Urinary incontinence
Urinary incontinence affects nearly 5% of the population. Among women, an average of one in three suffers from it during their lifetime. The ailment of incontinence is an embarrassing and embarrassing problem for the patient. Therefore, often the first visit to the doctor takes place when the disease begins to impede daily functioning or significantly reduces the comfort of a woman’s life. In Poland, this is partly due to the fact that already at the stage of collecting data from the patient there are no properly targeted questions in questionnaires, which creates a vicious circle – the patient does not perceive the disease because he or she is not asked about it, and it seems that the medical staff treats incontinence itself not with due attention. Meanwhile, at every stage of the disease, the patient can expect help and should receive it From the first visit to the doctor to specialized examinations and treatment, the patient with incontinence requires comprehensive medical care, and attention should be paid to his individual expectations. Predisposing and risk factors for urinary incontinence in women
White race alone predisposes to a higher incidence of urinary incontinence especially the stress form.
There is a noticeable increase in the incidence of urinary incontinence in women whose mother or grandmother suffered from it.
Any congenital abnormality of the genitourinary tract, including fistulas.
Neurological disorders of the brain and spinal cord congenital, e.g., spina bifida, as well as diseases such as multiple sclerosis , Parkinson’s disease
Among obstetric-gynecological factors, pregnancy and childbirth come to the fore. The occurrence of even temporary, urinary incontinence during pregnancy predisposes to the appearance of this type of ailment in the elderly of these ailments although, there are also studies that indicate a decrease in the impact of pregnancy and childbirth on the incidence of urinary incontinence with age
Previous gynecological surgeries, treatment with radiant energy in oncology patients. Reproductive organ statics disorders – that is, uterine and vaginal prolapse, urinary problems are more common in patients with this type of condition, and often it is incontinence that is masked by symptoms of reproductive organ prolapse. Hormone deficiency – estrogen, ailments associated with menopause, but also occurring in younger patients in whom there is a deficit of hormones in the course of various diseases or after treatment such as oncological treatment. Inflammatory conditions cause disorders of storage and urination. Ailments that are associated with infections do not allow an objective assessment of the genitourinary system, this is the most common additional reason why the patient comes to the doctor for help their proper treatment is the basis
Smoking, alcohol abuse, but also coffee and tea.
Irrational supply of fluids and the habit of holding back urination, constipation.
Leakage of urine without our intention is urinary incontinence Due to the mechanisms of formation, we distinguish the following types of incontinence Effort incontinence is the uncontrolled leakage of urine during an increase in pressure inside the abdominal cavity, which occurs during physical exertion, coughing sneezing and even everyday activities. It is the most common form of incontinence about 50% of patients have this type of incontinence, most often affecting younger women Urgency incontinence is sudden uncontrolled urination preceded just before the leakage by a strong urge-purge. Sudden contraction of the muscle responsible for emptying the bladder can be a symptom of overactive bladder syndrome. This form affects about 20% of patients, especially the elderly. It is the most common type of incontinence in men Mixed incontinence is the simultaneous occurrence of symptoms of stress and urgency incontinence. This type of incontinence occurs in about 30%
of patients Diagnosis Determining the type of incontinence begins at the interview stage – interviewing the patient assessing a questionnaire, evaluating a micturition questionnaire, general examination and urine culture. A proper medical and gynecological examination and, depending on indications, evaluation in an ultrasound of the reproductive organs and abdominal cavity (bladder, kidneys) is the stage that allows us to make a diagnosis and apply adequate treatment.
If it does not have the desired effect or the initial examination does not explain the cause, specialized examinations are carried out, such as evaluation of the backlog of urine in the bladder after urination or urodynamic study.
It is an examination to determine the function of the lower urinary tract, helpful in prognosis as to the effects and choice of treatment method. Urodynamic examination should always be considered in a broader context, taking into account the symptoms, clinical examination or other ancillary tests.
In special cases, electromyography is performed, i.e. the evaluation of the surrounding muscles and nerves by examining their electrical activity.
Cystoscopy – viewing the bladder with a special camera, or urography, i.e. radiological examination with the use of contrast, is used in the examination of the lower urinary tract and the search for the cause of urine leakage. Treatment Conservative treatment is based on changing behavior and developing new health-promoting habits in the patient, and does not use any drugs or surgery. It focuses on lifestyle changes, bladder and pelvic floor muscle exercises, the use of vaginal pessaries or electrical and magnetic stimulation of the muscles and nerves of the area. Rehabilitation of malfunctioning pelvic floor muscles. This can include neuromodulation, which involves stimulating the right nerve fibers responsible for bladder function and the surrounding muscles. Behavioral therapies which aims to improve bladder function controls including urination according to a set schedule. Targeted exercise training of the muscles of the pelvic floor, performed at home or under the supervision of a physical therapist Finally, biofeedback where the patient can see on a monitor screen and hear the effects of tensing and relaxing the muscles is the treatment of choice.
Pharmacological treatment – is used primarily in the treatment of urge incontinence – overactive bladder, where it is by choice the first most effective method of treatment.
There are no similar effects in the pharmacological treatment of other forms of urinary incontinence, and the side effects and contraindications of the drugs used mean that patients often disqualify this method of treatment.
The most common and available of the drugs used are tablets containing anticholinergic substances is the standard of treatment of overactive bladder. Supported by topical and systemic administration of estrogens in patients with hormone deficiency.
Unfortunately, these drugs are not tolerated by every patient , in people with ophthalmic, cardiac or elderly problems have limited use. The choice and dose of the drug depends on the severity of the ailment, but also on the general condition of the patient and the severity of the occurrence of side effects. The use of these drugs requires regular medical supervision of the patient. Operative treatment
When conservative treatment does not have the desired effect, or in the case of drug treatment there are contraindications to the administration of drugs, we propose specialized treatment, surgical correction of vaginal and bladder disorders. Methods most commonly used in the treatment of stress and mixed form of urinary incontinence Treatment of mixed form of urinary incontinence involves an attempt to determine which type of incontinence is leading and burdensome for the patient, depending on this we select the initial management that coincides with the analogous in the earlier types of incontinence.
It is in this type of incontinence that often the cure of one form leads to an intensification of the symptoms of the other The most popular nowadays are treatments with tapes – in the shape of a strip – tapes of polypropylene or other material. The surgeries performed nowadays involve the use of plastic materials, introduced into the body most often through the vagina which provide a kind of scaffolding to support the support and suspension of the urethra, vagina and bladder. Sometimes operations involving the suspension of the vagina and indirectly the urethra through specially placed sutures are performed through the abdominal or laparoscopic route. There are also used o injection of the urethra with special substances that impede the leakage of urine, these methods are associated with several procedures performed during cystoscopy( camera-guided viewing of the urethra and bladder ) with time after surgery the effectiveness of this treatment decreases. There are also methods associated with the implantation of an artificial sphincter, subject to the risk of serious side effects on this account is a method not of choice
In each type of incontinence, we try to treat the cause, for this reason, mistakes made at the stage of diagnosis can ultimately hinder treatment, and often cause the aggravation of complaints or the appearance of new ones. Treatment and at the same time complementing the diagnostic process should be as conservative as possible. This allows us to improve the quality of life without unnecessary resources and expenditures, which is not without significance, and at the same time to answer the question of whether the treatment has the right direction.
Treatment of all forms of incontinence begins with a change in lifestyle, first and foremost, avoiding risk factors includes taking fluids appropriately as to quantity and quality, regulating body weight, giving up substances that can irritate the bladder including drinking coffee, tea or alcohol, avoiding carbonated drinks, smoking. Proper treatment of upper respiratory tract infections or other coughing or sneezing situations, extreme strain and exercise, introducing regular urination, avoiding constipation. All examination and treatment methods should be discussed individually, taking into account both the severity of the disease and the patient’s expectations.
The choice of examination and treatment site should be dictated by proper technical facilities with medical personnel experienced in this field. Do not be afraid to ask and do not be afraid to ask. Urinary incontinence is already a social problem and will include more and more people. Let’s try not to make this a hidden problem with which we struggle alone.
Early and proper diagnosis in the current era gives a chance for complete success of treatment , allowing suffering women to live comfortably and with dignity.
