Urinary incontinence

Introduction Incontinence of urine 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: overflow urinary incontinence, non-resistance urinary incontinence, reflex urinary incontinence, acute near incontinence and stress urinary incontinence. Incontinence of urinary incontinence is caused by a serious mechanical (such as benign prostatic hyperplasia) or functional obstruction caused by urinary retention in the lower urinary tract. When the intravesical pressure rises to a certain extent and exceeds the resistance of the urethra, the urine continuously drops from the urethra. Out, the bladder of this type of patient is inflated. Non-resistance urinary incontinence is due to the complete loss of urethral resistance, the inability to store urine in the bladder, and the flow of urine from the urethra when the patient is standing. Reflex urinary incontinence is caused by a complete upper motor neuron lesion, which relies on spinal cord reflexes, and the patient involuntarily intermittently urinates (intermittent urinary incontinence) without urinating. Urge incontinence can be caused by strong local irritation such as partial upper motor neuron disease or acute cystitis. 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.

Cause

The causes of urinary incontinence can be divided into the following items:

1 congenital disorders, such as upper urethra.

2 trauma, such as trauma during women's production, pelvic fractures, etc.

3 surgery, in the adult for prostate surgery, urethral stricture repair and so on. The child is a posterior urethral valve surgery.

4 various causes of neurogenic bladder.

an examination

Related inspection

Bladder residual urine volume determination bladder ultrasound

Urinary incontinence, especially urinary incontinence caused by the neurogenic bladder, should be checked as follows:

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 Standing bladder angiography to observe whether the urethra is filled with contrast agent. Contrast agents in the urethral function are blocked by the bladder neck. If the sympathetic function of the urination is damaged, the smooth muscle of the posterior urethra is relaxed. On the contrast film, the contrast agent is filled in the proximal side of the posterior urethra 1 to 2 cm, because there is no striated muscle in this part of the urethra.

5 Close the urethral pressure map.

6 Synchronous examination of bladder pressure, urinary flow rate, and electromyography should be performed as necessary 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 is placed in the bladder and the other hole is in the posterior urethra. In patients with normal urinary tract function, the urethral pressure also rises when the intravesical pressure increases (such as coughing) 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.

Differential diagnosis

The clinical manifestations of urinary incontinence can be divided into five categories: overflow urinary incontinence, non-resistance urinary incontinence, reflex urinary incontinence, acute near incontinence and stress urinary incontinence.

1, overflow urinary incontinence is due to the lower urinary tract has more serious mechanical (such as benign prostatic hyperplasia) or functional obstruction caused by urinary retention, when the intravesical pressure rises to a certain extent and exceeds the urethral resistance, the urine continuously from the urethra Drop in. The bladder of this type of patient is inflated.

2, non-resistance urinary incontinence is due to the complete loss of urethral resistance, urine can not be stored in the bladder, the patient is all from the urethra when standing.

3, reflex urinary incontinence is caused by complete upper motor neuron lesions, urinary respiration depends on spinal cord reflex, patients involuntarily intermittent urination (intermittent urinary incontinence), no feeling of urination.

4, urge urinary incontinence can be caused by partial local motor neuron lesions or acute local inflammation such as acute cystitis, patients have very severe urinary frequency, urgency symptoms. Urinary incontinence occurs due to a strong detrusor contraction.

5, stress urinary incontinence is when the abdominal pressure increases (such as coughing, sneezing, going up the stairs or running) that there is urine out of the urethra. The cause of this type of urinary incontinence is complex and requires detailed examination.

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