A functional disorder of the nervous system, accompanied by an involuntary flow of urine, in medicine is designated by the term incontinence. This condition is more often observed in children, due to the influence of a number of psychological reasons. Provoking factors, including psychogenic ones (psychosomatics), lead to the development of pathology in adults. The presence of a problem affects the quality of life, provokes the development of complexes, anxiety and uncertainty.
Classification of the pathological condition
According to the International Classification of Diseases ICD-10, the disorder has the code F98. There are two main forms of enuresis: primary and secondary. Primary urinary incontinence (UTI) occurs in children at an early age and is due to the absence of a reflex responsible for the control of urination.
Secondary develops in the event that a person is not able to control the urge, which leads to an involuntary leak of urine during sleep.
Depending on the presence of pathologies of the genitourinary system, there are:
- false NM – involuntary excretion of urine with congenital or acquired defects of the urinary system, leading to a violation of the integrity of the urinary tract (epispadias of the urethra, abnormal location of the ureteral orifices, urinary fistula),
- true – develops in the absence of serious pathologies and defects of the urinary tract.
Additionally, they classify neurotic (has a direct relationship with psychological problems), neurosis-like (develops as a result of a violation of regulatory mechanisms due to previous diseases) and inorganic (in case of mental impairment) urinary incontinence.
Causes and types of disorder
The main causes of urinary disorders are the anatomical features of the body, trauma and malformations of the central nervous system.
Chronic inflammatory processes of the urinary system and surgical interventions cause damage to the structure of the urea, which affects its sensitivity.
The development of urinary incontinence in men is often associated with impaired blood circulation and rapidly progressing inflammatory, tumor-like processes and alcoholic dementia (dementia, against the background of prolonged intake of alcoholic beverages).
Types of urinary disorders:
- Stress urinary incontinence develops against the background of increased pressure in the intra-abdominal cavity. Even minor physical activity, jumping rope, running, coughing, sneezing and laughing, can cause an unpleasant state. At the same time, a person does not feel the urge, and complete or partial emptying occurs spontaneously. In rare cases, fractures of the pelvic bones and damage to the sphincter can provoke nervous enuresis. A common cause of stress MI in men is transurethral resection (TUR) of the prostate gland, radical prostatectomy (surgery to remove prostate adenoma and seminal vesicles).
- Urgent (imperative) urinary incontinence is characterized by imperative urge to urinate, which a person is not able to control and postpone even for a minimal period of time. The main cause of this disorder is an overactive bladder (OAB). In children under 2-3 years of age, this condition is the norm. With age, the tone of the detrudor increases, however, in 10-15% of cases, uncontrolled contraction persists throughout life. The disorder leaves an imprint on a person’s professional activity and social adaptation, provokes the development of psychological problems, deprives him of sleep, and limits sexual contacts.
- Mixed UM is characterized by the manifestation of symptoms of stress and imperative enuresis.
- Paradoxical (overflow incontinence) develops mainly in older people suffering from urinary retention, which leads to a weakening of muscle tone and a stretching of the urinary urea, as a result of which emptying becomes problematic, urine overflow and involuntary flow of urine occurs.
- Temporary (transient) urinary incontinence provokes external influences, when they are eliminated, the condition is corrected (cystitis, inflammation of the vagina and urethra, constipation, strong alcoholic intoxication).
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Enuresis at night
The nocturnal form of the disease in adults is extremely rare, the peak of development is recorded after 40 years, in particular, in the elderly.
Frequent nervous overstrain, infectious diseases of the urinary system, diabetes mellitus, profundosomnia (deep sleep) can affect the manifestation of nocturnal enuresis in men. In cases where examinations confirm the presence of the disease, and there is no effect of treatment, young men are not drafted into the army or alternative ways of doing military service are considered.
For the treatment of monosymptomatic enuresis, which manifests itself mainly in children and adolescents (not accompanied by mental, endocrine, urological and other pathological abnormalities), a special enuresis (urinary) alarm clock is used. The operation of the device is based on its activation when the humidity changes as a result of the ingress of urine on the surface of the device, which leads to awakening. This scheme helps the child to feel the urge at a reflex level.
Features of the course in men
In most cases, in men, incontinence is observed after 60 years, which is associated with the natural processes of wear and tear of the body. The causes of dysfunction include:
- age-related changes,
- back Bifida (incomplete closure of the neural tube in the spine),
- pathological changes in the urinary system,
- benign prostatic hyperplasia,
- prostate cancer,
- neurogenic bladder (violation of voluntary reflex accumulation of urine and its excretion),
- violation of potency and infertility,
- sexually transmitted infections
- hormonal disruptions
- hereditary factor (pathology can be transmitted at the genetic level),
- stones in the ureters and kidneys,
- senile multiple sclerosis,
- polyneuropathy (damage to the peripheral nervous system),
- disability (with damage to the spinal column),
- a hernia of the spine, which squeezes the nerve endings,
- enlarged adenoids,
- ureaplasma (damage by pathogenic bacteria),
- previously suffered strokes, micro-strokes or heart attacks,
- Alzheimer’s disease,
- systematic stressful situations.
It is noteworthy that more than half of the urinary problems that occur in adulthood are associated with untreated childhood disorders.
Lack of proper treatment can lead to the development of serious diseases, including inflammatory processes of the genitourinary system. In this case, the person has additional symptoms: high fever, burning sensation, discomfort when urinating, heaviness and acute pain in the lower back, fainting, vomiting, pain during intercourse and orgasm.
Diagnosis of urinary incontinence
Diagnostic measures allow you to identify the causes of urinary disorders. The urologist collects a complete anamnesis of the patient and conducts an initial examination, fills out the “Drip-test” questionnaire. During the conversation, the specialist receives the necessary information about the patient’s professional activity, lifestyle, signs of the disease and the presence of secondary pathologies.
Based on the data obtained, a set of diagnostic measures is assigned, including:
- Clinical analysis of urine.
- Cystourethroscopy. Visual examination of the genitourinary system using a specialized optical apparatus.
- X-ray examination. The procedure is aimed at identifying defects in the structure of the organs of the urinary system and the presence of neoplasms.
- Urodynamic study (UDI). The procedure measures urine flow and pressure in the urethra.
- Electroencephalography (EEG) is a study aimed at studying the state of the brain and spinal cord.
A complete examination of the body allows you to obtain information about the state of the urinary system and determine the degree of development of pathology. Based on the results of the examinations, an accurate diagnosis is made and complex therapy is prescribed.
To record the amount of urine and frequency of urination, it is recommended to keep a special diuresis diary. It contains data on the number, volume of urination during the day and night. Based on the information received, the doctor determines the degree of incontinence and decides on further treatment.
Elimination of the cause and the effectiveness of the treatment of urinary incontinence in men and women consists in a complex effect on the body. The standard therapeutic regimen is based on several basic techniques, including drug therapy, physiotherapy, specialized exercise, and psychotherapy. To accelerate the therapeutic effect, it is advisable to use a Foley catheter (forms a conditioned reflex of urinary excretion), homeopathic remedies and folk methods.
How to properly treat urinary incontinence with medicines? The complex of drugs is prescribed on an individual basis. Standard therapy includes the following groups of drugs:
- Alpha blockers. Their action is aimed at relaxing smooth muscles. The drugs help to normalize urine flow and prevent uncontrolled contraction of the bladder.
- 5-alpha reductase blockers. The action of drugs is aimed at reducing the frequency or eliminating urinary retention.
- Antidepressants. Allows you to relax the muscle muscles and block the impulses that provoke uncontrolled urination (Melipramine).
- Anticholinergic tablets relieve tension and promote natural urination (Atropine).
- Antispasmodics. Means that have a relaxing effect on muscles (Tenoten, Oxybutin, Knefron N).
- Nootropic drugs aimed at treating UM caused by neurological and mental factors (Glycine, Cortexin, Pantogam, Picamilon, Phenibut).
- Homeopathic remedies and herbal preparations for the treatment of concomitant diseases that caused UM (Fitosilin paste).
- Urodex gel is used to restore sphincter dysfunction caused by stress NM. The preparation contains hyaluric acid, gilan-gel and active microparticles of dextronomer, which promote the formation of collagen fibers and tissues that narrow the lumen of the urethra.
The need to use one or another group of drugs and their dosage is determined by the attending physician. The treatment regimen is subject to correction, depending on the patient’s condition and the achieved action.
Modern pharmaceutical companies have developed a wide range of hygiene products and devices for daily use that facilitate patient care and improve the quality of life of patients: pessaries (special tanks for collecting urine), specialized reusable underwear and panties, diapers, panty liners and tampons.
Physiotherapy and exercise
Physiotherapy improves the transmission of nerve impulses, normalizes the relaxation of the bladder walls and strengthens the sphincter. For this purpose, electrostimulation, electrophoresis, acupuncture, acupuncture, magnetotherapy, massage and reflexology are used.
In addition to physiotherapy, a set of special exercises (exercise therapy) is prescribed. Treatment according to the Kegel exercise regimen involves performing certain actions 5 times a day with alternating short and long contractions of the pelvic muscles that strengthen the sphincter. With daily exercise, a positive result is noticeable after a month. The optimal course duration is one year. The exercises can be done independently at home. Morning exercises, yoga, gymnastics, exercise machines and any other moderate physical activity have a beneficial effect on the body. Additionally, a diet free of hot spices and irritating foods is followed, which is based on natural products.
Biofeedback (biofeedback) is also used in the treatment of enuresis and encopresis. The essence of biofeedback therapy is that a person learns to independently control physiological reactions.
Psychotherapy is used if the development of involuntary urination is caused by a stressful effect on the body. The technique is based on the effect on consciousness through hypnosis. A person is put into a hypnotic trance, which allows him to instill the correct model of behavior. Persons suffering from schizophrenia and mental disorders, the use of the procedure is unacceptable.
Traditional methods of treatment
Correctly selected traditional medicine will help to increase the effectiveness of traditional methods. It is based on the use of infusions and decoctions of medicinal herbs. It is not recommended to independently resort to the help of folk methods, the wrong choice and use of medicinal plants can harm the body.
Experts recommend paying attention to the following medicinal herbs and berries: marshmallow, lingonberry, St. John’s wort, cherry leaves, sweet cherry, elecampane, centaury and blackberry. Recipes based on honey, yarrow, viburnum bark, dill seeds, sage and mullein oil will help to cope with dysfunction.
The use of folk remedies in combination with standard medicines and physiotherapy procedures allows you to achieve a positive result.
The operation is indicated in case of ineffectiveness of conservative therapy. Urological treatment consists in the use of sling techniques (TVT, TOT) – this is a minimally invasive method of restoring the elasticity of the bladder. As a result of the procedure, the urethra is suspended with a synthetic loop. TBT eliminates tension and prolapse of the pelvic organs. The operation is performed under general anesthesia or epidural anesthesia (if there are no contraindications).
Laser or beam plastic is often used. The laser acts on the walls of the urethra, helps to restore the muscle tone of the bladder and restore the function of the sphincter. As a result, urine “holds” and is excreted reflexively.
In the postoperative period, the patient must follow all the prescribed recommendations. A person needs to sleep on a firm mattress, lead a healthy lifestyle, eat right (exclude strong drinks and eat light food), and drink prescribed medications. The duration of rehabilitation and the prognosis depends on the type of surgery and the individual characteristics of the organism.
In order to avoid complications and relapses, it is necessary to observe preventive measures: timely treat colds (ARVI), inflammatory processes in the body and monitor the state of the urinary system.