23.12.2017 · 👁 6,763
Urinary incontinence in women: causes, symptoms, treatment, surgery
Urinary incontinence in women is the involuntary loss of urine, or in other words, any leakage of urine that occurs in a situation where the pressure in the bladder exceeds the pressure inside the urethra. This disease does not depend on any circumstances and is a very common problem among the female population.
Prevalence of urinary incontinence in women
To date, a large number of epidemiological studies have been conducted, which indicate that at least 30 percent (!) of the female population suffer from one form or another of this disease. In developed countries, such as the EU, USA, Canada and others, urinary incontinence, without exaggeration, is a problem of national scale, on which very significant amounts are spent annually (health education, scientific research, introduction of new treatment methods, etc.). International professional associations of specialists dealing with the problem of urinary continence have been created, for example ICS - International Continence Society. Congresses and seminars devoted to this problem are regularly held.
In our country, unfortunately, the situation is somewhat different. According to domestic researchers, no more than 5-10 percent of women suffering from this disease consult a doctor.
The main reasons why women do not seek help from a doctor:
• traditional “shyness” of the female population (despite all the absurdity, it is still customary to divide diseases into “noble” ones, which one is “not ashamed of” to suffer from, and “ignoble ones”, which one doesn’t even want to talk about, no matter how much they interfere with one’s life);
• lack of information among patients about effective and minimally invasive treatment methods;
• insufficient awareness of primary care specialists – doctors of clinics and antenatal clinics;
• the extremely wide prevalence of “ancient”, traumatic and ineffective surgical methods for treating urinary incontinence in gynecological and urological hospitals, which simply scares off patients and flatly discourages them from going under the knife.
Meanwhile, the treatment of urinary incontinence in women has literally undergone a revolution in the last 10-15 years. Now, without exaggeration, we can say that a qualified specialist who knows modern surgical and medicinal treatment methods can help at least 9 out of 10 patients! Truly effective and safe drugs have appeared.
Treatment of urinary incontinence with surgical methods has changed beyond recognition!
The operation - implantation of the so-called “synthetic suburethral sling” is performed through vaginal access through an incision of no more than 1 cm under local anesthesia (without anesthesia). In this case, patients (even elderly women) leave the hospital either in the evening on the day of surgery or the next morning. The long-term effectiveness (over 10 years of follow-up) of modern operations approaches 85 to 90 percent.
So, what are the current views on urinary incontinence in women?
1. Urinary incontinence in women is too common a pathology to be ashamed of.
2. Incontinence is a heterogeneous disease. There are at least three types of it: stress urinary incontinence (with tension, for example, when coughing), urge urinary incontinence (associated with an uncontrollable urge) and mixed.
3. There is no universal treatment method! Stress urinary incontinence in the vast majority of cases cannot be treated with medication. In case of urgent surgical treatment of urinary incontinence (for example, sling surgery) can significantly increase the pathological symptoms and make the patient’s life unbearable (repeated surgery will be required to remove the endoprosthesis). Mixed urinary incontinence is a complex situation and requires a highly qualified specialist to prescribe one or another type of treatment.
4. In connection with the above, a specialist involved in the treatment of urinary incontinence must be proficient in both medicinal and various surgical methods of treating this pathology. This is necessary to determine the correct tactics.
5. Urinary incontinence in women is NOT NORMAL! Not at any age. Age may influence the choice of specific treatment tactics, and that’s all!
6. Currently, there are a number of effective and relatively safe techniques that can cope with urinary incontinence in most patients.
7. Today, patients have a fairly wide choice. You should not go under the knife without hesitation without learning from various sources (including the Internet) about all possible treatment options.
Types of urinary incontinence in women
As already mentioned, at present, urinary incontinence in women is usually divided into three forms, which have different causes, clinical manifestations and, accordingly, treatment methods.
International Continence Society (ICS) classification:
• Stress urinary incontinence (SUI) – associated with a sudden increase in intra-abdominal pressure (during coughing, sneezing, laughing, exertion or strain, etc.)
• Urgent (imperative) urinary incontinence – associated with involuntary contraction of the detrusor, which is manifested by a sudden irresistible urge to urinate (a manifestation of a hyperresponsive bladder).
• Mixed (involuntary loss of urine associated with an irresistible urge to urinate, as well as caused by sneezing, coughing or other reasons)
Rarely found species:
• Nocturnal enuresis - involuntary loss of urine during sleep (common in almost 10% of children under 7 years of age, but in 2-3% of cases it persists until adulthood);
• Continuous incontinence (continuous leakage of urine);
• Incontinent incontinence (urinary incontinence when the woman does not know how it happened);
• Urinary incontinence during sexual intercourse (causes may be detrusor overactivity or urethral sphincter insufficiency).
Degrees of urinary incontinence:
• Mild (with a sharp increase in intra-abdominal pressure - severe sneezing, coughing, fast walking; urine loss is calculated in drops)
• Medium (with calm walking, light physical activity);
• Severe (at rest, when changing body position; complete or almost complete loss of urine);
Stress urinary incontinence (stressing, coughing)
Stress urinary incontinence (SUI) is commonly understood as urinary incontinence during coughing, physical activity, sneezing, laughing and other actions accompanied by an increase in intra-abdominal pressure. A synonym for the term “stress urinary incontinence” is the term “stress urinary incontinence - SUI”, which more clearly reflects the essence of the phenomenon.
The prevalence of stress urinary incontinence in women is very high. In general, at least 30% of the female population suffers from urinary incontinence (all types), with the incidence being higher in women over the age of 40.
True stress urinary incontinence occurs in 50-60% of patients; another 20-30% of patients have a mixed form of pathology.
The essence of stress urinary incontinence in women (urinary incontinence when coughing, sneezing, laughing, etc.) comes down to the fact that an increase in intra-abdominal pressure leads to “squeezing” urine out of the bladder through the urethra (urethra). In this case, the damaged sphincteric (closing) apparatus of the urethra is unable to resist the flow of fluid. The fundamental difference between stress incontinence and other types is the fact that urine loss occurs without the participation of the bladder: the muscular wall of the bladder (detrusor) remains relaxed during urine loss.
Causes of stress urinary incontinence (coughing) in women
The causes of urinary incontinence in women are very diverse, but among them the most common are the following:
• urinary incontinence after childbirth (large fetus, prolonged/accelerated course, rough obstetric care, etc.),
• hereditary defects of connective tissue (combined with the formation of hernias of the anterior abdominal wall, varicose veins, sagging skin, etc.),
• obesity,
• chronic respiratory diseases accompanied by coughing and sneezing (urinary incontinence when coughing),
• chronic constipation,
• lifting weights,
• operations on the pelvic organs (for example, removal of the uterus).
Stress urinary incontinence in women, as already mentioned, is manifested by involuntary loss of urine during coughing, laughing, straining, playing sports and other types of physical activity. In this case, as a rule, urine is lost in small portions (drop by drop) and the loss of fluid is in no way related to the urge to urinate.
Research in recent years has made it possible to identify the anatomical structure, damage to which is highly likely to lead to stress urinary incontinence. Normally, the urethra in its middle third “passes” through a complex muscular-fascial formation, the so-called urogenital diaphragm (UD). This structure performs two main functions: fixation and compression of the urethra at rest and, especially, with increased intra-abdominal pressure. Damage to this structure leads to pathological mobility of the urethra (urethral hypermobility), which is manifested by involuntary loss of urine.
Diagnosis of urinary incontinence in women
Diagnosis of stress urinary incontinence in women usually does not cause difficulties and is based on a thorough assessment of the patient’s complaints and examination data. Completing all the necessary studies will allow you to correctly determine the form of urinary incontinence and, as a result, select the correct treatment.
• Medical history, examination data
• Filling out specific questionnaires ICIQ-SF, UDI-6
• Keeping a urine diary
• Pad test (Pad test) for 24 hours
• Vaginal examination with cough test
• Ultrasound of the pelvic organs and kidneys
• Complex urodynamic study of CUDI
The implementation of such a protocol makes it possible to exclude the urgent form of urinary incontinence, which, according to the patient’s complaints, can be mistakenly interpreted as stressful, and to objectify the indications for surgical treatment.
Treatment of urinary incontinence in women
Correct determination of the cause that led to the disease will allow you to select the correct and effective treatment. Therapy is selected individually for each patient. Unfortunately, very often conservative therapy is ineffective; the only method of eliminating the problem is surgical treatment.
Conservative treatment:
• Lifestyle changes
• Performing special exercises aimed at training the pelvic floor muscles (Kegel exercises)
• Losing weight, quitting smoking, drinking caffeine-containing drinks
• Treatment of respiratory system diseases
• Treatment of chronic constipation
• Correction of general and local hormonal levels
• Physiotherapeutic treatment.
Unfortunately, in the vast majority of cases, conservative treatment is ineffective, since stress urinary incontinence in women is caused by an anatomical (structural) defect in the musculofascial apparatus of the pelvic floor (for example, urinary incontinence after childbirth). The only way to eliminate this defect is surgery.
Surgical treatment (surgery for urinary incontinence)
• Implantation of a synthetic midurethral sling (sling surgery, TVT, TOT, etc.)
111r.png The modern “gold standard” for the treatment of stress urinary incontinence in women, allowing for long-term effectiveness of up to 85-90 percent.
The main prerequisite for the effectiveness of this sling operation for incontinence is that the damaged fascial apparatus of the urogenital diaphragm is replaced with a synthetic bioinert tape. The implanted device grows with the patient’s own tissue and essentially becomes a “neofascia” that performs the necessary function of supporting the urethra when intra-abdominal pressure increases. By now, all the fundamental stages of the sling operation have been worked out to the smallest detail. For implantation of a synthetic sling, in most cases, regional anesthesia is used (the patient is conscious). The tape is installed through an incision on the anterior wall of the vagina no more than 1 cm long and 2 skin punctures (less than 5 mm) in the area of the inguinal folds or in the suprapubic region. After 2-3 months, even a professional may not find “traces” of the sling operation. Patients are discharged from the hospital the next day after the procedure. Return to full activity (including sexual activity) usually occurs 1 month after sling surgery.
222l.pngMidurethral sling in retropubic position and transobturator
Some differences exist in the methods of implanting tapes from different manufacturers. Today, implants from various companies are presented on the medical device market: UroSling (Lintex,
St. Petersburg), TVT, TVT-O, TVT-Secur (J&J), Monarc, Miniarc (AMS), Aris (Coloplast), etc.
Important information!
The apparent simplicity of installing “ribbons” or “meshes” for urinary incontinence and the commercial attractiveness of this operation today have led to the emergence of very alarming trends that may discredit the method.
1. Insufficient qualifications of specialists (who often have not received special training anywhere), especially in the field of diagnostics, leads to the fact that the installation of a synthetic suburethral sling is offered to almost all women suffering from involuntary loss of urine. Meanwhile, an outwardly identical manifestation does not always indicate the same CAUSE of the disease! This approach is guaranteed to lead to ineffective operations and operations that worsen the condition of patients.
2. There are many surgeons who are proficient in only one operation (most often the transobturator sling installation - TVT-O or TOT). Such figures are trying to cure urinary incontinence of all forms and degrees of severity, and sometimes even pelvic organ prolapse with one “proven” remedy. It doesn't always work out...
3. Sometimes, not entirely conscientious specialists, instead of special endoprostheses intended for the treatment of urinary incontinence, implant fragments cut from meshes intended for the surgical treatment of hernias. This is several orders of magnitude cheaper, but can lead to a whole range of adventures.
And the more experience accumulates, the fewer illusions remain that the problem of treating urinary incontinence has been solved!
Only knowledge, experience and perfect surgical technique can provide reliable results and minimize the risk of side effects and complications!
Thus, currently, the treatment of stress urinary incontinence in women is a problem that has an effective and safe solution. Don’t let this illness “steal” your precious days, months and years of a fulfilling life! Despite the obvious advantages of sling operations, their prevalence is still insufficient. The main reasons for this are the overly conservative views of clinicians, the reluctance to master new technologies and the lack of information about inexpensive domestic implants available to all segments of the population.
For any questions, please call: +(998 71) 140-03-03, +(998 71) 140-01-60. We remind you that the Urologic Complex clinic is located at Chilanzar, block 12, st. M. Shaykhzoda, 7
#urologiccomplex #urologicuz