Urinary incontinence

　　Urinary incontinence is a phenomenon of intermittent or persistent involuntary leakage of urine through the urethra caused by various reasons. The incidence rate in the population is about 2% to 10%. Due to insufficient understanding of the concept and shy psychology, many people with urinary incontinence are unwilling to seek medical treatment. Therefore, the 10% incidence rate may still be low. In the elderly in nursing homes, it can even reach 25%, while the consultation rate is only 0.7%.

　　The bladder and urethra cannot maintain their function of controlling urination, and urine leaks out involuntarily, which is called urinary incontinence. Urinary incontinence is divided into four categories according to the cause of onset: 1. Stress urinary incontinence, 2. Overflow urinary incontinence, 3. Urgency urinary incontinence, and 4. Mixed urinary incontinence.

　　1. Urgency urinary incontinence: There is a strong urge to urinate, but the urine leaks out through the urethra due to the inability to control it by will.

　　2. Overflow urinary incontinence: Excessive bladder distension, increased intravesical pressure, exceeding the pressure of the urethra, causing involuntary urine leakage.

　　3. Stress urinary incontinence: Unintentional urine leakage occurs when abdominal pressure increases, such as when coughing, laughing, sneezing, or lifting heavy objects, causing a sudden increase in intra-abdominal pressure, resulting in involuntary urine overflow, more common in postpartum women and postmenopausal women.

　　4. True urinary incontinence: Urine continuously flows out due to damage to the urinary sphincter.

　　About 13% of women in the population have varying degrees of urinary incontinence, about 7% have obvious symptoms of urinary incontinence, of which about 50% are stress urinary incontinence.

　　The main factors for the onset of urinary incontinence in women are mainly:

　　1. Age: With the increase of age, the prevalence of urinary incontinence in women gradually increases, with the peak age being 45 to 55 years.

　　2. Childbirth: The number of deliveries, the age of first childbirth, the mode of delivery, the size of the fetus, and the incidence of urinary incontinence during pregnancy are all significantly correlated with the occurrence of postpartum urinary incontinence. Women who deliver vaginally are more prone to urinary incontinence than those who undergo cesarean section, and women who undergo cesarean section are at a higher risk of urinary incontinence than those who have not given birth. The use of midwifery techniques such as forceps, vacuum extraction, and oxytocin to accelerate labor also increases the possibility of urinary incontinence; mothers of large-for-gestational-age infants are also at a higher risk of urinary incontinence.

　　3. Pelvic organ prolapse: Stress urinary incontinence and pelvic organ prolapse often coexist and are closely related.

　　4. Obesity: The incidence of stress urinary incontinence in obese women is significantly higher.

　　5. Race and genetic factors: Genetic factors have a clear correlation with stress urinary incontinence, with the prevalence rate of patients with stress urinary incontinence.

　　Difficulties in urination: This is mainly caused by the belt being too tight. Some patients may be related to preoperative damage to the detrusor muscle contraction or bladder outlet obstruction. For early postoperative difficulties in urination, intermittent catheterization can be used. A small number of patients may develop urinary retention postoperatively and require the cutting of the belt. The belt can be loosened or cut under local anesthesia through the vagina, and the difficulty in urination can disappear immediately after the operation. The adhesions caused by the belt still have a therapeutic effect on stress urinary incontinence.

　　Bladder perforation: It is most likely to occur in patients who have undergone previous surgery. Repeated cystoscopy during the operation is a necessary step. If bladder perforation occurs during the operation, re-puncture and installation are required, and a urinary catheter should be retained for 1-3 days. If bladder perforation is found postoperatively, the belt should be removed, and a urinary catheter should be left in place for a week, and the belt should be repositioned in a second phase.

　　Bleeding: Bleeding and postpubic hematoma are also easy to occur, mostly due to the puncture being too close to the postpubic area or the presence of scar tissue. Once postpubic space bleeding occurs, the bladder can be filled for 2 hours, and pressure can be applied to the lower abdomen. A uterine gauze is packed into the vagina, and the situation is closely observed. Most cases can be absorbed spontaneously.

　　Other complications include foreign body reactions to the inserted belt or delayed healing of the incision, erosion of the urethra or vagina by the belt, intestinal perforation and infection, etc., with the most serious being the injury to the iliac vessels.

　　Urinary incontinence can be divided into five types: overflow urinary incontinence, incontinent urinary incontinence, reflex urinary incontinence, urgency urinary incontinence, and stress urinary incontinence.

　　Overflow urinary incontinence is caused by severe mechanical (such as benign prostatic hyperplasia) or functional obstruction in the lower urinary tract, leading to urinary retention. When the intravesical pressure reaches a certain level and exceeds the urethral resistance, urine is continuously dripping out of the urethra. The bladder of these patients is in an expanded state.

　　Incontinent urinary incontinence is due to the complete loss of urethral resistance, resulting in the bladder being unable to store urine. When standing, urine flows out of the urethra completely.

　　Reflex urinary incontinence is caused by complete upper motor neuron lesions, with urination relying on spinal cord reflexes. The patient urinates involuntarily at intervals (intermittent urinary incontinence) without sensation.

　　Urinary incontinence of urgency can be caused by partial upper motor neuron lesions or acute cystitis and other strong local stimulations, with the patient experiencing severe symptoms of frequent urination and urgency. Urinary incontinence occurs due to the strong, uncontrolled contraction of the detrusor muscle.

　　Stress urinary incontinence occurs when abdominal pressure increases (such as coughing, sneezing, climbing stairs, or running), and urine is discharged from the urethra. The etiology of this type of urinary incontinence is very complex and requires detailed examination.

　　Urinary incontinence can occur at any age and gender, especially in women and the elderly. In addition to causing physical discomfort, urinary incontinence can also affect the quality of life of patients and even affect their mental health. Therefore, the prevention of urinary incontinence is very important.

　　Prevention methods of urinary incontinence:

　　One, do not hold urine in everyday life.

　　Two, maintain a normal diet and pay attention to weight loss. In terms of diet, it is necessary to be light and eat more foods rich in fiber, which can effectively prevent an increase in abdominal pressure caused by constipation, leading to female stress urinary incontinence.

　　Three, regulate one's mood and emotions, maintain a positive and peaceful attitude, and keep an optimistic and open-minded mood to face success and stress, as well as the troubles of life and work.

　　Four, if there is a feeling of obstruction in the vagina or the discharge is bloody and has an odor, there are lumps protruding from the vulva during urination or defecation, there is difficulty in urination, frequent urination, or uncontrollable urine, it is necessary to go to the hospital for timely medical treatment to prevent pelvic organ prolapse.

　　Five, maintain a healthy and regular sex life. Studies have shown that maintaining a healthy and regular sex life can reduce the incidence of stress urinary incontinence in postmenopausal women, delay the decline of estrogen function, and improve the health level of elderly women.

　　Six, actively engage in physical exercise and pelvic floor muscle exercises to prevent the occurrence of various diseases. It should be known that diseases such as asthma and obesity can cause an increase in abdominal pressure, leading to the occurrence of urinary incontinence. Therefore, it is necessary to actively treat various diseases that occur and improve the nutritional status of the body.

　　Seven, develop good hygiene habits to prevent urinary tract infections. Before sexual activity, women should clean the external genitalia, and after sexual intercourse, they should immediately void and clean the external genitalia. If there is dysuria or frequent urination after sexual intercourse, appropriate amounts of anti-urinary tract infection drugs can be taken for 3 to 5 days, quickly curing the inflammation in the early stage. If it cannot be effectively cured, it is necessary to seek medical treatment in a timely manner.

　　Perimenopausal women with urinary incontinence are generally due to negligence in their youth, so it is very necessary to enhance the understanding of urinary incontinence prevention knowledge to prevent urinary incontinence from becoming a trouble in life.

　　Urinary incontinence, especially urinary incontinence caused by neurogenic bladder, should undergo the following examinations:

　　① Measure the amount of residual urine to distinguish between urinary incontinence caused by high urinary tract resistance (urinary tract obstruction) and low resistance.

　　② If there is residual urine, perform voiding cystourethrogram during micturition to observe the site of obstruction at the bladder neck or the external urethral sphincter.

　　③ Bladder pressure measurement, observe whether there are inhibitory contractions, bladder sensation, and detrusor reflexes are absent.

　　④ Standing bladder urography to observe whether there is contrast agent filling in the posterior urethra. In normal urethral function, the contrast agent is blocked by the neck of the bladder. If the sympathetic nerve function related to urination is damaged, the smooth muscle of the posterior urethra relaxes, and the contrast agent can be seen to fill the near side 1-2 cm of the posterior urethra on the film. Because this part of the urethra has no striated muscle.

　　⑤ Closure urethral pressure measurement

　　⑥ If necessary, perform simultaneous bladder pressure, urine flow rate, and electromyography to diagnose cough-urgency urinary incontinence, coordination disorder of detrusor and sphincter function, and urinary incontinence caused by uncontrolled relaxation of the sphincter muscle.

　　⑦ Perform simultaneous bladder pressure, urine flow rate, and electromyography when necessary to diagnose cough-dysthymic urinary incontinence, coordination disorder of detrusor and sphincter function, and urinary incontinence caused by uncontrolled relaxation of the sphincter muscle.

　　Patients with urinary incontinence should avoid alcohol, drink less grapefruit juice, quit smoking, avoid caffeine, as caffeine is also a diuretic. Patients with urinary incontinence should control fluid intake, especially before bedtime.

　　The following are several dietary remedies for urinary incontinence:

　　Yam and Turtle Soup: 15 grams of yam, 10 grams of goji, one turtle, ginger, salt, and yellow wine in appropriate amounts. After slaughtering and cleaning the turtle, cook it with yam and goji. Add ginger, salt, and yellow wine to taste after it is cooked. Benefits: Nourishes yin and kidneys, invigorates the spleen and builds the body. Suitable for patients with urinary incontinence due to yin deficiency and weakness.

　　Mutton and Sticky Rice Porridge: 50 grams of mutton, 100 grams of green beans, 200 grams of sticky rice, salt, MSG, and pepper in appropriate amounts. Clean the mutton, cut into small pieces, add green beans, sticky rice, and enough water. Boil with high heat, then simmer with low heat until tender. Add salt, MSG, and pepper to taste. Benefits: Strengthens the middle and invigorates the qi, prevents and treats urinary incontinence due to deficiency of the middle qi.

　　Astragalus and Black Chicken Soup: 50 grams of astragalus, one black chicken, scallions, ginger, wine, and salt in appropriate amounts. After boiling the above ingredients, add scallions and salt to taste. Benefits: Nourishes the spleen and kidneys, suitable for patients with urinary incontinence due to long-term illness or weakness in the elderly. Adding sticky rice makes it Astragalus and Black Chicken Porridge, with the same benefits. Experimental research has shown that astragalus has estrogen-like effects and can effectively prevent and reduce urinary incontinence in postmenopausal women due to lack of estrogen.

　　Astragalus Honey Drink: 30 grams of astragalus, 10 grams of honey. Simply brew the astragalus with boiling water, cool it down, and mix in the honey. Benefits: Prevents and treats weakness in the elderly, stress urinary incontinence, and urinary incontinence in elderly women.

　　Senile urinary incontinence refers to the inability to control urine, which flows out involuntarily without one's will, and is mostly tension incontinence. It is appropriate to eat sour and astringent fruits such as chestnuts, lotus seeds, hawthorn, pomegranate, black plum, cherries, etc., to solidify urine. It is recommended to regularly consume foods such as mutton, dog meat, bird eggs, shrimp, chives, jujube, walnuts, and white sesame seeds, and avoid drinking too much tea, soup, juice, coffee, and other beverages. Drinking tea made from ginkgo leaves can prevent frequent urination caused by cold. In addition, foods with kidney-nourishing effects are beneficial for the prevention and treatment of frequent urination, such as shrimp, walnuts, and rice cakes. Among them, shrimp can treat nocturnal frequent urination, and walnuts can treat frequent urination caused by aging.

　　The treatment of urinary incontinence in Western medicine should be based on the corresponding treatment according to different pathogenesis:

　　1. Large amounts of residual urine can cause stress urinary incontinence or overflow incontinence. The treatment principle for this type of incontinence is to reduce residual urine by reducing urethral resistance through surgery (cervical or external urethral sphincter incision).

　　There are many methods of surgical treatment, mainly divided into three categories: vaginal urethral bladder neck fascia suture; retropubic bladder urethra suspension; fascia suspension. The most commonly used method is called MMK surgery and Cooper ligament suspension. In recent years, the development of laparoscopic Cooper ligament suspension has been rapid, and this operation has small trauma and fast recovery, suitable for patients with severe stress urinary incontinence.

　　After surgery, it is important to note that you can start normal activities 3-4 weeks after surgery, but you should not have sexual intercourse within two months; secondly, you should not lift heavy objects or exert abdominal force within half a year after surgery; at the same time, you need to strengthen physical exercise after surgery; in addition, for postmenopausal women or perimenopausal women, estrogen supplementation is needed after surgery. Of course, the dose of estrogen needs to be administered under the guidance of a doctor.

　　2. Overactive detrusor reflex or unstable bladder can cause urgency or reflex incontinence, and sometimes it can also cause cough urgency incontinence. The treatment principle is to suppress the uncontrolled contraction of the bladder through medication (such as verapamil), sacral nerve block, sacral nerve surgery, or bladder nerve resection.

　　3. Inadequate sphincter function leads to residual urine in these patients. The treatment principle is to increase the resistance of the urinary tract through medication (such as ephedrine, propranolol, etc.) or surgery. Patients with incontinence without resistance can be treated with artificial urinary sphincter implantation, urethral extension, urethral clamp (female) or penile clamp.