Treatment of urinary incontinence

Delicate urological problems are rarely discussed openly, however they significantly affect quality of life. Constant anxiety due to possible leakage, the need to use pads, limitation of physical activity and social contacts — all this may become a daily reality for a person with impaired control over urination. At the same time, modern medicine allows effective treatment of urinary incontinence regardless of the age and sex of the patient.

Incontinence is a condition in which a person loses control over the process of urination, which leads to involuntary release of urine. Urinary incontinence may be an independent disorder or a symptom of other urological, gynecological, or neurological diseases. The problem is based on dysfunction of the pelvic floor muscles, the sphincters of the bladder, or impairment of nervous regulation. Depending on the severity of the changes, involuntary urination may occur episodically or have a regular character.

In many patients, urine discharge appears during laughter, when coughing or sneezing. Leakage is also possible during active movements or when jumping. Such manifestations most often indicate a stress mechanism of the disorder, when even a slight increase in intra-abdominal pressure leads to loss of control.

People often believe that urinary incontinence in adults is a natural consequence of age-related changes. However, even in older age this condition is not a norm. If symptoms are present, it is important to consult a doctor in a timely manner, undergo examination, and determine the cause of the disorder.

Urinary incontinence is classified depending on the mechanism of development. Determining the type of disorder is an important stage of diagnosis, since further treatment tactics depend precisely on this.

Depending on the mechanism of occurrence, the following are distinguished:

• Stress form. Occurs with an increase in intra-abdominal pressure — during coughing, laughter, or physical exertion. In most cases, this is the so-called urethral incontinence, when due to sphincter insufficiency the urethra does not provide complete closure.
• Urgent form. Characterized by sudden, strong urges to urinate that are difficult or impossible to restrain. Most often associated with overactivity of the bladder.
• Mixed form. Combines signs of stress and urgent forms, therefore requires a comprehensive approach to treatment.

Functional incontinence is distinguished separately, which is not directly related to impaired functioning of the bladder or sphincters. In such cases, control over urination is preserved, however a person does not manage to reach the toilet due to concomitant diseases, cognitive disorders, or limited mobility.

Urinary incontinence in women

Urinary incontinence in women has its own characteristics обусловленные anatomical structure and hormonal changes. The female urethra is shorter and wider than in men, and the pelvic floor muscles undergo significant load during pregnancy and childbirth.

One of the most common causes of urine leakage in women is weakening of the pelvic floor muscles and ligaments after childbirth or during menopause, when the level of estrogens decreases and tissue elasticity deteriorates. In such cases, stress incontinence often develops. Also, incontinence in women may occur against the background of pelvic organ prolapse, chronic cough, increase in body weight, or regular intense physical exertion.

Urinary incontinence in men

Incontinence in men occurs less frequently. The most common factors are diseases of the prostate gland, in particular benign prostatic hyperplasia, as well as the consequences of surgical interventions on the prostate. Incontinence may occur due to damage to the sphincter or nerve structures responsible for control of urination. In some cases, urine leakage after urination in men is observed, which is associated with weakness of the pelvic floor muscles or retention of a small amount of urine in the urethra.

Urinary incontinence in elderly people

In elderly people, impaired control over urination often has a multifactorial character. Age-related changes in tissues, decrease in muscle tone, concomitant chronic diseases, neurological disorders, and intake of certain medications may affect the functioning of the bladder and the sphincter apparatus.

At the same time, urinary incontinence is not an обязательным or inevitable consequence of aging. With timely diagnosis and properly selected treatment, urinary incontinence in elderly people symptoms can be significantly reduced or completely eliminated.

Effective treatment always begins with accurate diagnosis. Since urinary incontinence has different mechanisms of development, it is important to determine the form of the disorder, its cause, and the severity of symptoms.

During the consultation, the doctor подробно collects the medical history: clarifies when the symptoms appeared, in which situations leakage occurs, whether there are concomitant diseases, whether there were surgical interventions in the history, and in women also — pregnancy and childbirth.

To establish an accurate diagnosis, the patient may be prescribed:

• ultrasound examination of the organs of the urinary system and pelvic organs;
• urine tests to exclude an inflammatory process;
• cystoscopy — endoscopic examination of the bladder;
• urodynamic studies to assess the functioning of the bladder and sphincters;

Consultations of related specialists (gynecologist, neurologist, endocrinologist) may also be required.

How to treat urinary incontinence in women

Treatment tactics in women depend on the form of the disorder, the age of the patient, hormonal status, and the presence of concomitant gynecological changes. Most often, treatment begins with conservative methods.

In the stress form, the basis of therapy is regular exercises for the pelvic floor muscles (Kegel exercises). They help restore urethral support and reduce episodes of leakage during physical exertion. Additionally, physiotherapeutic methods may be used — electrical stimulation and biofeedback.

During menopause, in the presence of atrophic changes of the mucous membrane, local estrogen therapy may be prescribed, which improves the condition of urethral tissues and increases their elasticity.

In the urgent form or overactive bladder, medication therapy is used, aimed at reducing excessive bladder contractility and decreasing the frequency of urges.

If conservative treatment does not provide sufficient effect, minimally invasive or surgical methods are considered. The most common are sling operations — placement of a special supporting tape under the middle part of the urethra, which ensures its stability during physical exertion. One of the modern and effective options is TVT-O surgery, which предусматривает transobturator placement of the sling and allows restoration of control over urination in the stress form of incontinence. When combined with pelvic organ prolapse, reconstructive correction may be performed to restore anatomical support.

The choice of method depends on the clinical situation and the expected result, and the decision is made after a full examination.

How to treat urinary incontinence in men

In men, treatment is primarily aimed at eliminating the underlying cause of the disorder. It is often associated with diseases of the prostate gland or the consequences of surgical interventions.

At the initial stages, exercises to strengthen the pelvic floor muscles are used, which help restore control over urination, especially after prostate surgery. According to indications, medication treatment of urinary incontinence is prescribed if the symptoms are associated with overactive bladder or impaired urine outflow.

In cases of pronounced sphincter insufficiency, surgical methods may be used. Modern options include male sling systems, which support the urethra and reduce leakage, as well as implantation of an artificial urinary sphincter — a special implant that allows control of the urination process.

Modern techniques allow achieving a stable result even in prolonged course of the disease. The main thing is not to postpone a visit to the doctor and to undergo examination in a timely manner.

To reduce the risk of development or progression of urinary incontinence in adults, it is recommended to:

• maintain normal body weight, since excess weight increases intra-abdominal pressure and creates additional load on the pelvic floor muscles;
• regularly perform exercises for urinary incontinence to strengthen the pelvic floor muscles and improve control over urination;
• adhere to a rational drinking regimen: consume a sufficient amount of water during the day, but avoid excessive fluid intake in the evening;
• limit caffeine, alcohol, and other beverages that may irritate the bladder and provoke urges;
• timely treat urinary tract infections, gynecological and urological diseases;
• avoid chronic constipation, which leads to constant straining and weakening of the pelvic floor muscles;
• treat chronic cough, which may provoke leakage when intra-abdominal pressure increases;
• undergo preventive medical examinations when the first symptoms appear, even if they are minor or episodic.

Adherence to these recommendations helps maintain normal bladder function, preserve the tone of the pelvic floor muscles, and reduce the risk of developing disorders of urination control.

The method of treatment of urine leakage is selected individually — depending on the form of the disorder and its cause. In different cases, conservative treatment, minimally invasive procedures, or surgical intervention may be used, therefore the final cost is determined after the diagnosis is established.

You can ознакомиться with the current prices for a doctor's consultation and other medical services in Kyiv at the clinic "Oxford Medical" here. In more detail about possible treatment options and their cost, the doctor will inform you after conducting the necessary examinations.

To make an appointment, use the online booking form or contact the phone numbers indicated on the website. Timely consultation with a specialist allows determining the cause of the disorder and choosing the optimal treatment path.