Treatment of stress urinary incontinence

  This article is written for your mothers, as children, we will go online and know about this disease, but often our mothers tend to treat this disease as normal and difficult to talk about, but it is affecting the quality of life of mothers.  Urinary incontinence usually occurs after the mother has given birth to a child. It usually occurs when coughing, laughing, or during strenuous activity, and in severe cases, it may even occur during a little activity. There are also some cases where incontinence occurs when one is in a hurry. The former is called stress incontinence, the latter is called urge incontinence, and some people may have both conditions, called mixed incontinence.  Urinary incontinence is often related to childbirth, which occurs after childbirth due to excessive pressure on the muscles of the pelvic floor during the descent of the fetus, resulting in nerve and muscle damage. Some of these cases occur within a short period of time after childbirth, while others occur some time after childbirth and may be combined with uterine prolapse (the uterus falls out of the vagina or even comes out of the vagina). After menopause, the symptoms of urinary incontinence tend to worsen whenever the estrogen in the body decreases. As a result, urinary incontinence has become a common problem among middle-aged and older women, with epidemiological surveys showing that 30% of perimenopausal women have urinary incontinence.  As life expectancy increases and the quality of life improves, this problem should be properly understood and promptly seen in a hospital.  There are already solutions to the problem of urinary incontinence.  After the visit, the doctor may ask the patient to fill out a bladder diary to record daily water intake, urine output, and incontinence to help the doctor understand the severity of the incontinence. Completing a one-week urinary diary prior to the visit will help the doctor understand the condition.  Routine urinalysis helps to understand whether the patient has any urinary tract infections or hematuria. Individual patients may also need to have kidney function tests.  A special test for urinary incontinence is called a urodynamic test to see if there is a combination of internal sphincter dysfunction and neurological problems.  For treatment, a distinction needs to be made between the degree of incontinence, fertility requirements and age.  For each patient voiding management, bladder training and pelvic floor exercises are indicated.  Voiding management refers to the proper management of fluid intake, drinking regularly, small amounts of water, avoiding large amounts of water at a time, and avoiding water during the night for 4 hours before going to bed.  It is important to avoid irritating foods such as caffeine, soda, alcohol, spicy acidic foods, and dessert additives, all of which can irritate the bladder causing bladder irritation symptoms.  Bladder training is to extend the time interval between urination through behavioral training. This usually starts with regular 45-minute urination and gradually lengthens the interval of urination. In the process of holding urine, if the desire to urinate occurs, urination is inhibited by contraction of the pelvic floor muscles and by imagining that the symptoms of urgency subside. In general, after 2 weeks of training, the interval between urination is extended by 15-30 minutes until the goal of urination every 3-4 hours during the day and once at night is achieved.  Topical estrogen therapy is indicated for postmenopausal patients. After menopause, as estrogen levels decline, the mucous membrane of the genital tract appears to have symptoms of atrophy, and topical estrogen ointment applied in moderation in the vagina can help improve urinary incontinence symptoms.  Pelvic floor exercises, or Kegal training, can be used for patients with any degree of incontinence. Kegal training can be done by suddenly holding in the urine during the process of urination, and the muscle contraction felt during the process is the pelvic floor muscle. Pelvic floor training can be exercised for 10-15 minutes daily. Pelvic floor exercises not only relieve the degree of urinary incontinence, but also help women improve their sexual function.  There are various surgical procedures, but the current gold standard procedure is called TOT/TVT, in which a sling about 1cm wide is placed under the urethra and tightened to raise the angle of the urethra for the purpose of treating urinary incontinence. Of course, the surgery is not 100% successful at this time, with about 50% of people achieving complete cure and another 30% achieving remission, but there are still about 10-20% of patients who will fail the surgery.  In complex cases of combined uterine prolapse, in the case of severe cases, correction of uterine prolapse and treatment of urinary incontinence is often an option during surgery. The specific situation needs to be evaluated in an outpatient examination before deciding on a treatment plan.