Stress incontinence (incontinence) of urine in women is called its involuntary release during any physical exertion (coughing, laughing, straining or sneezing), which causes an increase in intra-abdominal pressure. Stress urinary incontinence (abbr. SUI) in urogynecology is more commonly referred to as stress urinary incontinence. The essence of this urological pathology lies in the "squeezing" bladder urine at the time of increased pressure in the abdomen. Due to damage to the ligamentous apparatus and sphincters of the urethra, the listed structures cannot counteract the outflow of urine. Characteristically, involuntary urination in SNM occurs without contraction of the muscular layer of the bladder. How SNM is diagnosed, what modern methods of treating pathology have been developed, will answer estet-portal.com.
Stress urinary incontinence: its types
Stress urinary incontinence is classified according to a number of criteria:
1. According to the mechanism of pathology development:
• SNM due to anatomical reasons – displacement, weakness of the ligamentous apparatus (complicated childbirth, traumatic gynecological operations, prolapse of the genital organs);
• SNM, due to physiological changes that caused a breakdown in the functions of the sphincters – estrogen insufficiency (menopause, postmenopause, removal of the ovaries).
2. Severity:
• drip – less than 50 ml of urine excreted within 4 hours;
• light – the amount of involuntarily excreted urine is 50 – 100 ml;
• medium – the volume of urine is 100 – 200 ml;
• heavy – urine output in 4 hours reaches 200 – 300 ml;
• extremely heavy – the volume of urine exceeds 300 ml.
Stress urinary incontinence: how is it diagnosed
STM is diagnosed based on:
• study of the anamnesis (parity, risk factors, working conditions) and complaints of the patient;
• studying a urinary diary;
• carrying out a gynecological examination with the simultaneous performance of a functional test (an involuntary outflow of urine is established when coughing or straining);
• performing a one-hour lining test (the patient drinks 0.5 liters of liquid and does physical exercises for 60 minutes: walking, tilting);
• Ultrasound examination of the uterus, appendages, kidneys;
• general and bacteriological analysis of urine;
• uroflowmetry;
• cystometry.
The patient is asked to keep a urination diary for 2 days. It should record the volume of urine excreted per urination, the number of urinations during 24 hours, each episode of involuntary urination, the number of pads used, physical activity.
Stress urinary incontinence: current treatment options
The treatment of SUI is determined by the cause and degree of pathology. Elimination of the problem is possible with the help of medical, non-pharmacological and surgical methods.
Conservative treatment of stress urinary incontinence
Non-surgical treatment is used in the early stages of the pathology and includes:
• Gymnastics
The patient is advised to do daily Kegel exercises. The duration of the lessons is at least 20 minutes. Gymnastics helps to strengthen the muscles of the perineum.
• Physiotherapy
Rectal, vaginal or urethral sensors are used, through which galvanic, electromagnetic or pulsed currents are passed, causing contraction of the muscles of the perineum.
• Drug therapy
Patients with estrogen deficiency (in the perimenopausal period) are prescribed hormone replacement therapy, which improves blood flow and nutrition, increases the contractile activity of the pelvic muscles. To increase the tone of the muscles of the sphincters of the urethra and bladder, an alpha-adrenergic agonist is prescribed. In some cases, a drug is indicated that destroys cholinesterase, which is involved in the excitation of nerve fibers. As a result, the tone of the muscles of the ureters, bladder and sphincters of the urethra and detrusor increases. To normalize the emotional state, foreign authors recommend taking antidepressants.
Surgical treatment of stress urinary incontinence
The best results are achieved with surgical methods. Surgical intervention is performed with the failure of conservative treatment, 2-4 degrees of severity of the pathology, prolapse of the genital organs, cystocele.
Basic methods of surgical treatment:
• Injection of gels into the urethra
The bulking agent (gel) is injected under the mucosa of the urethra, where it forms a kind of "pillow"; around the urethra. The gel is injected into several points, as a result, the lumen of the urethra narrows.
• Anterior colporrhaphy
This operation restores the normal anatomy of the urethra and bladder.
• Retro-urethrocystocervicopexy
During the operation, the pubocystic ligaments are strengthened, which are responsible for holding the bladder in an anatomically correct position.
• Sling Operations
SUI recurrence after sling surgery occurs in 6-30% of cases. The possibility of developing complications is not excluded: damage to the bladder, urethra, pelvic vessels, development of urethral obstruction and purulent-necrotic processes in the pubic bones.
One of the effective treatments for stress urinary incontinence. Positive results are achieved in 90%. The operation is based on prosthetics of the urogenital diaphragm by installing the – synthetic loop. After a surgical intervention, the implant sprouts with the patient's own tissue and becomes a new fascia of the diaphragm, supporting the urethra when intra-abdominal pressure rises. xxxx>
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