In China, many middle-aged and elderly women encounter an embarrassing situation: whenever they cough or laugh at something happy, their pants get wet with just a little effort on their abdomen. These dripping embarrassments happen mostly to women after giving birth and in their older years. The medical term for this non-life-threatening leakage of urine that occurs only when coughing or laughing is stress urinary incontinence. Although urinary incontinence is not a fatal disease, it brings a lot of inconvenience to women’s lives and often causes great distress to patients. According to statistics, about 20% of postmenopausal women suffer from it.
A. Why does female stress incontinence occur?
Stress urinary incontinence is caused by factors such as birth injuries and menopause, resulting in muscle relaxation at the bottom of the pelvis, which reduces the ability of the urethra to control urine. Clinically, 80% of women with stress incontinence have varying degrees of bladder bulge and 50% have varying degrees of bladder bulge with stress incontinence. In women with normal pelvic floor support structures, when abdominal pressure increases, pressure is transmitted to the bladder and urethra in equal amounts and incontinence does not occur. When the abdominal pressure increases (such as when coughing, laughing, sneezing, or running), the pressure is transmitted only to the bladder and not to the urethra, which has shifted downward, and the pressure difference between the bladder and urethra causes urine to flow out involuntarily.
There are three levels of stress incontinence.
Mild: Occurs when coughing and sneezing, with at least 2 episodes per week.
Moderate: Occurs during daily activities such as walking quickly.
Severe: occurs when urinary incontinence occurs in the standing position.
II. Risk factors for onset
The onset of stress incontinence is associated with age, gender, vaginal delivery, sleep, obesity, living alone, and lack of help. The prevalence is significantly higher in those who are older, have more vaginal deliveries, have vaginal instrumental deliveries, have newborns weighing more than 4000 grams, have mobility problems, live alone, and are obese. The incidence of stress urinary incontinence tends to increase with age, and the prevalence groups are mainly middle-aged and older women with multiple births and postmenopause.
Third, whether to see a doctor
Although urinary incontinence is a very troublesome disease, it does not seem to receive much attention in daily life. Many people believe that the body or physiological changes that occur, can not control urination, leakage of urine is considered normal, there is no need to see a doctor. Many female patients are influenced by economic culture and religious taboos and prefer to take self-care rather than seek help from a doctor. According to the survey, 2/3 of women find incontinence difficult to talk about, embarrassed to tell the doctor, preferring to change pants and use urine pads rather than go to the hospital.
In fact, urinary incontinence is not a minor problem. Frequent urine loss and leakage in women may cause eczema, bed sores, skin infections and inflammation of the urinary system. And urinary incontinence causes bad feelings such as anxiety, embarrassment and frustration in women, which can also seriously affect their quality of life. Such as anxiety, anxiety and loss of confidence due to bad odor, it can also affect normal social activities with friends and family, and even affect sexual life. But for most women, after menopause, urinary incontinence will become more severe and less controllable as women lose more estrogen.
Fourth, how to treat
The vast majority of patients with stress urinary incontinence can be completely cured or have their symptoms relieved with treatment. However, many patients do not receive proper treatment because they are ashamed to talk about it. Therefore, overcoming shyness and going to the hospital is the first step toward treatment. Generally speaking, urologists are specialists in the treatment of urinary incontinence.
Patients with mild to moderate incontinence can be treated with medication and behavioral therapy, while behavioral exercises are given to improve the efficacy of medication and reduce symptoms. For patients with severe stress urinary incontinence, surgery is the main treatment, and there are a variety of surgical procedures available, commonly used are a variety of slings and suspension surgery.
Patients with urinary incontinence should also be timely treatment of diseases that increase abdominal pressure, such as constipation, chronic cough and other diseases.
1, behavioral treatment
1, training treatment.
Do Kegel exercises by: tightening the anus for more than 3 seconds and then relax. Do it continuously for 15 to 30 minutes, 2 to 3 times a day. Or 150 to 200 times a day, 6 to 8 weeks for a course of treatment. The purpose is to enhance the pelvic floor muscle groups of the torsion, the backward or prolapse of the bladder reset, so as to restore the normal angle between the bladder and urethra.
2, pelvic floor muscle training method.
① squatting to urinate, better than sitting on the toilet, but pay attention not to add abdominal pressure.
② usually sitting, lying, standing, when you imagine that you are relieving the bowels, try to hold back to relieve the bowels, clench the muscles around the anus and perineum, repeatedly contract, mind silently 1, 2, 3, 4, 5, and then relax.
2.Surgical treatment
Many women use sanitary napkins to solve the problem, and others think of going to the hospital for a solution only after a number of years. If you are already a serious urinary incontinence patient, it is recommended that you perform surgical treatment. Under the guidance of a medical professional, this will help you to get rid of your incontinence sooner and regain your “control” as soon as possible.
At present, the treatment of moderate to severe incontinence is mainly surgical treatment, supplemented by drugs and training treatment. Surgical treatment can completely cure urinary incontinence, while non-surgical treatment can only improve the symptoms of urinary incontinence, can not achieve a curative effect. Therefore, non-surgical treatment is often used as an adjunct to consolidate the effectiveness of surgery.
At present, in foreign developed countries, the main treatment for stress urinary incontinence is the “transconjunctival tension-free urethral suspension (TVT-O)”, with good results. In China, the TVT-O procedure has been widely carried out in the Department of Urology of Tianjin People’s Hospital, for example. Compared with traditional surgery, TVT-O is minimally invasive, safe and has a better treatment effect, with a cure rate of about 90%.
Special tips.
V. How to prevent
Women in their 30s: Women should prevent urinary incontinence after the age of 30. Often do Kegel exercises, can exercise the pelvic muscles, promote pelvic blood circulation, and also have a beneficial effect on the sexual life of couples.
Maternity: 6 weeks after childbirth should pay attention to rest, do not move too much, do not bear weight and work on the ground too early, so as not to cause pelvic floor muscle relaxation. No obstetric protection caused by the birth canal injury, but also easy to lead to pelvic floor muscle relaxation and incontinence. In addition, pregnant women should go to the hospital for regular checkups during the perinatal period.