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Incontinence after pregnancy. Postpartum urinary incontinence. What are the pelvic floor muscles

Postpartum urinary incontinence is a problem that many women face, especially if they have complications such as childbirth big kid etc. Many young mothers do not pay due attention to this pathology, believing that everything will go away on its own. But this is not always the case. How to identify the disease, which are the most effective ways dealing with postpartum incontinence?

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The causes of the appearance of pathology

Predisposing moments for the development of urinary incontinence can form in women even before pregnancy. These include:

  • history of spinal injury;
  • frequent inflammatory diseases of the urinary tract;
  • chronic constipation;
  • others.

By itself, childbirth can be a starting point in the development of the clinical picture of the disease, especially if they proceed with complications. In general, there are about five causes of urinary incontinence in women during this period.

Changes in the nervous regulation of the bladder and its structures

As the baby passes through the birth canal, all nearby tissues are compressed. Including a special load is experiencing bladder and the rectum. It is to reduce the trauma of these organs that a woman is constantly recommended to urinate, and is put on the eve.

The risk group includes girls with an alleged large fetus, and other complications in childbirth, as a result of which the baby passes very slowly, the whole process is delayed longer than acceptable. Compression of the nerve plexuses of the bladder leads to disruption of its work.

A similar clinical picture may develop after performing caesarean section... The difference is only in the mechanism. During surgical intervention, especially if this is a repeated cesarean section, even with the most careful execution, the intersection of the nerve endings occurs. Their recovery takes some time, on average - several weeks, during which urination disorders may occur.

As a result, after childbirth, the following can be observed:

  • The woman does not feel the urge to urinate. As a result, the bladder stretches as much as possible, enlarges and compresses the uterus. At the same time, insignificant pulling pains lower abdomen, which forces a woman to see a doctor. After excretion of urine using a catheter, the condition returns to normal. For a while, a young mother should try to empty the bladder without even feeling it is full.
  • With the same frequency, the opposite may occur - urinary incontinence after childbirth when sneezing or coughing. It happens that urine leaks a little, and this is revealed when the laundry gets wet. As a rule, everything goes away in a month or two, but in individual cases serious treatment is required.

Abnormal mobility of the urethra

This pathology occurs due to loss of tone of the pelvic floor muscles, changes in the position of the urethra due to various injuries and diseases. As a result, its physiological bend is straightened, and the woman can no longer control her urination. If the reason lies precisely in this, then the situation can be corrected by such methods as injecting a gel under the urethra, performing TVT operations, and others.

This is the case in the case of serious injuries with complicated childbirth. This pathology is more common in women after the appearance of the second and subsequent babies, since each time the pelvic floor muscles weaken, stretch, especially if you do not prevent their "wear and tear".

Insufficiency of the sphincters of the urethra and bladder

These conditions can develop after trauma, for example, during childbirth. Also, if the innervation of the sphincters is disturbed, a similar picture is observed: they simply do not fully contract, and urine spontaneously flows out or appears with slight straining, sneezing, etc.

Bladder pathology

This includes both various diseases of the organ, as well as its injuries, functional features, including an unstable position in the pelvic cavity.

Girls at risk

It is sometimes difficult to find the exact causes of urinary incontinence after childbirth, very often they are combined, which makes diagnosis and treatment difficult. It is possible to unambiguously identify risk groups for the development of this pathology. These include:

  • overweight or fast and a large set body weight during pregnancy;
  • those who have a baby over 4 kg;
  • if the size of the pelvis is small (narrow, flat, rickety, etc.);
  • if the family has a predisposition to this pathology, which is most likely associated with a feature of the connective tissue in the body;
  • with difficult long childbirth and multiple breaks;
  • if there was a history of any neurological diseases of the sacro-lumbar region of the spine, including trauma.

Symptoms

Despite the fact that the causes of the pathology may be different, the symptoms are common to all clinical cases. The main complaints are as follows:

  • discharge of droplets of urine or even a decent amount when sneezing, coughing, physical activity, sexual intercourse, etc .;
  • such episodes are often triggered by alcohol;
  • incontinence even in horizontal position;
  • when urinating, it is difficult to interrupt or reduce the set of the jet by the force of the muscles of the perineum.

Types of pathology

Most often, you have to deal with stress urinary incontinence, which occurs immediately with even a slight stress on the woman. But there are other types, these include:

  • Urgent incontinence, when a person cannot control the process of urination with a full bladder;
  • reflex, in this case, the release of urine is provoked by the sound of pouring water, with a cry, etc.;
  • bedwetting, but this is more of a childish problem and is very rare in adult women;
  • involuntary urination immediately after emptying the bladder;
  • incontinence of the paradox, when there is some obstacle in the way of urine outflow, as a result of which it is constantly separated in small portions (for example, when, etc.).

It is difficult to understand each of the forms not only independently, but sometimes the specialist does not immediately determine the right one. Therefore, if a problem occurs, you should consult a doctor who, after a thorough examination, will establish the cause and prescribe the most effective treatment urinary incontinence after childbirth.

Diagnostics

The diagnosis is established on the basis of the woman's complaints, general examination and detailed examination... So, already at the initial visit, the doctor may ask the patient to strain while she is on the gynecological chair. In case of incontinence, a few droplets or even a whole portion of urine will be discharged from the urethra. This is a "cough test".

For a more detailed assessment of the clinical situation, it is sometimes suggested to fill out questionnaires - questionnaires with detailed complaints. Also, the technique of keeping a urination diary is used for at least a week. It records the amount of fluid drunk and discharged, and also notes all the nuances and provoking factors in detail. In some cases, the clinical picture is so vivid and understandable that this is not required.

Also often for diagnostic purposes various diseases cystoscopy is used - viewing the urethra and bladder with a special instrument. This can reveal inflammation, hernias, diverticula, etc.

It is also necessary to perform a general examination: urine analysis, culture for flora and sensitivity, ultrasound procedure kidney and others at the discretion of the doctor.

Much less commonly used special methods tests such as uroflourometry and cystometry to monitor bladder filling and urine flow rate.

Treatment options

How to treat urinary incontinence after childbirth is most effective can only be said by a specialist after examination. In some cases, conservative treatment will suffice, in others without surgical intervention not enough.

Conservative

There are no drugs that would improve the function of the bladder overnight. Sometimes used medicines to stimulate its contractile activity, but more often it helps in the absence of the urge to urinate after childbirth, rather than incontinence. Everything else is various workouts aimed at strengthening the pelvic floor muscles.

As a rule, after childbirth, these techniques are quite effective. First, the body is young and quickly responds to various influences. Secondly, in most cases of incontinence after childbirth, we are talking about the weakness of the muscles of the perineum. And if you train them, all the symptoms of pathology disappear or significantly decrease.

The main training exercises include the following:

  • Kegel lessons. These include alternating contraction and tension of the perineal muscles. Some women compare it to something like drawing water in the vagina, others with contractions similar to lifting an elevator. But the meaning is the same: it is necessary to squeeze the muscles of the perineum in two stages - first a little, then to the fullest.

After that, it is necessary to connect to the cuts the tissues located around the anus. There should be as many such repetitions as possible, it is advisable to do the exercises not only at home, but also in public transport, at work, because they are absolutely invisible to others. To check how trained the muscles are, you can try to squeeze the stream of urine while urinating. If this can be done without difficulty, both at the beginning and at the end, the tissues are in normal tone.

  • Lessons with weights. There are special systems designed to train the muscles of the perineum. They help with prolapse of the vaginal walls, and can also be effective for incontinence. Such weights can be bought and practiced independently, but now such weights are carried out even in fitness centers under the name "wumbling".
  • Electromyostimulation of the muscles of the perineum and other physiotherapy procedures are also used.

In most cases, conservative methods are quite effective for incontinence in women after childbirth. The result should be assessed no earlier than after a year of intense training. If the woman feels an improvement during this time, you can continue this way.

Surgical methods

Surgical treatment for urinary incontinence after childbirth, which occurs when coughing, sneezing, physical exertion, is used only if conservative measures are ineffective. The following types of interventions are used:

  • The introduction of the gel into the space under the urethra. So you can fix the situation urethra... The advantage of the method is low invasiveness, it can be performed even in outpatient... However, the risk of recurrence of the pathology is quite large, therefore, such an operation is not always used.
  • Sling or TVT operations. There is a wide variety of them, including with and without the installation of an alloprosthesis (special supporting mesh). Complications of these operations are rare, but with injury sciatic nerve the consequences are so unpleasant that many doctors refuse these methods.

The fact is that some stages of the intervention are carried out "blindly", which increases the risk of injury. Also, the installed meshes are often rejected, and they have to be removed with a second operation. All this has diminished the popularity of this technique in recent years.

  • There are also rarely used other options for fixing the bladder and urethra. But today it’s more historical reference rather than popular techniques.

Prophylaxis

Of course, understanding why urinary incontinence develops after childbirth, prevention of this pathology should be carried out. The main recommendations include the following:

  • it is necessary to control your weight, especially if there have been cases of similar urinary incontinence in the family;
  • during childbirth, it is necessary to try to follow all the recommendations of doctors and midwives, because other injuries largely depend on this;
  • even if the girl does not have problems with urination or weakness of the pelvic floor muscles, with preventive purpose you can regularly do Kegel exercises and the like;
  • should be prevented, since this leads to overstrain of the muscles of the perineum, which ultimately can lead not only to, but also to urinary incontinence;
  • timely detection and treatment of other diseases of the urogenital tract is recommended.

If a woman experiences urinary incontinence after childbirth, such as through sneezing, coughing or physical exertion, do not postpone the visit to the doctor. The pathology detected in time can be completely eliminated in the early stages without surgical intervention. But this will require regular exercise and strict adherence to all other recommendations. Don't be shy or hide your incontinence. This is a common problem that many women experience.

After giving birth, most women face various problems with health and ailments. Postpartum urinary incontinence is one such problem affecting women who have given birth. Most moms see this as embarrassing, and long time hide the essence of their problem from others. It is not right position taken, disrupting normal life activity and negatively affecting health. Why does childbirth provoke malaise, and how can you protect yourself from it?

Causes of urinary incontinence after childbirth

Urinary incontinence is a condition in which there is uncontrolled urination. In women after childbirth, this condition is often observed, which is called stress. Uncontrolled urination with this anomaly occurs with prolonged muscular work: bending, squatting, running, carrying weights. Often there is urinary incontinence in women during sex with tension in the hip and abdominal muscles.

The reason for this condition is postpartum period there is a dysfunction of the pelvic floor. Failure occurs due to the load on the pelvic organs during the period of gestation, after difficult childbirth and caesarean section. Factors affecting the likelihood of getting sick:

  • large fruit;
  • narrow pelvis of a woman in labor;
  • operation - cesarean section;
  • improper placement of the fetus in the uterus;
  • pregnancy with more than one fetus;
  • secondary labor;
  • rupture of the vaginal walls;
  • overweight;
  • existing diseases of the genitourinary organs (pyelonephritis, urethritis, cystitis, etc.)

Types of uncontrolled urination

In the postpartum period, the following types of incontinence are likely to occur:

  • Stress urinary incontinence (SUI) is an involuntary discharge of urine when coughing, crying, or with loud laughter. This type of incontinence develops in most cases during the postpartum period.
  • Urgent - the separation of urine (urine) with frequent and intense urge to urinate, the inability to contain them.
  • Reflex - occurs under the influence of inciting reasons (splashing water, noise of rain).
  • Uncontrolled passing of urine - a slight separation of urine throughout the day.
  • Enuresis is the discharge of urine at night.
  • Leakage with overcrowded bladder - occurs under the influence internal factors(existing infectious diseases of the genitourinary organs, the appearance of benign formations).

Symptoms of the condition

With urinary incontinence in women, the following symptoms begin to appear:

  • systematically and uncontrollably urine leaks;
  • when leaking, a fairly large amount of urine is released;
  • frequent urine leakage during sex and physical work.

When a woman rarely has incidents, one way or another, they should alert and induce the woman in labor to resort to medical care... Timely contacting a medical institution and identifying an ailment will help to correct the condition and avoid negative consequences. In the absence of deviations, the patient after the examination will be calm about her health.

The severity of the disease

The choice of therapeutic measures depends on the severity of the violations.

There are three degrees of severity of the ailment:

  • Lightweight. Urinary leakage occurs with excessive muscle work (sports, stress abdominal, gymnastics, running).
  • Average. The symptomatology manifests itself with a slight tension of the abdominal press - during crying, laughter, and coughing.
  • Heavy. Leakage occurs at night (enuresis), with a change in posture during sleep and for no apparent reason. The severe stage of the disease requires a competent approach to the choice of treatment.

Diagnostics

Diagnostic measures are carried out by a specialist in this field, that is, by a doctor - urologist. The attending physician will examine the patient, conduct a test procedure (ask the woman to cough or strain her abdominals) to check for spontaneous urination. If the test is positive, the woman will henceforth take notes of the time and cause of involuntary urination. Based on these records, the doctor will select a specific treatment strategy for this condition.

More accurate and faster diagnostics include the following activities:

  • Ultrasound of the kidneys, pelvic organs.
  • Laboratory analyzes of blood and urine.
  • If necessary, urodynamic testing is performed - uroflowmetry. Allows you to determine the violation of the dynamics of the lower urinary tract.
  • Cystometry is a study that allows you to study pathologies in the work of the bladder.
  • Urethral profilometry is a urodynamic study that allows you to assess the condition of the urethra.

Pathology treatment


Treatment of the disease involves both medical method and surgical intervention.

Many women feel ashamed and do not dare to tell the doctor about their discomfort in the postpartum period, because they do not know what to cure the disease on early stages it is quite possible with timely diagnosis. If mild degree diseases are treated without surgery, then a severe form involves exclusively surgical intervention.

Conservative treatment

A conservative therapy technique is used for the stressful form of uncontrolled urination. It includes:

  • exercises for the muscles of the vagina;
  • bladder training;
  • physiotherapy;
  • taking medicines.

Exercises for the muscles of the vagina

Holding the weights with the vaginal muscles. Small weights with a maximum weight of 50 grams are taken and placed in the vagina. For 15 minutes, a woman walks around the house, goes about her business, while holding the weights inside. The exercise is performed 3-4 times a day. The mass of weights at the beginning of therapy will be minimal, gradually increasing every day. This exercise will help control a woman. pelvic muscles and control the outflow of urine.


By performing Kegel exercises, a woman increases the tone of the pelvic floor muscles.

Kegel exercise. The basis of the exercise is to squeeze and unclench the vaginal muscles. Exercise should be done at least a hundred times a day. When urinating, you should try to hold back the flow of urine for a couple or three seconds, then continue the process. This exercise is very simple and does not require any dedicated time.

The content of the article:

The period of pregnancy and childbirth is stress for the female body. The hormonal background is changing. The genitourinary system is under enormous stress. In the moment generic process the nervous regulation of the soft tissues of the internal organs is disrupted, the muscles of the pelvic floor are weakened. As a result, many representatives fair half complain of urinary incontinence after childbirth.

The main causes of urinary incontinence after childbirth are:

1. Over the course of nine months of pregnancy, there is a gradual change in the ilio-sacral and pubic joints.

2. Closer to childbirth, a significant amount of the hormone relaxin is observed in the blood of a pregnant woman. It helps to weaken the muscles and ligaments of the pelvic floor, which leads to an increase in bone dynamics.

3. During labor, the pelvic bones expand, this protects the child passing through the birth canal from the possibility of injury. It is the expansion of the pelvic tissues that causes spontaneous urination in women who have given birth.

4. Another reason that causes urinary incontinence after childbirth is ruptures resulting from the birth process. Quite often, obstetricians resort to the perineal incision method to facilitate the passage of the baby's head. The result is the resulting pathology.

Types of urinary incontinence after childbirth

Up to 40% of women who have given birth suffer from urinary incontinence. They postpone going to the doctor for many reasons. Someone is embarrassed to talk about it, someone hopes that "it will pass by itself."

Medical practice highlights the following types pathology:

1. Uncontrolled urination (urgent). Sudden violent urge to urinate.

2. Involuntary urination at the slightest exertion (stress). It is observed at the slightest physical exertion, and even coughing.

3. Overflowing bladder (paradox ischuria). It lies in the inability to endure.

4. Involuntary urination with fright, noise of water (reflex).

5. Inability to control urination at night.

6. Residual discharge of urine after emptying the bladder.

7. Regular, uncontrollable flow of urine.

8. Involuntary urination when the body is in a horizontal position. It also occurs during intercourse.

Symptoms of urinary incontinence after childbirth

Uncontrolled urination, urine leakage, involuntary urination during physical exertion, frequent urge to urinate, situations when "I felt like it but did not run out", the noise of water and overexcitation cause urination. The presence of any of these symptoms indicates a problem in the genitourinary system and requires immediate appeal to the doctor.

What to do with urinary incontinence after childbirth

The most common occurrence of urinary incontinence after childbirth is referred to as stress incontinence. To determine the cause of the pathology and the purpose of treatment, it is necessary to carry out comprehensive examination women. This must be done, since the cause of this pathology can also be:

Heredity;

Wrong development of the pelvic organs;

Hormonal disorders;

Mental disorders;

Overweight;

Diseases nervous system;

Surgery;

Consequences of radiation exposure.

Diagnosis of urinary incontinence after childbirth

If you find any signs of pathology associated with urinary incontinence, it is advisable to urgently make an appointment with a urologist. How used to be a woman it does, the more effective the treatment will be.

The danger of the disease lies in its gradual development... Ignoring this problem, the woman condemns herself to long-term treatment afterwards. In order to avoid the need for surgical intervention, when the first signs of incontinence appear, urgent medical attention is indicated.

First of all, the specialist will carry out a complete diagnosis of the patient who has applied.
Diagnostic measures include determining the type of pathology and the degree of its manifestation. An integral measure is the assessment of the functional action of the urinary tract.

The doctor carefully examines the possibility of incontinence. Talking to the patient, the urologist finds out everything possible factors the appearance of pathology. Therefore, even the smallest details should not be overlooked when talking to a doctor.

When collecting information in mandatory the possible risks are being clarified:

Complicated labor (multiple or single);

The presence of a hormonal disorder in a woman's body;

Chronic diseases;

Available surgical interventions;

Various neurological diseases.

The urologist may ask not very "comfortable" questions related to purely personal life women. Throwing aside the embarrassment, it is required to give frank answers to them.
Reliable patient information is a guarantee of the accuracy of the diagnosis.

Physical and laboratory examination

Medical examination of women with urinary incontinence pathology includes three stages.
Initial stage - gynecological examination... The structure of the female reproductive system is studied, the location of the genitals (prolapse or prolapse) is checked. Smears are taken for examination without fail:

From the urethra;

Cervix;

Vaginal microflora.

According to the results of the tests done, it becomes clear about the presence (absence) of inflammatory and infectious processes in the genitourinary system of the patient.

Also, an examination using a gynecological chair makes it possible to determine a neoplasm in the pelvic area. The neoplasm compresses the bladder, thereby causing urinary incontinence.

The bladder neck is examined, its mobility is assessed. To carry out the study, tests are carried out - cough and Valsalva.

Are being studied skin in the perineum and vaginal mucosa.

A prerequisite is the delivery of urine tests - a clinical analysis and urine culture for flora.

Observation

The patient is invited to keep a diary for monitoring urination for a couple of days. In it, she indicates:

The amount of liquid consumed during the day;

One-time volume of excreted urine;

The number of trips to the toilet for urination during the day;

The amount of urinary incontinence during the investigated period of time;

Quantitative application of spacers; the degree of physical activity.

Stages of postpartum urinary incontinence

The next stage is instrumental research.

The patient is scheduled for transvaginal ultrasonography. Performance this study makes it possible to correctly diagnose the location of the urethrovesical segment and determine the sphincter insufficiency. The localization of the bottom of the bladder is diagnosed by scanning the perineum, measuring the length and diameter of the urethra. The bladder neck and urethra are assessed.

Application of three-dimensional ultrasound examination helps to explore the inner surface of the mucous membrane and bladder neck.

When stress urinary incontinence is diagnosed using a two-dimensional scan, the result is an ultrasound symptom complex. During the Valsalva test, the mobility of the urethrovesical segment is observed. At the same time, the anatomical length of the urethra is reduced, and in the middle section and proximal it is expanded.

The final stage is a complex urodynamic study

It is assigned in cases of observation of signs:

Urgent urinary incontinence;

Cases of the assumption of the combined nature of the pathology;

The ineffectiveness of the applied therapeutic treatment;

Inconsistency between the symptoms of pathology and the resulting final examination results;

Pathology of urination as a result of past surgical interventions;

Various neuropsychiatric disorders;

Continuous pathology after the use of surgery.

Comprehensive urodynamic study is the most effective method diagnostics of diseases of urinary incontinence in women after labor. This is an opportunity to make an accurate diagnosis and apply a competent therapeutic prescription to patients with hyperactive bladder without resorting to surgical intervention.

A comprehensive urodynamic study includes:

1. Uroflowmetry - test electronic test dysfunction of urination. It is carried out using measuring instrument in which the patient urinates.

2. Cystometry - fixing the ratio of the volume of the bladder and the force of pressure in it during its filling. In addition, the method allows for control by the receptors of the nervous system for the urinary response.

3. State of urinary continence based on the analysis of the urethral pressure profile.

4. Cystoscopy - the method allows to exclude inflammatory and neoplastic lesions of the bladder.

Differential diagnosis of different types of urinary incontinence

Diagnosis is carried out using a special questionnaire P. Abrams, A.J. Wein (1998). This makes it possible to determine the presence of such pathologies of urinary incontinence as stress and urgent.

The questionnaire lists eight main symptoms characteristic of these pathologies:

Frequency of urge to urinate;

Sudden painful urge to urinate;

Frequency of urination during nighttime sleep;

The ability to get to the toilet in time when you urge to urinate;

Inability to keep urination when coughing, sneezing, laughing.

The symptom of an increased amount of urination indicates an overactive bladder and excludes the pathology of stress urinary incontinence.

The symptom of unexpected painful urges is also characteristic of an overactive bladder.

Frequent nocturnal urination is common in an overactive bladder, but rarely serves as an indicator of stress urinary incontinence.

Samples that allow you to visually determine the pathology of urinary incontinence

A cough test is performed on a gynecological chair. The woman's bladder should be full. The doctor asks the patient to cough several times. If urine leaks as a result of coughing, the test is positive. And this speaks of the failure of the urethral sphincter.

If there is no urine leakage during a cough test, the patient is given other tests.

One of these tests is the Valsava test. It is also performed on a gynecological chair with a full bladder. The patient should push for a deep breath. In the presence of a pathology of urinary incontinence, urinary excretion will occur from the urethra when pushing.

Stop test using a tampon applicator. To carry out a sample in the vagina, a tampon-applicator is inserted into the area of ​​the bladder neck of a woman. Physiological solution (up to 350 ml.) Fill the bladder and instruct to isolate the solution. The urination process is interrupted after two seconds. A quantitative measurement of the released liquid is carried out. Further, the patient is asked to complete the urination process. Again, a quantitative measurement is made. This test gives a clear description of the braking reflex mechanisms.

Pad test for one hour. At the initial stage, the initial weight of the pad used in the test is recorded. The woman is invited to drink no more than five hundred milliliters of water. Further, she must perform various physical activities for an hour. After the set time has elapsed, the gaskets are weighed. Based on the results obtained, the stage of urinary incontinence is determined.

Narrow specialist consultations

If a woman is found to have problems associated with disorders of the nervous system, an additional examination is prescribed. Most often it is medical consultations neuropathologist, endocrinologist, psychotherapist. Based on the results, a treatment regimen for the patient is drawn up.

Treatment of postpartum urinary incontinence

Treatment of pathologies of urinary incontinence after childbirth with conservative methods

The most common manifestation of postpartum urinary incontinence pathology is stress urinary incontinence. More than 40% of women who have given birth are faced with this pathology. There are several training methods for solving this problem.

To achieve the effectiveness of treatment, methods are used to help train the muscles of the pelvic floor and bladder. For this, the patient must systematically perform exercises to hold the weights with the muscles of the vagina. The weight of the weights is constantly increasing in the course of training.

The use of vaginal cones strengthens the muscles involved in urinary retention.

Kegle exercises remain an effective method in the therapeutic process of treatment. Their essence lies in the daily tension of the muscles of the vagina and rectum. It is enough just to independently determine the location of the muscles that need to be strained. When urinating, you need to hold back the stream of urine. It is required to remember this feeling. This is exactly how you need to strain your muscles.

A sufficient amount of stress is at least two hundred times a day. Exercise helps to normalize work genitourinary system.

The urination control schedule is developed by a doctor - urologist or urologinecologist for each patient individually, for a period of two months. It consists in emptying the bladder through a certain amount of time. This means that the patient can empty the bladder only during the period of time that is agreed with the attending physician. Thanks to this method, a woman learns to control the process of urination.

The use of physiotherapy (stimulation with an electromagnet) in conjunction with
recommended exercises is a fairly effective method to achieve positive result in the treatment of pathology of urinary incontinence after childbirth.
The treatment is quite long, it can be up to one year in duration. Physiotherapy sessions are performed up to four times a year for two weeks. Physical exercises can be done daily. After a year of conservative treatment, the achieved result is assessed.

Medication for urinary incontinence after childbirth

There are no narrowly targeted drugs for treating the pathology of urinary incontinence. An exception is the pathology of enuresis. In this case, drugs with targeted action on certain parts of the brain are used.

For the treatment of the pathology of urinary incontinence, it is prescribed medications anticholinergic series. They can slightly alleviate the course of pathology. For example, oxybutin is used to treat bladder dysfunction. At the same time, taking these medicines causes side effects... Therefore, drug treatment this series must be supervised by a physician.

Most often, drugs are prescribed that affect the nervous system, such as depressant... Also in the appointment, drugs are used to improve blood circulation, to strengthen the vascular wall. A vitamin course is prescribed without fail. In cases of hormonal imbalance (estrogen deficiency), hormone replacement therapy is used.

Important! During the entire period of treatment, it is necessary to be observed by the attending physician.
Therapeutic treatment of the pathology of urinary incontinence after childbirth is most effective for patients with a mild stage of the disease. In more severe cases, surgery is recommended.

Surgery for the treatment of urinary incontinence after childbirth

The use of surgical methods of treating pathology is an effective tool.

1. Conducting minimally invasive sling (loop) operations. During such operations, the TVT technique is used - the middle third of the urethra is strengthened with a free synthetic loop. In order to design this support, use synthetic material prolene. This material does not dissolve and retains its strength.

The duration of the operation is from thirty to forty-five minutes. Local anesthesia is used, general anesthesia does not apply. Indications for conducting - for any pathology of urinary incontinence. Already on the second day, the woman is discharged home. Physical activity is allowed after two weeks.

It is characteristic that relapse after surgery by this method occurs extremely rarely. Although a few years ago it was up to 30%.

Existing risks:

Damage to the bladder;

Damage to the vessels of the small pelvis;

Damage to the intestines;

Difficulty in urine outflow, etc.

The main contraindication to the operation is the woman's planning of pregnancy.

2. Also applies surgical treatment by introducing helium in the urethra region, as a result of which the necessary support is formed in the middle part of the canal. The operation lasts about thirty minutes, local anesthesia is applied. This surgery is often performed on an outpatient basis, outside the hospital.

3. The operative method of urethrocystocervicopsia is rarely used. It is not only technically difficult to perform, but also postoperative period recovery takes a long time.

In the treatment of the pathology of urinary incontinence after childbirth, the surgical method of treatment is rarely used. In most cases, this method is used to diagnose serious disorders of the bladder.

The pathology of urinary incontinence is treated with the help folk remedies... Collection of medicinal herbs and individual medicinal herbs help in the initial stages of the disease. Their use requires strict adherence to the proportions in the preparation of the broth.
Some patients believe that this method of treatment is the only panacea for pathology. They categorically reject medical intervention. As a result, advanced stage diseases - the occurrence infectious diseases the urinary system as a whole.

How to prevent the onset of pathology of urinary incontinence after childbirth

The problem of urinary incontinence after childbirth will not arise if the necessary preventive measures are taken in time. They are simple and powerful. A woman should take care of her health throughout her life.

Compliance with basic hygiene rules and recommendations medical professionals- the main points of the prevention of pathologies. TO preventive measures relate:

1. Skittle gymnastics is a reliable assistant. Regular training of the pelvic floor and vaginal muscles will not only help avoid the development of urinary incontinence pathology, but also make the muscles strong and elastic. Exercise is also useful for a favorable course of the labor process. Trained vaginal muscles are a guarantee of no tears.

3. Exclusion from the use of alcohol, tobacco products. Monitor the quality of food. Do not eat salty, spicy, fatty foods.

4. Control your weight. Being overweight often leads to problems with urinary incontinence.

5. Regular bowel movements.

6. During the day, take at least one and a half to two liters of liquid.

Conducted studies on the problem of urinary incontinence after childbirth in women confirm that in most cases it is stress urinary incontinence. That is, a psychological problem. Sometimes, this pathology disappears without medical intervention. This phenomenon is an exception to the rule.

Unfortunately, many women do not immediately turn to specialists, but try to solve it on their own. This is their gross mistake... The disease process is in a state of neglect. And this is already fraught with application operational method treatment of pathology. Therefore, if there is a feeling of discomfort in the vagina or a feeling of insufficient emptying of the bladder after urination, this is already a reason to consult a urologist.
Disease of the pelvic organs can lead to complex complications, up to serious infectious diseases.

If symptoms of urinary incontinence occur, it is necessary to urgently consult a doctor - urologist or doctor - urologinecologist. In no case can we hope that "maybe it will pass." This is a pathology and must be treated. And what methods will be used for treatment, the doctor will tell after a full examination.

conclusions

Medical science does not stand still, but is developing by leaps and bounds. New developments are being introduced in the treatment of pathology. Pharmaceutical companies are doing significant work to help solve the problem of urinary incontinence after childbirth. Pharmaceutical scientists are working on obtaining drugs that can target the source of the disease.

Postpartum urinary incontinence is a treatable process. Women who are planning a pregnancy and those who are already waiting for a baby are strongly advised to monitor their health. Do not disregard the process of urination. In order to cope well with the duties of a mother, one should not start the disease. You can not leave "for later" a visit to the doctor, referring to the busyness of the baby. The child needs an active, healthy mother. Be attentive to your physical condition... Follow your doctor's recommendations when diagnosed with urinary incontinence.

After giving birth, several weeks have passed, the perineal incision has already healed, the lochia has stopped, and the baby smiled for the first time. However, the joy is not always cloudless. It's okay if a baby needs diapers. It will take a long time before he learns to control his bladder and stomach emptying. But it happens that a young mother suddenly has similar problems: after giving birth her bladder has lost the ability to close tightly, therefore, when laughing or sneezing, a few drops of urine are always released.

Atony bladder after childbirth- a very common disease. A large number of women are faced with this problem, but many, embarrassed to talk, are silent about it.

This is a serious mistake. You can cope with urinary incontinence due to childbirth. It is to blame for the weakness of the muscles of the pelvic floor, and the muscles are easy to train.
To do this, you need to know how female body. Internal organs the upper part of the body is supported by the diaphragm, and such organs of the hypogastric region as the urethra (urethra), intestines, and uterus are supported by the pelvic floor. The muscle layer that forms the pelvic floor is stretched, like a hammock, between pubic bone and the coccyx, and has only three openings: for the urethra, vagina and anus. Usually the muscles of the pelvic floor are in a state of moderate tension. They push the bladder and urethra up; the latter, in an upright position, tightly locks the bladder.

The bladder has two opposite tasks: to collect urine (then the urethra should seal it tightly) and empty (the urethra in in this case relaxes and passes urine). Both happen by themselves: the bladder and urethra are composed of smooth muscles that do not lend themselves to volitional influence.

In contrast, the pelvic floor is composed of striated muscles that can be trained and manipulated at will. This is important for childbirth, when the woman in the ejection phase relaxes the pelvis, tense muscles or pushes. The longer the childbirth takes and how larger child, the more stretched (and often overstretched) the pelvic floor muscles. As a result, the muscles of the pelvic floor lose elasticity, become weakened or even sag, and therefore the angle formed by the urethra and bladder changes. The normal functioning of the locking mechanism is impaired. If, moreover, the pressure in abdominal cavity- due to coughing, sneezing, laughing, climbing stairs or lifting weights, a few drops of urine get into the panties.

After a normal delivery, almost every woman has a weakened pelvic floor. Therefore, it is necessary to strengthen his muscles at the first symptoms of incontinence, and best of all - before they appear.
The best workout is exercises that you can start doing in about two to three weeks. The essence of these exercises, repeated ten times a day, ten times, is to deliberately tighten and relax the pelvic floor. To understand how this is done, try several times while on the toilet. a short time interrupt urination or tightly squeeze the sphincter of the anus. If you are not sure that during the exercise the muscles you really need are contracting, and not just the buttocks, then for testing it is best to insert two fingers into the vagina, about two centimeters. If at the moment of compression you feel that your fingers are getting tighter, then you are doing everything right.

The advantage of such clenching exercises is that they can be done everywhere and unnoticed by others - while washing dishes and at the desk, on the bus.

There are special pessaries (not to be confused with contraceptive) that are placed in the vagina, squeeze the urethra up and hold the bladder in the desired position. As the obstruction angle becomes correct again, the involuntary flow of urine ceases.
Medications that are prescribed for older women after menopause for atony of the bladder do not help young mothers, since their incontinence is not caused by estrogen deficiency.

Compression exercises and gymnastics are best done consistently and regularly before pregnancy. Studies carried out on female athletes have shown that trained pelvic floor muscles lose only 20% of their weight (and thus strength) as a result of pregnancy, while untrained pelvic floor muscles lose 80%. Thus, the risk of negative consequences of pregnancy on the pelvic floor is increased.

But those who begin to do the contraction exercises only after the onset of complaints also have a good chance of recovery.

Exercises to strengthen the pelvic muscles

IN THE BACK POSITION: while inhaling, stick out the stomach, while exhaling, raise the buttocks and draw in the stomach for two to three seconds.

IN THE SIDE POSITION: while exhaling, press the heel to the heel and take one knee to the side, stretch your back, while inhaling, bring your knees together.

BEST TRAINING - EXERCISE

Gymnastics for the pelvic floor is very effective - special exercises that can be shown to you in the classroom physiotherapy exercises... With consistent exercise, most women with mild incontinence can heal themselves. Other treatments for urinary incontinence should be consulted with your doctor.

Urinary incontinence is one of the urgent problems modern urogynecology. First, the frequency of this pathology is quite high and amounts to 38–40?%. Secondly, women often prefer to remain silent about their illness and do not have information about possible ways solving this problem, which significantly reduces the quality of life of such patients, leads to the development of depressive disorders in them.

Urinary incontinence often occurs in women who have given birth: in 40% of cases - after re-birth, at 10-15?% - after the first.

What is urinary incontinence

  • Involuntary discharge of urine during minor physical exertion (for example, when standing up suddenly, squatting, bending over), when coughing, sneezing.
  • Uncontrolled urination when lying down, during sexual intercourse.
  • Feeling of a foreign body in the vagina.
  • Feeling incomplete emptying Bladder.
  • Urinary incontinence with alcohol intake.
  • The amount of urine excreted can be different: from a few drops with straining to constant leakage throughout the day.

Causes of urinary incontinence after childbirth

The main factor in the onset of urinary incontinence after childbirth is dysfunction of the pelvic floor muscles and the normal anatomical relationships between the pelvic organs (bladder, urethra, uterus, vagina, rectum). Even during a safely proceeding pregnancy, there is an increased load on the pelvic floor muscles, which serve as a support for developing fetus, they also take part in the formation of the birth canal through which the child passes. In childbirth, the muscles of the pelvic floor are compressed, blood circulation and innervation (supply of organs and tissues with nerves that provide communication with the central nervous system) are disturbed.

The development of urinary incontinence is facilitated by traumatic childbirth (for example, with the use of obstetric forceps, with ruptures of the muscles of the pelvic floor, perineum), large fruit, polyhydramnios, multiple pregnancy. A large number of childbirth in the patient is also a provoking factor for her subsequent development of urinary incontinence.

As a result of exposure to traumatic factors, the following pathological mechanisms can develop:

  • violation of the normal innervation of the bladder and pelvic floor muscles;
  • pathological mobility of the urethra (urethra) and bladder;
  • functional disorder of the sphincters (blocking muscle formations) of the bladder and urethra.

Risk factors for developing urinary incontinence include:

  • genetic factor (the presence of a hereditary predisposition to the development of this disease);
  • pregnancy and childbirth, especially repeated;
  • anomalies in the development of the pelvic organs, incl. pelvic floor muscles;
  • overweight;
  • hormonal disorders(lack of estrogen - female sex hormones);
  • surgical interventions on the pelvic organs, when there was damage to the pelvic floor muscles or a violation of their innervation;
  • neurological diseases (as a result of spinal injury, multiple sclerosis);
  • infections urinary tract;
  • exposure to radiation;
  • mental illness.

Types of urinary incontinence

  • Stress urinary incontinence is the involuntary discharge of urine when coughing, sneezing, or exercising. Most common in women after childbirth.
  • Urinary incontinence - the discharge of urine with a sudden, strong, "imperative" urge to urinate.
  • Reflex urinary incontinence - discharge of urine with loud sound, the sounds of pouring water, i.e. when exposed to any external provoking factor.
  • Urinary incontinence after the end of the act of urination is a condition when, after emptying the bladder, urine continues to drop or leak for a short period of time (up to 1–2 minutes).
  • Involuntary urine leakage is the uncontrolled secretion of urine in small portions, drop by drop, throughout the day.
  • Bedwetting (enuresis) - involuntary urination during sleep, is common in children and is very rare in adults.
  • Overfilling incontinence is a drop of urine when the bladder is full. It is observed with urinary tract infections, pelvic tumors that compress the bladder, for example, uterine fibroids.

Diagnosis of urinary incontinence

To solve the problem of urinary incontinence, you should contact a urologist or urogynecologist. During a visit to a doctor, a woman should be extremely frank, not conceal or conceal anything, since maximum openness will help to formulate the correct diagnosis and choice effective method treatment.

During the first consultation, the doctor asks the patient in detail about complaints, previous illnesses, operations and injuries, about the course and number of births, weight of children at birth, about injuries during childbirth, complications after them. Also, the specialist will inquire about the health status of the next of kin, whether they have symptoms of urinary incontinence.

Further, as a rule, the woman is allowed to fill out several questionnaires. They should describe how you feel on the day you see a doctor and during the previous month. All questions are aimed at clarifying the state of the genitourinary system on this moment, the choice of additional research methods and the correct diagnosis.

In addition to the questionnaire, the patient is encouraged to start keeping a urination diary at home. It is filled in within 24–48 hours, after which the doctor analyzes the data received. In this diary, the following information is recorded every 2 hours: the amount of fluid drunk and excreted, the frequency of urination and the presence (absence) of discomfort during the emptying of the bladder, a description of episodes of urinary incontinence is kept: what the woman was doing at the moment, how much urine was involuntarily released.

Next, an examination is performed on a gynecological chair. To exclude infectious inflammatory diseases the urinary tract doctor can take swabs for flora and urogenital infections from the urethra, cervical canal and vagina. Also, a vaginal examination reveals the presence of tumor formations in the pelvic organs that compress the bladder and change its position (for example, uterine fibroids).

When viewed on a gynecological chair, a "cough test" is performed to diagnose urinary incontinence. The doctor asks the patient to cough, and if urine is released from the external opening of the urethra, the test is considered positive.

At the next stage of diagnostics, additional methods research. As a rule, these are:

Laboratory research(common and biochemical analyzes blood, general analysis urine culture, urine culture and antibiotic sensitivity).

Ultrasound of the kidneys and bladder, with the help of ultrasound, it is possible to determine the volume of residual urine, indirect signs inflammatory processes in the genitourinary system, structural changes in the kidneys and bladder.

Cystoscopy- a study, during which a special optical device, a cystoscope, is inserted into the bladder through the urethra (urethra). This diagnostic method allows you to examine the bladder from the inside, assess the state of its mucous membrane, identify changes that can cause urinary incontinence or complicate the course of the disease (inflammatory diseases of the bladder - cystitis, protrusion of the mucous membrane - diverticula, polyps of the bladder and urethra).

Urodynamic studies characterizing the act of urination:

  • profilometry - a study by which the pressure in the urethra is measured, sequentially at its different points;
  • cystometry - a study of the relationship between the volume of the bladder and the pressure in it, which makes it possible to assess the condition and contractile activity of the muscular wall of the bladder, its ability to stretch when filling, as well as control of the central nervous system over the act of urination;
  • uroflowmetry - measurement of the volume of urine excreted per unit of time. Research provides an opportunity to obtain graphic image act of urination, to assess the maximum and average speed of the urine stream, the duration of the process of emptying the bladder, the volume of excreted urine.

During the second visit to the doctor, the information received is analyzed, the doctor prescribes additional examinations necessary to clarify the diagnosis and the choice of therapy - for example, cystoscopy, profilometry, cystometry, uroflowmetry. In the event that the diagnosis is clear, the tactics and method of treatment are discussed.

Treatment of urinary incontinence after childbirth

Based on the survey data, a choice is made best method treatment. Since in women after childbirth, it is almost always stress urinary incontinence that occurs, we will dwell on the treatment of this disease in detail.

Conservative methods. When stress urinary incontinence occurs after childbirth, conservative treatments are most often used to train the muscles of the pelvic floor and bladder.

Holding weights. To strengthen the muscles of the pelvic floor, a woman is invited to hold with the help of the vaginal muscles the weights of the increasing weight in the form of a cone (from several grams to several tens of grams). The exercise is performed for 15-20 minutes 3-4 times a day, starting with weights with a minimum weight, then the load can be corrected by the attending physician, taking into account achieved result... Kegel exercises also give a certain effect - in both cases, the vaginal muscles are trained.

Kegel exercise. It is necessary to strain and hold in a contracted state for a few seconds the muscles around the bladder and rectum 100-200 times a day. To detect these muscles, you need to try to stop the stream during the act of urination. The muscles that are straining at the same time should be trained. The convenience of Kegel exercise is that it can be performed anywhere without being noticed by others.

Physiotherapy. Physiotherapy techniques are also used (for example, electromagnetic stimulation of the pelvic floor muscles). Exercise can be alternated with physiotherapy courses. For example, exercises are performed for 1 year and in parallel with them 3-4 courses of physiotherapy are prescribed for 14 days each. During treatment, the patient must periodically visit the doctor (on average, once every 3 months) to assess the dynamics of the course of the disease and correct therapy, if necessary. The effectiveness of the treatment is assessed after 1 year.

Bladder training. The main point of this technique is to adhere to a urination plan drawn up in advance and agreed with the doctor. The patient should urinate at regular intervals. In a woman suffering from urinary incontinence, a stereotype is gradually formed according to which she seeks to empty the bladder, even with a slight filling, for fear of not retaining fluid. The bladder training program aims to increase the gap between urinations. In this case, the patient should not urinate when the urge arises, but in accordance with the developed plan. Strong urge to empty the bladder is recommended to be contained by contraction of the anal sphincter. Thus, as a result of treatment, the time interval between acts of urination gradually increases to 3–3.5 hours. At the same time, the woman develops a new psychological stereotype of urination. This treatment is carried out over several months.

Medicines. Perhaps the appointment of an auxiliary drug therapy(anti-anxiety drugs that improve blood circulation, strengthen vascular wall, vitamins, etc.). However, there are currently no medications that directly target the cause of urinary incontinence. An exception is enuresis (bedwetting), in which it is possible to prescribe courses of drugs that affect certain areas of the brain.

Surgical methods. If conservative therapy is ineffective, the woman is offered surgical treatment.

Loop (sling) operation. The most common method is to perform a loop (sling) operation. This creates an additional reliable support for the urethra by placing a loop under its middle part, which can be made of different material(skin with inner surface thigh, labia minora, tissue taken from the anterior wall of the vagina).

Currently, operations are often performed using TVT techniques(free synthetic loop). In this case, a synthetic non-absorbable material called prolene is used to create support in the middle part of the urethra, which does not lose its strength over time. This operation is performed within 30-40 minutes under local anesthesia. It is less traumatic and is done through small incisions in the skin. It is indicated for any degree of urinary incontinence.

Patients are discharged as early as 1-2 days after the procedure. TO active life women return after 1–2 weeks, sex and sports are allowed after 4–6 weeks. The likelihood of recurrence is very low.

Planned pregnancy is a contraindication for performing TVT surgery, since the effect of the surgery may be lost during subsequent pregnancy and childbirth.

Operation using a gel. Another type of surgical intervention is the introduction of a gel into the space around the urethra, due to which the necessary additional support is created in its middle part. The operation can be performed both on an outpatient and inpatient basis, more often under local anesthesia. Its duration is 30 minutes.

Urethrocystocervicopexy. During this operation, the pubic-vesical ligaments are strengthened, which hold the bladder in a normal position. Long-term rehabilitation is required after this surgical intervention. First, this is a technically difficult manipulation. Secondly, it takes time to restore the function of the ligaments after surgery.

Currently, urethrocystocervicopexy is rarely used.

Prevention of urinary incontinence after childbirth

Watch for regular bowel movements: constipation can worsen clinical manifestations urinary incontinence. If you are constipated while trying to have a bowel movement, your pelvic floor muscles become overly stressed, which can worsen symptoms. To prevent this from happening, it is recommended to eat more vegetables and fruits (as they contain fiber), fermented milk products, wholemeal bread.
It is desirable to maintain normal body weight, because excess body weight puts additional stress on the bladder and worsens urinary incontinence.

It is important to timely treat cystitis, urethritis and other inflammatory diseases of the pelvic organs, which are one of the factors contributing to the development of uncontrolled urination.
It is imperative to carry out all the recommended examinations during pregnancy, since with their help it is possible to timely identify diseases of the genitourinary system and prescribe effective treatment.

A brace should be worn during pregnancy to support the abdominal muscles and reduce stress on the pelvic floor muscles. Kegel exercises can be used to prevent urinary incontinence.

Women should know that this urogenital problem is solvable. A timely visit to a specialist will help you quickly and efficiently cope with the disease, thereby improving the quality of life in general.