Urinary incontinence

Introduction to urinary incontinence Urinary incontinence is the loss of urinary self-control ability due to bladder sphincter injury or neurological dysfunction, causing urine to flow involuntarily. Urinary incontinence can be divided into five categories according to symptoms: overflow urinary incontinence, non-resistance urinary incontinence, reflex urinary incontinence, urge incontinence and stress urinary incontinence. The cause of this type of urinary incontinence is complex and requires detailed examination. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people. Mode of infection: non-infectious Complications: urinary tract infection

Causes of urinary incontinence

Congenital disorders (30%):

Such as urethral fissure, urethral fissure is a congenital urethral external malformation caused by defects in the dorsal urethral fusion, male patients with urethral orifice on the dorsal side of the penis, female patients with urethral upper wall fistula, clitoris Split, the distance between the labia majora is wider. Since congenital urethral fissures often coincide with bladder eversion, embryology can be considered as part of the bladder valgus. The upper urethra is more common in men, with a male to female ratio of about 3:1.

Trauma (20%):

For example, women's trauma, pelvic fractures, etc., pelvic fractures are a serious trauma, mostly caused by direct violent pelvic compression. More common in traffic accidents and landslides. In wartime, it was a firearm injury. More than half of pelvic fractures are associated with comorbidities or multiple injuries. The most serious is traumatic hemorrhagic shock, combined with pelvic organ injury, and a high mortality rate due to improper treatment.

Surgery (20%):

In adults, prostate surgery, urethral stricture repair, etc.; children for posterior urethral valve surgery.

Urinary incontinence prevention

1. Be optimistic, open-minded, learn to adjust your mood and mood. Strengthen physical exercise, actively treat various chronic diseases, and at the same time carry out appropriate physical exercise and pelvic floor muscle training. The easiest way is to wake up before going to bed every morning and go to bed at night, and then do 45 to 100 times each. Tightening the anus and lifting the anus can significantly improve the symptoms of urinary incontinence.

2. Prevent urinary tract infections, develop the habit of going to the back and rub the toilet paper after urinating, avoid urinary tract infection, before sex, the husband and wife first wash the vulva with warm water, after the sexual intercourse, the woman immediately empties the urine, cleans the vulva, if After sexual intercourse, urinary pain occurs, frequent urination, can take anti-urinary tract infection drugs for 3 to 5 days, quickly heal in the early stage of inflammation, and maintain a regular sex life.

3. Strengthen physical exercise, actively treat various chronic diseases, and at the same time carry out appropriate physical exercise and pelvic floor muscle training. The easiest way is to wake up before going to bed every morning and go to bed at night, and then do 45~100. Tightening the anus and lifting the anus can significantly improve the symptoms of urinary incontinence.

4. Women should pay attention to rest after giving birth, do not prematurely load and fatigue, daily contraction of the anus for 5 to 10 minutes, usually do not urinate, but also pay attention to weight loss, if there is a birth injury to repair in time.

5. Early detection, early treatment, if the vagina is found to have a clogging sensation, there is a blockiness protruding from the vulva when the urine or force is used, the vaginal secretions have odor or blood, dysuria, not smooth, frequent urination or incontinence, backache, belly drop If you have symptoms, you should see a doctor in time to prevent prolapse of the pelvic organs.

Urinary incontinence complications Complications, urinary tract infections

Urinary tract infection, dysuria.

Urinary incontinence symptoms common symptoms detrusor no reflection urinary incontinence urinary frequency prostatic hyperplasia urgency kidney ectopic with ureteral ectopic retention

Incontinence of urinary incontinence: Urine continuously drips from the urethra, and the bladder of such patients is inflated.

Non-resistance urinary incontinence: When the patient is standing, the urine is completely discharged from the urethra.

Reflex urinary incontinence: Patients involuntarily intermittently urinate (intermittent urinary incontinence), urinating without feeling.

Urgent urinary incontinence: The patient has very severe urinary frequency, urgency, and urinary incontinence due to strong detrusor contraction.

Stress urinary incontinence is when urine pressure increases (such as coughing, sneezing, going up the stairs or running), that is, urine flows out of the urethra. The cause of such urinary incontinence is complicated and requires detailed examination.

Examination of urinary incontinence

1 Determination of residual urine volume to distinguish between urinary incontinence caused by excessive urethral resistance (lower urinary tract obstruction) and low resistance.

2 If there is residual urine, urinary bladder urethra angiography, obstruction in the bladder neck or external urethral sphincter.

3 bladder pressure measurement, to observe whether there is no inhibition of contraction, bladder sensation and detrusor no reflection.

4 After standing cystography, the urethra is filled with contrast agent. The urinary tract function is blocked by the bladder neck. If the sympathetic function of urinary tract is damaged, the posterior urethra smooth muscle is relaxed. The posterior urethra is visible on the contrast. There is contrast agent filling at the side 1 to 2 cm, because there is no striated muscle in this part of the urethra.

5 Close the urethral pressure.

6 If necessary, bladder pressure, urine flow rate, simultaneous electromyography, to diagnose cough-urgent urinary incontinence, detrusor sphincter dysfunction, and urinary incontinence caused by sphincter non-inhibitory relaxation.

7 dynamic urethral pressure map: a special double lumen tube, two holes at the end, one hole in the bladder, the other hole in the posterior urethra, normal urethral function when the intravesical pressure increases (such as coughing The urethral pressure also rises to prevent the outflow of urine. There are a few patients with stress urinary incontinence. When the intravesical pressure is increased, the urethral pressure does not rise, and the urine is outflowed.

Diagnostic identification of urinary incontinence

diagnosis

Urinary record: The history of urinary incontinence is complicated, and it is also affected by other factors, so it is difficult for elderly patients to accurately describe the characteristics and severity of their symptoms. The urination diary can objectively record the urination of the patient within the specified time (usually recorded for 2-3 days), such as the amount of urine per urination, the time of urination, and accompanying symptoms. These objective data are the basis for the diagnosis of urinary incontinence.

Physical examination: to understand the presence or absence, stroke, spinal cord injury and other central or peripheral nervous system diseases and other signs related to urinary incontinence, to understand whether there is heart failure, limb edema.

Laboratory routine examination: laboratory tests should be carried out in urine routine, urine culture, liver and kidney function, electrolytes, suggesting polyuria, blood glucose, blood calcium and albumin should be examined.

Urodynamic examination: Through medical history and physical examination, the type and cause of urinary incontinence can be understood in most cases. If the empirical conservative treatment fails, or prepare for surgery, etc., urodynamics should be performed to check blood sugar. If the urination diary is checked, the diagnosis cannot be confirmed.

Differential diagnosis

Detrusor movement disorders: Symptoms are similar to stress urinary incontinence. However, detrusor movement disorder is abnormal contraction of the detrusor, urinary incontinence caused by urinary sphincter dysfunction; bladder neck elevation test is negative; bladder urethra angiography shows normal bladder neck position after bladder urethra; detrusor pressure during cough Raise.

Bladder bulging: a history of urinary incontinence, but there is a lower abdomen and perineal sensation, measuring the residual urine volume of the bladder, vaginal anterior wall bulging when forced. The X-ray signs of bladder urethrography are in the normal range of the posterior urethral angle and the urethral tilt angle; the symptoms of bladder bulging after vaginal anterior wall repair are improved, but the symptoms of stress urinary incontinence may even worsen.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.