Urinary incontinence: treating the problem
Urinary incontinence is a very common problem that is not usually talked about. According to epidemiological studies, the problem of incontinence, to one degree or another, affects about half of the women in the population of our country: at some point, during physical exertion, coughing, sneezing, during intercourse, an involuntary discharge of urine occurs. Because of this, women are forced to constantly use special pads, experience psychological discomfort and constantly think about the need for hygiene procedures.
Especially for the readers of medportal.ru, we talked with the leading specialist of Frau Klinik, obstetrician-gynecologist Igor Grigorievich Davydov and found out the answers to the most common questions about urinary incontinence:
Who can experience incontinence?
How to treat the problem of uncontrolled urination?
Is surgery always necessary? Or can you get by with medication and exercise?
What types of operations are there? And how long does the effect of the operation last?
– Igor Grigorievich, tell us at what age a woman can face the problem of incontinence? What are the reasons for this?
Most often, the problem arises at the age when a woman is successful: she works, takes an active life position, but at the same time has to think all the time about how to behave, what to wear, whether to drink water again in the morning and think about the nearest ones on the way toilets. The average age of a woman who experiences incontinence is about 45-50 years. This is due to the weakening of the supporting function of the sphincters of the urinary canal (due to age-related changes throughout the body / due to prolapse of the pelvic organs / after prolonged childbirth or childbirth of large children). Sometimes involuntary urination can occur after normal childbirth, you should not panic, most often it goes away on its own or with temporary drug support for 4-6 months.
– What other causes can become a symptom of incontinence? How are they treated?
The classification is quite complicated, it is worth dwelling on the 2 most common causes of urinary incontinence:
An overactive bladder is a syndrome in which it is impossible to contain the urge to urinate. In this case, the patients do not need an operation; a properly selected drug treatment is sufficient.
Stress urinary incontinence is an involuntary loss of urine during exercise.
In most cases, surgical treatment is necessary. Sometimes it is enough to restore the correct anatomy after the developed prolapse, sometimes it is necessary to install a sling (synthetic loop). Slings of various models are made from prolene, a material that has been used in surgery for several decades and does not cause rejection. Such a mesh is installed under the urethra and creates an additional obstacle for the flow of urine (takes on the function of weakened sphincters of the urinary canal). As a result of the operation, the woman again begins to control urination. The operation itself is simple and does not require a lot of time from the patient, including recovery, it is easily tolerated, it lasts no more than 30 minutes. After installing the sling, the woman spends no more than 1 day in the hospital, there are no special restrictions after the operation: patients should temporarily restrict their sex life (up to several weeks).
– How effective is the prolene mesh technique in treating urinary incontinence? And how to choose a sling with such a variety (TVT, TOT and others)?
Surgical mesh placement in incontinence treatment is reliable and permanent. Sling operations are almost 100% effective (94 to 98%), regardless of the degree of incontinence. Sometimes it is necessary to combine the operation to correct the droop and set the mesh. During sling operations, various types of nets are used (from TVT to mini-slings), all of them show high results, the choice of a sling is carried out at an in-person consultation by a gynecologist and depends on the chosen surgical tactics and other points.
Sling surgeries for the treatment of urinary incontinence do not have a long rehabilitation period, give a lifelong effect and do not require re-correction!
– Is it possible to avoid surgical treatment of urinary incontinence?
Yes, today there are techniques in which a gynecologist injects bulking agents (fillers) into the area around the urethra. Such fillers are specially developed by leading pharmaceutical companies for patients with high operational risk (very elderly patients or patients with severe concomitant diseases). For a while, this solves the problem, from the outside “pressing” the urethra, which creates an additional obstacle to the flow of urine. The disadvantage is the “resorption” of the filler after 6-8 months.
– Often young mothers after natural childbirth face the problem of urinary incontinence, how is the problem solved in this case?
Sometimes urinary incontinence is one of the symptoms of prolapse of the vaginal or cervical https://en.wikipedia.org/wiki/Cervix lining after childbirth. In this case (if there are no obvious signs of dysfunction of the urethral sphincters), it is recommended to first restore the anatomy. In most cases, all symptoms go away (the woman begins to control urination again), but sometimes, after 2-3 months, the situation does not improve, then we install a mesh – a sling – and permanently solve this problem.