Urinary incontinence in women

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Urinary incontinence in women

Urinary incontinence is an involuntary, uncontrollable release of urine that any person can face. Most often, this problem occurs in women due to the peculiarities of the anatomical structure. According to statistics, about 40% of women after 40 years, and about 60% of women after 50 years suffer from urinary incontinence. Or rather, they had at least some period in their lives when they had urinary incontinence.

Despite the apparent insignificance of this problem, urinary incontinence affects all aspects of a woman's life, significantly limiting freedom of movement and reducing the quality of life. The obvious reluctance of patients to complain about urinary incontinence is often combined with the lack of interest of doctors in this problem. According to numerous surveys, no more than 60% of doctors do not ask patients about urinary retention when collecting anamnesis. Very often, patients consult with each other about urinary incontinence, rather than with a doctor, which leads to the fact that urinary incontinence is perceived as a normal phenomenon by many women, especially older ones, and even as something inevitable in postmenopause.

The main causes of urinary incontinence in women:

Complicated, traumatic or multiple births;
Operations on the pelvic organs; Weightlifting and other sports;
Heavy physical labor;
Obesity;
Chronic inflammatory diseases;
Hormonal changes in postmenopause;
Spinal cord injuries;
Multiple sclerosis;
Diabetes mellitus;
Tumors;
Radiation therapy for malignant tumors of the female genital organs;
Developmental anomalies;
Overactive bladder, etc.

There are three main groups of causes of urinary incontinence in women:

Violations of the mutual arrangement of the pelvic organs (bladder, urethra and other organs of the pelvic floor) or the sensitivity of their nerve endings. Such conditions occur after complicated or multiple births, operations on the pelvic organs, weightlifting and other sports, obesity, chronic inflammatory diseases. Normal urination is ensured by the work of the bladder and urethra, their muscles, as well as the fascia and ligaments that hold the bladder and pelvic muscles.
During menopause, hormonal changes occur, which cause tissue aging, atrophy (thinning) of the mucous membranes of the genitourinary system, muscles, pelvic ligaments, which contributes to urinary incontinence.
Changes in the nervous system, accompanied by dysfunction of the pelvic organs (spinal cord injuries, circulatory disorders in the spinal cord, inflammatory diseases of the spinal cord, multiple sclerosis, diabetes mellitus, tumors, developmental abnormalities).

There are three main forms of urinary incontinence:

Stress urinary incontinence (urinary incontinence under stress)
Urge urinary incontinence (overactive bladder)
The combination of the two forms is called "Mixed urinary incontinence"
The third, most rare type of urinary incontinence is paradoxical ischuria

Risk factors for urinary incontinence:

Age. There is a persistent tendency for the frequency of urinary incontinence to increase with age due to the relaxation of the fascial apparatus supporting the urethra, as well as an increase in the frequency of neurological disorders and such concomitant problems that also contribute to urinary incontinence as constipation, diseases of the nervous system, etc.
Heredity. There is evidence of a hereditary predisposition to the so-called "connective tissue dysplasia" - its weakness, which may more likely lead to stress urinary incontinence.
Obesity. A number of studies have shown a link between obesity and urinary incontinence. Moreover, after weight loss, the frequency of urinary incontinence decreased somewhat.
Pregnancy and childbirth. There is evidence that pregnancy and childbirth increase the frequency of urinary incontinence. It is interesting that a cesarean section in itself does not have any special advantages over a vaginal birth, i.e. there is no point in having a cesarean section to prevent stress urinary incontinence.
Smoking tobacco. There is some evidence that stress urinary incontinence is more common in women who smoke. It is believed that this is due to the increased frequency and strength of coughing in these women, which leads to earlier development of anatomical defects of the ligamentous apparatus of the genitals. And this in some cases is the cause of stress urinary incontinence.

Manifestations of urinary incontinence. Stress urinary incontinence is an involuntary and uncontrolled leakage of urine during coughing, laughing, running, walking, playing sports, sexual intercourse, standing up suddenly and other physical actions that lead to increased pressure inside the abdominal cavity and, consequently, inside the bladder. Stress urinary incontinence is manifested by urine leakage from a few drops to large amounts.

Urge urinary incontinence (overactive bladder and overactive urinary sphincter) is an involuntary leakage of urine associated with an irresistible strong urge to urinate (imperative urge).

Mixed urinary incontinence is a condition in which a woman exhibits signs of the above-mentioned types of urinary incontinence at the same time.

How is stress urinary incontinence treated?

The choice of treatment method for stress urinary incontinence is determined by its causes, severity, age of the woman, concomitant diseases of the heart, endocrine and nervous systems.

There is currently no effective drug treatment (pills, injections) for true stress urinary incontinence . Antidepressants - serotonin reuptake inhibitors - are somewhat effective, but the cost of long-term treatment is quite high. The drug is ideal for a combination of depressive disorders and stress urinary incontinence.

For elderly patients with contraindications to surgical treatment, mechanical means can be recommended: urethral valves, vaginal pessaries. In mild cases of stress urinary incontinence, a laser "lift" of the suburethral zone can be used. Temporary correction of mild stress urinary incontinence is also possible by introducing fillers (usually high-density hyaluronic acid) under the urethra .

In most cases of stress urinary incontinence, surgical treatment has the best and most lasting effect . Today, there are various surgical options: endoscopic, laparoscopic, bladder neck suspension methods and minimally invasive loop (sling) operations using TVT systems and their analogues.

Today, synthetic materials are widely used in surgical gynecology. In pelvic floor surgery in patients with connective tissue defects, this is especially relevant, since the use of one's own tissues to reposition uterine position anomalies increases the risk of recurrence of prolapse.

The most appropriate method of surgical treatment of stress urinary incontinence is sling operations using synthetic suburethral loops (TVT systems). Such operations have virtually no complications, are very effective and simple. The patient only needs to stay in the clinic for 24-48 hours, after which she almost immediately returns to normal activities and a qualitatively new life. Thanks to innovative TVT systems and progressive caring doctors, since 2001, millions of women have been able to start a comfortable life anew without restrictions and embarrassment [4].

Recommendations for women who have undergone TVT or TVT-0.

Free synthetic TVT or TVT-0 urethropexy is recommended for all patients with stress urinary incontinence and for women with mixed incontinence in cases where the stress component predominates. Contraindication to the surgery is current or planned pregnancy. Obesity is not a contraindication to free synthetic TVT or TVT-0 urethropexy.

After surgery, all patients are advised to limit heavy lifting for the first two months. If symptoms of obstructive urination (inability to start urinating after the urge or a feeling of incomplete bladder emptying) occur, especially in the first days after surgery, it is necessary to consult a doctor.

Women with genital prolapse should not allow intra-abdominal pressure to increase throughout their lives. To do this, it is necessary to exclude, if possible, constipation, physical exercises that contribute to an increase in intra-abdominal pressure, exacerbation of chronic bronchopulmonary diseases, lifting weights, etc.

Patients are advised that TVT or TVT-0 free synthetic loop plasty does not prevent the risk of overactive bladder symptoms at various times after surgery. The occurrence of such symptoms may require drug treatment. To prevent imperative urination disorders in peri- and postmenopausal patients who are most at risk of developing these symptoms, it is advisable to prescribe hormone replacement therapy or local estriol preparations in combination with the nootropic drug picamilon, which reduces detrusor hypoxia, which develops in most patients with age.

When performing sling operations, one should not neglect strict adherence to the surgical technique. The apparent simplicity of the operation often leads to sad complications . One of such complications is hypercorrection, which leads to urethral obstruction, the inability to urinate independently. Fortunately, such complications are curable.

Prevention of stress urinary incontinence. The basis for the prevention of stress urinary incontinence are special sets of exercises for the intimate and pelvic muscles, and balanced physical activity. Women over 40 should carefully regulate the intensity and nature of physical exercise, and avoid lifting weights. Women who have given birth more than twice are most susceptible to developing stress urinary incontinence, and in most cases it is impossible to prevent the development of stress urinary incontinence. In such cases, at the first symptoms and suspicions, you should contact a qualified gynecologist or urologist, specialists in the field of diagnostics and treatment of stress urinary incontinence.

Author of the article:

Vergeichik Andrey Nikolaevich

obstetrician-gynecologist, head of department

10.09.2024