Urinary incontinence - involuntary outflow of urine from the urethra (true incontinence) or from unnatural openings in the urinary tract (false incontinence).
Bedwetting, involuntary urination during ta (enuresis) occurs mainly in young children and has a tendency to spontaneous disappearance. You can talk about enuresis in cases where a child 5-6 years old urinates in bed twice a month or more, and an older child at least once a month.
Stress urinary incontinence refers to the expiration of urine during physical exertion (changing body position, lifting weights, coughing , laughing, etc.), which is accompanied by a sharp increase in intra-abdominal and intravesical pressure. It is mainly caused by damage to the sphincters of the bladder and pelvic floor muscles, which is observed after perineal injuries, including during childbirth, with weakness of the ligamentous apparatus of the bladder, prolapse of the walls of the vagina, uterus, epispadias, diseases of the central and peripheral nervous system, etc.
Acute urinary incontinence is possible at the "height" of an imperative (imperative) urination. It is accompanied by the adoption by patients of one of the characteristic poses that contribute to the suppression of the imperative urge: crossing legs, torso forward, squeezing the glans penis, etc. The causes are dysregulation of the bladder function, dishormonal conditions, cystitis , sclerosis of the bladder, etc.
Reflex urinary incontinence is characterized by involuntary, sudden outflow of urine without prior urination. It is associated with reflex contraction of the muscular membrane of the bladder (detrusor) and associated relaxation of the sphincters and is the result of increased excitability of the spinal reflex arc. It is observed with injuries and tumors of the spinal cord, myelitis with localization of the pathological process above the lumbar segments.
Excessive urinary incontinence - involuntary outflow of urine with a crowded and distended bladder. The reasons are narrowing of the urethra due to adenoma of the prostate gland, urethral valves, sclerosis of the bladder neck, etc. in combination with loss of tone and contractile activity of the detrusor, as well as diseases of the peripheral nervous system, polyuria in diabetes mellitus, chronic renal failure, etc.
False urinary incontinence is observed, in particular with urinary fistula. In this case, urine is partially or completely excreted through the fistula outside the act of urination.
The diagnosis is established on the basis of medical history, examination of the patient, determination of the daily rhythm of spontaneous urination, the amount of residual urine, the results of excretory urography, cystography, cystoscopy and other research methods.
Treatment . A child suffering from enuresis should be reassured, explain to him and his parents the features of this condition and the possibility of a complete cure. They use a variety of psychological methods to teach the child to control urination, as well as hypnosis, psychotherapy. Drug treatment is used in children older than 5 years in cases where other methods are ineffective. With imperative and stressful urinary incontinence and enuresis, drug therapy is prescribed to suppress detrusor contraction - anticholinergic drugs, drugs with muscle relaxant effects, such as diazepam , calcium antagonists, etc .; increased output resistance (beta-blockers, electrical stimulation of the pelvic floor muscles). Physical therapy provides a certain effect, aimed at strengthening the muscles of the anterior abdominal wall and pelvic floor. Exercises with sudden movements, quick changes in body position, breath holding and static stress are not recommended. Jumps, jumps, running on the spot are excluded. Daily walks are also advisable with a gradual increase in distance and alternating speed of movement. Patients with initial forms of the disease are recommended for skiing, skating, swimming, hiking. Also useful are air baths, wipes, showers. In case of urinary incontinence as a result of malformations of the spinal cord, various reconstructive operations are used, as well as drugs of vegetotropic action, physiotherapy, physiotherapy exercises. With false urinary incontinence, surgical interventions aimed at restoring the integrity of the urinary tract are performed.
The task of the average health worker is reduced to the early referral of patients to the urologist, monitoring the treatment and providing care for the patients at home. In order to avoid irritation of the skin of the perineum and thighs with urine, frequent washing and subsequent application of protective ointments to the skin, as well as the use of urinals, the use of pads, disposable diapers from materials with increased hygroscopicity, etc.