home › Tests › After pregnancy, urinary incontinence. Conservative treatment of urinary incontinence after childbirth

After pregnancy, urinary incontinence. Conservative treatment of urinary incontinence after childbirth

Urinary incontinence is one of the most unpleasant consequences of childbirth, which people prefer to remain silent about. According to official statistics, the pathology occurs in 15% of women who gave birth for the first time, and more than 40% in mothers with two and three children. Many patients are embarrassed to address this problem to a doctor, which makes it difficult to access information about the pathology and treatment methods.

A delicate problem: why does urinary incontinence occur after childbirth?

The main cause of urinary incontinence, as well as frequent urges to bladder emptying is a decrease in the elasticity of the pelvic muscles after childbirth. During gestation, the excretory system experiences pressure that increases as the fetus develops. When a baby passes through the birth canal, the muscles are compressed as the tone of the uterus decreases and the tension that has been familiar for many months disappears.

During the birth of a baby, the pelvic muscles experience the greatest load during the entire gestation period. Supporting the fetus and forming a “corridor” for the baby to leave the womb, the muscles become overstrained and suffer from impaired blood circulation and innervation - connections with the central nervous system, which is why the brain does not receive a signal in time about the need to empty bladder.

The risk of urinary incontinence increases after a complicated delivery with perineal ruptures, the birth of a large fetus, and a second birth. Despite successful course pregnancy, the pelvic muscles still experience enormous stress, which often leads to problems with urination.

Why doesn't my urine last after caesarean section? It is mistakenly believed that urinary problems occur only after natural childbirth. A woman who has undergone a cesarean section also carries the fetus for 9 months, pressing on her pelvic organs. Of course, the degree of bladder atony in this case is less, but requires similar treatment.

Physiotherapeutic procedures

Physiotherapy is indicated for incontinence after difficult childbirth, with overly relaxed muscles. To strengthen muscles pelvic floor, resort to electromagnetic stimulation and electrical stimulation. The goal of physiotherapeutic procedures is to restore the process of transmitting impulses signaling the need to empty the bladder, from excretory system to the brain.

Exercises for the pelvic floor muscles and urination routine

The most the easy way Strengthen your pelvic muscles with Kegel exercises. You need to quickly squeeze and unclench the vaginal muscles at least 100 times. The easier the classes are, the more repetitions there should be. If there is a violation, you need to hold the flow of urine for a few seconds while urinating and continue the process.

Exercises with weights help improve control of the pelvic muscles. On initial stage use bars weighing no more than 50g. The weight is placed in the vagina, then you need to walk around the room for 15-20 minutes, trying to keep it inside. The exercise is repeated 4 times a day. As the therapeutic effect is achieved, the weight of the weight is increased.

Urinary incontinence will go away faster if you do daily morning exercises. Performing the exercises takes no more than 20 minutes a day and allows the patient to feel increased blood flow in the pelvic area.

Muscle training includes:

Squats. Straightening your back and placing your feet shoulder-width apart, you need to do slow squats (not to the floor), strongly squeezing the vaginal muscles. Having reached the bottom point, they pause for 15 seconds and return to the starting position. Repeat 15 times.
Lifting the buttocks off the floor. You need to lie on your back, pressing your lower back and buttocks to the surface, fix your heels on the floor, put your arms along your body. Next, slowly raise your pelvis, trying to tighten your vaginal muscles as much as possible. Repeat 20 times.
Description of circles. Taking a similar position, but straightening your legs, you need to raise your limbs up and rotate them clockwise and counterclockwise for several minutes, describing an imaginary figure. Repeat 3 times.
Pull your legs towards the wall. Having taken the same position, but at a distance of 0.5 m from the wall (with your head towards it), you need to carefully, not abruptly, throw your limbs behind your head, trying to touch the support. Repeat 10 times.

Surgery is a last resort

If conservative treatment does not produce results, a woman is diagnosed with a severe form of the pathology, or the disease is rapidly progressing, surgical intervention is necessary. To eliminate urinary incontinence, the following operations are performed:

Introduction of shaping gel. An effective and least painful way to treat pathology. It is characterized by the introduction of the drug into the urethral area, due to which a synthetic sphincter is formed that keeps the urinary canal from leaking. Surgical intervention is performed under local anesthesia. Therapeutic effect will last up to 2 years.
Sling (loop) operation. The most effective and safe option surgical treatment. It is characterized by insertion into the urethral area, between the urethra and the vaginal wall, supporting the loop. The patient is under medical supervision for 2 days, after which she can return to normal life.
Implantation of an artificial sphincter. Installation of a prosthesis instead of a natural valve is carried out mainly for stress urinary incontinence. The device is installed through a large labia and activated 1.5 months after surgery. During this time, the artificial sphincter must take root in the tissues, and the patient must adapt to the presence foreign body in the small pelvis.
Urethrocystocervicopexy. The most complex type of operation, associated with a risk of complications and requiring a long recovery. Involves “tightening” the ligaments that hold the bladder, urethra and uterus. It is performed open or laparoscopically through the abdomen under general anesthesia.

Preventing urinary problems before birth

To prevent the development of bladder atony, you need:

do not tolerate the urge to urinate;
give up the habit of crossing your legs while sitting;
do not wear tight clothes;
do not lift weights weighing more than 5 kg;
control body weight, especially for women with a hereditary predisposition to bladder atony;
adhere to an active lifestyle, including daily walks, sports, or at least morning exercises;
wear a bandage after the fourth month of pregnancy.

If you delay treatment of urinary incontinence after childbirth, surgical intervention will be required. A progressive inflammatory disease of the excretory system reduces the tone of the bladder walls. To prevent urinary incontinence after childbirth, you should strictly undergo all examinations prescribed by your doctor, which allow you to diagnose inflammation at the initial stage.

Urinary incontinence after childbirth is a problem that many women face, especially if it was accompanied by some complications, for example, the birth of a large baby, etc. Many young mothers do not pay enough attention to this pathology, believing that everything will go away on its own. But this doesn't always happen. How to identify the disease, which are the most effective ways dealing with incontinence after childbirth?

Read in this article

Causes of pathology

Predisposing factors for the development of urinary incontinence can develop in women even before pregnancy. These include:

history of spinal injuries;
frequent inflammatory diseases urinary tract;
chronic constipation;
others.

Childbirth itself can become a trigger point in the development of the clinical picture of the disease, especially if it occurs with complications. In general, there are about five reasons for urinary incontinence in women during this period.

Changes in the nervous regulation of the bladder and its structures

As the baby passes through the birth canal, all nearby tissues are compressed. In particular, the bladder and rectum experience special stress. It is to reduce trauma to these organs that a woman is constantly recommended to urinate, and the day before it is placed.

The risk group includes girls with suspected large fruit, and other complications during childbirth, as a result of which the baby passes very slowly, the whole process is delayed longer than acceptable. Compression of the nerve plexuses of the bladder leads to disruption of its functioning.

A similar clinical picture may develop after a cesarean section. The only difference here is in the mechanism. During surgery, especially if it is a repeat cesarean section, even with the most careful execution, the nerve endings are crossed. Their recovery takes some time, on average several weeks, during which urination problems may occur.

As a result, after childbirth you can observe the following:

The woman does not feel the urge to urinate. As a result, the bladder stretches as much as possible, enlarges and puts pressure on the uterus. In this case, minor nagging pain in the lower abdomen, which forces the woman to see a doctor. After urine is removed using a catheter, the condition returns to normal. For some time, the young mother should try to empty her bladder even without feeling it full.
With the same frequency, the opposite may occur - urinary incontinence after childbirth when sneezing or coughing. It happens that urine leaks a little, and this is discovered when the laundry gets wet. As a rule, everything goes away in a month or two, but in some cases serious treatment is required.

Abnormal mobility of the urethra

This pathology occurs due to loss of tone of the pelvic floor muscles, changes in the position of the urethra due to various injuries and diseases. As a result, its physiological bend straightens, and the woman can no longer control her urination. If the reason lies precisely in this, then the situation can be corrected in such ways as introducing a gel under the urethra, performing TVT operations, and others.

This is observed in the case of serious injuries during complicated childbirth. This pathology is more common in women after the birth of their second and subsequent babies, since each time the pelvic floor muscles weaken and stretch, especially if their “wear and tear” is not prevented.

Incompetence of the urethral and bladder sphincters

These conditions can develop after trauma, for example during childbirth. Also, if the innervation of the sphincters is disturbed, a similar picture is observed: they simply do not compress fully, and urine spontaneously flows out or appears with slight straining, sneezing, etc.

Bladder pathology

This includes various diseases of the organ, as well as its injuries, functional features, including an unstable position in the pelvic cavity.

Girls at risk

It is sometimes difficult to find the exact causes of urinary incontinence after childbirth; very often they are combined, which makes diagnosis and treatment difficult. It is definitely possible to identify risk groups for the development of this pathology. These include:

women with overweight or fast and large set body weight during pregnancy;
those who gave birth to a child weighing more than 4 kg;
if the size of the pelvis is small (narrow, flat, rachitic, etc.);
if there is a predisposition to this pathology in the family, which is most likely due to the peculiarities of connective tissue in the body;
with complex, lengthy labor and multiple ruptures;
if there was any history of neurological diseases sacrolumbar spine, including trauma.

Symptoms

Despite the fact that the causes of the pathology may be different, the symptoms are common to all clinical cases. The main complaints are as follows:

the release of droplets of urine or even a decent amount when sneezing, coughing, physical activity, sexual contact, etc.;
such episodes are often provoked by alcohol;
incontinence even in a horizontal position;
When urinating, it is difficult to interrupt or reduce the flow by using the force of the perineal muscles.

Types of pathology

Most often we have to deal with stress urinary incontinence, which occurs immediately with even slight stress on a woman. But there are other types, these include:

Urge incontinence, when a person cannot control the process of urination when the bladder is full;
reflex, in this case the release of urine is provoked by the sound of pouring water, when screaming, etc.;
bedwetting, but this is more of a children's problem and is very rare in adult women;
involuntary urination immediately after emptying the bladder;
Paradox incontinence, when there is some obstacle to the outflow of urine, as a result of which it is constantly separated in small portions (for example, when, etc.).

Not only is it difficult to understand each form on your own, but sometimes even a specialist does not immediately determine the correct one. Therefore, if a problem occurs, you should consult a doctor, who, after a thorough examination, will determine the cause and prescribe the most effective treatment urinary incontinence after childbirth.

Diagnostics

The diagnosis is established based on the woman’s complaints, general examination and detailed examination.. So, already during the initial visit, the doctor may ask the patient to strain while she is on the gynecological chair. In case of incontinence, a few drops or even a whole portion of urine will be released from the urethra. This is a “cough test”.

For a more detailed assessment of the clinical situation, it is sometimes suggested to fill out questionnaires - questionnaires detailing complaints. The technique of keeping a urination diary for at least a week is also used. It records the amount of fluid drunk and excreted, and also notes all the nuances and provoking factors in detail. In some cases, the clinical picture is so clear and clear that this is not required.

Cystoscopy is also often used to diagnose various diseases - viewing the urethra and bladder using a special instrument. This way you can identify inflammation, hernia formations, diverticula, etc.

It is also necessary to perform a general examination: urine analysis, culture for flora and sensitivity, ultrasound examination of the kidneys and others at the discretion of the doctor.

Much less commonly used special methods studies such as uroflowrometry and cystometry to monitor bladder fullness and urine flow rate.

Treatment Options

Only a specialist after an examination can tell you how to treat urinary incontinence after childbirth most effectively. In some cases, conservative treatment will be sufficient; in others, surgery cannot be avoided.

Conservative

There are no drugs that would improve bladder function overnight. Sometimes medications are used to stimulate its contractile activity, but more often this helps with the absence of the urge to urinate after childbirth, rather than with incontinence. Everything else is various workouts aimed at strengthening the pelvic floor muscles.

As a rule, after childbirth these techniques are quite effective. Firstly, the body is young and quickly responds to various influences. Secondly, in most cases of incontinence after childbirth, we are talking about weakness of the perineal muscles. And if they are trained, all the symptoms of the pathology disappear or are significantly reduced.

The main training exercises include the following:

Kegel exercises. They involve alternating compression and tension of the perineal muscles. Some women compare this to something like the vagina drawing water in, others to contractions similar to going up an elevator. But the meaning is the same: you need to squeeze the muscles of the perineum in two stages - first a little, then as hard as you can.

After this, it is necessary to connect the tissues located around the anus to the contractions. There should be as many such repetitions as possible; it is advisable to do the exercises not only at home, but also in public transport, at work, because they are completely invisible to others. To check how well your muscles are trained, you can try to squeeze the stream of urine while urinating. If this can be done without difficulty both at the beginning and at the end, the tissues are in normal tone.

Exercises with weights. There are special systems designed to train the perineal muscles. They help with prolapse of the vaginal walls, and can also be effective for incontinence. You can buy similar weights and practice on your own, but now this is done even in fitness centers under the name “wumbuilding”.
Electromyostimulation of the perineal muscles and other physical procedures are also used.

In most cases conservative methods Quite effective for incontinence in women after childbirth. The result should be assessed no earlier than after a year of intensive training. If the woman feels improvement during this time, you can continue this way.

Surgical methods

Surgery for urinary incontinence after childbirth, which occurs when coughing, sneezing, physical activity, is used only if conservative measures are ineffective. The following types of interventions are used:

Injection of the gel into the space under the urethra. This is how you can improve the situation urethra. The advantage of the method is its low invasiveness; it can be performed even on an outpatient basis. However, the risk of relapse of the pathology is quite high, so this operation is not always used.
Sling or TVT operations. There is a wide variety of them, including with and without the installation of an alloprosthesis (special supporting mesh). Complications of these operations are rare, but when the sciatic nerve is injured, the consequences are so unpleasant that many doctors refuse these techniques.

The fact is that some stages of the intervention are carried out “blindly,” which increases the risk of damage. Also, often installed meshes are rejected and have to be removed through repeated surgery. All this has reduced the popularity of this technique in recent years.

There are also rarely used other options for fixing the bladder and urethra. But today it's more historical reference, rather than popular techniques.

Prevention

Of course, understanding why urinary incontinence develops after childbirth, one should prevent this pathology. The main recommendations include the following:

it is necessary to control your weight, especially if there have been cases of similar urinary incontinence in the family;
during childbirth, you must try to follow all the recommendations of doctors and midwives, because other injuries largely depend on this;
even if a girl does not have problems with urination or weakness of the pelvic floor muscles, for preventive purposes you can regularly perform Kegel exercises and the like;
should be prevented, since this causes overstrain of the perineal muscles, which can ultimately lead not only to, but also to urinary incontinence;
Timely detection and treatment of other diseases of the urogenital tract is recommended.

If a woman experiences urinary incontinence after childbirth, for example due to sneezing, coughing or exercise, she should not delay visiting a doctor. Timely identified pathology can be completely eliminated early stages without surgical intervention. But this will require regular exercise and strict adherence to all other recommendations. There is no need to be embarrassed or hide your incontinence. This is a common problem that occurs in many women.

For nine long months a woman carries a child, it seems that the birth will pass and everything will be over. But sometimes unpleasant surprises await a young mother after she is discharged from the hospital. This is urine leakage after childbirth. Many women are embarrassed by this situation and do not try to solve it with the help of a doctor, believing that over time the problem will go away on its own.

Urine leakage after childbirth is disconcerting beautiful time motherhood. It occurs in approximately 12% of primiparous women, and in 20% of multiparous women. Occurs during natural childbirth with a higher probability than during delivery by cesarean section. Why does urine not hold after the birth of a child and what to do in this case?

A little about the anatomy of the pelvic floor muscles

The pelvic floor is a kind of layer, which consists of three muscle layers. There are two types of pelvic floor. The anterior perineum (front of the pelvic floor) is located between the anal sphincter and back labia, and the posterior perineum is located between the tailbone and the anus. The main role of the perineal muscles is to support the organs located in the pelvic cavity (including the bladder and urethra), control the act of defecation, and the birth of the fetus. The circular muscles of the pelvis tightly cover the final section of the large intestine and the urethra, thus forming sphincters.

Organs that support the pelvic muscles

How is urine retained in a healthy body?

The retention of urine in the normal state of the body occurs due to the interaction of four main mechanisms:

stable location of the bladder in the pelvic cavity;
fixed fixation of the urethra;
normal innervation of the muscular corset of the perineum and bladder;
proper functioning of the sphincters of the bladder and urethra.

The main cause of the disease is weakness of the muscles that are located at the entrance to the bladder, these muscles are called sphincters. In a normal state they are closed, and when urinating they are in a state of relaxation. Weakness occurs as a result of the fact that during pregnancy the pressure on the perineal muscles increases. They are an excellent support for the uterus, which grows with the baby inside it.

Also, during childbirth, mainly during pushing, tissue overstretching occurs, especially if the child is large. Overstretching and compression of muscles causes disruption of innervation and blood supply in this area. In addition, a pelvic floor injury results in a bladder that does not have stable position, i.e. shifts.

The main risk factors for urinary incontinence are:

increased body weight;
second and subsequent births;
infectious diseases of the genitourinary system;
hormone imbalance (low estrogen);
surgical interventions on the pelvic muscles;
heredity;
episiotomy (dissection of the perineum and posterior wall of the vagina during childbirth in order to avoid complications from the mother and child);
neurological diseases;
atypical presentation of the fetus (breech);
multiple pregnancy;
narrow pelvis both anatomically and clinically.

Types of Urinary Incontinence

Medicine distinguishes seven types of the above pathology:

stress-related urinary incontinence. At the same time, urine flows unconsciously when a woman coughs, laughs, or sneezes. This type occurs after the birth of a child;
imperative - leakage of urine during a very strong urge to urinate.
reflex incontinence - urine flows when triggered, for example, the sound of water pouring;
involuntary leakage of urine - uncontrolled leakage of urine in the form of drops during the day;
incontinence with a full bladder - urine leaks in the form of drops when the bladder is full. This type can be found in the presence of fibroids in the uterus;
leakage of urine at night;
leakage after the end of urination.

There are also three degrees of incontinence, they were identified to facilitate the choice of treatment method.

light (manifests itself during intense physical activity);
moderate (symptoms occur with slight stress - coughing, laughing, sneezing);
severe (incontinence can manifest itself even during sleep).

How does this disease manifest itself?

A woman notices urinary incontinence after childbirth in certain situations. Cough, laughter, slight straining, walking briskly: All this leads to confusion. Incontinence during sex while lying down is also possible. Alcohol intake aggravates these symptoms. These manifestations do not pose any threat to the patient’s health, but they negatively affect her quality of life, causing psychological discomfort, fear of sex, and self-doubt.

When postpartum urinary incontinence occurs, the sphincter is not closed enough, this is the main cause of the disease

What to do in this situation? And how can a doctor help?

First of all, you need to understand which doctor to go to. A urologist will help in this situation. At the first visit, he will offer a questionnaire aimed at finding the cause of the disease. It will also give you a diary in which you should note how much liquid you drank per day, how many times you urinated and how much urine was released, and whether there were uncontrollable urges. This diary needs to be kept for three days.

To establish the final diagnosis, a cough test is performed, in which the woman is asked to cough. If urine is released during this, the test is assessed as positive.

From diagnostic instrumental procedures Cystoscopy (examination of the bladder) is prescribed to exclude inflammatory and tumor processes.

Must pass general tests blood and urine. According to indications, the woman undergoes urine culture for microflora.

An appointment is usually required. ultrasound examination bladder and kidneys, so the presence of residual urine is examined.

IN hospital conditions if necessary, uroflowmetry, cystometry and profilometry are performed.

How to treat?

If infectious, neurological and other causes are excluded, the urologist prescribes a non-invasive treatment method. It consists of performing exercises to restore the muscles of the perineum. This technique bears the name of its author, Kegel. The effect of this therapeutic measure assessed after a year.

The essence of these exercises is to alternately tense and relax the pelvic muscles at different speeds. This brings them into good shape. The Kegel technique must be practiced for many months every day, only then can you achieve success. To feel the muscles of the perineum, it is enough to hold the stream of urine while urinating. Also an excellent exercise is pushing out, in which you need to strain the muscular corset of the perineum as during labor. Many women note an improvement in their condition after 3-4 months of regularly performing the Kegel method. The more often the exercises are performed, the it will pass faster disease.

Electrical muscle stimulation is a great addition to Kegel exercises. And also electromagnetic therapy.

In case of weak dynamics, surgical treatment is possible, during which a special support is created for the urethra, thus fixing it. The main types of surgical intervention include:

the use of a special gel that is injected into the urethra;
fixation of the urethra, cervix and bladder different ways(urethrocystopexy);
fixation of only the middle part of the urethra using a polypropylene loop (synthetic material).

Most often, minimally invasive loop operations are performed, which have the least complications and short recovery period.

As for drug correction, only sedatives (calming) can be noted here. Medicines There are no products that eliminate urinary incontinence.

Yoga trains all muscle groups, including the perineal muscle corset

From common methods The doctor usually recommends the following measures:

avoid constipation;
lose weight;
drink enough water;
do not consume spicy and salty foods, as well as alcohol;
Empty your bladder in a timely manner.

Prevention

Preventive measures should be taken before pregnancy and continued while the baby is pregnant. Among the “working” techniques, the above-mentioned Kegel exercises, swimming in the pool, and walking at a moderate pace should be noted. IN Lately Fitball exercises and yoga became widespread.

Conclusion

Urinary incontinence requires the help of a specialist; you should not self-medicate. This condition is now completely curable. Don't deprive yourself of a full, vibrant life.

Often, after giving birth, a woman discovers that even with slight stress, her urine begins to leak. A natural question arises: what is the cause of this condition and does it require medical attention?

Many women believe that postpartum urinary incontinence will “go away on its own” and are in no hurry to see a doctor. And even if this condition only worsens over time, the patient, as a rule, prefers to come to terms with the existing state of affairs, embarrassed to complain about incontinence even at a doctor’s appointment. Some women think this state the norm and do nothing about it. Meanwhile, we are talking about a complication of childbirth, which is called stress urinary incontinence (SUI). This condition does not so much worsen the patient’s health as it reduces her quality of life. We will try to answer the most pressing questions regarding SNM.

What can cause SUI?

Urinary incontinence is pathological condition, in which involuntary loss of urine occurs as a result of:

disruption of adequate innervation of the muscular membrane of the bladder and pelvic floor muscles (innervation is the control of an organ or muscle certain areas nervous system);
pathological mobility of the urethra;
failure of the closing apparatus of the bladder and urethra;
unstable position of the bladder - instability of intravesical pressure.

What types of urinary incontinence are there?

There are seven types of urinary incontinence:

Stress urinary incontinence- involuntary release of urine during physical activity, coughing, sneezing, i.e. in cases of a sharp increase in intra-abdominal pressure.
Urgent urinary incontinence- involuntary release of urine with a sudden, strong and unbearable urge to urinate.
Reflex urinary incontinence- leakage of urine in various “provoking” situations, for example, the sound of water or a loud scream.
Involuntary leakage of urine.
Bed-wetting(enuresis) is a disease most common in childhood.
Leakage of urine after finishing urination.
Overfill incontinence(ischuria paradox). In this case, urine is separated drop by drop, despite an overfilled bladder (acute urinary retention occurs, for example, in patients with large uterine fibroids).

Women most often experience stress urinary incontinence.

What is the mechanism of normal urinary retention? Normally, urinary continence occurs through the interaction of four main mechanisms:

stable position in the body of the bladder;
immobility of the urethra;
adequate innervation of the pelvic floor muscles and the muscular lining of the bladder;
anatomical and functional integrity of the closing apparatus of the bladder and urethra.

The mother's body is subject to increased stress throughout pregnancy and especially during childbirth. The greatest overload is experienced by the pelvic floor muscles, which during pregnancy serve as a reliable support for the growing uterus, and during childbirth they are the natural birth canal, turning into a “tunnel” through which the baby emerges. During the passage of the fetus through birth canal excessive compression of soft tissues occurs, which may result in disruption of the innervation of the latter and, as a consequence, loss of some functions. That is why, after childbirth, the development of SUI is possible as a result of disruption of the interaction of the above mechanisms. Complications during labor such as ruptures of the soft tissues of the perineum and vagina increase the likelihood of developing SUI. It should be noted that each subsequent birth also increases the risk of developing the disease.

Risk factors

The development of SNM is promoted by:

pregnancy, childbirth;
gender (urinary incontinence is more common in women);
increased weight;
surgical interventions - damage to the pelvic nerves or muscles;
hereditary factor ( genetic predisposition to the development of urinary incontinence);
neurological factor - the presence of various diseases of the nervous system ( multiple sclerosis, Parkinson's disease, spinal injuries);
anatomical factor - disturbances in the structure of the pelvic floor muscles and pelvic organs.

It is important to note that the risk of developing urinary incontinence increases in direct proportion to the number of births. About 54% of all multiparous women experience episodes of SUI.

Main symptoms

Manifestations of SNM are:

involuntary release of urine during physical activity, coughing, sneezing, etc.;
episodes of urinary incontinence during sexual intercourse;
episodes of urinary incontinence when lying down;
increased frequency of episodes of urinary incontinence when drinking alcohol.

What to do?

Urinary incontinence is a disease that never leads to serious disturbances in the functional activity of the body or to death. However, as already mentioned, as this problem progresses, it is fraught with a gradual deterioration in the quality of life, and sometimes with complete isolation of the patient. This is why it is important to know that urinary incontinence can be treated. To do this, first of all, you need to seek help from a qualified specialist who will help you choose the most effective and suitable specific case treatment method.

If you notice symptoms stress incontinence urine (involuntary release of urine when coughing, sneezing, fast walking, physical activity), you should consult a urologist. You shouldn’t hide anything, much less be ashamed of what happened to you. Remember: even what you think is an insignificant detail can have a significant impact on treatment tactics.

Diagnostics

On your first visit medical institution The doctor will carefully question you about the manifestations of the disease and ask you to fill out several questionnaires. They may look different, for example like this.

Have you noticed the following symptoms? If yes, how often (never - 0; rarely - 1; average number of times - 2; often - 3):

frequent urination;
urinary incontinence, accompanied by an unbearable urge;
urinary incontinence after physical activity, coughing, sneezing;
loss of a small amount (a few drops) of urine;
difficulty urinating;
pain or discomfort in the lower abdomen/genital area.

Although the number and nature of questions may vary, they are all aimed at subjective assessment of the disease. Therefore, we must try to answer the questions as accurately as possible. At the same time, you should be guided by the state of your body only for last month- no need to remember what happened a month or two ago.

To make a correct diagnosis and choose adequate therapy, it is necessary to find out the problems that are bothering you at the present time.

The doctor will also ask you to fill out a urination “diary,” which allows you to give a more objective assessment of the patient’s symptoms. When filling out the diary, the amount of fluid drunk, the frequency and volume of urination, the presence of imperative (unbearable) urges and episodes of urinary incontinence are taken into account. The voiding diary cannot be assessed without the patient. Thus, after filling out the diary for 24-48 hours, you will again come to see the doctor, who will pay attention to the frequency of urination, its volume and how you yourself describe the act of urination. The voiding diary records the following factors for every 2 hours:

what liquid did you take and in what quantity;
how many times have you urinated;
how much urine was released (a little, medium, a lot);
have you experienced an unbearable urge to urinate?
what were you doing at that moment;
whether you have had an episode of involuntary urinary leakage;
how much urine was passed during the episode;
What were you doing during the involuntary loss of urine?

After the conversation and filling out questionnaires, the doctor will conduct an examination in a gynecological chair and a cystoscopy. The examination in the chair will be similar to the examinations you receive on a regular basis. scheduled visit your gynecologist. This will include a routine vaginal examination to rule out diseases of the uterus and vagina that may also cause SUI. In addition, the doctor will conduct several specific tests (tests) that will most likely diagnose SUI. The main one is the so-called “cough” test, in which the doctor will ask you to cough. The test is positive if urine is released from the external opening of the urethra when coughing. It is important to note that even a small amount of urine excreted in this way allows a diagnosis of SUI to be made.

Cystoscopy is an examination of the bladder, in which a special device (cystoscope) is inserted into its cavity through the urethra, with which the bladder is examined. It is important to note that cystoscopy is a mandatory examination method, regardless of the results of specific tests. Cystoscopy allows you to identify diseases of the bladder such as (inflammation of the bladder mucosa), diverticulosis (protrusions of the bladder wall, such as hernial sacs), etc., which can complicate SUI.

These two studies can be carried out both on an outpatient basis and in a hospital, however, in case of difficult diagnosis and if it is necessary to clarify treatment tactics, it is necessary to carry out additional research in a hospital setting. Such studies include:

laboratory tests (blood, urine culture);
Ultrasound of the kidneys and bladder (determination of residual urine);
complex urodynamic study (uroflowmetry, cystometry and profilometry, during which the act of urination is reproduced in artificial conditions with sensors located inside the bladder and rectum for continuous monitoring of changes in pressure indicators).

This study is invasive; infectious complications may develop, so it is preferable to perform it in a hospital.

Treatment tactics

Based on the results of a comprehensive examination, the optimal treatment tactics will be selected. In case of development of SUI as a postpartum complication, conservative therapy is preferable. The most important and fundamental part of this treatment is performing exercises aimed at strengthening the pelvic floor muscles. These include the so-called step-free therapy; At the same time, you will have to hold specially designed “weights” of increasing weight with your muscles in the vagina.

The effectiveness of conservative therapy is assessed after a year of treatment. The criterion for recovery is the complete disappearance of symptoms of SUI. If the dynamics are weak, positive or negative, you will be offered surgery. Along with special exercises, it is possible to perform electrical stimulation and electromagnetic stimulation of the pelvic floor muscles. If SUI develops after childbirth, conservative treatment is carried out over the next year: in this case, its effectiveness is quite high.

It should be noted that medicinal method There is no cure for SUI.

The main type of treatment for stress urinary incontinence is surgical methods, the purpose of which is to create additional support for the urethra in order to eliminate the pathological mobility of the latter. The choice of one method or another largely depends on the degree of urinary incontinence.

Introduction special gel into the periurethral space. The operation can be performed both on an outpatient basis and as an inpatient basis, both under general and under local anesthesia. The duration of the operation, as a rule, does not exceed 30 minutes. With this type of treatment, there remains a high probability of recurrence (recurrence) of the disease.
Urethrocystocervicopexy. During this operation, the urethra, bladder, and cervix are fixed in different ways. In various variants (Burch's operation, Raz's operation, Gittis' operation, etc.), urethrocystocervicopexy is a full-fledged surgical intervention that requires long-term postoperative recovery. Currently, this method is rarely used.
Sling (loop) operation in various options. This is the most common surgical procedure. There are many options for loop (sling) operations, during which the effect of urinary retention is achieved by creating reliable additional support for the urethra by placing it under middle part urethral loops from different material(vaginal flap, skin, synthetic materials and etc.).

Recently, minimally invasive - with minimal surgical intervention - loop operations have become increasingly popular. They have the following advantages:

good tolerability (the method is used for any degree of urinary incontinence);
small incisions in the skin through which the intervention is carried out;
use of synthetic polypropylene mesh as loop material;
the possibility of performing the operation under local anesthesia;
short duration of the operation (about 30-40 minutes);
short postoperative period(the patient can be discharged home on the day of surgery or the next day);
good functional results - low probability of disease relapse.

To summarize, I would like to emphasize once again that SUI is a pathology, a disease, and not a normal condition of the female body. According to studies, only 4% of women in Russia who suffer from SUI do not consider their condition to be natural. However, urinary incontinence is a disease that can never be cured on its own without the help of a qualified specialist. You shouldn’t put up with this problem, traumatizing your psyche and giving up a full life.

Konstantin Kolontarev, urogynecologist,
employee of the Department of Urology
Moscow State dental university,
Moscow

Discussion

Useful article! It would be great if Kegel exercises were described in the same grammatical manner!

06/28/2016 20:25:31, LanaLen

Very useful article. It seems to me that the problem of urinary incontinence worries many women, but for some reason everyone tries to hide it instead of taking timely treatment.

06/29/2015 16:03:54, Flew past

Comment on the article "Urinary incontinence: hide or treat?"

Urinary incontinence is cases of spontaneous urination (the child does not feel the urge to urinate), urinary incontinence... Enuresis in a child: treat or wipe up puddles and do exercises? Wet bed complex: bedwetting in children.

Discussion

My eldest also had enerus until he was 6 years old. The surgeon at the clinic sent me for an X-ray, which showed incomplete fusion of the posterior arch of S1. It turns out that this was the reason. Physiotherapy helped us a lot. Almost everything went away

03.12.2017 17:23:08, yutta2

To what extent are there no fears? Doesn't understand ranks or titles?
Against the background of hyperactivity, it’s time to see a neurologist. The neurologist probably has nothing to do with it.
Many years of treatment with a neurologist did not help us.
1) A decoction of St. John's wort helped the situation. Strengthens the nervous system. (cannot be taken during periods of solar activity)
2) Quickly, like a grandmother, whispered from the first visit - acupuncture! (you need to go to trusted ones - there are a lot of charlatans. But those who have techniques can also scam money)
3) The enuresis alarm clock helped. Although it never reacted. But just on a mental level.
4) Caving chambers strengthen the central nervous system. Leading to slow, deep breathing.

03.12.2017 04:48:27, Krokotyk

What to do, what to do... Someone had similar situations? Who overcame enuresis? I have second cousin I suffered from enuresis until I was 12-13 years old, no one did anything, in my opinion they didn’t wash the clothes, in the house Wet bed complex: bedwetting in children.

Discussion

I would advise you to interview adults who once had a similar problem. You can do it here or in the girls’ room (they’re happy to answer there). Find out for yourself (if you personally are not in the know) how a child feels if he finds himself in such a piquant situation at least once in his life.

03/05/2014 16:32:42, Akella

Who overcame enuresis? ...I find it difficult to choose a section. Adoption. Discussion of issues of adoption, forms of placing children in families, raising adopted children, interaction with guardianship, training at school for adoptive parents.

Discussion

Try to find this, maybe you sell a similar system, or maybe you can order it directly from the manufacturers, I have no idea how much it costs; We have friends who used a similar system, the last time I talked to my mother, she said that my daughter had not peed once since she put on the bracelet, then we moved, I don’t know how everything turned out later

my second cousin suffered from enuresis until she was 12-13 years old, no one did anything, in my opinion they didn’t wash the clothes, it was impossible to go into the house, and then it went away on its own

Fecal incontinence. Health. Teenagers. Parenting and relationships with children adolescence: transitional age, problems at school, career guidance, exams, Olympiads, Unified State Examination, preparation for university. Enuresis is urinary incontinence. Encopresis is fecal incontinence.

About a third of all women experience urine leakage after childbirth. Some people spontaneously secrete only a few drops, while others have very significant volumes of urine. Most women consider urinary incontinence after childbirth to be a normal condition and do not contact their doctor about this. Some consider the problem to be delicate and prefer to get rid of it folk ways. It is important to understand that this postpartum condition is pathological and requires correction.

Urinary incontinence: concept

This disease is characterized by spontaneous release of urine. Currently, the pathology is not uncommon; most often it is detected in the postpartum period and in women over 40 years of age.

The disease does not pose a serious threat to health, but significantly reduces the quality of life and negatively affects psycho-emotional state. Many women believe that urinary incontinence after childbirth is normal condition. Contrary to popular belief, it must be treated.

Symptoms

It is important to understand that isolated cases of urinary incontinence in women after childbirth do not always indicate pathology. One-time episodes can also occur in a completely healthy person.

The basis for diagnosis is following symptoms:

Involuntary urine discharge occurs regularly, including at night. It cannot be controlled.
The volume of urine leaked is usually significant.
Episodes of incontinence occur during sports, sexual intercourse, and being under stress.
After emptying the bladder, residual secretions continue to flow out.
Frequent and sudden urges.

However, even if the involuntary discharge of urine is not regular, it is necessary to consult a doctor in order to confirm or rule out the presence of an inflammatory process in the body.

Types of incontinence

There are several types of the disease, each of which has characteristic symptoms.

Urinary incontinence is of the following types:

Urgentnoe. It is impossible to control, the urge to urinate is very strong and appears suddenly.
Stressful. Urine leakage is observed even with slight exertion. For example, urinary incontinence appears after childbirth when sneezing, laughing, coughing, during physical activity of both low and high intensity, etc.
Paradoxical ischuria. Spontaneous discharge urine occurs when the bladder fills. In this case, it is impossible to control the process.
Reflex. Act involuntary urination is a consequence of fear. It can also occur if a person hears the sound of flowing water.

As a rule, in women after childbirth, urinary incontinence is of a stress nature.

Causes

The occurrence of complications is associated with changes occurring in a woman’s body during pregnancy and its completion.

The main ones are considered following reasons urinary incontinence after childbirth:

Weak ligaments. During pregnancy, changes occur in the pubic and iliosacral joints. They are characterized by gradual relaxation of the ligaments, which is normal during pregnancy.
Weak pelvic muscles. The closer the birth process is, the higher the concentration of the hormone relaxin in the blood. This substance is necessary in order to weaken the muscles and ligaments of the pelvic floor. This is necessary to increase the degree of bone dynamics.
Expansion of pelvic tissues. The separation of the bones during labor is necessary to prevent the child from being injured.
Breaks. They are not uncommon during childbirth. In addition, doctors may resort to episiotomy, a method of facilitating the passage of the child, which involves cutting the perineum. A natural consequence of ruptures and this surgical procedure is urinary incontinence after childbirth when coughing, playing sports, sneezing, etc.

The following factors also influence the increased likelihood of complications:

hereditary predisposition;
overweight bodies;
developmental anomalies of the pelvic organs;
psychoemotional disorders;
hormonal disbalance;
pathologies of the nervous system;
the person has been exposed to radiation in the past;
was previously carried out surgical intervention into the pelvic organs.

Thus, there are many reasons for urinary incontinence in women after childbirth, and therefore a thorough examination is recommended for each patient.

Which doctor should I contact?

When the first alarming symptoms you need to make an appointment with a urologist. He will find out the causes of urinary incontinence after childbirth, and prescribe the most effective treatment.

It is important to understand: the disease is dangerous because it develops gradually. The sooner you contact a specialist, the less time the treatment period will take, and the likelihood that you will be able to avoid surgical intervention will increase many times over.

Diagnostics

During a conversation with the patient, the doctor needs to establish the type of pathology and determine the degree of its manifestation.

During the history taking process, he should receive answers to the following questions:

how many births the woman had, whether complications arose;
does she have any diseases? chronic;
whether a hormonal imbalance has ever been detected;
whether surgery was performed;
whether the patient suffers from pathologies of the nervous system.

In addition, the doctor may ask other questions that may not seem entirely appropriate to the woman, since they relate to her personal life. It is necessary to understand that this information is required by a specialist in order to make an accurate diagnosis, so it is important to provide it.

Diagnosis of urinary incontinence consists of several stages:

Examination on a gynecological chair. The doctor evaluates the location of the organs of the reproductive system, checks the presence or absence of neoplasms, examines the mobility of the bladder neck, examines the mucous membrane and skin in the perineal area. After this, he takes biomaterial for research from the urethra, cervix and vagina. These tests are necessary to confirm or exclude the presence inflammatory processes. IN mandatory also appointed general research urine and bacterial culture.
Keeping an observation diary. In order to obtain the most complete information about the existing pathology, the doctor recommends that the patient write down the following information for 2-3 days: how much liquid was drunk during the day, how much urine was excreted at one time, how many acts of urination and episodes of incontinence there were in 24 hours ., how many pads were used, what load the patient was exposed to. Analysis of the observation diary will help the urologist not only in making a diagnosis, but also in drawing up effective scheme treatment.
Instrumental research. As a rule, the patient is prescribed a transvaginal ultrasound, during which the condition of the urethra, the bladder itself is analyzed, and sphincteric insufficiency is detected or excluded.

After completing all diagnostic measures the doctor makes a diagnosis and prescribes treatment. In cases where it is ineffective, the results obtained do not correspond to the symptoms, the woman suffers from psycho-emotional disorders, etc., a comprehensive urodynamic examination is indicated. It includes: uroflowmetry, cystometry, cystoscopy.

If, during the diagnostic process, a woman’s nervous system disorders are identified, she is referred for a consultation with a psychotherapist or neurologist. A consultation with an endocrinologist is often necessary.

Conservative treatment

Urinary incontinence after childbirth in women is a pathology for which medications are extremely rarely prescribed. The exception is when the patient is diagnosed with enuresis. To reduce the severity of symptoms, taking vitamins and medications that provide positive impact on the condition of blood vessels, the circulatory process and the functioning of the nervous system.

Basic conservative methods Treatment of urinary incontinence after childbirth:

Strengthening the muscles of the organ itself and the pelvic floor. Your doctor may recommend exercises using weights and vaginal cones. Holding foreign objects helps to gradually strengthen the muscles of the vagina and those involved in the process of urination. Good effect achieved by regularly performing Kegel exercises. They are also based on muscle training. To understand which of them and how you need to strain, you need to stop the stream during urination and remember these sensations. Thus, you need to constantly strain the muscles of the rectum and vagina. For achievement best result it is necessary to perform at least 200 repetitions per day.
Carrying out urination according to schedule. Its essence is that the patient must empty the bladder strictly prescribed by a doctor time. This method helps improve bladder function and gain control over the situation. For each woman, the schedule is developed individually. It must be followed for at least 2 months.
Physiotherapy. As a rule, treatment with electromagnetic waves is prescribed. Combined with exercises this method brings the best results.

At the end of the course of treatment, the doctor evaluates the changes. If they are insignificant or absent altogether, surgical intervention is prescribed.

Duration of treatment

Urinary incontinence after childbirth is a complication that requires individual approach. As a rule, the process of getting rid of pathology is quite long. The patient should perform the exercises regularly throughout the year. During this time she needs to undergo 4 courses of physiotherapy. After 1 year, the doctor evaluates the patient’s condition. If the illness does not subside, the woman is sent to the hospital with a referral for surgery.

Surgery

In practice, several methods of getting rid of pathology are used. Typically, the operation takes 30 to 45 minutes. It is performed under local anesthesia. On the second day the woman is discharged from the hospital, but if her daily activities involve intense physical activity, the patient can start using it no earlier than 2 weeks after the operation.

Possible complications include: damage to the walls of the bladder, blood vessels, and intestines. Contacting a highly qualified doctor reduces the likelihood of these risks to a minimum.

If not treated?

Urinary incontinence after childbirth is a complication that is not dangerous at the initial stage. But it significantly worsens the quality of life and emotional state of every woman. Ignoring this problem leads not only to its progression, but also to the occurrence of inflammatory processes in the organs of the genitourinary system.

Forecast

In most cases it is favorable. The overwhelming number of women forget about the problem of urinary incontinence after childbirth. Very rarely, conservative treatment methods do not bring the desired result; surgical intervention is prescribed only in isolated cases. But even after it is carried out, the likelihood of relapse is minimal.

Preventive measures

In order to prevent the occurrence of complications, it is necessary to follow throughout your life simple recommendations:

regularly train the muscles of the pelvic floor and vagina;
do not tolerate if the bladder is full;
eat a balanced diet, do not abuse alcoholic beverages, do not smoke;
keep body weight under control;
empty your bowels regularly;
observe the drinking regime.

Paying attention to your health significantly reduces the risk of pathology.

Finally

A third of women experience urinary incontinence after childbirth. What to do? First of all, make an appointment with a urologist. Ignoring the problem can lead to serious illnesses. Based on the diagnostic results, an individual treatment plan will be drawn up. In most cases it is enough to do special exercises and go to physical therapy. If these methods are ineffective, surgical intervention is indicated.

Popular in the category: