Urinary incontinence in women after 50 years of treatment and causes

Urinary incontinence in women - is involuntary expiration of the urethra through the external opening of the urethra. Urinary incontinence in women - is involuntary expiration of the urethra through the external opening of the urethra. This disease affects about 30% of women older than 60 years - 15% women to 45 years, and only 7% It is the result of a congenital pathology of the internal structure of the urogenital organs and urinary bladder in particular.

Causes, symptoms and treatment will depend on the severity of the disease and its etiology and pathogenesis. Can be used as a therapeutic preventive exercises to strengthen the pelvic floor muscles, and medical or surgical treatment.

How does the bladder?

In bladder has 2 main objectives: to accumulate urine into the kidneys, and periodically emptied, notifying the advance brain (to give a signal that it was time to go in a little).

To control both of these processes, there are sphincters (special muscle), which are compressed, preventing the urine to flow continuously, and relax during urination. Any healthy person can consciously control the work of their sphincters.

Causes of

These factors are almost all females, but urinary incontinence occurs in women after 50, if the combination of circumstances allows you to combine terms.

The most frequent causes of urinary incontinence in women:

• Incontinence - is one of the symptoms of a stroke;
• overactive bladder due to the breakdown in communication with the nerve fibers of the spinal cord;
• inflammatory diseases of the bladder and urethra (cystitis, urethritis) against chronic gynecological diseases, enterocolitis expressed constipation;
• in lesions of the pelvic organs traumatic urinary syndrome often complementary serious fractures, bruises, internal bleeding;
• bedwetting is more common in women with neurological diseases, neuroses, mental disorder; pathology appears in girls, the clinical importance is the age limit of 5 years, when the child already has to control urination;
• deferred surgery on the uterus and appendages, cesarean section, leading to the interruption of nerve branches, providing sufficient reduction of urinary sphincter bladder, effective treatment of uterine fibroids by amputation gives rise to urinary incontinence (considered a complication of surgery, but practically gynecologists is taken into account);
• involuntary leakage of urine during the night and daytime contribute bronchus and lung disease accompanied by severe cough (for example, chronic smoker's bronchitis), it generates a DC voltage abdominal muscles and increases intravesical pressure.

These mechanisms are involved in the formation of urinary incontinence such chronic diseases of women:

• stones in the urinary organs;
• obesity;
• congenital malformations of the urinary tract;
• chronic cystitis and urethritis;
• diabetes;
• pelvic prolapse;
• Parkinson's disease and Alzheimer's;
• tumors of the bladder, the uterus;
• multiple sclerosis;
• damage of brain and spinal cord;
• chronic alcoholism.

There is evidence that a breach of control over urination contribute:

• smoking;
• long-term use of diuretics, antidepressants,
• fascination with strong coffee and carbonated beverages.

Causes arising in a particular case, are often mixed. To assign the correct treatment, the physician should understand the previous clinical manifestations and conduct a survey.

Classification

Medicine There are several types of this disease, the most common include:

1. Imperative - developing due to a malfunction of the nervous system. Woman suffering from a strong urge to release urine, which sometimes can not be stopped by force of will. During the day she goes to the toilet "in a little" not less than 8 times, and had to get up at night. This kind of manifested in overactive bladder.
2. Stress - develops with increasing abdominal pressure, manifested in severe coughing, laughing, lifting heavy objects. As a rule, it arises from the weakness of the pelvic muscle, which contributes to reduction of collagen production, thus manifested urinary incontinence in women after 50 years. Medical statistics show that half of the members of the fairer sex, who took menopause, faced with a similar problem.
3. Mixed - a combination of the first two species most often occurs after childbirth, complicated injuries. This type is characterized by a strong desire and streaks, which can not be controlled under load.
4. It includes a combination of urge spontaneous separation and prior to this compelling desire. Sometimes a woman does not have time to run to the toilet.
5. Enuresis is characterized by involuntary urination not only during the day but also at night. It is especially important for this type of bedwetting in women.
6. "Undermining" - appears when, after going to the toilet "in the small" drip urine is released is collected and is not completely exiting the urine.
7. Permanent - develops when impaired bladder, urinary tract, ureter.

How to treat incontinence?

It takes treatment of urinary incontinence in women after 50 a long time and is complex. It includes compliance with the general recommendations for changes in the daily routine and lifestyle, medication, performing physical exercise to strengthen muscles, psychological training. In some cases, the decision on surgical intervention.

Implementation of common rules, the corrective lifestyles, includes:

• a change in diet, can significantly reduce the weight or get rid of obesity;
• decrease in the volume consumed tea, coffee, soft drinks;
• rejection of addictions (alcohol, smoking);
• compliance regime urination (going to the toilet at certain times, regardless of the desires);
• detection and treatment of chronic diseases of the urogenital sphere;
• psychological training, allowing escape from the disturbing thoughts and shift attention.

Depending on the cause of enuresis in women assigned different drugs, pills. They act on the cause of the problem and thus solve the problem itself and. You can select groups such drugs are prescribed depending on why there was incontinence:

1. Sympathomimetics - Ephedrine - helps reduce the muscles involved in urination. The result - bedwetting stops.
2. Estrogens - preparations in the form of female hormones progestin and estrogen - are appointed, if incontinence is caused by a lack of female hormones. This happens during menopause.
3. Antidepressants - Duloksitin, imipramine - discharged, if the cause is stress incontinence.
4. Anticholinergic drugs - oxy-butyne, Driptan, Tolteradin - appointed when the urinary bladder caused gipereaktivnostyu.
5. Desmopressin - reduces the amount of urine produced - discharged during temporary incontinence.

Incontinence in women due to stress there are several possible treatment options. Choose the best of them can only be a doctor after the conduct of research and analyzes of results.

Medication:

1. Agonists (Gutron) increase the tone of the sphincter and the urethra, but act on vascular tone. Rarely used because of the low effectiveness or side effects (increased blood pressure)
2. Anticholinesterase drugs (Ubretid) also increase muscle tone. It recommended for women who identified hypotension bladder on the results of surveys.
3. Antidepressant duloxetine (Cymbalta), effective in half of the cases, but has side effects on the digestive system.

Treatment of stress urinary pills are very rare because of frequent relapses and side effects.

training

Intense exercise pelvic floor muscles will be very efficacious, by the way, this method will not take much of your strength, and the time you spend - nothing at all! A few examples:

• Oddly enough, but very well strengthens the muscles of bladder control. That is, try to control the delay of the restroom, do not go immediately to the toilet, a little bear. Thus, you will strain the muscles, thus training them.
• You can train the muscles in this way: take a comfortable position, sitting on a chair, the feet should thus rest against the floor, knees slightly dissolve in different directions. Leaning his elbows on the hips, torso forward. This provision clearly record the belly + buttocks. Then, by muscle tension retract the anal passage 10 seconds. Relax for 5 seconds. Repeat 6-7 times the action is desirable.
• Another effective exercise: tighten your vaginal muscles, stay in this state for 10 seconds. Actions must be repeated 6 times - you need to make sure that there was no pain, extreme fatigue. It is recommended to repeat the exercise 6-10 times throughout the day. The retention time of the voltage should be gradually increased to a reasonable limit for you.

Especially effective is to help restore the pelvic floor muscles performing Kegel exercises. When you run this gym is necessary only to strain the muscles of the pelvic and buttock, thigh, and the press must remain at rest. This gymnastics is based on three techniques:

• Performing slow contraction of pelvic muscles that help to stop urination. This exercise will begin to perform a tension muscles of the pelvic floor, which hold 3 seconds in the compressed position, and then relax. Then count to 3 and back strain. Gradually increase the interval of muscles being in a compressed position to 20 seconds. Do exercise 10-30 times three times a day.
• Performing cuts the pelvic floor muscles. Make exercise alternately reducing quickly and then relaxing the muscles of the lower part of the pelvis. Do exercise 10-30 times three times a day.
• Performing pushing muscles of the pelvis. To do this exercise, muscles need to work that is involved with vain attempts at childbirth and during the process of defecation. It is necessary to strain the delay (2 seconds) and relax the muscles. Do exercise 10-30 times three times a day.

operative therapy

In stress incontinence in women operation is the method of choice. There are several surgical procedures that differ in complexity of execution. Preference for an operation is given, depending on the degree of incontinence and urethra female anatomical features.

Sling operations (TVT-O, TVT)

These interventions minimally invasive and are performed for 30 minutes under local anesthesia. The essence of such an intervention is extremely simple: the introduction of a special synthetic mesh in the form of a loop at the bladder neck or urethra. This loop hold the urethra in its physiological position, not allowing the urine to flow due to increased intra-abdominal pressure. For the introduction of such a grid make some or all of a single incision in the vagina or in the inguinal crease, cosmetic defect is not formed. Over time, this grid grows in connective tissue and securely locks the urethra.

Recovery from this type of intervention comes rather quickly, but the effect is felt immediately. Despite the apparent attractiveness of the sling operations, the risk of recurrence when they saved. In addition, when anatomical defects of the urethra and detrusor instability such surgery can be inconclusive.

Despite the difficulties mentioned above today loop minimally invasive surgery - the "gold standard" in the treatment of stress urinary incontinence.

Laparoscopic Burch colposuspension

The operation is performed under general anesthesia, usually laparoscopic access. Tissue surrounding the urethra, as if suspended from the inguinal ligament. These ligaments are very strong, so the long-term results of the surgery is very convincing.

But due to the type of anesthesia and the complexity of the procedure, colposuspension has more contraindications and complications than sling surgery. Typically, such an intervention is carried out after untenable loop procedure or in violation of the anatomical structure of the urogenital system.

Injections bulking agents

In the course of such manipulation under control tsitoskopa entered a special substance into the submucosa of the urethra membrane. In most cases, a synthetic material that has anti-allergic properties.

This leads to compensation of missing tissue (soft) and the restoration of the anatomic position of the urethra. And low-traumatic procedure and is performed on an outpatient basis under local anesthesia, but also does not rule out recurrence.

colporrhaphy

Closure of the vagina special resorbable yarns, used for prolapse of pelvic organs. The operation has a number of complications (scarring of tissue, for example) and lose the effect in a few years.

prevention

Incontinence, for the prevention of the disease need to avoid adverse effects, and to follow the recommendations:

1. It is worth to stop smoking;
2. Engage in physical activity;
3. Eat a small amount of products that irritate the bladder: alcohol, coffee and sweet food and drinks, spicy food and spices, citrus fruits, tomatoes;
4. In the presence of excess weight - lose weight. Overweight weakens the pelvic muscles;
5. It is impossible to drink less water, this can lead to dehydration and irritation of the urinary organs (less fluid - a more concentrated urine);
6. Observe the intimate hygiene. Incontinence can be caused by bacteria and infections of the genitourinary system. Therefore, it is important to keep track of personal cleanliness, wear underwear made of natural fabrics. You can use the urological pads. Pros use - bactericidal effect and absorption of odors.

Incontinence in women after 50 years, is causing a lot of inconvenience. But correctly chosen method of treatment can help get rid of the unpleasant symptoms after only a few treatments.