Overflow incontinence

　　The causes of overflow incontinence include:

　　1. Lower urinary tract obstruction. Due to poor urination, urine accumulates gradually, leading to long-term overdistension of the bladder, which weakens the contractile force of the bladder muscle, fails to complete normal physiological urination function, and urine continuously leaks out with the increase of abdominal pressure. The most common cases are elderly male patients with benign prostatic hyperplasia, followed by female patients with bladder neck obstruction and male patients with prostatic cancer, etc.

　　2. Various neurological diseases. They keep the bladder in a paralytic state, lose the contraction function of the bladder detrusor muscle, and cannot complete the normal micturition action. They can be seen in patients with peripheral nerve injury in diabetes, patients after cerebral vascular accidents, patients with spinal cord injury or congenital developmental abnormalities. According to the onset of the disease, they can be divided into two major categories: acute filling urinary incontinence and chronic filling urinary incontinence. The former is more common in central nervous system diseases and injuries, due to bladder reflex paralysis or urethral sphincter spasm, causing acute urinary retention. It can also occur after delivery, lower abdominal and perineal surgery, due to urinary reflex disorders causing urinary retention. If not treated in time, the bladder will be overfilled, the bladder pressure will be too high, the blood circulation in the bladder wall will be obstructed, the intramural nerve receptors will undergo degenerative changes, the muscle fibers will be torn and altered, the vesicoureteral reflux will occur, and even renal hydronephrosis; the latter is more common in bladder outlet obstruction, benign prostatic hyperplasia, posterior urethral valve, hypertrophy of the prostatic fossa, etc.

　　Filling urinary incontinence can occur in both men and women, especially in middle-aged and elderly women. They often encounter the embarrassment of urinary incontinence. Some friends feel embarrassed and dare not seek medical attention or mention it to others, just endure it again and again. Some friends think that as they get older, urinary incontinence is inevitable and do not pay much attention to it. In fact, urinary incontinence is not a small problem. If it persists for a long time, it can have a significant impact on patients and even trigger some complications. The main complications include:

　　(1) Difficulty in urination: This is mainly caused by tight suspension. Some patients may be related to bladder detrusor muscle contraction impairment or bladder outlet obstruction before surgery. For early postoperative urinary difficulties, intermittent catheterization can be adopted. A small number of patients may develop urinary retention after surgery and may need to cut the吊带. Under local anesthesia, the吊带 can be released or cut through the vagina, and the difficulty in urination can disappear immediately after surgery. The adhesions caused by the吊带 still have a therapeutic effect on stress urinary incontinence.

　　(2) Bladder perforation: It is most likely to occur in patients who have undergone previous surgery. Repeated cystoscopy during the operation is an essential step. If bladder perforation occurs during the operation, re-puncture and installation should be performed, and a urinary catheter should be retained for 1-3 days. If bladder perforation is found after surgery, the吊带 should be removed, a urinary catheter should be left in place for a week, and the吊带 should be re-installed in a second stage.

　　(3) Hemorrhage: Hemorrhage and postpubic hematoma are also prone to occur, most often due to puncture too close to the postpubic area or the presence of scar tissue. Once postpubic space hemorrhage 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 close observation is made. Most cases can be absorbed spontaneously.

　　(4) Other complications: Including foreign body reactions to the implanted吊带的异物 or delayed wound healing at the incision site, erosion of the吊带 into the urethra or vagina, intestinal perforation and infection, etc., the most serious being the injury to the iliac vessels.

　　Urinary incontinence is not a trivial matter, and now many young people also encounter urinary incontinence. Do not hesitate to seek medical attention, and timely medical treatment is the key to solving the problem. Otherwise, it will be too late to regret if the above complications occur.

　　Overflow incontinence is more common in patients with benign prostatic hyperplasia, so these patients should have symptoms of urinary difficulty. The early clinical manifestations before the occurrence of urinary incontinence mainly include: urinary difficulty, frequent urination, urgency, thin urinary stream, weak urinary flow, incomplete voiding sensation, increased number of nocturnal urination, and other urinary obstruction symptoms. With the continuous increase in the degree of obstruction, the residual urine increases, and then the bladder function becomes maladaptive, resulting in urinary incontinence without realizing it. This type of urinary incontinence usually occurs intermittently. When the bladder pressure rises to a certain degree, urine will flow out, but it will stop quickly due to the decrease in bladder pressure, and then it will appear again after a while, and so on. If the obstruction is caused by bladder stones, symptoms such as dysuria and interrupted urination may also occur. In the late stage, symptoms of renal function damage may appear.

　　During physical examination, the lower abdomen is obviously bulging, and the enlarged bladder can be palpated with slight tenderness and discomfort. The patient shows numerous trips to the toilet even without interruption, with urinary incontinence mostly occurring after falling asleep. As the condition worsens, urinary incontinence also occurs when awake. Acute cases may have a strong urge to urinate and abdominal pain. Overflow incontinence is more common in men and is generally related to urethral obstruction caused by benign prostatic hyperplasia, followed by urethral stricture, diabetic neuropathy, nerve injury, and some medications. Among all types of urinary incontinence, overflow incontinence poses the greatest harm to the human body. Patients have obvious lower abdominal pain, restlessness, a strong urge to urinate but cannot, but sometimes urine leaks out from the urethra.

　　Overflow incontinence is caused by the bladder being overfilled and the internal pressure exceeding the control ability of the urethral sphincter, which forces urine to leak out drop by drop. It is common in conditions such as lower urinary tract obstruction, such as benign prostatic hyperplasia, urethral stricture, neuropathy, and bladder atony. Timely catheterization is the key to preventing overflow incontinence. Generally, if there is still no urination after 8 hours of surgery, it can be seen that the bladder is obviously full, and the dullness of percussion is raised, indicating that catheterization should be carried out promptly. If the time is prolonged too long, it can lead to hydronephrosis and renal atrophy, causing renal function damage. The flow rate of urination during catheterization should not be too fast, generally 20-30ml per minute is appropriate. If the catheterization speed is too fast, it can cause the overdistended bladder to collapse due to the sudden drop in internal pressure, leading to the rupture of mucosal capillaries and the appearance of hematuria. At the same time, the first-time catheterization volume should be controlled at about 300-400ml, and it is not advisable to remove the catheter immediately after emptying, because after the bladder is overdistended (the total urine volume can exceed 1000ml in general), the bladder muscle, due to the long-term stretching, will temporarily lose its contraction ability. Therefore, the catheter should be left in place for several days to allow the bladder muscle to recover its tension. Early removal of the catheter will反而延长膀胱肌肉张力的恢复时间.

　　The examination of overflow incontinence includes the following aspects:

　　First, physical examination

　　1. Medical history: Patients with overflow incontinence may have a history of bladder neck or urethral obstruction diseases, such as urethral stricture, post-urethral valve, benign prostatic hyperplasia, etc.; they may have a history of certain neurological diseases, such as spina bifida, spinal cord tumor, injury, meningocele, etc.; they may have a history of tuberculous contracted bladder, etc. Patients often have urinary obstruction symptoms such as difficulty in urination, weak urinary stream, frequent urination, urgency, and then appear urinary retention and lower abdominal pain. Urinary incontinence often occurs after falling asleep, and then gradually worsens, and can also occur when awake.

　　2. Physical examination: During the physical examination, a smooth and enlarged spherical mass can be palpated in the lower abdomen, with positive tenderness, percussion sound is dull, the bladder bottom can reach the navel or even above the plane. Neurological examination can suggest decreased sensation in the perineum, disappearance of perineal muscle reflex and anal muscle reflex, and relaxation of anal sphincter. Digital rectal examination suggests enlargement of the prostate, smooth surface, tough and elastic texture, and flattening or disappearance of the central groove.

　　Second, instrument examination

　　1. Ultrasound examination: Ultrasound examination shows that the bladder is full of urine and the bladder is extremely full.

　　2. Other examinations: To clarify the cause, it is possible to perform corresponding examinations after the treatment of overflow incontinence. Such as voiding cystography and bladder urethra cystography, which can see bladder contraction, urethral stricture, etc.; cystoscopy and urethroscope examination can find obstructive diseases of the bladder and urethra, such as bladder neck prominence, elevation, prostate prolapse into the bladder cavity, trabecular and small chamber hyperplasia, granuloma, inflammatory polyps, or suture residue in the urethra; bladder pressure measurement indicates that the bladder pressure is proportional to the accumulated fluid in a straight line. During the filling process, there are no uninhibited contractions. For those caused by neurological factors, the bladder pressure is very low, and the residual urine and bladder capacity are often very large.

 For patients with overflow incontinence, they can eat some sour and astringent fruits to firm up their urine, such as chestnuts, lotus seeds, hawthorn, pomegranate, black plum, cherry, etc. They should often eat foods such as mutton, dog meat, sparrow eggs, shrimp, chives, jujube, walnuts, and white fungus, and should not drink 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. Common medicinal diet formulas include:

    Dongshen pork bladder stewed with litchi meat: 30g of litchi meat, 30g of glutinous rice, and 1 pork bladder (pig bladder). First, clean the pork bladder thoroughly to remove the smell of urine, and cut it into strips; select and clean the litchi meat, and put it together with the washed glutinous rice into a pot, add an appropriate amount of water, boil it with high heat, add pork bladder strips and cooking wine, then change to low heat to stew until the pork bladder is tender, the glutinous rice is soft, and the soup is thick. Take it warm and eat it every night. It is especially suitable for elderly patients with urinary incontinence due to lung and spleen deficiency and those with frequent urination at night.

    Huang Qi Sang Luo Liu Xue Porridge: 30g of Huang Qi, 15g of Sang Luo Liu Xue, 100g of glutinous rice. First, select and clean Huang Qi and Sang Luo Liu Xue, cut Huang Qi into slices, and chop Sang Luo Liu Xue, put them in a gauze bag, tie the mouth, and put them in a pot with cleaned glutinous rice. Add an appropriate amount of water, boil over high heat, then simmer over low heat for 30 minutes, remove the medicine bag, and continue to simmer until the glutinous rice is soft and tender. Take it twice a day in the morning and evening. It is suitable for elderly urinary incontinence with lung and spleen Qi deficiency.

    Dang Shen Walnut Soup: Take 20g of Dang Shen, 15g of walnut meat, add an appropriate amount of water to cook soup, finish it in one day. This recipe has the effect of invigorating Qi and solidifying the kidney, and has a significant effect on elderly urinary incontinence caused by kidney deficiency.

    Ren Shen Shan Yao Stewed Mutton: 10g of white Ren Shen, 30g of Shan Yao, 200g of mutton. First, wash and dry or dry the white Ren Shen and Shan Yao and cut them into slices for later use; wash the mutton clean, cut it into thin slices with a sharp knife, put it in a pot, boil over high heat, add scallions, ginger juice, add cooking wine, and add white Ren Shen and Shan Yao slices, then simmer over low heat until the mutton is tender. Add a little salt, monosodium glutamate, and five-spice powder, mix well, pour in sesame oil, and it is ready. It can be eaten as a dish with meals and taken with meals. It is suitable for elderly urinary incontinence with lung and spleen Qi deficiency and nocturnal enuresis.

    Dang Shen Su Ye Soup: Take 20g of Dang Shen, 10g of Su Ye, 7g of Chen Pi, add an appropriate amount of water, boil and take the juice, add a little sugar to drink as tea, finish it in one day. This recipe has the effects of nourishing the lung and reducing urine, smoothing the qi and opening the chest, and has a good effect on elderly patients with lung Qi deficiency and cough with urinary incontinence.

    Hetao Yang Yan Porridge: 2 sheep kidneys, 30g of walnut kernel, 100g of glutinous rice. First, wash and cut open the sheep kidney, remove the adrenal glands, cut it into thin slices or small cubes, and put it in a pot with cleaned and selected walnut kernel and glutinous rice. Add an appropriate amount of water, boil over high heat, then simmer over low heat to make a thick porridge. It can be taken as breakfast or divided into two servings in the morning and evening. It is especially suitable for elderly urinary incontinence with kidney Qi instability.

    Gui Yuan Zao Ren Xian Shi Soup: 20g of Gui Yuan meat, 15g of fried Zao Ren, 12g of Xian Shi, add an appropriate amount of water, boil and take the juice, finish it in one day. This recipe has the effects of nourishing blood and calming the mind, benefiting the kidney and solidifying essence, and reducing urine. (

    Bai Guo Walnut Cake: 120g of Bai Guo meat, 120g of walnut kernel, 250g of honey. After selecting and cleaning the Bai Guo meat and walnut kernel, wash them with warm water, beat them into a paste, add honey, and make honey cake. Take 15g twice a day, as a tea snack. It is suitable for elderly urinary incontinence with kidney Qi instability.

    Lian Xu Stewed Fish Bladder: 3g of Lian Xu, 15g of fish bladder. First, fry the fish bladder with soybean oil, then soak it in clean water, put it in a bowl; wrap Lian Xu in a cheesecloth bag and put it in the bowl with fish bladder. Add an appropriate amount of chicken soup or boiling water, steam until the fish bladder is tender. Eat it the same day. It is suitable for elderly urinary incontinence with kidney Qi instability.

    Juhua Ren Stewed Pork Kidneys: 20g of Juhua Ren, 1 pork kidney. First, cut open the pork kidney, remove the adrenal glands, wash it clean, slice it, and put it in a pot with the cleaned and selected Juhua Ren. Add an appropriate amount of water, boil over high heat, add cooking wine, scallions, and ginger juice, then simmer over low heat until the pork kidney slices are tender. Add a little salt and monosodium glutamate, and simmer for a while longer. Eat the kidney slices and drink the soup, and finish it in one serving. It is especially suitable for elderly urinary incontinence with kidney yang deficiency.

    Eucommia ulmoides and Euryale ferox powder: 200g of Eucommia ulmoides, 300g of Euryale ferox. Clean and dry the Eucommia ulmoides and Euryale ferox separately, grind them into fine powder, prevent moisture, and store them. Take 10g twice a day, with a dilute salted warm water. A course of treatment is 2 months. It is suitable for elderly urinary incontinence due to kidney-yang deficiency.

　　Traditional Chinese medicine has certain efficacy in the treatment of overflow incontinence:

　　1. Acupuncture Therapy

　　Acupuncture at acupoints such as Zhongji, Guanyuan, Zusanli, and Sanyinjiao can also improve the tension of the pelvic floor muscles, thereby improving bladder function.

　　2. Traditional Chinese Medicine Treatment - Xuefu Zhuyu Capsule

　　The formula of Xuefu Zhuyu Capsule originated in the Qing Dynasty and is one of the commonly used Chinese patent medicines for treating cardiovascular diseases in the geriatric department of traditional Chinese medicine hospitals. At present, it also has some new uses.

　　Treating benign prostatic hyperplasia: Benign prostatic hyperplasia is a common disease in the elderly, characterized by frequent urination, progressive difficulty in urination, urinary retention, and overflow incontinence. This disease belongs to the category of 'stranguria'. Traditional Chinese medicine believes that the cause of the disease is complex, but most long-term patients have internal damp-heat, blood stasis, and meridian obstruction, leading to difficulty in urination and difficulty in urination. Take Xuefu Zhuyu Capsule, twice a day, 3-6 capsules each time, and take 10g of fried Wangbuluxing decoction to send it. It can promote blood circulation, remove blood stasis, and relieve fluid retention.

　　3. Traditional Chinese Medicine Diet Therapy

　　Yam Turtle Soup

　　Ingredients: 15g of yam, 10g of wolfberry, one turtle, ginger, and a moderate amount of salt and yellow wine.

　　Preparation: After the turtle is slaughtered and cleaned, it is cooked with yam and wolfberry together, then add ginger, salt, and yellow wine after it is cooked, and season with it.

　　Effect: Nourish the yin and tonify the kidney, invigorate the spleen. Suitable for patients with urinary incontinence due to yin deficiency and weak physique.

　　Mutton and Glutinous Rice Porridge

　　Ingredients: 50g of mutton, 100g of green beans, 200g of glutinous rice, salt, monosodium glutamate, and a moderate amount of pepper.

　　Preparation: Clean the mutton and cut into small pieces, add green beans, glutinous rice, and a sufficient amount of water, bring to a boil with strong fire, then simmer with low fire until tender, add salt, monosodium glutamate, and white pepper to taste.

　　Effect: Tonify the middle-jiao and invigorate the body. It has the effects of preventing and treating urinary incontinence due to deficiency of the middle-jiao.