CONTAINING URINARY - Involuntary discharge of urine from the urethra (true incontinence) or from unnatural openings in the urinary tract (false incontinence).
Urinary incontinence, involuntary urination during ta (enuresis) occurs mainly in young children and has a tendency to spontaneous disappearance. It is possible to talk about enuresis in cases where a child of 5–6 years old urinates into bed twice a month and more often, and an older child at least once a month.
Stress urinary incontinence refers to urine outflow during physical exertion (change in body position, weight lifting, coughing , laughter, etc.), which is accompanied by a sharp increase in intra-abdominal and intravesical pressure. Caused mainly by lesions of the sphincters of the bladder and pelvic floor muscles, which is observed after perineal injuries, including during childbirth, weak bladder ligamentous apparatus, prolapse of the walls of the vagina, uterus, epispadias, diseases of the central and peripheral nervous system, etc.
Acute incontinence is possible at the “height” of the imperative (imperative) urge to urinate. Accompanied by the acceptance by patients of one of the characteristic postures that contribute to the suppression of an imperative urge: crossing the legs, bending the body forward, squeezing the head of the penis, etc.
Reflex urinary incontinence is characterized by involuntary, suddenly occurring flow of urine without a prior urge to urinate. It is associated with a reflex contraction of the muscular layer of the bladder (detrusor) and the associated relaxation of the sphincters and is the result of increased excitability of the spinal reflex arc. Observed with injuries and tumors of the spinal cord, myelitis with the localization of the pathological process above the lumbar segments.
Excessive urinary incontinence - involuntary leakage of urine when the bladder is full and distended. Causes are narrowing of the urethra due to prostate adenoma, urethral valves, bladder neck sclerosis, etc., combined 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 incontinence is observed, in particular with urinary fistulas. In this case, the urine is partially or completely excreted through the fistula outside the act of urination.
The diagnosis is made on the basis of anamnesis, patient examination, 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 needs to be reassured, explaining to him and his parents the peculiarities of this condition and the possibility of a complete cure. Use a variety of psychological methods to teach a child to control urination, as well as hypnosis, psychotherapy. Drug treatment is used in children over 5 years of age in cases when other methods are ineffective. In case of imperative and stressful urinary incontinence and enuresis, drug therapy aimed at suppressing the detrusor contraction is prescribed - holinoblokatory, drugs with muscle relaxant action, such as diazepam , calcium antagonists, etc .; increased output resistance (beta-blockers, electrical stimulation of the pelvic floor muscles). A certain effect is provided by physical therapy aimed at strengthening the muscles of the anterior abdominal wall and pelvic floor. Exercises with sharp movements, a quick change in body position, breath holding and static stress are not recommended. Excluded jumps, jumps, running on the spot. Daily walks with a gradual increase in the distance and alternation of the speed of movement are also advisable. Patients with the initial forms of the disease are recommended to ski, skate, swim, and tourism. Also useful air bath, wiping shower. In case of urinary incontinence as a result of malformations of the spinal cord, various restorative surgeries are used, as well as drugs of vegetotropic action, physiotherapy, and physical therapy. In case of false incontinence, surgical interventions are performed to restore the integrity of the urinary tract.
The task of the average health worker comes down to the early referral of patients to the urologist, monitoring the treatment and providing care for patients at home. In order to avoid irritation of the skin of the perineum and thighs with urine, frequent washing out 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. are advisable.