Urine incontience
Contents:
Description:
The incontience of urine is an involuntary release of urine which can be revealed visually.
Data on urine incontience frequency in various age groups are very contradictory that, probably, depends on the choice of the studied population. Urine incontience frequency at women in various age groups makes from 14 to 56%. Frequency of the request for medical care concerning an urine incontience very low. The prevalence of an incontience of urine increases with age.
Urine Incontience symptoms:
The incontience of urine is subdivided on true and false.
The false incontience of urine - involuntary release of urine without desires on an urination - can be caused by the inborn or acquired defects of an ureter, a bladder or urethra, for example, at an ekstrofiya of a bladder, a total epispadiya of an urethra, a total hypospadias, an ectopia of mouths of ureters with their unusual arrangement (for example, in an urethra or a vagina). The acquired defects conducting to a false incontience of urine, as a rule, are connected with an injury as a result of which integrity of urinary tract with the subsequent formation of the uric fistulas opening on skin in a vagina or a rectum is broken.
True incontience of urine by definition of the International society of deduction of urine (International Continence Society - I.C.S.) "involuntary loss of urine, objectively demonstrable and causing social and hygienic problems" is.
Now the true incontience of urine can be classified as follows:
* A stressful incontience of urine, or an urine incontience at a tension.
* The Urgentny (imperative) incontience of urine - involuntary loss of urine with the previous urgent desire on an urination.
* The mixed urine incontience - a combination of a stressful and urgentny incontience of urine.
* Enuresis - any involuntary loss of urine.
* Night enuresis - urine loss during sleep.
* Constant incontience of urine.
* Other types of an incontience of urine - can be situational (at sexual intercourse, laughter).
The true incontience of urine is observed at injuries of a spinal cord, spinal hernia, the started cystitis complicated by wrinkling of a bladder. The true incontience of urine at a tension can appear at change of position of a body, at an exercise stress of this or that degree of manifestation, i.e. at increase in intra belly pressure It is caused by decrease in a tone of muscles of a pelvic bottom, weakening of sphincters of a bladder. At men the true incontience of urine can be a complication of operations on a bladder neck, a prostate, a seminal hillock. In a climacteric at women the true incontience of urine can be connected with disturbance of a tone of a detruzor and dysfunction of the switching device of a bladder owing to the developing oestrogenic deficit. Mechanisms of a true incontience of urine come to light at patients with a paradoxical delay of an urination against the background of overflow of a bladder which is followed by restretching internal and the increasing insufficiency of an outside sphincter of a bladder and the disappeared desires on an urination.
To a true incontience of urine at a tension symptoms of a hyperactive bladder with an urgentny incontience of urine or without it can independently join or develop. Hyperactive function of a detruzor is characterized by its involuntary reductions during a phase of filling of a bladder which can be both spontaneous, and provoked (at bystry filling, change of position of a body, cough, walking, jumps and so forth) while the patient tries to suppress these reductions. The state is diagnosed when carrying out an urodynamic research. In addition to a pollakiuria existence of imperative (urgent) desires on an urination and/or not deduction of urine is characteristic of clinical implication of a hyperactive bladder at such desire (an urgentny or imperative incontience of urine). The incontience of urine or, even, not deduction of urine can be also a consequence of instability of an urethra.
Urine Incontience reasons:
The urine incontience at tension can be two main types: the disease connected with dislocation and weakening of the copular device, not changed urethra and uretrovezikalny segment that belongs to an anatomic incontience of urine, and the disease connected with the changes in the urethra and the sphincteric device leading to dysfunction of the switching device.
Deduction of urine is provided with interaction of urethral and ekstrauretralny factors, and also the correct anatomic provision of internal generative organs.
Conditions for deduction of urine are:
* full-fledged condition of an urothelium and availability of slime in an urethra gleam;
* elasticity of the collagenic structures which are a part of connecting tissue of urethra;
* the kept tone of smooth muscles of an urethral wall;
* full-fledged vascularization of an urethra
Among a set of the factors influencing urodynamic of uric ways, the significant role belongs to fluctuations of a ratio of sex and glucocorticoid hormones and their mediated influence on and - and beta and adrenergic receptors. It should be noted that in a female body potentiation of effects of a sympathetic nervous system on function of the sphincteric device of a bladder depends on cyclic changes in ovaries which happen both over all life, and during one menstrual cycle.
Etiological factors of development of the urgentny incontience of urine which is one of symptoms of a hyperactive bladder or instability of an urethra can be neurogenic (owing to a neurologic disease) and not neurogenic.
Not the neurogenic reasons:
* age;
* infravezikalny obstruction (IWO);
* oestrogenic deficit at women in a climacteric;
* blood circulation disturbances;
* myogenetic disturbances (ultrastructural changes of a detruzor - disturbance of contact between myocytes and emergence of protrusions of cellular membranes of adjacent myocytes);
* touch disturbances (disturbance of barrier properties of an urothelium);
* anatomic changes of position of an urethra and bladder;
* influence of prostaglandins and serotonin.
Treatment of the Incontience of urine:
The incontience of urine is eliminated with conservative and surgical methods.
Not operational methods of treatment are shown to patients with easy degree of an incontience of urine at a tension, the urgentny incontience of urine caused by a hyperactivity of a detruzor or an urethra at a combination of a stressful and urgentny incontience of urine. Treatment of an incontience of urine at a tension is conducted in two directions. The first is an increase in a tone of the switching device of a bladder, a detruzor tone, the second - braking of activity of a detruzor at the urgentny and combined urine incontience forms.
Believe that at women in a menopause a stressful and urgentny incontience of urine are an effect of the increasing oestrogenic deficit. At women with an urine incontience in a climacteric purpose of estrogen is followed by reliable increase in intra urethral pressure. It is considered that irrespective of a way of administration of estrogen (oral, vulval, transdermalny, intramuscular) the estrogenoterapiya leads to positive takes in treatment of a stressful incontience of urine at women in the menopause period.
Carrying out complex conservative therapy of an incontience of urine at a tension, it is necessary including to increase exercise stresses, to normalize a diet as body weight at many patients exceeds norm approximately for 30%. The physiotherapy exercises (LFK) improve blood supply of bodies of a small pelvis, strengthen the muscular and copular device, increase compensatory function of cardiovascular and respiratory systems and improve the mental status of patients.
Incontiences of urine, seldom sick with easy degree, use pessaries of various designs. Need of their extraction before an urination, and then the return installation causes considerable inconveniences to patients. Moreover, cases of formation of decubituses when using a pessary are described. An exception are electronic pessaries which action is based on a mechanical compression of an urethra.
Satisfactory results are received after electrostimulation of bodies and fabrics of a basin. At easy degree of an incontience of urine also acupuncture is effective.
Injection therapy at women who have no expressed omission of walls of a vagina and bladder, and also neurogenic frustration of an urination belongs to low-invasive surgical methods of treatment of an incontience of urine at a tension. For performing injection therapy various substances - the collagen, teflon paste homogenized аутожир, etc. are used.
