Although urinary incontinence is a common and widespread problem, surveys have found that Chinese people know very little about it. Even though many people are troubled by urinary problems, they still think that the “faucet” switch is not working and that it is just a problem of old age. I do not know that incontinence is not the patent of the elderly, as the saying goes, know your enemy, a hundred battles can be won, the correct understanding of the disease, in order to overcome the disease.
Urinary incontinence can be subdivided into four categories.
1, stress urinary incontinence
2, acute urinary incontinence
3, mixed incontinence (stress and urgency at the same time)
4, overflow incontinence
Stress incontinence is most common in postpartum and menopausal women. Patients with stress incontinence usually do not show incontinence, but when there is a sudden increase in intra-abdominal pressure (such as coughing, sneezing, crying and laughing, going up stairs or lifting heavy objects, etc.), urine will involuntarily flow from the urethra; serious cases can occur when walking or standing upright. This kind of incontinence is not accompanied by urinary frequency, urinary urgency symptoms, incontinence of urine volume is also not much; standing activity incontinence aggravated, lying down after the reduction of symptoms; many patients are also complicated by uterine prolapse, bladder urethral bulge, etc..
Treatment of stress urinary incontinence.
1, for mild urinary incontinence patients can take behavioral therapy or drugs.
2, For patients with moderate or severe cases, it is difficult to achieve the desired effect with purely conservative treatment, and surgical treatment – transvaginal tension-free midurethral sling – must be adopted.
Urge incontinence is characterized by a sudden uncontrollable sensation of urination and frequent urination. These patients need to use the bathroom frequently, even every half hour, and bedwetting at night is a frequent occurrence.
Occasionally, I see such patients in the clinic: I have to get up almost once an hour to urinate so frequently in the middle of the night that I can’t sleep well.
Urge incontinence is mainly due to involuntary contraction of the bladder, called overactive bladder disorder. Under normal circumstances, the bladder does not contract automatically unless there is a conscious need to relieve urine, then the bladder pressure rises and the urethral sphincter relaxes at the same time to complete the action of relieving urine. However, urge incontinence is a condition in which the bladder contracts involuntarily, and once the contraction pressure of the bladder is higher than the pressure of the urethral sphincter, urine will flow out of the urethra and the phenomenon of urine leakage will occur.
There are many causes of urge incontinence including.
1, neurological diseases: stroke, multiple sclerosis or Parkinson’s disease may induce the problem of urge incontinence.
2, spinal disease: Sometimes multiple spinal diseases can also cause the formation of urge incontinence, including spinal tumors, spinal trauma, may cause urge incontinence.
3, diabetes: because diabetic patients are prone to neuropathy, also prone to cause the problem of urge incontinence.
4, urinary tract infection: urinary tract infection, especially cystitis or urethritis can also cause the problem of urge incontinence, so patients in the doctor will first test the urine for patients to determine whether there is a problem of urethritis.
Distinguish the type of urinary incontinence, in order to prescribe the right medicine, the treatment of urge incontinence.
1, for mild urinary incontinence patients can take behavioral therapy or drugs.
2, for moderate and severe patients, and stress incontinence treatment is completely different, for conservative treatment is not effective or can not tolerate the side effects of drugs, now internationally recognized as more effective is the sacral nerve electrical stimulation (commonly known as bladder pacemaker).
3, There is another surgical method called bladder enlargement, in which the bladder enlargement will lead to a weakening of muscle contraction and improve the overactive bladder state as the forceps urinaryis muscle used for urination at the top of the bladder is cut off. However, since this procedure is irreversible, postoperative complications may include leakage, persistent incontinence remaining and kidney damage. Long-term risks include bladder stones, bladder tumors and persistent urinary incontinence. Careful consideration is recommended for younger patients and those with high quality of life requirements.
Filling incontinence is the overflow of urine from the urethra after chronic urinary retention due to urethral obstruction (urethral stricture, prostatic hyperplasia) and weak bladder contraction, when the bladder is extremely full and the pressure in the bladder exceeds the resistance of the normal urethral sphincter. When the increase in urine causes the intravesical pressure to exceed the maximum urethral pressure, even a small amount of urine overflows involuntarily. Long-term elevated intravesical pressure can cause upper urinary tract obstruction and impair renal function. Common clinical causes include diseases such as prostatic hyperplasia, prostate cancer and neurogenic bladder.