Urine incontience

Urine incontience – the release of urine which is not controlled by the person which comes to light visually.

Statistically, the incontience of urine happens in 14-56% of cases. But these indicators are very contradictory as the request for medical care at this disease very low.

Classification of an incontience of urine

The incontience of urine is subdivided on true and false.

False incontience of urine is called involuntary release of urine at which the person does not test a desire to an urination. The inborn or acquired defects of an ureter, urethra or bladder can be the reasons of an incontience of urine of false. As a rule, the acquired defects result from the injury breaking integrity of urinary tract.

True incontience of urine – involuntary release of urine, visually observable and causing hygienic and social problems.

The true incontience of urine is divided on:

• the stressful incontience arising at an excessive tension;
• urgentny incontience – an involuntary urination with the previous urgent desire;
• the mixed incontience – a combination of an urgentny and stressful incontience;
• enuresis – any uncontrollable loss of urine;
• Bed wetting;
• constant enuresis;
• situational incontience of urine (at strong laughter or sexual intercourse).

The set of factors can be the reasons of an incontience of urine of true. This symptom at injuries of a spinal cord, the started cystitis, spinal hernia, the complicated wrinkling of a bladder is observed.

The urine incontience at a tension is caused by weakening of sphincters of a bladder and a weak tone of muscles of a pelvic bottom. At men the urine incontience quite often happens after the postponed operative measures on a bladder neck, a seminal hillock or a prostate. Women in the period of a climax have the reason of an incontience of urine a dysfunction of the switching device of a bladder or disturbance of a tone of a detruzor owing to deficit of estrogen.

Are the main reasons for an incontience of urine:

• old age;
• deficit of estrogen at women in the period of a menopause;
• blood circulation disturbances;
• infravezikalny obstruction;
• touch disturbances;
• influence of serotonin and prostaglandins;
• anatomic changes of position of a bladder and urethra;
• myogenetic disturbances.

Bed wetting occurs preferential at children though happens also at adults. The fright or a severe psychological injury is the most common cause of bed wetting.

Diagnosis of an incontience of urine

A certain complexity in diagnosis of an incontience of urine is represented by various mouths of an ureter of an ectopia. As a rule, the malrelated mouth is defined at a tool research (survey of a vagina through a mirror, an uretrotsistoskopiya, a rektoskopiya). Sometimes it is reasonable to apply indigokarminovy test to identification of the reason of an incontience of urine. For this purpose intravenously enter solution of indigo carmine of 0,4% in number of 5 ml and observe how it will be allocated together with urine from the malrelated mouth.

Also in diagnosis of an incontience of urine apply such methods:

• Survey on a gynecologic chair. It is possible to define existence and extent of omission of walls of a vagina by this diagnostic method, to the tsistotsela, a uterus.
• The tussive test by means of which it is possible to obtain the visual evidence of an incontience of urine at a tension.
• Pro-masonry test.
• Radiological methods of a research, such as uretrotsistografiya. By means of these methods it is possible to define a shape of a bladder, position of his neck and dynamics of changes at a tension and at rest.
• Ultrasonic diagnostic methods. Correctly executed ultrasonography of a crotch gives the same information that an uretrotsistografiya, only at the same time the patient is not exposed to beam loading.

For the choice of adequate treatment of an incontience of urine a basis is the urodynamic research of the patient added with the diary of urinations. The urodynamic research is conducted for the purpose of determination of parameters of evakuatorny and accumulative functions of a bladder.

Recently the MRT method at inspection of women with an urine incontience at a tension gains distribution.

Treatment of an incontience of urine

Depending on a cause of illness treatment of an incontience of urine can be:

• conservative;
• surgical (operation at an urine incontience).

Conservative methods are shown to the patients with easy degree of an incontience at a tension, an urgentny incontience called by a hyperactivity of an urethra or a detruzor. Treatment of an incontience of urine at a tension has two directions: braking of activity of a detruzor and increase in a tone of the switching device of a bladder.

It is considered that an urgentny and stressful incontience of urine at women in the period of a climax are effects of shortage of estrogen therefore by it appoint estrogensoderzhashchy drugs. As a rule, it leads to quite positive takes.

At conservative treatment of an incontience of urine the doctor normalizes a food allowance of the patient, increases to it exercise stresses. It is necessary to carry physiotherapy exercises to national treatment of an incontience of urine first of all. It promotes improvement of blood supply of bodies of a small pelvis, increases compensatory function of respiratory and cardiovascular systems, strengthens the muscular and copular device and contributes to normalization of a mental condition of patients.

At easy degree of an incontience such national treatment of an incontience of urine as pessaries can help. They, of course, do not remove a cause of illness, but are capable to help the patient to avoid an embarrassment. It should be noted that essential inconvenience causes to the patient need of extraction of a pessary before an urination and the subsequent its establishment. Besides, some patients note that when using a pessary decubituses can develop.

The positive effect in treatment of an incontience of urine is observed after electrostimulation of fabrics   and bodies of a basin. And at easy degree of an incontience of urine some patients noted positive effect from acupuncture.

At an incontience of urine it is possible to refer injection treatment at women with the expressed omission of a bladder and walls of a vagina to low-invasive operations, and also with neurogenic frustration of an urination. When performing injection therapy use teflon paste, the collagen homogenized аутожир and other substances.

It is also necessary to note transvaginal operation at an incontience of urine of 1-2 types – an uretrotservikopeksiya. Recently loopback or slang operations at an urine incontience were widely adopted. As a free loop use a rag from a front wall of a vagina, a musculoaponeurotic rag, a piece of leather or synthetic materials. It is possible to judge final result of operational treatment after at least three years after carrying out intervention.