Urinary incontinence is the involuntary release of urine that occurs during physical exertion (coughing, laughing, sneezing, running, etc.) or with an uncontrollable urge to urinate. A combination of both forms is possible.
The term "bladder atony" is often used for all types of urinary incontinence. In Germany, about 4-5 million people suffer from this disease. But first of all, this problem is typical for women. In the age group over 70, almost one in three women suffers from urinary incontinence. Among men, this disease is observed in 0.5 million people, which is significantly less than the figure among women.
stress urinary incontinence during physical exertion is a consequence of the weakness of the sphincter (muscle fibers surrounding the urethra) of the bladder. In contrast to men, whose urinary incontinence problems are often associated with the result of operations performed near the sphincter, the cause in women can be many factors: age, number of births and body weight all play a role. Often there is weakness, weakening of the muscles of the entire pelvic floor.
Imperative form of urinary incontinence with an unbearable urge, it is an expression of increased irritation of the nerves responsible for sensitivity, or the nerves responsible for motor skills. Causes range from inflammation of the bladder or lining of the urethra (urethra), tumors of the lining of the urethra, nerve disease, to an enlarged prostate in men and prolapse of the bladder or uterus in women.
Stress incontinence is characterized by uncontrolled urination during physical exertion (sneezing, coughing, laughing, running, etc.), in the absence of a corresponding urge.
The imperative form of urinary incontinence (incontinence) is characterized by uncontrolled urination, which is preceded by an unbearable urge.
The main diagnostics includes the following types of examinations:
- clarification and reproduction of the history of the development of the disease (the number of births, the frequency of emptying the bladder and possible features, the moment of uncontrolled urination, other diseases),
- general examination (identification of signs of prolapse of the bladder or uterus, as well as determining the level of estrogen in the vagina in women, the size and shape of the prostate / prostate gland in men),
- laboratory analysis of urine to exclude inflammation of the urinary tract,
- ultrasound examination (ultrasound) of the bladder (changes in the structure of the bladder wall, violation of the mechanism of emptying the bladder),
- as well as keeping a 24-hour diary of the amount of fluid consumed, the number of bladder emptyings and recording the moment of uncontrolled urination.
As part of a special diagnosis, the function and sensitivity of the bladder during filling and emptying (urodynamic examination) is examined. If necessary, an examination of the urethra (urethra) and bladder with a contrast agent or endoscopy of the bladder is performed.
With stress incontinence depending on the severity of the disease, such methods of treatment as therapeutic exercises, drug therapy and surgical intervention are used. During surgical (surgical) treatment, both a sling operation, called the TVT technique, which involves the use of a synthetic support loop without tension, endoscopic injections of drugs into the sphincter, and a complete reconstruction of the pelvic floor in the pelvic area are possible. A very effective method of treatment is the implantation of an artificial sphincter.
If imperative form Urinary incontinence is a consequence of any organic problem, it can also be eliminated surgically. This is achieved through partial removal or laser surgery for benign prostate enlargement, resection of a tumor of the bladder mucosa, minimally invasive (with minimal penetration into the body) incision for narrowing of the urethra (urethra), and reconstruction of the pelvic floor in women through mesh implants.
As an alternative, medications are used that dampen the activity of the bladder. In severe forms of incontinence, it is necessary to introduce special substances into the bladder or purposefully paralyze the muscles of the bladder by injecting botulinum, a type A toxin, into the wall of the bladder during endoscopic manipulation.