Urine incontience after the delivery

Urine incontience after the delivery – morbid condition at women at which there is an involuntary urination. The puerperal involuntary urination is carried more often to a stressful incontience of urine when allocations happen at an exercise stress, laughter, sneezing, cough, sexual intercourse (in cases of sharp increase in intra belly pressure).

The incontience of urine is not a disease, and disturbance of normal functioning of an urinary system. The incontience of urine is the puerperal complication arising at 10% of women during the first pregnancy and childbirth and at 21% of women during the second and each subsequent pregnancy. At natural childbirth the probability of development of an incontience of urine is slightly higher, than at Cesarean section.

The puerperal incontience of urine is not natural state of the woman and demands correction. Urethral function is recovered on average within a year. In certain cases independent recovery does not happen. The incontience of urine does not pose an essential threat for health of the woman (in cases of lack of complications in the form of inflammatory and infectious processes), however considerably reduces quality of life. At timely diagnosis and the correct therapy the puerperal incontience of urine completely is eliminated. If in time not to diagnose a problem and not to take a measure for normalization of an urination, the state can be aggravated over time. The started cases give in to correction much more difficult, are characterized by a frequent recurrence.

Reasons of development of an incontience of urine after the delivery

After the delivery stretching and weakening of muscles of a pelvic bottom which provide a sufficient support for a uterus throughout all pregnancy is the main reason for an incontience of urine.

Pelvic bottom – the powerful muscular and fascial layer serving for maintenance of internals, saving their normal provision, regulation of intra belly pressure, and also promoting an expulsion of the fetus at childbirth forming a parturient canal. The muscle strain of a pelvic bottom occurs under weight of a uterus and the fruit developing in it. Difficult delivery, a large fruit, birth trauma are also the reasons of weakening of muscles.

The incontience of urine is after the delivery caused by the following factors:

• Disturbance of an innervation of muscles of a pelvic bottom and bladder;
• Disturbance of switching function of an urethra and bladder;
• Pathological mobility of an urethra;
• Instability of position of a bladder, fluctuation of intravesical pressure.

There is a number of the risk factors promoting development of an incontience of urine after the delivery:

• Heredity (genetic predisposition to disturbance development);
• Features of an anatomic structure of bodies of a basin and muscles of a pelvic bottom;
• Disturbances of neurologic character (diseases of a nervous system, multiple sclerosis, Parkinson's disease, and also spine injuries);
• Surgical interventions at childbirth and birth trauma;
• Large fruit;
• An excessive set of weight during pregnancy.

Urine incontience symptoms after the delivery

In medical practice allocate 7 main types of an incontience of urine:

• Urgentny incontience of urine – any urination at a sharp, strong desire which is not giving in to control;
• Stressful incontience of urine – urination at any types of an exercise stress, increase in intra belly pressure;
• Ischuria of a paradox or incontience of refilling – release of urine at a full bladder;
• Reflex incontience – an urination at influence of provocative factors (loud shout, a fright, a water sound);
• Bed wetting;
• Involuntary continuous dribble of urine;
• Dribble of urine after end of a full-fledged urination.

The urine incontience after the delivery often is carried to a stressful incontience (SNM). Statement of the exact diagnosis requires comprehensive examination.

The diagnosis of an incontience of urine is after the delivery made if at the woman the following symptoms are observed:

• Regular episodes of involuntary release of urine;
• The essential volume of urine at each episode;
• Increase of releases of urine at physical activity, stresses, during sexual intercourses.

At irregular episodes of an involuntary urination it is also necessary to see a doctor for correction of a state. It should be noted that isolated cases of an involuntary urination in insignificant volumes are characteristic also of a healthy organism.

Urine incontience after the delivery: treatment and forecasts

It is necessary to approach treatment of disturbance of an urination correctly. Many women ignore a problem, and, without seeing a doctor, try to fix independently a problem or to reconcile to this morbid condition. At an urine incontience after the delivery treatment assumes conservative and radical methods.

At an incontience of urine it is not recommended to self-medicate as this state demands careful inspection for an exception of possible inflammations and the infectious reasons of development of an incontience.

At an urine incontience after the delivery treatment does not assume use of medicamentous drugs. Medicines are appointed in urine incontience complication cases inflammatory process or an infection.

Diagnosis of an incontience of urine is made by the following methods:

• Collecting the anamnesis (the subjective signs of the patient characterizing disturbance);
• Survey on a gynecologic chair;
• Tsistoskopiya (endoscopic research of a bladder);
• Conducting laboratory tests;
• ULTRASONOGRAPHY;
• Complex urodynamic research (tsistometriya, profilometriya, urofloumetriya).

Conservative methods of treatment of an incontience of urine after the delivery are performance of physical exercises for strengthening of muscles of a pelvic bottom and so-called step-free the therapy assuming a training of muscles by deduction of certain small weights of the increasing weight.

Criterion for evaluation of efficiency of conservative techniques is total disappearance of episodes of an involuntary urination. On average normalization of an urination borrows till 1 year.

At inefficiency of conservative techniques of treatment of an incontience of urine surgical methods of correction of a problem are after the delivery applied. Now low-invasive operational techniques practice.

The main methods of surgical correction are:

• Uretrotsistotservikopeksiya – full-fledged surgical intervention for fixation of a bladder, an urethra and a uterus. This method is used extremely seldom at essential disturbance of a structure of pelvic muscles;
• Administration of gel – manipulation is carried out to paraurethral space as in the conditions of a hospital, and is out-patient. At such method of correction of an incontience there is high a risk of development of a recurrence;
• Slang loopback surgical corrections – placement under a middle part of an urethra of the synthetic loop providing additional support.