Stress urinary incontinence can happen and happens at any age, but the causes of the age groups may vary. The overall prevalence of urinary incontinence is increasingly being increases with age.
One of three people has some form of difficulty with bladder control, and twice more likely it is to appear in women. More than 50% of residents nursing homes are incontinent. Incontinence of urine may be the reason for placing the elderly in an institution and develops as a result of wounds lying in the same position, urinary bladder and kidney, and depression. Incontinence of urine also instills a sense of shame and powerlessness.
The kidneys constantly produce urine, which flows through two long, narrow tubes (ureters) to the bladder, where it is stored (saved). The lowest part of the bladder (neck) ring-shaped muscle (urinary sphincter) remains compressed and thus closes the tube through which urine leaves the body (urethra), which allows the retention of urine in the bladder until it is filled. At this point, along the nerves from the bladder to the spinal cord and the brain continues to send out the signals, so people become aware of the need to urinate. The person then can consciously and voluntarily decide whether to release urine from the bladder, or will it keep for a while. When a decision is made on urination, ring the muscle relaxes, allowing urine leakage through the wall of the urethra and bladder contraction to squeeze the urine. Extrusion can be increased by tightening the muscles of the abdominal wall and pelvic floor to increase the pressure on the bladder (bladder).
The whole process of retention and release of urine (urine) is complex, and the ability to control urination can stop (damage) in different places are different disorders. The outcome of such interruption is a loss of control - incontinence of urine.
The forms of incontinence are classified according to whether the incontinence started recently and suddenly or develop gradually and is permanent. Incontinence, which often begins suddenly suggests a disorder of the urinary bladder. His most frequent cause of infections (cystitis). Other causes include medication side effects, physical movement disorders, or those that cause confusion, excessive intake of beverages containing caffeine or alcohol, and conditions that irritate the bladder and urethra, such as atrophic vaginitis (inflammation of the lining of the vagina in older women, which is due to the lack of female genital hormone and characterized by mucosal dryness, increased secretion and increased propensity to inflammation of the vagina). expressed or constipation.
Ongoing (chronic) incontinence may be due to changes in the brain, changes in the bladder and urethra, or disorder of the nerves that come to the bladder or depart from it. These changes are particularly common in older people and women in menopause.
Types of incontinence:
Incontinence of urine is further classified based on the method of presenting symptoms:
First urgency incontinence
Second Stress incontinence
Third overflow incontinence due to bladder or
4th complete incontinence
5th psychogenic inkontineciju
6th mixed incontinence
First Urge incontinence is the irresistible need to urinate followed by uncontrolled release of urine.Normally, people are after the first sensation that the bladder is full, can hold urine for a while. People with urge incontinence, in contrast, typically do not have much time for getting to the toilet. The women can develop this disorder alone or in combination with stress incontinence of various degrees (mixed incontinence). The most common cause of sudden urinary tract infections. However, infection without urge incontinence is the most common form of incontinence in older people, often without apparent cause. Common causes of urge incontinence in older people is an overactive bladder and neurological disorders such as stroke and dementia that interfere with brain activity in the prevention of bladder activity. Urge incontinence becomes particularly pronounced as a problem in circumstances of illness or injury that prevents a person to quickly get to the toilet.
Second Stress incontinence is the uncontrolled release of urine when coughing, sneezing, lifting or carrying out a movement to raise the pressure within the abdominal cavity. Stress incontinence is the most common form of incontinence in women. It can be caused by weakness of the urinary sphincter.Sometimes they cause changes in the urethra due to childbirth or surgery hirururškog within the pelvis. In women after menopause, stress incontinence develops because of estrogen deficiency leads to weakening of the urethra, thus reducing the resistance to flow of urine through it. In men, stress incontinence and may occur after the estrangement of the prostate (prostatectomy, transurethral resection of prostate) is injured when the upper part of the urethra or bladder neck.
Third Overflow incontinence due to bladder is uncontrolled release of small amounts of urine from a full bladder. This release occurs when the bladder becomes enlarged and insensitive because of the permanent retention of urine. The pressure in the bladder is increased to the point that small amounts of urine come out. During physical examination, the doctor can often felt full bladder.
A person can eventually become unable to urinate because urine stream is blocked or because the bladder muscles can no longer set. In children, inhibition of lower urinary tract can be caused by a narrowing of the end of the urethra or bladder neck. In adults, inhibition of urine release (part of the urethra that opens into the bladder) is usually caused by benign prostatic enlargement or prostate cancer in men. Less commonly, barriers can be caused by narrowing of the bladder neck or urethra (urethral stricture), that may occur after surgery on the prostate gland in men. Even constipation can lead to incontinence due to bladder overfilling, because when the chairs are full final part of the colon, may be followed by pressure on the bladder neck or urethra. A number of drugs that act on the brain and spinal cord, or influence the transmission of nerve signals, such as anticholinergic drugs and narcotics, can damage the ability of the bladder contractions leading to prerastegnutog bladder and incontinence due to bladder overfilling.
Disorder of the nerves leading to neurogenic bladder can also cause incontinence due to bladder overfilling. Neurogenic bladder can occur for many reasons, including injury to the spinal cord and nerves caused by multiple sclerosis, diabetes, injury, alcohol abuse and the harmful effects of drugs.
4th Total incontinence is a condition in which urine continuously, day and night, otkapava from the urethra. Do it occurs when the urinary sphincter does not close properly. Some children have this form of incontinence due to congenital disorders in which the urethra is formed into a tube.
In women with complete incontinence is usually the cause of injury to the bladder neck and urethra during labor. In men, the most common cause of injury bladder neck and urethra is surgery, especially prostate removal for cancer.
5th Psychogenic Urinary incontinence that occurs due to psychological rather than physical causes.
This form is sometimes develops in children and even adults who have problems with feelings.Persistent nocturnal enuresis in children (enuresis) can serve as an example.
On a psychological cause can be suspected when the obvious sense of disorder or depression, and exclude other causes of incontinence.
6th Sometimes it is developing a mixed form of incontinence, for example. child may have incontinence due to a disorder of the nerves and psychological factors. A man may have incontinence due to overfilling of the bladder enlargement with urgent incontinence for stroke. Older women often have a mixture of urge and stress incontinence.
Diagnosis
People usually try to live with inkontinen ¬ whose free to seek professional help because they are afraid or embarrassed to discuss this issue with their physician or because they live in a mistaken belief that incontinence is normal with aging. However, many cases of incontinence can be cured or controlled, especially when the treatment starts early enough.
Usually the cause can be detected and the treatment plan after the doctor examine the person and the duration and development issues. Search the urine should be performed to determine whether there is infection. The amount of residual urine in the bladder after urination (residual, residual urine) is often measured using the UZ, or bladder catheterization (introduction tube called a catheter into the bladder). A large amount of residual urine indicates disturbance or obstruction in connection with the nerves or muscles of the bladder (bladder).
Sometimes it may be necessary during a special search of urination (urodynamic evaluation). These tests measure the pressure inside the bladder when you urinate and when full, and are particularly useful in chronic incontinence. The catheter is introduced into the bladder that fills with water through the catheter, there has been pressure within the bladder. Normally, the pressure is slowly rising. For some people, the pressure rises in sudden jumps or too quickly, before the bladder is completely full.The manner of growth pressures helps the doctor to determine the mechanism of incontinence and the best treatments.
There is another test that measures the rate of flow of urine. This test helps in determining the flow of urine is obstructed, and whether the bladder muscles to tighten enough to squeeze out the urine out.
Stress incontinence is diagnosed by examining the course of development disorders, examination of the vagina in women and the detection of loss of urine when coughing or straining. Gynaecological Search also helps in determining whether the lining of the urethra or vagina thinned due to loss of estrogen.
Treatment
Best Treatment depends on the careful consideration of the problems with each individual and varies depending on the specific nature of the problem. Most of the people with urinary incontinence can be cured or they can greatly help.
Treatment often requires taking some simple changes in behavior. Many people retain control of the bladder using simple procedures such as regular urination, every 2-3 hours, in order to maintain the bladder is relatively empty. Avoiding bladder irritants such as caffeine-containing beverages, and drinking adequate amounts of water (6-8 glasses a day) to prevent concentration of urine, which can irritate the bladder, may be helpful. It is often possible to stop taking drugs that adversely affect the operation of the urinary bladder. It is necessary to try to target treatment.
If incontinence can not completely control the targeted treatment, specially shaped and designed pads and underwear (diapers) can protect the skin and allow people to feel dry, you feel comfortable and active in society. This means do not bother and they are easily accessible.
Episodes of urge incontinence can often anticipate the bladder at regular intervals before the show needs. Ways to exercise the bladder, which include pelvic muscle exercises and moral support can really help. I can help and medications that relax the bladder, such as propantheline, imipramine, hiosciamina, and oksibutinina diciklomina. Although many available drugs can be very helpful, each operates slightly differently and has possible side effects, for example. a drug that relaxes the bladder may reduce the excitability of the bladder and a strong urge to urinate, but can cause excessive dryness of the mouth or urinary retention. Sometimes the effects of other drugs can be used just for the benefit of, for example. antidepressant imipramine is effective and can really help a person who is incontinent and also depressed. Sometimes combinations of medicines are helpful. Drug therapy should be monitored and adjusted to the needs of the individual.
Many women with stress incontinence use of estrogen vaginal cream or taking estrogen pills can alleviate the problem. Estrogen as a skin patch is not tested in the treatment of incontinence. Other medications that can help strengthen the sphincter, such as pseudoephedrine or phenylpropanolamine, should be used along with estrogen.
In people with weak pelvic muscles can help (Kegel) exercises for the pelvic muscles. Learning how to squeeze these muscles alone is not easy, and often need tutoring. Nurses and physical therapists can help you learn the exercises. Exercises include repetitive muscle clenching many times a day to strengthen, and learning how to use these muscles appropriately in situations that cause incontinence, such as coughing.
Napkins for incontinence can be used to absorb small amounts of urine, which usually expire by stress or exertion.
More severe cases that do not improve without surgical treatment, can be surgically repaired using any of several procedures that raise the bladder and increases the output part. Injection of collagen around the urethra is effective in some cases.
Incontinence due to bladder overfilling caused by enlarged prostate or other obstruction, it is usually necessary surgery or removal of the prostate. The drug finasteride can often reduce the size of the prostate or stop its increase, so that surgery can be avoided or postponed. Drugs that relax the sphincter, such as terazosin, may also be helpful.
When the cause of poor bladder contraction, medications that can help increase bladder contraction, such as betanekhola. Mild pressure brought by squeezing the lower abdomen just above the bladder palms can also help, especially people who can empty his bladder, but have difficulty fully emptying.In some cases, bladder catheterization is necessary, in order to empty the bladder and forestall complications such as recurrent infections and kidney damage. The catheter can be left in place permanently or can be introduced and removed as needed.
Complete urinary incontinence can be treated by different surgical procedures, for example. urinary sphincter that does not close properly, it can be replaced artificially.
Treatment of psychogenic incontinence consists of psychotherapy, usually in line with changes in behavior and using a device that is a child from sleep once you start wetting the bed, or drugs that inhibit bladder contractions. The person who is incontinent and depression medicines can help treat depression (antidepressants).
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