Often the woman after the delivery finds out that even at an insignificant tension at it urine begins to leak. There is a natural question: in what the reason of this state and whether it demands medical care?
Many women consider that they a postnatal incontience of urine “will pass“ and do not hurry to see a doctor. And even if over time this state only worsens, the patient, as a rule, prefers to reconcile to the current situation, hesitating to complain of an incontience even on reception at the doctor. Some women consider this state as norm and undertake nothing about it. Meanwhile it is about complication of childbirth which is called the stressful incontience of urine (SIU). This state not so much worsens health of the patient how many reduces quality of her life. Let`s try to answer the most topical issues concerning SNM.
What can cause SNM?
the Incontience of urine is a pathological state at which involuntary release of urine results:
of violation of an adequate innervation of a muscular cover of a bladder and muscles of a pelvic bottom (an innervation management of body or a muscle of certain sites of nervous system is called);
of pathological mobility of an urethra;
of insolvency of the switching device of a bladder and urethra;
of unstable position of a bladder - instability of vnutripuzyrny pressure.
What types of an incontience of urine exist?
are Allocated by seven types of an incontience of urine:
of the Stressful incontience of urine - involuntary release of urine at physical activity, cough, sneezing, i.e. in cases of sharp increase of intra belly pressure.
the Urgentny incontience of urine - involuntary release of urine at a sudden, strong and intolerable desire to an urination.
the Reflex incontience of urine - dribble of urine at various “provocative“ situations, for example at a sound of water or loud shout.
Involuntary dribble of urine.
Bed wetting (enuresis) - the illness which is most often found at children`s age.
Dribble of urine after end of an urination.
refilling Incontience (paradox ishuriya). At the same time urine separates on drops, despite the refilled bladder (the sharp delay of urine happens, for example, at patients to myoma of a uterus of the big sizes).
At women most often observe a stressful incontience of urine.
What mechanism of deduction of urine is normal of
? Normal deduction of urine is carried out by interaction of four main mechanisms:
the situation of stability in a bladder organism;
adequate innervation of muscles of a pelvic bottom and muscular cover of a bladder;
anatomic and functional integrity of the switching device of a bladder and urethra.
mother`s Organism throughout all pregnancy and especially at the time of delivery is exposed to the raised loading. The greatest overloads test muscles of a pelvic bottom which during pregnancy serve as a reliable support for the growing uterus, and at the time of delivery are natural patrimonial ways, turning into “tunnel“ on which there is a kid. During passing of a fruit on patrimonial ways there is an excessive sdavleniye of soft fabrics therefore there can be a violation of an innervation of the last and, as a result, - loss of part of functions. For this reason development of SNM as a result of violation of interaction of above-mentioned mechanisms is after the delivery possible. Such complications of a course of childbirth as ruptures of soft tissues of crotch, vaginas, increase probability of development of SNM. It should be noted that each subsequent childbirth also increases risk of development of a disease.
to Development of SNM promote
a floor (the urine incontience meets at women more often);
the increased weight;
surgical interventions - injury of pelvic nerves or muscles;
hereditary factor (genetic predisposition to development of an incontience of urine);
a neurologic factor - existence of various diseases of nervous system (multiple sclerosis, Parkinson`s illness, spine injuries);
an anatomic factor - violations in a structure of muscles of a pelvic bottom and pelvic bodies. >
it is important to li to note
that the risk of development of an incontience of urine increases in direct ratio to the number of childbirth. About 54% of all povtornorodyashchy women test SNM episodes.
the Main symptoms
Manifestations of SNM are:
involuntary release of urine at physical activity, cough, sneezing etc.;
episodes of not deduction of urine at the sexual intercourse;
episodes of not deduction of urine in a prone position;
increase of episodes of not deduction of urine at alcohol intake.
What to do?
the Incontience of urine is a disease which never leads to serious violations of functional activity of an organism and by a lethal outcome. However, as it was already told, this problem in process of progressing is fraught with gradual deterioration of life, and sometimes - and full isolation of the patient. For this reason it is important to know that the incontience of urine can be cured. For this purpose first of all it is necessary to ask for the help the qualified specialist who will help to pick up the most effective and suitable treatment method for a concrete case.
At detection at itself symptoms of a stressful incontience of urine (involuntary release of urine at cough, sneezing, fast walking, physical activities) needs to see a doctor - the urologist. You should not conceal nothing and furthermore - to be ashamed happened to you. You remember: even the insignificant, in your opinion, detail can have significant effect on treatment tactics.
At the first visit of medical institution the doctor will carefully ask you on displays of a disease and will suggest to fill several questionnaires. They can look differently, for example so. whether
you at yourself Noted existence of the following symptoms? If yes, that as is frequent (never - 0; seldom - 1; average number of times - 2; often - 3):
the speeded-up urination;
the urine incontience which is followed by an intolerable desire;
an urine incontience after physical activity, cough, sneezing;
loss of a small amount (several drops) of urine;
of difficulty at an urination;
morbidity or discomfort in the bottom of a stomach / in genitals.
In spite of the fact that the quantity and character of questions can differ, all of them are directed to value judgment of a disease. Therefore it is necessary to try to answer questions as it is possible more precisely. At the same time you have to be guided by a condition of your organism only for the last month - it is not necessary to remember that there was a month or two ago.
For statement of the correct diagnosis and the choice of adequate therapy needs to find out those problems which disturb you exactly now.
Also the doctor will suggest you to fill in with
“diary“ of urinations which allows to give more objective assessment of symptoms of the patient. When filling the diary the amount of the drunk liquid, frequency and volume of urinations, existence of imperative (intolerable) desires and episodes of an incontience of urine are considered. The diary of urinations cannot be estimated without patient. Thus, having filled in the diary within 24 - 48 hours, you will come to reception again to the doctor who will pay attention to the frequency of urinations, their volume and to how you describe the act of an urination. In the diary of urinations the following factors for each 2 hours are fixed:
what liquid you accepted
and in what quantity;
how many times you urinated;
what amount of urine at the same time was allocated to
(a little, so-so, there is a lot of); whether
tested an intolerable desire to an urination;
what you at this moment were engaged in
you had an episode of involuntary release of urine;
what amount of urine was allocated to
during this episode;
what you were busy with
during involuntary release of urine.
Records is recommended to be kept for 3 next days. For receiving the most exact and reliable results it is recommended to have constantly the diary at itself.
After conversation and filling of questionnaires the doctor will perform inspection in a gynecologic chair and a tsistoskopiya. Survey in a chair will remind those surveys which you pass at regular planned visit of your gynecologist. It will include the usual vaginal research necessary for an exception of diseases of a uterus and a vagina which can also be the reason of SNM. Besides, the doctor will carry out several specific tests (tests) allowing with the greatest share of probability to diagnose SNM. The main of them is so-called “kashlevy“ test at which the doctor will ask you to cough. Test is positive if at cough from an external opening of an urethra urine is emitted. It is important to note that even the small amount of the urine emitted thus allows to make the diagnosis to SNM.
are represented by research of a bladder at which through an urethra enter the special device (cystoscope) by means of which examine a bladder into his cavity. It is important to note that the tsistoskopiya is an obligatory method of research, irrespective of results of specific tests. Tsistoskopiya allows to reveal such diseases of a bladder as cystitis (an inflammation mucous a bladder), divertikulez (protrusions of a wall of a bladder, type of hernial bags), etc. which can complicate SNM.
These two researches can be conducted by
as it is out-patient, and in a hospital, however in case of difficult statement of the diagnosis and in need of specification of tactics of treatment it is necessary to conduct additional researches in the conditions of a hospital. Treat such researches:
laboratory tests (analysis of urine, blood, urine crops);
of ultrasonography of kidneys and bladder (definition of residual urine);
complex urodinamichesky research (an urofloumetriya, a tsistometriya and a profilometriya during which there is a reproduction of the act of an urination in artificial conditions to an arrangement of sensors in a bubble and a rectum for continuous monitoring of changes of indicators of pressure).
This research is invasive, development of infectious complications therefore its performance is more preferable in a hospital is possible.
on the basis of the received results of complex inspection will be chosen by
optimum tactics of treatment. In case of development of SNM as postnatal complication carrying out conservative therapy is preferable. The most important and main part of such treatment is performance of the exercises directed to strengthening of muscles of a pelvic bottom. Their number includes so-called step - free therapy; at the same time you should hold muscles in a vagina specially developed “small weights“ of the increasing weight. Efficiency of conservative therapy is estimated by
after a year of treatment. Criterion of recovery is the total disappearance of symptoms of SNM. At weak positive or negative dynamics will offer you operation. Along with special exercises performance of electrostimulation and electromagnetic stimulation of muscles of a pelvic bottom is possible. In case of development of SNM after the delivery the konservativnoyelecheniye is carried out to a vta - a cheniye of the next year: in this case its efficiency is rather high.
needs to be noted that the medicamentous method of treatment of SNM does not exist.
the Main type of treatment of a stressful incontience of urine are surgical methods which purpose - creation of an additional support for an urethra for the purpose of elimination of pathological mobility of the last. The choice of this or that method in many respects depends on urine incontience degree.
of Introduction of special gel to okolomocheispuskatelnokanalny space. Operation can be carried out as it is out-patient, and permanently, both under the general, and under local anesthesia. Operation duration, as a rule, does not exceed 30 minutes. At this type of treatment there is a high probability of a retsidivirovaniye (repetition) of a disease.
of Uretrotsistotservikopeksiya. during this operation in the different ways fix an urethra, a bladder, a uterus neck. In various options (Bertsch`s operation, operation of Time, Gittis`s operation, etc.) the uretrotsistotservikopeksiya is the full surgery demanding long postoperative restoration. Now this method is used seldom.
of Slingovaya (loopback) operation in various options. This most widespread surgery. There is a set of options of loopback (slang) operations during which the effect of deduction of urine is reached by creation of a reliable additional support to an urethra by placement under a middle part of an urethra of a loop from various material (a vaginal rag, skin, synthetic materials, etc.) . >
Recently the increasing popularity enjoy li minimum invasive - with the minimum surgical intervention - loopback operations. They have the following advantages:
good tolerance (the method is used at any degree of an incontience of urine);
small cuts on skin through which intervention is carried out;
use as loopback material of a synthetic grid from polypropylene;
a possibility of carrying out operation under local anesthesia;
short duration of operation (about 30 - 40 minutes);
the short postoperative period (the patient can be written out home in day of operation or next day);
good functional results - small probability of recurrence of a disease.
Summing up of
the result, there is a wish to emphasize once again that SNM is pathology, an illness, but not a normal state of a female organism. According to the conducted researches, only 4% of women in Russia from among the suffering SNM do not consider the state natural. Nevertheless, the incontience of urine is an illness which never recovers independently, without the assistance of the qualified specialist. You should not be reconciled with this problem, injuring mentality and refusing full-fledged life.