Български
МакедонскиIncontinence (involuntary leakage of urine)
Incontinence – the illness that steals from your life
Do you have cases of involuntary leakage of urine when coughing, sneezing, laugh, exercising, lifting heavy objects or other sudden moves of the body in your daily activities?
Do you have cases when you can not hold urination till you get to the restroom?
Do you have cases of leakage of urine when you are under emotional stress or excitement?
Do you use sanitary pads or diapers because of the inability to hold urination?
If you have answered positive of at least one of these questions you should immediately consult your specialist-urologist.
Those who have such a problem think that it is connected with the processes of aging and that it is a condition for life time. This problem is met in different ages – each fourth woman has at least one case of involuntary leakage of urine. Today, above 100 million people worldwide are suffering from involuntary leakage of urine. The problem is spread rare for men. Although the problem of the involuntary leakage of urine is so widespread as the hair loss or nail fungi are people share very unwillingly and try to hide it. A lot of the patients have never been to a specialist and haven’t tried to solve their problem. They don’t realise how serious the problem is and are afraid of the treatment.
At the same time day after day the involuntary leakage of urine is worsening their quality of life – it depresses them, isolates them from society, and leads to appearance of complexes. The involuntary leakage of urine causes difficult-to-solve social and hygienic problems for people that are able to work. The involuntary leakage of urine in older people is extremely difficult for their relatives. Incontinence can be eliminated when diagnosticated and treated in time.
The lower urinary tract – the bladder and the urethra – is a complex anatomy-physiological structure that is synchronised, and keeps in norm and adequate control functions of collecting, holding and voiding of the urine. The hold of urine is a condition when the urethral pressure exceeds the bladder pressure in every moment.
Incontinence in men is most often as a result of prostate gland and urethra disorders as well as after operations in the area near the sphincter of the urethra.
Women’s bladder and urethra are in touch with the muscular layer called pelvic floor muscles. They assist urethra to open. If these muscles weaken or their elasticity become worse an involuntary leakage of urine is possible.
These pelvic floor muscles can stretch and weaken for instance during pregnancy. Besides, additional pressure over these muscles is caused by overweight.
Menopause is another reason for incontinency in women. Along with the aging of the body muscles and the lowered hormone levels (estrogen) during menopause, the mucous membrane of the bladder and the urethra walls get thinner. The blood supply of the pelvic floor muscles and their functioning decrease and this affects the involuntary leakage of urine also.
Mental disorders can also be reason for incontinence in women.
Urologists recognize the following types of incontinence:
- Urge incontinence;
- Stress incontinence;
- Unconscious incontinence (incontinence reflex);
- Constant incontinence;
- Bedwetting (enuresis);
- Leakage of urine after urination.
Most often occurs the urge incontinence when patients tell that the involuntary leakage of urine is as a result of unbearable need to urinate. Such symptoms are usually found as symptoms of infections of the lower urethra as well as increased stress.
There are different reasons for this: bladder or urethral mucous membrane inflammation, mucous membrane formations, nerve disorders, enlarged prostate in men and bladder and uterine prolapse in women.
If the urge incontinence is as a result of particular organic problem it can be treated with operation also. This is achieved by a partial elimination or operation with laser in cases of benign prostate hyperplasia, resection of the bladder mucous cancer, minimum invasive procedures (with minimum penetration in the organism), operative cutting of a narrowing, urethra structures, as well as reconstruction of the pelvic floor in women by netlike implants, the so called sling operations.
Drugs that slow down the activity of the bladder are provided as alternative. In cases of serious form of incontinence a special substances are applied in the bladder or purposeful paralysis of the bladder muscles is provoked by injecting botulinum toxin (botox) type A in the bladder wall during endoscopic manipulation.
Women suffer most often from stress incontinence. The name of the disorder does not correspond to the mechanism of the development of the involuntary leakage of urine symptom entirely: the involuntary leakage of urine is not as a result of stress but of increased abdominal pressure combined with insufficient support of the bladder and the urethra.
The development of stress incontinence is due to a number of factors: anatomic disorders; pregnancy and delivery; pelvic operations; changes of aging; traumas in the groins; overweight, etc.
There are over 200 methods in medicine at this point for correction of stress-incontinence. The most preferable ones are the minimum invasive surgical operations which recover the holding function of the pelvis successfully. The success is above 90%.
The conservative methods of treatment are not effective enough for patients with stress incontinence. Weight reduction is most expedient in this case thus decreasing the intra-abdominal pressure and holding urine. For some patients Kegel exercises are effective method as they are intended to strengthen and retrain pelvic floor muscles. Usually the therapy with m-cholinolytics is successful only in cases of stress incontinence with dominating urgent symptoms. The substituting therapy with estrogen has good results in patients with initial symptoms of stress incontinence after the climax.
The most effective method for stress incontinence treatment is sling procedure. The over activity of the urethra and the lower bladder are successfully treated with it.
With the sling operation an artificial and supporting bond (sling) is created that supports the bladder and the urethra in the right position. The sling itself is made by high-quality modern synthetic mesh materials that are strong and bio-compatible. TVT and TVT-O are the most high-quality methods for stress incontinence treatment.
The monitoring after the operation is not longer than 2-3 days.
The advantages of the sling operation are:
- Minimal traumatisation
- Short post-operative period
- Optimal use of the medical equipment
The basic diagnosis includes the following requirements:
Clarification and re-creation of the history of the illness (number of deliveries, frequency of bladder voiding, other illnesses), general examination (pointing the symptoms of lowered bladder or uterine and defining the estrogen levels in woman’s vagina, size and shape of the prostate in men), laboratory analysis of the bladder in order to exclude urinal infections, sonographic examination of the bladder (structural changes of the bladder walls, disorders in the voiding mechanism of the bladder) as well as record of the liquids taken for 24 hours period, the quantity of the urine and record of the moment of involuntary leakage of urine.
The function and the sensitiveness of the bladder when it is filling and voiding are examined within a special diagnostics (urodinamic examination). The urethra and the bladder are examined with contrast substance and the endoscopy of the bladder is done in case of necessity.
The causes for the appearance of incontinency are various and that is why the methods of treatment differ. Control over the illness and solution of the problem are achieved as a result of an applied adequate treatment. It is important to define the exact cause for the appearance of incontinence before choosing a method of treatment. Supporting substances and solution can be selected for each patient thus improving his/her condition in order to allow patients enjoy life again.
