Incontinence after 40. Urinary incontinence in women - causes and treatment. Treatment of stress and bedwetting in women

Urinary incontinence in women is a rather serious problem that causes a lot of inconvenience. It can occur at any age, for example, in young people this happens after a complicated birth. But most often this occurs in older women.

Causes, diagnosis and treatment of urinary incontinence in women

The problem for women of Balzac age is due to the fact that during menopause the production of estrogens, female sex hormones responsible for the elasticity of body tissues, the ligamentous and muscular apparatus of the pelvic floor, is significantly reduced. Accordingly, a decrease in their production leads to a deterioration in the tone of the urethra, involuntary leakage of urine under the slightest load, coughing, and sneezing.

In young women, this is noticed after pregnancy and childbirth. The first manifestations are usually detected when trying to get in shape, for example, when visiting the gym or doing home exercises. What to do in this case?

In medicine, this phenomenon is called incontinence. It is classified into three types depending on the symptoms:

• Stress incontinence- occurs when there is an increase intra-abdominal pressure, for example, during heavy lifting, exercise, sexual intercourse, even minor stress (eg sneezing, laughing, coughing);
• Urgentnoe, or urge incontinence- unbearable urge to urinate. In the presence of such a condition, a woman does not always have time to react. In this case, the bladder may be filled very slightly;
• Mixed – combines manifestations of the first and second forms.

Causes of the pathology: what leads to the stressful form of the disease?

The provoking factor can be a difficult birth accompanied by injuries. For example, this is not only a rupture of the soft tissues of the perineum, but also excessive overstretching of the pelvic floor muscles.

The reasons may lie in large quantities overweight. That is, such a pathological condition often occurs in obese people.

Gynecological operations, for example, removal of tumors or cysts of the uterus/ovaries, can lead to this phenomenon.

Urinary incontinence in women after 40 years of age is explained by the fact that they enter menopause, which we already discussed above. Decreased estrogen production provokes weakness of muscles and ligaments. That is, the reason lies in natural hormonal changes.

In addition, it is necessary to take into account the characteristics of male and female female anatomy. The urethra in women is only 3-4 cm in length, while in men it is 20-30 cm. In women its width is 6-10 mm, and in men it is 4-7 mm. Therefore, ladies need strong pelvic floor muscles, otherwise urine will spill out due to the short and wide urethra.

What causes urge incontinence?

This form of pathology is often associated with hyperactivity or neurogenic syndrome Bladder. Unpleasant situations can occur even after a woman deliberately limits the amount of fluid she consumes. Patients try not to go far from the toilet, since the urge is observed quite often - about once every 1.5-2 hours.

The cause of this problem may be a neurological pathology, for example, traumatic brain or spinal injury, stroke. Sometimes similar symptoms accompanied genitourinary infections. In the latter case, it is enough to cure the disease, and the problem will go away on its own.

Bedwetting in women: what are the causes?

IN in this case the volume of urine at night significantly exceeds that during the day. This phenomenon often occurs as a symptom of a number of pathologies, for example, this is observed with the inability of the kidneys to concentrate urine, diabetes mellitus, cardiac and renal failure. In addition, taking a number of medicines includes this condition among side effects. Most often, in women, bedwetting occurs as a complication of cystitis and atrophy of the pelvic floor muscles.

In this case, the doctor prescribes a urine test according to Zemnitsky, an analysis of the level antidiuretic hormone(in people over 40 years old). Treatment is primarily aimed at eliminating the cause of urinary dysfunction. Usually they manage with conservative methods of therapy, which we will describe below.

Treatment of urinary incontinence in young and elderly women

There are several methods to get rid of this unpleasant phenomenon. They are divided into conservative and radical. The first, conservative ones are bladder training; exercises to strengthen muscles; physiotherapy procedures.

Training involves creating a urination plan and implementing it. This process is controlled by the attending physician, gradually increasing the intervals between trips to the toilet. The fact is that women suffering from a similar illness develop the habit of going to the toilet even with a weak urge, in order to prevent embarrassment.

But during treatment you need to restrain yourself. The intervals between visits to the restroom increase by 30 minutes weekly, eventually reaching 3-3.5 hours.

This treatment regimen allows you to develop a new habit. As a rule, such training is complemented by drug therapy. The training and medication course lasts 3 months.

As for physiotherapy procedures, microcurrents, heating and electromagnetic pulses are most often used.

Drug treatment of incontinence

Quite effective various drugs have proven themselves in the urgent form of pathology. First of all, drugs from the group of antispasmodics and antidepressants are prescribed. IN Lately Driptan is increasingly being prescribed - a drug that has a relaxing effect on the muscles of the bladder, inhibiting impulses to urge from nervous system.

After its use, the bladder, relaxing, increases in volume, and accordingly, the urge to go to the toilet disappears. Typically, the course of treatment with driptan exceeds 1 month.

Surgical treatment of incontinence

Most often, surgical intervention is resorted to in the stressful form of the disease, but sometimes it is also performed in urgent cases. It is worth noting that patients young in most cases they help conservative methods therapy. Modern surgery performs about 25 different operations that allow you to get rid of the problem. Many of them are also successfully practiced by domestic doctors.

In addition, minimally invasive surgeries are now available, differing short term recovery and low risk of complications, for example, this can be said about throwing a synthetic loop. After such an event, the patient is discharged from the hospital the next day. The only thing they should watch out for after surgery is cystitis, which most often occurs after hypothermia.

Kegel exercises - a treatment method for women with urinary incontinence

This complex is designed specifically to strengthen the pelvic muscles. It is worth noting that this method is very effective and leads to positive results, especially for those who suffer from stress incontinence. The principle of this treatment method is quite simple. It’s immediately worth noting that in order to achieve effective results, you need to practice every day.

Urinary incontinence is an involuntary, uncontrollable loss of urine that can affect anyone. Most often, this problem occurs in women due to the characteristics anatomical structure. According to statistics, about 40% of women after 40 years of age, and about 60% of women after 50 years of age suffer from urinary incontinence. Or rather, they had at least some period in their life when they had urinary incontinence.

Despite the seeming insignificance of this problem, urinary incontinence affects all aspects of a woman’s life, significantly limiting freedom of movement and reducing the quality of life. The apparent reluctance of patients to complain about urinary incontinence is often combined with a lack of medical interest in this problem. According to numerous surveys, no more than 60% of doctors do not ask patients about urinary retention when collecting anamnesis. Very often, patients consult with each other about urinary incontinence rather than with a doctor, which leads to the fact that urinary incontinence is perceived as normal phenomenon by many women, especially older women, and even as something inevitable in postmenopause.

The main causes of URINary INCONTINENCE in women.

Complicated, traumatic or multiple births;
- Surgeries on the pelvic organs;
- Weightlifting and other sports;
- Hard physical labor;
- Obesity;
- Chronic inflammatory diseases;
- Hormonal changes in postmenopause;
- Injuries spinal cord;
- Multiple sclerosis;
- Diabetes;
- Tumors;
- Radiation therapy for malignant tumors of the female genital organs;
- Developmental anomalies
- Overactive bladder, etc.

Before talking about the mechanisms of development of urinary incontinence, let us dwell on brief anatomy(Fig. 1).

Rice. 1. Anatomy of structures involved in urinary continence in women

The processes of urinary continence depend on the balance between the pressure exerted by the bladder and abdominal cavity, as well as “resistance forces” - the sphincters of the urethra and its correct anatomical position.

There are three main groups of causes of urinary incontinence in women:
. Violations of mutual position pelvic organs(bladder, urethra and other pelvic floor organs) or their sensitivity nerve endings. Such conditions occur after complicated or multiple births, operations on the pelvic organs, exercise weightlifting and other sports, for obesity, chronic inflammatory diseases. Normal urination is ensured by the work of the bladder and urethra, their muscles, as well as the fascia and ligaments that hold the bladder and pelvic muscles.
. During menopause, hormonal changes occur, which cause tissue aging, atrophy (thinning) of the mucous membranes of organs genitourinary system, muscles, ligaments of the pelvis, which contributes to urinary incontinence.
. Changes in the nervous system, accompanied by disruption of the pelvic organs (spinal cord injuries, circulatory disorders in the spinal cord, inflammatory diseases of the spinal cord, multiple sclerosis, diabetes, tumors, developmental disorders).

There are three main forms of urinary incontinence
. Stress urinary incontinence (stress incontinence)
. Urge urinary incontinence (overactive bladder)
. The combination of these two forms is called "Mixed urinary incontinence"
. The third, most rare type of urinary incontinence is paradoxical ischuria (Fig. 2)

Rice. 2. Mechanisms of urinary incontinence

A separate form of urinary incontinence is paradoxical ischuria. It occurs as a result of prolonged urinary retention, when not only the muscular wall of the bladder is overstretched, but also the sphincters, and urine entering the overfilled bladder is involuntarily released in drops. Most common cause paradoxical ischuria in women there is a narrowing of the urethra, including that associated with hypercorrection when performing sling operations (for STRESS URINARY INCONTINENCE).

For mild degrees of stress urinary incontinence, a “tightening” of the suburethral zone can be used with . An option for laser vaginal lifting is described here.

It is also possible to temporarily correct mild degrees of stress urinary incontinence by inserting it under the urethra. fillers(usually high density hyaluronic acid).

In most cases of stress urinary incontinence, the best and most lasting effect is provided by surgery. Today there are various options operations: endoscopic, laparoscopic, bladder neck suspension methods and minimally invasive loop (sling) operations using TVT systems and their analogues.

Today, synthetic materials are widely used in operative gynecology. In pelvic floor surgery in patients with connective tissue defects, this is especially important, since the use of one’s own tissues to reposition abnormalities in the position of the uterus increases the risk of recurrent prolapse.

In 1995, U. Ulmsten proposed the TVT procedure, a new method for the treatment of stress urinary incontinence using a tension-free prolene loop placed retropubically under the urethra. The author has developed a set of tools that greatly simplifies the intervention. A prolene tape placed in a polyethylene cover with the help of special perforators is carried out retropubically from the side of the vagina under the urethra, after positioning the tape, the protective cover is removed, the free sections of the prosthesis are cut off and immersed under the skin, the wounds of the vagina and skin are sutured.

Since 2002, the TVT obturator method has been widely used - transobturator access to urethropexy with a synthetic loop. Having similar results to TVT, the operation is distinguished by minimal risk intraoperative complications: bladder perforation, infectious and hemorrhagic complications.

An important condition for the use of synthetic mesh prostheses in pelvic floor surgery is the need not only to provide mechanical support, but also to “adapt” to the work of the pelvic organs, providing good functional results, namely the implementation of specific functions of the rectum, bladder and urethra, vagina.

The most appropriate method of surgical treatment of stress urinary incontinence is sling surgery using synthetic suburethral slings (TVT system). Such operations have virtually no complications, are very effective and simple. It is enough for the patient to stay in the clinic for 24-48 hours, after which she almost immediately returns to normal activities and a qualitatively new life. Thanks to innovative TVT systems and progressive, caring doctors, since 2001, millions of women have had the opportunity to start a comfortable life again without restrictions and embarrassment.

Watch my video of one of the most frequently performed surgical interventions by gynecologists for stress incontinence - the TVT-o operation.

Anesthesia method for TVT-o surgery:

• general IV anesthesia with mechanical ventilation or endotracheal anesthesia
• spinal anesthesia

Length of hospital stay:

• From 1 to 4 days

Where is TVT-o performed:

• exclusively in hospital

What complications are possible after TVT-o surgery:

• pain in the area inner surface hips (less than 1%)
• hematomas in the area where the loop is placed (serious, very rare)
• paradoxical ischuria due to overcorrection (depending on the surgeon, very rare when performed correctly)
• inefficiency in various reasons (5-10%)
• infectious complications (less than 1%)

What tests are necessary before the TVT-o operation (order No. 620 of the Ministry of Health of Ukraine):

1. Blood type, Rh
2. Complete blood count + platelets
3. General urine analysis
4. Blood glucose
5. Coagulogram
6. Electrolytes, proteins, liver, kidney. complex
7. Blood for RW, HIV, HbsAg, HCV
8. ECG, therapist
9. Fluorography
10. Vaginal smear
11. Cytogram of the cervix

Urethropexy with a free synthetic loop TVT or TVT-0 is recommended for all patients with stress urinary incontinence and women with mixed incontinence in cases where the stress component predominates. A contraindication to surgery is a current or planned pregnancy. Obesity is not a contraindication to urethropexy with a free synthetic TVT or TVT-0 loop.

After surgery, all patients are advised to limit heavy lifting for the first two months. If you experience symptoms of obstructive urination (inability to start urinating after the urge appears or a feeling of incomplete emptying of the bladder), especially in the first days after surgery, you should consult a doctor.

Women with genital prolapse should not allow increased intra-abdominal pressure throughout their lives. To do this, if possible, it is necessary to exclude constipation, physical exercise that increases intra-abdominal pressure, exacerbation of chronic bronchopulmonary diseases, heavy lifting, etc.

Patients are cautioned that loop repair with a TVT or TVT-0 free synthetic loop does not prevent their risk of overactive bladder symptoms. different terms after operation. The appearance of such symptoms may require drug treatment. To prevent imperative urinary disorders in peri- and postmenopausal patients, who are most at risk of developing these symptoms, it is advisable to prescribe hormone replacement therapy or topical estriol preparations in combination with the nootropic drug picamilon, which reduces detrusor hypoxia, which develops in most patients with age.

When performing sling operations, one should not neglect strict adherence to the surgical technique. The apparent simplicity of the operation often leads to sad complications. One of these complications is overcorrection, which leads to urethral obstruction and the inability to urinate independently. Fortunately, such complications are treatable. One example of loop dissection after a failed TVT-like operation can be viewed.

Prevention of stress urinary incontinence.
The basis for the prevention of stress urinary incontinence are special sets of exercises for the intimate and pelvic muscles, and a balanced physical activity. Women over 40 should carefully regulate the intensity and nature of physical exercise, avoid lifting heavy objects. Women who have given birth more than 2 times are most susceptible to developing stress urinary incontinence, and in most cases it is impossible to prevent the development of stress urinary incontinence. In such cases, at the first symptoms and suspicions, you should contact a qualified gynecologist or urologist, specialists in the diagnosis and treatment of stress urinary incontinence.

Urge urinary incontinence (overactive bladder).

A clinical syndrome defining urinary urgency (with or without urge incontinence), which is usually accompanied by urinary frequency and nocturia. Synonyms for OAB are urgency syndrome and frequent urgent urination syndrome.

The cause of frequent and urgent urination in most patients is detrusor overactivity, a urodynamic manifestation characterized by the presence of involuntary contractions of the detrusor (spontaneous or provoked) during the filling phase (International Continence Society).

If the patient is diagnosed neurological disease(Alzheimer's disease, Parkinson's disease, etc.), then this is neurogenic detrusor hyperactivity. When the cause of detrusor overactivity is not clear, it is customary to talk about idiopathic detrusor overactivity (in the old terminology - detrusor instability).

Detrusor overactivity can be identified in patients at different times after TVT surgery as a new urinary disorder.
The appearance of urgent (imperative) urinary disorders with urgency, pollakiuria, low-volume urination, difficulty urinating, a feeling of incomplete emptying of the bladder or episodes of urinary incontinence in patients at various times after surgery can simulate a relapse of stress incontinence.

KUDI, carried out at different times after surgery, makes it possible to clarify the nature of the pathology and timely resolve the issue of drug treatment of these disorders. In the absence of the possibility of performing COUD or ambulatory urodynamic monitoring, which allows simultaneously recording fluctuations in intravesical, intra-abdominal and detrusor pressure, determining the state of the urethral closing apparatus and fluctuations in intraurethral pressure, one should focus on the clinical symptoms of the disease.

The main method of treating overactive bladder is the use of drugs from the group of M-anticholinergics (oxybutynin and others). In addition, the method of biological feedback, injection of botulinum toxin into the bladder wall during cystoscopy.

Most known drugs for the treatment of overactive bladder - driptan (oxybutynin), detrusitol (tolterodine), spasmex (trospium chloride).

Anticholinergic drugs block muscarinic cholinergic receptors in the detrusor, preventing and significantly reducing the effect of acetylcholine on the detrusor. This mechanism leads to a decrease in the frequency of detrusor contraction when it is hyperactive. Currently, five types of muscarinic receptors (M1-M5) are known, of which two are localized in the detrusor - M2 and M3.

Detrusitol (tolterodine) is a competitive muscarinic receptor antagonist that is highly selective for bladder receptors over salivary glands. The drug's good tolerability allows it to be used for a long time in women of all age groups. Detrusitol is prescribed 2 mg twice a day.

Spazmex is an anticholinergic drug, which is a quaternary ammonium base, which has a relaxing effect on the smooth muscles of the detrusor bladder, both due to the anticholinergic effect and due to the direct antispastic effect by reducing the tone of the smooth muscles of the bladder. The mechanism of action of this drug is the competitive inhibition of acetylcholine on receptors of postsynaptic smooth muscle membranes. The drug has ganglion-blocking activity. The active substance of the drug, trospium chloride, being a quaternary ammonium base, is more hydrophilic than tertiary compounds. Therefore, the drug practically does not penetrate the blood-brain barrier, which contributes to its better tolerability, ensuring the absence side effects. The drug is prescribed 5-15 mg 2-3 times a day.

Driptan (oxybutynin) is a drug with a combined mechanism of action, since, along with anticholinergic activity, it has an antispasmodic and local anesthetic effect. The drug is prescribed 2.5-5 mg two to three times a day. The drug requires dose selection due to the severity of side effects (dry mouth, dysphagia, dyspepsia, constipation, xerophthalmia). Typically, reducing the dose to 7.5 mg per day in combination with topical use of estrogens in elderly women does not reduce the effectiveness of the drug.

A good effect was obtained when using the tricyclic antidepressant melipramine (25 mg) 1-2 tablets per day.
Overactive bladder is characterized by a long-term recurrent course. Therefore, the duration of treatment is determined by the clinical picture of the disease.

The effectiveness of therapy is assessed according to urination diaries and the patient’s subjective assessment of her condition. A urodynamic study is carried out according to indications: in patients with negative dynamics during therapy, in women with neurological pathology.

All postmenopausal patients are simultaneously treated with hormone replacement therapy in the form of suppositories with estriol topically according to the traditional regimen or with medications systemic action depending on age. The earlier HRT is recommended, the higher its effectiveness.

Literature

1. V. Gomel. Female Genital Prolapse and Urinary Incontinence, 2008. - Informa Healthcare USA. - 253 p.
2. P.J. Culligan, R.P. Goldberg. Urogynecology in Primary Care, 2007. - Springer-Verlag London Limited. - 166 p.
3. P.E. Zimmern, P.A. Norton, F. Haab. Vaginal Surgery for Incontinence and Prolapse, 2006. - Springer-Verlag London Limited. - 303 p.
4. J. Haslam, J. Laycock. Therapeutic Management of Incontinence and Pelvic Pain, 2008. - Springer-Verlag London Limited. - 301 p.

Developed by me together with Johnson and Johnson (USA).

A few words about mesh prostheses (mesh):

Who can benefit from sling surgery for urinary incontinence?

Urinary incontinence is an annoying problem that older women often face. This symptom may indicate serious pathologies, it cannot be ignored. Leakage of urine leads to the fact that the woman begins to experience severe discomfort and refuses social contacts.

Features of urinary incontinence in women

Urinary incontinence is a pathology that develops due to a violation of the reservoir (storage) function of the bladder. The organ cannot hold urine, resulting in a small amount leaking through urethra. Involuntary urination may increase with physical activity, sneezing, coughing and laughing.

Urinary incontinence causes many hygienic and social nature. The unpleasant smell of urine is the main cause of the patient’s psychological complexes. The woman is afraid of involuntary urination in public, so she does not go to visit people, quits her job, and avoids meeting with friends. Pathology drags along serious complications. The risk of developing genitourinary tract infections increases. Constant stress and anxiety can lead to neuroses.

In women 40–45 years old, urinary incontinence may develop during late labor. The pelvic floor muscles weaken, so urine cannot be properly retained in the bladder. The risk of developing enuresis (urinary incontinence) increases if a woman experiences perineal tears during childbirth.

If you do not pay attention to the problem in a timely manner, it may get worse. After 60–70 years of age from urinary incontinence varying degrees up to 30% of women suffer. After 80 years, the problem occurs in every second representative of the fairer sex.

Experts identify the following types of urinary incontinence in women:

• stressful. Involuntary urination occurs without the urge to go to the toilet during physical activity, sneezing, running, coughing, etc.;
• urgent. Urine is released after a sudden irresistible urge to go to the toilet. The pathology is also called “overactive bladder”;
• mixed. Overactive bladder syndrome occurs during physical activity;
• constant urinary incontinence. Urine leaks at any time of the day. The pathology is associated with weakening of the muscular walls of the bladder or urethra. Urine can also leak if a fistulous tract has formed between the bladder and vagina.

Causes and provoking factors

There are many diseases and pathological conditions of the body that ultimately lead to urinary incontinence in older women. IN to a greater extent Representatives of the fairer sex who have had to give birth to more than two babies are at risk of encountering this problem. Women who have given birth once may also experience urinary incontinence in the future if the fetus was large enough (more than 4 kg).

The most common causes of urinary incontinence include dysfunction of the muscular wall of the bladder or urethra. Due to operations, difficult pregnancy and childbirth, the pelvic muscular system may also weaken. With age, the likelihood of encountering such a problem increases. Elderly women with overweight bodies. However, a change in the state of the muscular system is not the only reason that can lead to the development of pathology.

The hereditary factor also plays a role. If a mother suffers from urinary incontinence, there is a good chance that her daughter will also have to deal with the problem.

Overactive Bladder

An uncontrollable desire to go to the toilet occurs against the background of a small accumulation of urine. Congenital defects of the bladder or spinal cord, Parkinson's disease, malignant tumors, diabetes. This problem is often encountered by women who have suffered a stroke. Sometimes it is not possible to establish why hyperactivity develops. In this case, they talk about the idiopathic nature of the disease.

People suffering from neuroses, often experiencing stress, and being in a state of depression are predisposed to the development of pathology.

An overactive bladder does not necessarily lead to urinary incontinence. However, the urge can be so strong that the woman simply does not have time to get to the toilet. As a result of the disease, problems with sleep may appear, which only aggravates the situation. A common complication is urinary tract infections.

Urinary incontinence during menopause

Hormonal changes can cause bladder dysfunction. Often, stress urinary incontinence may indicate the onset of menopause. At normal level estrogen, the bladder functions fully. A decrease in the amount of sex hormones leads to weakening of the pelvic floor muscles. As a rule, this happens by the age of 45–50, but not all women. If a representative of the fairer sex plays sports and leads an active lifestyle, the likelihood of developing pathology is minimized.

If urinary incontinence develops in a young woman, disturbances are observed menstrual cycle, this may also be due to hormonal changes in organism. It is worth making an appointment with a gynecologist-endocrinologist.

Taking medications

Enuresis can result from the use of certain drugs. Often the pathology develops against the background of an overdose of diuretics or long-term use sedative medications. Many older women are prescribed sleeping pills. In this case, bedwetting often develops. The fairer sex sleeps so soundly that she simply cannot respond to the urge to go to the toilet.

Infections

Bacterial, viral or fungal diseases bladder can lead to the development of enuresis. Stress urinary incontinence is often observed in older women suffering from chronic cystitis.

Pathology may have non-infectious nature. An unpleasant symptom often indicates a stone in the bladder.

Diagnostics

Urinary incontinence is a symptom that can occur when various diseases. It is important to establish the exact cause of the unpleasant pathology in order to prescribe adequate therapy. For this, the following differential diagnostic methods are used:

1. Patient interview. The doctor clarifies when the unpleasant symptoms appeared and what preceded them. It matters how many times a woman had to give birth, what operations she had previously undergone, whether she has chronic diseases, etc.
2. Examination by a gynecologist. The specialist assesses the degree of prolapse of the bottom of the bladder and vaginal walls. While in the chair, the doctor may ask the patient to cough to see if urine is released with slight physical exertion.
3. Ultrasound examination of the pelvic organs. The technique allows you to assess the condition of the bladder, identify inflammation or stones.
4. General urine analysis. The presence of protein in the test material may indicate a bladder infection.
5. Gasket test. The study allows you to determine the amount of urine released involuntarily. Initially, the weight of the clean gasket is measured. After 4 hours, it is necessary to estimate the mass of the hygiene product used.
6. Urination diary. For several days, a woman needs to record the time she goes to the toilet and the volume of urine she produces.
7. Cystometry. In laboratory conditions, the bladder is artificially filled through a catheter, then the pressure inside the organ is measured.
8. Electromyography. This urodynamic study method allows you to evaluate how correctly the perineal muscles contract.

Urinary incontinence in women is a pathology that may require consultation with several specialists. Absolutely necessary make an appointment with a urologist and a gynecologist. You may need the help of a psychotherapist if the problem appeared after suffering stress.

Treatment of urinary incontinence in older women

The specialist selects the treatment method in accordance with the reasons causing the unpleasant symptom. If the muscular system is not subject to irreversible changes, and urinary incontinence manifests itself in mild form, we can manage special exercises and taking medications. Physiotherapeutic procedures may also be prescribed.

Treatment of urinary incontinence in elderly women can be carried out using the following groups of drugs:

1. Adrenergic agonists. Drugs in this category help improve decreased tone of the urethra and sphincters. Midodrine and Hypertane can be used.
2. Antidepressants. Medicines in this category help improve bladder tone. The drugs Imipramine and Duloxetine are widely used.
3. Preparations for hormone replacement therapy. Such medications are used if urinary incontinence develops during menopause. The doctor may prescribe Divina and Klimara.
4. Antispasmodics. Medicines in this category can be used for overactive bladder syndrome. The drugs Spazmex and Urotol are widely used.

Any of the listed medications must be taken strictly as prescribed by your doctor.

Drug therapy - photo gallery

Klimara is a drug that is widely used for menopause. Spazmex is used for overactive bladder syndrome.
Urotol is a popular antispasmodic drug

Physiotherapy

If the pathology is not advanced, electrical stimulation of the pelvic muscles shows good results. Using electrodes inserted into the patient's vagina, the muscles responsible for closing the bladder sphincter are selectively stimulated.

Electrophoresis also shows good results. Thanks to a low-intensity current, medications are carried through the mucous membranes, restoring the functioning of the urinary tract.

Considered effective physiotherapy. The specialist prescribes a set of exercises to improve the tone of the pelvic floor muscles.

Video: Kegel exercises

Many older women suffering from urinary incontinence are hesitant to seek medical help. They believe that an unpleasant symptom is an integral part of the physiological aging of the body. In fact, timely seeking medical help will avoid unpleasant complications. In addition, the sooner therapy is started, the faster the problem will be resolved.

Women who experience enuresis are advised to reconsider their diet. It is necessary to avoid diuretic drinks: alcohol, strong tea, coffee. The diet should be rich in vitamins and microelements necessary for normal functioning all organs and systems.

It's important to keep track emotional state. Stress and anxiety aggravate the problem. Recommended for women good sleep, refusal of excessive mental stress.

Special underwear will help you lead a normal life and feel comfortable at the same time. These are panties or urological pads that absorb involuntary urine. It is necessary to select a model in accordance with the anatomical parameters and the degree of enuresis. It is worth understanding that special underwear cannot be related to therapy methods. It's just aid, making a woman’s life easier during the treatment of the disease.

Surgical intervention

If conservative therapy does not show good results, the doctor may decide to perform surgery to eliminate enuresis in the woman. Usually, surgical intervention performed for stress or mixed urinary incontinence. Loop operations are considered effective. The intervention is not complicated and can be performed under local anesthesia and takes no more than half an hour.

The essence of the procedure is to install a mesh tape under the urethra, which allows you to retain urine. The intervention can be carried out in two ways:

• TVT surgery (two incisions are made above the pubic bone and one in the vagina);
• TOT surgery (two incisions are made in the groin and one in the vagina).

During the procedure, the tension of the mesh tape is adjusted. The bladder is specially filled through a catheter, then the doctor asks the patient to cough. In this way, it is possible to understand whether the incontinence was eliminated thanks to the tape.

After the operation, the woman needs to spend a few more days in a hospital setting. A specialist monitors the urination process. The doctor must make sure that there is no inflammation due to the operation, and also clarify whether the organ is functioning correctly.

May persist for several days after the intervention painful sensations which worsen with urination. Small ones are also considered normal. bloody issues from the vagina. As a rule, after 2-3 days the unpleasant symptoms disappear. In most cases, the woman can be discharged home after 5–6 days.

Collagen injections

Modern techniques can effectively combat stress urinary incontinence in women. Collagen is injected into the base of the bladder (where the urethra begins). Due to this, the volume of the tissue increases, as a result of which urine leakage can be eliminated.

The procedure is performed under local anesthesia, as it is quite painful. Over time, collagen is removed from the body. Repeated intervention may be required after a few years. Before the manipulation, the doctor must carry out skin test to exclude an allergy to the substance that will be injected into the bladder tissue.

ethnoscience

On early stage pathological process Traditional medicine recipes can come to the rescue. However, their use should also be discussed with your doctor.

A medicinal infusion will help fight frequent urges to urination. A teaspoon of dry corn silk you need to pour a glass of boiling water, cover with a lid and leave for about 15 minutes. Then you need to strain the product and drink it as tea. Therapy is recommended to be carried out daily until the unpleasant symptom disappears.

St. John's wort and centaury

Dry crushed plants must be mixed in equal proportions. Pour a teaspoon of the mixture into a glass of boiling water, cover with a lid and wait to cool. Then the medicine must be filtered and drunk.

Both fresh and dried berries are suitable for therapy. Pour 500 ml of boiling water over a tablespoon of the product and cook over low heat for 10 minutes. The finished broth should be strained and drunk throughout the day in small portions (30–50 ml).

Dill seeds

A tablespoon of raw material should be poured with a glass of boiling water and left for 2 hours. The finished product must be strained and drunk in one go. Treatment must be carried out daily until the pathology is eliminated.

Traditional medicine recipes - photo gallery

Corn silk is used for cooking medicinal infusion Blueberry - delicious medicine St. John's wort effectively fights urinary incontinence

Treatment prognosis and prevention

The prognosis depends on the stage and form of the pathological process. The sooner a woman seeks help, the greater the chance of coping with urinary incontinence. If exercises and medications do not show good results, surgery can help you return to a normal lifestyle.

Refusal of treatment leads to a number of problems. A woman cannot lead a full life and refuses social contacts. The patient's sleep is disturbed and psychological complexes develop. We must not forget about the financial side of the issue. Special underwear requires significant costs.

Constant leakage of urine leads to the development inflammatory processes. Refusal of treatment may cause serious illnesses threatening a woman's life.

Prevention of pathology comes down to management active image life, giving up bad habits, keeping the body in shape, fighting overweight. When the first symptoms of enuresis appear, you should consult a urologist.

Urinary incontinence in women after 40 years – common problem, which you shouldn’t be ashamed of. Modern techniques will help cope with urine leakage, restoring self-confidence to patients. At the first warning signs you should consult a doctor, he will help you choose correct treatment.

What is the cause of the problem

Urinary incontinence in women after 40 years of age, the causes are very diverse, is quite common. According to medical statistics, about 45% of premenopausal women suffer from the disease. The disease may occur indirectly or make itself felt by a sharp deterioration in well-being. Among the main causes of the disease:

• hormonal imbalance;
• overweight and obesity;
• frequent childbirth accompanied by complications;
• cystitis and other inflammatory diseases;
• smoking;
• age-related atrophy of the pelvic muscles;
• chronic constipation;
• infectious diseases genitourinary organs and their consequences;
• surgeries on the pelvic organs;
• long-term use of potent medications.

Doctors highlight following forms illnesses

1. Stressful or involuntary incontinence . Occurs without the urge to urinate at any time of the day. Most often occurs during short-term stress: lifting heavy objects, sneezing, laughing, or a sudden change in body position.
2. Urge incontinence(overactive bladder syndrome). The urge to urinate occurs abruptly and makes it impossible to empty it under normal conditions.
3. Mixed incontinence. Combines both of the above options. The patient feels an urgent need to empty the bladder during coughing, laughing, or sudden movement.
4. Nocturnal enuresis. Leakage of urine without a pronounced urge, occurring at rest, usually during sound sleep.
5. Constant leakage. Usually associated with acquired atrophy of the pelvic muscles. May occur after surgery, trauma, sudden hormonal imbalance. Sometimes the reason is congenital anomaly, worsened with age (for example, displacement of the ureter).
6. Undermining. Prolonged drip leakage after normal emptying of the bladder. Caused by leakage of urine into the diverticulum of the urethra or vagina. May get worse with age.

Symptoms and manifestations

It’s easy to understand that it’s time to see a doctor. At first, a woman may notice a single leak. Gradually the problem arises more and more often. In addition to the involuntary loss of urine, the following symptoms indicate the disease:

• unpleasant odor;
• itching and burning in the urethra associated with constant irritation;
• swelling and redness of the external genitalia;
• minor inflammation;
• short-term increase in temperature;
• general deterioration of health.

Unpleasant sensations can be not only physical, but also psychological. The woman feels constant anxiety, is afraid to relax, and tries to constantly control the most insignificant urges. This can lead to neurosis and even depression. It is no coincidence that the therapy program includes not only medication, but also sessions with a psychologist.

Diagnostic methods

At the first alarming signs, you need to contact a therapist, who can provide a referral to specialized specialists. First, the doctor collects anamnesis, summarizing information about childbirth, termination of pregnancy, infectious (including sexually transmitted) diseases, injuries and operations. It is necessary to take a blood test to exclude such dangerous illnesses like diabetes or stroke.

After this, the woman visits a gynecologist and takes a smear from the cervical and vaginal canals. The next stage is an ultrasound of the bladder and kidneys. After this, the doctor uses a series of tests to assess the amount of urine produced, measure the tone of the perineal muscles and the pressure in the urethra.

Treatment Options

Only a doctor can explain how to treat urinary incontinence after 40 years. Therapy depends on the type of illness, individual characteristics body, the presence or absence of other chronic diseases. For stress incontinence not associated with the urge to urinate, minimally invasive surgical intervention is recommended. There are many different techniques, but the loop hold is especially effective. After surgery, a woman should be careful about her health, avoiding hypothermia, which can lead to relapse.

If the patient is not ready for surgery, she will be offered conservative therapy. Magnetic stimulation of the pelvic organs and biofeedback therapy have proven themselves well. Useful Kegel exercises associated with alternating tension and relaxation of the muscles of the perineum and anus. Special gymnastics will be a good preventive measure for women at risk. Recommended during premenopause hormonal treatment. It not only stops involuntary urine leakage, but also improves general state patients.

With an overactive bladder, women are prescribed medication therapy in combination with therapeutic exercises. Surgery is contraindicated in such patients. Bedwetting in women over 40 is also treated with medications. Behavioral therapy and physical therapy are prescribed at the same time. Warming up, microcurrents, and the use of electromagnetic pulses give good results.

From medical supplies Driptan is most often prescribed. It dampens impulses from the nervous system while relaxing the bladder muscles. The course and dosage are prescribed by the doctor; self-medication is strictly prohibited. Abuse of medications can worsen the patient’s condition, transferring the disease from the acute phase to the chronic phase.

Traditional medicine recipes can also help with incontinence. A good effect is achieved by taking a course of decoctions of medicinal herbs: St. John's wort, marshmallow root, centaury, bear's ears, nettle, yarrow. 2 tbsp. spoons of the collection are brewed with 500 ml of boiling water, heated for 5 minutes and infused in a thermos. This portion should be drunk in small doses throughout the day. The decoction is useful lingonberry leaves, as well as lingonberry or cranberry juice, which has a general strengthening and antioxidant effect.

Especially for women, super-absorbent panty liners have been developed that can accommodate significant amount urine. They protect clothes, eliminate unpleasant odors and restore a feeling of confidence. In pharmacies you can select products of the desired size and degree of absorbency, intended for daytime or nighttime. They need to be changed frequently to prevent inflammation and irritation of the genital organs.

A mandatory point of therapy is proper nutrition. A woman should eat more fruits, vegetables, and low-fat fermented milk products, activating beneficial microflora. It is advisable to reduce the amount of animal protein, completely eliminate fatty foods, smoked foods and pickles. Alcohol, which can provoke an exacerbation, is strictly prohibited. It is advisable to give up not only strong drinks, but also beer, cocktails, and energy drinks that contain high doses of caffeine.

Urinary incontinence in women over 40 years of age, which must be treated under medical supervision, is very common. Timely diagnosis and proper treatment allows you to relieve the most unpleasant symptoms, and after a while completely get rid of the problem. With timely treatment, relapses and complications are rare.

The urinary bladder (UB) performs two main tasks in the body: storing urine, which is excreted by the kidneys, and emptying it. Before urine is removed from the body, the MP sends a warning signal to the brain.

The accumulation and emptying of MP is controlled by special muscles, sphincters. They shrink, preventing urinary incontinence in women over 60. And they are in a relaxed state when it comes time to urinate. Every healthy man involuntarily controls the sphincter mechanism.

Why is urinary incontinence detected in women after 60?

A number of factors can lead to loss of sphincter control:

• The pelvic muscles are in a flabby state. In this case, they are unable to support the internal organs.
• Lack of estrogen (important female hormone not only at sixty years old).
• Unsuccessful postoperative period(for example, surgery in the uterine area).
• An infection has entered the urogenital canals.
• Prolapse of the vaginal/uterine wall.
• Among the rarer ones are stroke, stress, urolithiasis.

There is a generally accepted form for describing bladder incontinence. It includes six points:

• Stress incontinence. Occurs when there is a change in state (getting up, laughing, walking fast). The bladder does not transmit a signal to the brain about possible urination.

• Urgentnoe. Such urinary incontinence in women occurs after an urgent signal from the bladder. Due to the speed of the signal and the intense desire, it is almost impossible to get to the toilet in time.
• Mixed. An urgent urge to go to the restroom after a change in state (getting up, laughing, etc.)
• Nocturnal enuresis. Involuntary urination during sleep. It can also appear during the daytime.
• Constant leakage of urine. Indicates problems connecting the sphincters to the bladder. May indicate an abnormal position of the ureter. This item rarely occurs in women over 60 years of age.
• Dripping after full urination. Occurs due to excessive accumulation of urine or inflammation of the urethra.

If you suffer from any form of incontinence, consult a doctor immediately for diagnosis and prompt treatment.

Diagnosis and treatment

Comprehensive diagnostics usually includes:

• Anamnesis. Your detailed story about the sensations before incontinence, about possible reasons involuntary loss of urine.
• Vaginal smear analysis.
• Ultrasound examination of the ureter and kidneys.
• Leakability test.
• Conducting a urodynamic study (keeping an incontinence diary, comparing bladder pressures, profilometry of the urethra, examination of the sphincter muscles).

After collecting data and tests, the doctor can announce a diagnosis and treatment regimen depending on the form of incontinence. Conservative and operating methods. Conservative treatment includes:

• A course of medications. For example, if an overactive bladder is detected, the doctor may prescribe Spazmex for two to three months.
• Therapeutic gymnastics of the perineal muscles. Kegel exercises not only prevent urinary and fecal incontinence, but also improve blood circulation in the pelvic organs as a whole. Before class, be sure to empty your bladder.
• Magnetic therapy (stimulation of the neuromuscular part of the pelvic floor).

Enuresis has a comprehensive treatment: physiotherapy and a course of medications.

Surgery - popular minimally invasive loop operation. This is a correction of the internal sphincter. A “sling” (loop) made of natural/synthetic materials is placed. It becomes an additional support for MP against incontinence.

Odor control

• The urine pad should be changed after each episode of incontinence. Wash the external genitalia regularly (or use wet wipes for intimate hygiene).
• Don't limit yourself to water! This will not solve the problem, but will make it worse. Water affects the concentration of urine, and if you don't drink enough liquid, your urine will only smell stronger.
• Take vitamin C (if there are no contraindications) or add cranberry juice to your diet. This will help improve the smell of your urine.
• You can try the Nullo dietary supplement. It neutralizes urine odor and eliminates unpleasant odors from the mouth, and sweat.

Products that should be avoided if you have urinary incontinence: coffee, alcoholic drinks, fresh citrus fruits or juices from them, chocolate and other sweets.

According to doctors, every second woman aged 60-70 years experiences urinary incontinence. However, not every one of them seeks medical help. It is important to understand that there is nothing to be ashamed of here. This natural process, a disease that can and should be fought.