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Urinary incontinence is a major problem after childbirth. Delicate problem after childbirth with urinary incontinence

Hello dear readers!

Postpartum urinary incontinence is an extremely sensitive topic, rarely discussed, however. and no less urgent. This question is rarely ignored. To one degree or another, the majority of women who have given birth face this problem.

Urinary incontinence with a small child in your arms is a very unpleasant phenomenon. On the Internet, as always, there is a mass of contradictory and incomplete information. Let's try to figure it out and add something.

There are several types of urinary incontinence. The most common ones are:

  • stressful (when coughing, sneezing, laughing, running, jumping ...)
  • urgent (the urge to urinate occurs suddenly and extremely demanding, while it is impossible to hold urine)
  • mixed type

Stress incontinence develops due to weakness in the pelvic floor muscles.

Urgent is a neurological problem - the innervation of the muscles that contract the bladder is disrupted.

The mixed type includes those already listed, and not only the reasons.

Urinary incontinence also occurs:

  • With a changed hormonal background of a woman (including after childbirth).
  • Against the background of inflammatory diseases of the genitourinary system.

It is for these reasons that an examination by your gynecologist is simply indispensable for making the correct diagnosis.

Stress urinary incontinence is most common after pregnancy and childbirth.

In our culture, it is not customary to pay much attention to intimate muscles, and during pregnancy and childbirth, they do a tremendous job. It turns out overload and, as a result, their weakness after childbirth. Weakened and overstretched muscles are simply not able to hold the pressure of urine and it begins to flow out at the most inconvenient moment.

  • The rapid course of childbirth.
  • Large fruit.
  • Breaks.
  • Vacuum extraction.
  • Applying obstetric forceps.

These causes can negatively affect the health of even the most trained pelvic floor muscles and provoke urinary incontinence.

Another reason is congenital connective tissue features.

With complicated childbirth, not only stressful, but also other types of urinary incontinence can develop, and they have their own methods of treatment. That is why a visit to the doctor will be useful.

2. Methods of treatment

Modern medicine offers a fairly wide range of treatments for urinary incontinence, including after childbirth. This type of incontinence can be influenced, perhaps, only by physical methods:

  • Pelvic floor training - effectiveness depends on the regularity of the exercise.
  • Collagen injection into the submucous layer of the urethra - lasts for about a year.
  • Sling operations (TVT or TVT-O) and other types of surgical interventions.

The last point, in addition to the high price, has one feature - the subsequent pregnancy will negate the effectiveness of the operation. And who of us can say with confidence that he will no longer give birth? In life, there are the most unusual and unexpected turns of events.

All types of exercise have been clinically proven to be highly effective:

  • On one's own.
  • With a special Kegel trainer.
  • With feedback trainers.

In the early period after childbirth, it is advisable to train on your own without using a simulator. Let's take a closer look at them.

3. Exercises to strengthen the pelvic floor

You can start training, if there are no stitches and tears, on the first day after childbirth. The main goal is to learn how to control the work of the pelvic floor muscles. Deliberately contract and relax them. Here are some tips for mastering this technique:

  • Find the right muscles. To identify the pelvic floor muscles, urination must be stopped. Once you succeed, consider that the right muscles have been found. This action can be performed only 1 time per 1 urination. Stop the thread at the beginning of the process. Repeat this action no more than 2 to 3 times a day.
  • Improve your technique. Once the target muscles are identified, empty your bladder and sit on a firm surface with your legs wide apart. Tighten your pelvic floor, hold it in tension for 5 seconds, and then release and pause for 5 seconds. Repeat these steps 4-5 times in a row. Our goal is to keep the tension for 10 seconds, followed by relaxation for 10 seconds.
  • Repeat 3 times a day. Optimal training frequency: 3 sets daily. Each set has 10 reps.

Do not use Kegel exercises while urinating. Exercising while emptying your bladder can result in:

  • Weakening of muscles.
  • Incomplete emptying of the bladder.

We do not need either one or the other.

4. The secret that no one talks about!

To prevent stress urinary incontinence, use deep sitting in parallel with Kegel exercises. You can find such names for this pose as "tailor's pose", "malasana", "garland frog pose", the essence remains the same.

When done correctly, this pose offers a range of health benefits, especially for women. This is stretching, and breathing exercises, and beautiful posture, and a healthy pelvic floor, and beautiful hips ... All in one!

It is necessary to give up this exercise in the first time after childbirth and with the prolapse of the pelvic organs! If you have mild urinary incontinence, you should refrain from any wide-leg exercise!

The practice of malasana is also limited in the presence of the threat of premature birth.

On the other hand, malasana will be extremely useful in case of difficulties during urination or defecation. And as a preventive measure for people without pelvic floor problems and incontinence.

So let's get started! Stand straight with feet shoulder-width apart, or slightly wider, toes apart. The back is straight, the chest is deployed, the chin is parallel to the floor. Stretch your arms in front of you, bend your knees. Do not lift your heels off the floor! If it doesn’t work, put a support under your heels.

Spread your knees apart, put your hands together with your palms and place between your knees. We look straight ahead, the back is straight, the top of the head is pulled up, the shoulders are lowered, the shoulder blades are not brought together.

Urinary incontinence is one of the most pressing problems of 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 to solve this problem, which significantly reduces the quality of life of such patients, leading to the development of depressive disorders in them.

Urinary incontinence often occurs in women who have given birth: in 40% of cases - after repeated births, in 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 of incomplete emptying of the 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 occurrence 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 the 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), a large fetus, polyhydramnios, and multiple pregnancies. 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 trauma, multiple sclerosis);
  • urinary tract infections;
  • 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 - the release of urine with a loud sound, the sound 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 in making the correct diagnosis and choosing an effective method of 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 at the moment, at choosing additional research methods and making 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 and inflammatory diseases of the genitourinary organs, the doctor may take smears 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 diagnosis, additional research methods are assigned. As a rule, these are:

Laboratory research(general and biochemical blood tests, general urine analysis, urine culture for flora 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 of 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, protrusions of the mucous membrane - diverticula, bladder and urethral polyps).

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. The study makes it possible to obtain a graphic image of the act of urination, to estimate the maximum and average speed of the urine stream, the duration of the process of emptying the bladder, and 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, the choice of the optimal treatment method is carried out. 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 the 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 auxiliary drug therapy (sedatives that improve blood circulation, strengthen the 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 various materials (skin from the inner surface of the 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. Women return to active life 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

Monitor for regular bowel movements: Constipation can worsen the clinical manifestations of 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 (since they contain fiber), fermented milk products, and 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.

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 the female body works. The internal organs of the upper body are supported by the diaphragm, and the organs of the hypogastric region, such as the urethra (urethra), the intestines, and the uterus, are supported by the pelvic floor. The muscle layer that forms the pelvic floor is stretched like a hammock between the 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 close it tightly) and empty (in this case, the urethra 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 labor and the larger the baby, the more stretch (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, in addition, the pressure in the abdominal cavity increases - due to coughing, sneezing, laughing, climbing stairs or lifting weights - then a few drops of urine fall 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 to do this, while in the toilet, try interrupting urination for a short time several times or tightly squeezing 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 physiotherapy exercises. With consistent exercise, most women with mild incontinence can heal themselves. Other treatments for urinary incontinence should be consulted with your doctor.

In this article:

A problem such as urinary incontinence after childbirth is familiar to about 40% of women who have given birth. Many women are silent about this problem and are ashamed to admit it even to a doctor. But in vain. Indeed, due to the inability to fully control the process of urination, a woman harms her health and deliberately reduces the quality of her life.

What is urinary incontinence

Incontinence is understood as a pathological condition manifested by involuntary, uncontrolled urine flow. The amount of discharge can be different: from a few drops once a day to constant leakage throughout the day.

Women who have given birth tend to have stress incontinence. In this case, involuntary urination can occur with any tension of the abdominal muscles: during physical exertion (bending over, sharp squatting), when laughing, coughing, sneezing or having sexual intercourse. In a severe form of pathology, involuntary urination can occur when the position of the body changes and even during sleep.

Causes

Spontaneous urination is most often associated with dysfunction of the pelvic floor muscles. During gestation, the muscles that support the developing fetus and form the birth canal are subject to significant stress. They stretch, become less elastic, resilient and unable to fully perform their functions.

Urinary incontinence can develop after a long and difficult labor, accompanied by ruptures of the perineum or pelvic muscles. Re-giving birth are also at risk.

Symptoms of pathology

Urinary incontinence can be talked about if there is an uncontrolled flow of urine in any volume when sneezing, laughing, or during a change in body position.

Also, a woman may complain of a feeling of fullness of the bladder after emptying it, or a feeling of a foreign body in the vagina.

Diagnostics

The solution to this problem should be dealt with by a urologist or urogynecologist. A woman who seeks qualified help should be extremely frank, since maximum openness in this case helps to make the correct diagnosis and prescribe an effective therapy.

During the appointment, the doctor, as a rule, asks the patient about the injuries, diseases, operations, the number and course of childbirth, the weight of the child at birth, injuries during childbirth and complications after them. He may also be interested in information about the frequency of urination, the presence or absence of discomfort during urination.

To make a diagnosis, a visual examination is required on the gynecological chair, laboratory tests of urine and blood, cystoscopy and ultrasound of the abdominal cavity are prescribed. To clarify the diagnosis, profilometry, cystomerism and uroflowmetry can be prescribed.

Treatment

What to do if urinary incontinence after childbirth did not go away spontaneously, but became a real exhausting problem? Urinary incontinence is a pathology that does not pose a threat to the health and life of a woman. However, as mentioned above, it leads to a deterioration in the quality of life. That is why a woman faced with this problem should know that there are many modern methods of therapy for this pathology. To do this, you need to contact a specialist who will select the most appropriate treatment method.

Treatment of urinary incontinence after childbirth can be done conservatively or surgically.

Conservative treatment includes the following procedures:

  • Holding weights. The woman must hold the weights placed in the vagina, made in the form of a cone and having different weights. You should start with small weights, gradually moving to heavier ones. The load must be coordinated with the attending physician. The exercise should be done every day 3-4 times for 15-20 minutes.
  • Kegel exercises. Throughout the day, a woman should strain 100-200 times and hold the muscles around the rectum and bladder in this state for a few seconds.
  • Bladder training. The doctor develops a urination plan, according to which the patient must empty the bladder at regular, gradually increasing intervals. However, she should urinate only in accordance with the developed plan. Thus, the woman learns to restrain urination and empty the bladder at long intervals. This treatment usually lasts at least 2 months.
  • Physiotherapy. Physiotherapy can be used to strengthen the pelvic muscles, in particular, electromagnetic stimulation. Effectively alternating physiotherapy with exercises for urinary incontinence.
  • Drug therapy. In case of urinary incontinence, the administration of sedative drugs that improve blood supply, strengthen the vascular wall, vitamin complexes, etc. can be prescribed. However, drugs whose action would be aimed directly at eliminating the causes of urinary incontinence in women do not exist in modern pharmacology.

If conservative treatment of pathology is ineffective or ineffective, surgical treatment is performed.

A number of operations in surgical treatment:

  • Loop operation. It is currently the most common surgical treatment for uncontrolled urination. An additional support in the form of a loop is placed under the urethra, made of the skin of the upper thigh, labia minora, etc. In some cases, a loop made of durable synthetic material is used to create support, which does not cause rejection and does not dissolve over time. The operation is performed through a small incision in the skin, it is low-traumatic and is indicated for any degree of pathology
  • An operation performed using a gel. A support is created around the urethra from a special medical gel. The operation is carried out more often under local anesthesia, both on an outpatient and inpatient basis. Its duration does not exceed 30 minutes.
  • Urethrocystocervicopexy. During this operation, the pubic-vesical ligaments are strengthened, which hold the bladder neck and urethra in a normal physiological position. This is a technically difficult operation, performed under general anesthesia and requires a long postoperative recovery period. That is why it is rarely used.

Prophylaxis

To avoid urinary problems, it is important to follow these guidelines:

  • Monitor your body weight. Extra pounds create a significant load on the bladder and increase the clinical manifestations of pathology.
  • Timely treat and prevent infectious diseases of the urinary organs.
  • During pregnancy, it is imperative to follow all the recommendations of the gynecologist, undergo all examinations and take the prescribed tests. This will make it possible to timely identify the pathology and begin its treatment.
  • Wear a bandage during pregnancy.

Thus, urinary incontinence is not an incurable pathology, it can be easily corrected with the help of modern methods of treatment. Therefore, every woman should know that the problem of urinary incontinence can be solved. Do not hide it, qualified specialists will help you solve it quickly and efficiently.

Helpful Video About Urinary Incontinence in Women

- a condition characterized by uncontrolled urination. Normally, urine secretion is controlled by immobility, the anatomical and functional integrity of the organs of the urinary system, and the normal innervation of the muscles of the urethral sphincter. With an increase in the size of the uterus during pregnancy, the tension of the ligaments increases, the muscles of the pelvic floor endure heavy loads. Also, there are changes in the interposition of adjacent organs (uterus, rectum, vagina, bladder, urethra), which entails postpartum changes in the body.

This condition occurs in 10-15% of cases in women giving birth for the first time, with repeated births, the value increases to 40%.

Classification

There are many reasons for the onset of pathology, ranging from emotional disturbances to changes in the work of internal organs. There are eight types of involuntary urination:
  1. Stress urinary incontinence - occurs in women after the shocks received during childbirth, manifests itself as uncontrolled urination with a sharp jump in intraperitoneal pressure: coughing, sneezing, laughing.
  2. Reflex - arises as a result of a reaction to provoking situations, such as the noise of water, a loud cry.
  3. Imperative (urgent) - occurs when there is a strong sudden urge to urinate, regardless of the fullness of the bladder.
  4. Involuntary leakage - when dripping urine occurs throughout the day.
  5. Post-voiding urinary incontinence - after the bladder is empty, the flow of urine continues for 1 to 2 minutes.
  6. Nocturnal enuresis - the sphincter relaxes at night, leading to urination.
  7. Horizontal - urinary incontinence when resting in a supine position or during an intimate process.
  8. Overflow incontinence - there is an acute urinary retention, discharge occurs in small quantities, despite the overflow of the bladder.
According to the severity of the development of the disease, three forms are distinguished: the mild one is expressed by the uncontrolled flow of urine during heavy physical exertion. The average occurs when walking calmly, sneezing, coughing, laughing violently. A severe form of pathology is characterized by uncontrolled urination in large volumes when changing position, during sleep or during intercourse.

Causes of urinary incontinence

Regulation of the bladder requires precise interaction and feedback between the organs of the urinary system, the muscles of the small pelvis, and the brain and spinal cord. The function of keeping urine is performed by two structures: the first is the sphincter, which clamps the urethra in the place where it leaves the bladder and prevents urine from flowing out, the second is a muscle tape that holds the muscles and all organs of the small pelvis, and is also another sphincter , which can be voluntarily strained by pinching the urethra and preventing urine from flowing out.

The urinary function is performed by a number of coordinated actions, the violation of which can be due to one of the following seven reasons:

  1. Difficult long labor - when there is a rupture of the muscles of the perineum or pelvic floor, or it is necessary to carry out delivery operations (application of obstetric forceps, vacuum extraction of the fetus).
  2. The genetic factor is the presence of relatives suffering from this disease.
  3. Hormonal disorders - a drop in the amount of estrogen after pregnancy impairs the functioning of the vaginal self-cleaning system, which leads to the development of infectious diseases of the urinary tract.
  4. Neurological diseases - violation of muscle innervation due to postpartum spinal injuries.
  5. The presence of diseases of the urinary system, such as cystocele, urethrocele, chronic cystitis.
  6. Mechanical damage due to rough and improper actions of an obstetrician-gynecologist.
  7. Obesity causes pelvic muscle atrophy.

Symptoms of urinary incontinence

Postpartum urinary incontinence can manifest itself in a number of cases: during physical exertion, intercourse, laughing, sneezing. There is a feeling of incomplete emptying of the bladder, itching and burning of the genitals, a constant desire to relieve themselves. The volume of urine passed during the day can range from a few drops to continuous leakage.

Diagnosis of the disease

If symptoms of urinary incontinence appear, you should consult a urologist. He will collect anamnesis, conduct an initial examination, send for laboratory tests and hardware diagnostics. After that, the patient will be assigned an individual course of treatment.

First, the abdominal cavity, genitourinary organs, and the pelvic area are examined, and a rectal examination is performed. When examining the abdominal cavity, the doctor presses on the abdomen, thus checking whether the bladder is enlarged and whether there are tumor formations.

The pelvic organs are examined on the gynecological chair. The doctor inserts a speculum into the vagina, with the help of which he examines the inner surface for the presence of postpartum injuries. Thus, signs of estrogen deficiency, a decrease in the thickness of the vaginal walls, can be detected.

The doctor inserts two fingers into the vagina and checks the organs for pain response, for the presence of abnormal formations, prolapse or prolapse, examines the tone of the pelvic muscles. He may ask the patient to squeeze the muscles, stand up or sink down so that the bladder and uterus will also advance. Bladder weakness can be detected when stressed., which is not installed in the supine state.

For digital rectal examinations of women, the doctor inserts one gloved finger into the rectum and the other into the vagina. By examining both organs at the same time, you can detect obstruction of the urethra, as well as re-examine the state of the uterus and ovaries from a different angle.

After the examination, a general and biochemical analysis of blood and urine is taken. When the results are received, the doctor will draw up a treatment plan, if the picture of the disease is not completely clear, then a number of urodynamic studies will need to be passed.


- a procedure during which a cystoscope is inserted into the bladder through the urethra. It becomes possible to study the mucous membrane of the urinary system for the presence of inflammation.

Cystometry is a diagnostic test that measures the pressure in the bladder as it fills. With the help of a catheter, the bladder is gradually filled with sterile water, the doctor monitors and measures the strength and speed of reflex reactions, another catheter is inserted into the rectum or vagina, which allows you to measure intra-abdominal pressure. The urologist asks the patient when he feels a full bladder and when the urge to urinate appears and draws conclusions.

Uroflowmetry measures the strength and speed of urination, as well as the amount of urine excreted. The woman sits on a special toilet seat, the doctor records the time spent urinating, its strength and the amount of urine excreted in one second. These data allow you to establish whether the bladder and urethra patency are contracting normally.

Treatment of urinary incontinence

In the initial stage of the disease, special conservative treatment methods are used. Medications are used, such as vaginal suppositories, antidepressants - Tofranil or Duloxetine, as well as tablets Omnik, Simbalta, Spazmex. Experts advise to perform Kegel exercises to strengthen the pelvic muscles, physiotherapy procedures (electrophoresis).

If these methods are ineffective, surgical intervention will be required. Today, there are about 150 types of surgical operations to eliminate this ailment.

Most often, a universal method is used, when a synthetic tape 8 cm long and 4 mm wide is inserted under the urethra. The operation takes place under local anesthesia for 15 minutes, after which the patient is under the supervision of specialists for 2-3 hours. The effectiveness of this procedure is 95%, which excludes the likelihood of relapse.

A new method in urology, when a doctor injects a special chemical composition into the urethra, which came to gynecology from plastic surgery - polyacrylamide gel. It seals the organ by closing the diameter of the urethra, which helps to maintain the tone of the urethra. The duration of the operation is 5 minutes, and the efficiency is 70%.

Prophylaxis

This problem brings discomfort to a woman's daily life. It is important to adhere to an active lifestyle, which includes all sports activities (morning exercises, jogging, gymnastics, swimming, yoga), monitor body weight, avoid excessive consumption of sugar, coffee, and alcoholic beverages. Maintain the body's water balance, treat inflammatory diseases in a timely manner.

It is necessary to carry out special exercises to improve the muscles of the small pelvis. Kegel exercise consists of alternating tension and relaxation of the vaginal muscle fibers, it is recommended to do 5 approaches 50 times a day. To feel which muscles need to be contracted, a woman needs to interrupt the act of urination with their help.