts). The reason for not using a specific name is that the causes of these symptoms are complex and the treatment varies widely, as do the outcomes. The causes of this syndrome are usually divided into two simple categories: one bacterial and the other non-bacterial. This can greatly simplify the examination and treatment tools for the convenience of the patient.
Bacterial lower urinary tract irritation is mainly caused by common pathogenic bacteria of the urinary tract, such as Escherichia coli and Proteus mirabilis, and is often combined with hematuria at the end of urination in addition to the symptoms mentioned above. In addition to the above symptoms, hematuria at the end of urination is often combined with more white blood cells and red blood cells in urinalysis. Based on the above symptoms and routine urine test results, the diagnosis can be made clearly. Treatment: Oral cephalosporin or quinolone antibiotics are preferred and can be taken for 3-5 days continuously. It is recommended to assist in the oral administration of heat-clearing and detoxifying Chinese medicines, such as Qinglin granules and urinary pellets. The purpose is to further relieve the symptoms, reduce the dosage of antibiotics, shorten the duration of antibiotics, and avoid the side effects and drug resistance caused by long-term medication to the human body. If the symptoms are not heavy, you can choose only oral antipyretic Chinese medicine, on the contrary, those with combined back pain and fever need to choose the intravenous route to apply antibiotics.
It should be reminded that the above-mentioned patients should consider the presence of specific pathogenic bacterial infections or organic lesions of the urinary tract if the effect of ordinary medication is not good, the symptoms are recurrent, and the reduction of white blood cells in urine tests is not obvious. Further examination should be performed to exclude mycoplasma, chlamydia and Mycobacterium tuberculosis infections, and to exclude urinary stones and obstruction.
The main manifestations are as follows.
1. Urinary urgency: a sudden and compulsive urge to urinate that is difficult to delay. Urinary urgency is a mandatory symptom for all patients with overactive bladder (OAB).
2, frequent urination: the number of urination is more than 8 times in 24 hours (with the exception of drinking a lot of water, especially in winter), and the volume of urination is less than 200 ml each time. more than 1 time after going to sleep, the need to urinate is awakened by urinary distension, and the volume of urination is small, almost or basically accompanied by the feeling of incomplete urination or discomfort of lower abdomen.
3.Urgent urinary incontinence: the emergence of the desire to urinate after not being able to wait and hold back and the involuntary leakage of urine. It occurs in about one-third of patients with overactive bladder (OAB). The pathogenesis of overactive bladder disorder (OAB) is generally considered to be related to the increased contractile activity of the bladder forceps muscle, which has M1-55 known subtypes of M-receptors. Among them, M2 and M3 subtypes play a major role, while M3-receptors play a major role in mediating the contraction of the detrusor muscle. This suggests that the main cause of overactive bladder (OAB) may be due to some factor causing overactivity of the M-receptors of the detrusor muscle of the bladder. The diagnosis of overactive bladder (OAB) is determined primarily by the patient’s clinical presentation and the absence of abnormalities on urinalysis. Urodynamic testing is not a mandatory test and the author believes it is more clinically relevant to detect residual bladder urine in patients over the age of forty.
The main treatment for overactive bladder (OAB) includes two aspects.
First, pharmacological treatment. Currently the most used M-receptor antagonists, such as solifenacin succinate (Weixikang) tablets, the efficacy is certain, generally 1-2 weeks of medication can be used, a few patients need 4-6 weeks of medication time. The author’s experience is that it is more effective to use Chinese medicines (such as Shujutong Pill, etc.) to clear heat and detoxify toxins.
Second, behavioral intervention.
1.Living habits change. Less spicy diet, not sedentary, avoid excessive holding urine (more than three hours), more exercise, to moderate walking is better.
2, psychological adjustment. Fully understand that the disease is related to lifestyle habits and ageing, excessive worry will aggravate the self-consciousness of the disease, and appropriate participation in social activities is conducive to psychological burden reduction.
3, appropriate drinking and eating more vegetables can keep the bowels open, reduce the additional stimulation of the bladder, so as to achieve the purpose of relieving the symptoms of lower urinary tract irritation.
4.Bladder holding training. Initially, when you have the urge to urinate, deliberately insist on not urinating to dilute the feeling of the urge to urinate, gradually increase the bladder’s ability to store urine, and slowly increase the interval to 1-2 hours.
5.Repeat urination. When the residual urine in the bladder is more than 50 ml, in addition to the urethral sphincter antagonist, the elderly patient should be instructed to urinate again after the initial urination.
6. Kegel exercise methods. These exercises can strengthen the contraction ability of the urethral sphincter and pelvic floor muscles, thus achieving an increase in the ability to control urination. They are effective for first or mild second degree stress incontinence and overactive bladder (OAB). Before the exercise, empty the urine, beginners to practice lying on their backs, knees bent and apart, relax the whole body, contract the muscles near the perineum and anus, force for about 5 to 10 seconds, then slowly relax, rest for 10 seconds, repeat this collection and release action twenty times. This contraction of the pubococcygeus muscle is similar to interrupting the flow of urine and stopping defecation by contracting the anus. When you first start practicing, you can put your index finger into the vagina to feel the tightness that comes with it and gradually master the exercise. This will not only relieve frequent urination and improve urinary incontinence, but also increase sexual desire and make it easier to reach orgasm.
Main prevention methods.
1, all of the above behavioral interventions.
2, actively prevent and control gynecological diseases, change underwear regularly, preferably choose better quality cotton fabric. Try to choose the shower way to wash perineum, after defecation from the front to back sassafras anal.
3, both sides before sex perineum clean, the woman immediately after sex urination.