Menopausal urinary incontinence

　　1. Causes of Disease

　　1. The characteristics of elderly female bladder and urethra are that the bladder function changes with age. The bladder capacity of elderly women decreases, the residual urine volume increases, and uncontrollable contractions occur. Alroms and Torrens conducted urinary tests on women around 50 years old, with a urine flow rate of 75ml/s, and those over 50 years old have a urine flow rate greater than 18ml/s. If the urine output per second is less than 15ml, it indicates the presence of urethral obstruction. Parviren conducted a bladder造影 study on 59 elderly women and found that many patients had trabecular diverticula and funnel-like prolapses, which were unrelated to urinary tract infections. After menopause, due to the decrease in estrogen levels, the vaginal and urethral mucosal epithelium becomes thin, the dense elastic fiber tissue around the bladder neck, and the glands and ducts surrounding the urethra and bladder neck become thin. Studies have confirmed that estrogen receptors exist on the cell membranes or nuclei of bladder trigone, bladder mucosa, and urethral mucosa cells in women, and the concentration of receptors in the urethra is significantly higher than that in the bladder. Therefore, post-menopausal women are prone to urinary incontinence. Studies have shown that estrogen replacement therapy for post-menopausal women can reduce nocturia, indirectly confirming that estrogen deficiency can reduce bladder stability. Animal studies have shown that hormone withdrawal can affect the density of receptors in the bladder and urethra and their sensitivity to hormones, and restoring normal estrogen levels can reverse these effects, increasing the number of receptors and their response to muscarinic and adrenergic agents. Moreover, the decrease in estrogen levels will promote the decrease in the responsiveness of smooth muscle to neural stimulation.

　　2. At the histological level, anatomical and ultrastructural research has found that the smooth muscle and striated muscle of the urinary tract in elderly women have obvious degenerative changes. In elderly women without obvious urogenital system lesions, abnormal changes may also be observed, which is the reason why elderly women are prone to functional disorders of the urogenital system.

　　3. The fibrosis of the bladder muscle in elderly women is the earliest confirmed cause of dysuria. The collagen fibers and elastic proteins in the bladder of elderly women have increased, and Levy and Wight focused on the submucosal layer accounting for 25% of the bladder wall thickness. They studied the bladder biopsy tissue under light and electron microscopes and found urinary dysfunction, mostly due to the separation and disarray of collagen, and almost no collagen tissue was found in patients with urgency. Elbadawi examined the bladder tissue, combined with urinary dynamics research, and the ultrastructure obtained confirmed that the histological changes were consistent with the clinical manifestations, with muscle cell and axon degeneration leading to a decrease in contractility, and the characteristic of urinary dysfunction is the instability of bladder detrusor function related to the dysfunction pattern and changes in ultrastructural muscle structure.

　　4. In recent years, the changes in the striated sphincter of the elderly bladder have accelerated cell apoptosis and programmed cell death, which are related to the reduction of muscle cells and may be a possible cause of urinary incontinence in elderly women.

　　5. The maintenance of urination in women relies not only on the urinary tract muscle tissue but also on the support of the pelvic floor. The pelvic floor muscles related to the female urinary tract are generally similar to those in men, with the urogenital diaphragm much thinner than in men. In addition to the urethra passing through it, the vagina also passes through the urogenital diaphragm. The free margin below the urogenital diaphragm has the superficial transverse perineal muscle, which originates from the ischial tuberosity and terminates at the central tendon. The ischiocavernosus muscle originates from the ischial tuberosity and terminates at the clitoris. The bulbocavernosus muscle originates from the central tendon, separates on either side of the vagina, passes through the vaginal orifice and urethra, and terminates at the clitoris. The pubococcygeus muscle originates from the lateral wall of the urethra and vagina, these muscles have a supporting effect on the pelvic floor and also play a role in suspending the urethra. The damage to these muscles can shorten the length of the urethra, reduce urethral resistance, and this is one of the reasons for stress urinary incontinence in elderly women.

　　6. Causes of stress urinary incontinence:

　　(1) Pregnancy and vaginal delivery are the main causes of stress urinary incontinence. During the process of pregnancy and delivery, excessive compression of the pelvic floor muscles by the presenting part of the fetus, the use of vacuum extraction and breech delivery by vaginal surgery, and increased abdominal pressure after delivery can all cause relaxation of the pelvic floor tissues. The multivariate regression analysis of a case-control study group by Van found that stress urinary incontinence is not related to the second stage of labor of the first child, but is significantly related to the use of forceps (Van, 2001). Persson found that the occurrence of stress urinary incontinence is significantly related to the age of first delivery, the number of deliveries, the birth weight of the fetus, and perineal anesthesia.

　　(2) Urethra and vagina surgery The repair of the anterior and posterior walls of the vagina, radical hysterectomy for cervical cancer, resection of urethral diverticula, and other surgeries can destroy the normal anatomical support of the urethra and bladder.

　　(3) Dysfunction Congenital insufficient support of bladder and urethra surrounding tissues or incomplete neural支配, is the pathogenic cause of young women and nulliparous women. Postmenopausal women due to the decrease of estrogen, while causing the submucosal veins of the urethra and bladder triangle to become thinner, blood supply is reduced and mucosal epithelium degenerates, the superficial epithelial tissue of the urethra and bladder becomes loose, the urethra and surrounding pelvic floor muscles atrophy, and thus urinary incontinence. Salinas also found that although the menopausal state is related to the occurrence of stress urinary incontinence, the risk of occurrence does not increase with age, and the risk of stress urinary incontinence after 52 years old disappears. The onset before menopause is often due to malnutrition, physical weakness, leading to atrophy of the muscle and fascia of the urethra and bladder neck, and urinary incontinence.

　　(4) Pelvic mass When there is a large mass in the pelvic cavity, such as uterine fibroids, ovarian cysts, it can increase abdominal pressure, lower the position of the bladder and urethra junction, and cause urinary incontinence.

　　(5) Body weight Many literature reports indicate that the occurrence of stress urinary incontinence is related to the increase of the patient's body mass index (BWI).

　　(6) The symptoms of stress urinary incontinence in the second half of the menstrual period are more obvious in patients with cyclic stress urinary incontinence, which may be related to the relaxation of the urethra caused by progesterone.

　　2. Pathogenesis

　　1. General pathogenesis

　　(1) Characteristics of the female pelvis: The anterior part of the female pelvic outlet is wide, and the pelvic floor muscles are relatively flat, unlike males, which are not inclined. Therefore, the support for the organs in the anterior pelvis and the support are weaker than males, and the external urethral sphincter is not as strong as males. When these supporting tissues are damaged, the bladder bottom can droop, causing the upper urethra to descend into the peritoneal cavity. Therefore, stress urinary incontinence is more common in elderly women.

　　(2) Decreased urethral resistance: The urethra can prevent the outward flow of urine, which is related to the length and tension of the urethra. If the urethra is shorter than 3 cm, it cannot prevent the outward flow of urine. The higher the tension of the urethral wall, the greater the urethral resistance. The length of the urethra is proportional to the tension of the urethral wall and inversely proportional to the diameter of the urethral lumen. The Laplace law can express P = T/r (P - urethral wall tension, T - urethral length, r - urethral diameter).

　　(3) Under normal circumstances, due to the contraction of the anal muscle, the external urethral sphincter, and the pelvic floor muscles, the urethra elongates, the lumen becomes finer, and the tension increases significantly, preventing the urine in the bladder from flowing out due to increased pressure because the urethra has a certain length and tension. The urine can reach the proximal 1/3 of the urethra at most under the influence of abdominal pressure and then returns to the bladder. Urinary incontinence occurs due to dysfunction of the sphincter system, damage to the above muscles, or decreased tension of the smooth muscle. The muscle contraction force is not enough to elongate the urethra. When abdominal pressure increases, the urethral resistance is insufficient, that is, the urethral pressure is less than the bladder pressure. As a result, the urine does not flow back into the bladder as normally after entering the urethra, and thus it is involuntarily discharged.

　　(3) Dysfunction of the surrounding supporting tissues of the urethra: Under normal circumstances, the bladder urethra junction during the storage phase is above the middle third of the pubic symphysis, the posterior angle of the bladder urethra is 90° to 100°, and the anterior tilt angle of the urethra is 30° to 45°. The position and angle change little with changes in body position and increased abdominal pressure, making the bladder neck and the proximal urethra become intra-abdominal organs. When abdominal pressure increases and bladder pressure increases, this part of the urethra also receives the same pressure effect, known as the pressure transmission effect. It makes the bladder neck and urethra flat instead of funnel-shaped, and the surrounding supporting tissues of the female urethra play a very important role in urine control. The relaxed and prolapsed pelvic floor and urogenital diaphragm are not conducive to the function of the external urethral sphincter. During stress urinary incontinence, the posterior angle of the bladder urethra disappears, and the tilt angle of the urethra increases. Congenital pelvic floor weakness, multiple childbirth, insufficient estrogen, hysterectomy, pelvic surgery, and trauma can all weaken the surrounding supporting tissues of the urethra and be replaced by fat and other connective tissues. The result is:

　　① The bladder neck and urethra descend, and the proximal urethra shortens.

　　② Relaxation of the bladder neck and the proximal urethra.

　　③ When abdominal pressure increases, the closing force of the bladder neck and the proximal urethra is insufficient, and the bladder and the proximal urethra are opened due to the sudden increase in bladder pressure.

　　④ Decreased closing ability of the external urethral sphincter, if the bladder pressure is sufficient to overcome the pressure of the insufficiently closed urethral segment of the external urethral sphincter, stress urinary incontinence will occur.

　　(4) Atrophy of urethral mucosa: The soft and皱褶的urethral mucosa can seal the urethral space left after the contraction of the sphincter, preventing urinary incontinence. The urethral mucosal pad plays a relatively important role in female urine control. Before the age of 45, the urethral mucosa and its submucosal tissues and blood vessels are rich, and with the decrease in estrogen levels, the above tissues atrophy, the sealing effect of the urethral mucosal pad decreases, and urinary incontinence is more likely to occur.

　　2. Pathogenesis of Stress Urinary Incontinence Stress urinary incontinence is classified into high mobility of the bladder neck type and urethral sphincter dysfunction type. The former accounts for more than 90%, and the latter for less than 10%. The pathogenesis of stress urinary incontinence is not yet clear. No hypothesis has been widely accepted, but possible mechanisms include the following:

　　(1) Decreased urethral resistance: To maintain an effective urinary control mechanism, two factors are required: complete urethral internal structure and sufficient anatomical support. The integrity of the urethral internal structure depends on the resistance produced by the combination of the urethral mucosa and the urethral closure pressure. The combination of the urethral mucosa is formed by mucosal folds, surface tension of secretions, and submucosal venous plexus, and the combination can prevent leakage. The urethral closure pressure comes from the tension of the submucosal blood vessels and muscles. An increased urethral closure pressure results in greater resistance and can control urination. The relaxation and injury of the pelvic floor tissues lead to reduced urethral resistance. Some studies have found that the nerve-muscle conduction disorder cannot reflexively cause an increase in urethral pressure when the intra-abdominal pressure increases. This type of stress urinary incontinence is characterized by urethral sphincter dysfunction.

　　(2) The pressure relationship between the urethra and bladder: In those with good urinary control mechanisms, the pressure of the proximal urethra is equal to or higher than the intravesical pressure. When the intra-abdominal pressure increases, due to the average transmission of intra-abdominal pressure to the bladder and 2/3 of the proximal urethra (located in the abdominal cavity), the urethral pressure is still maintained equal to or higher than the intravesical pressure, so urinary incontinence does not occur. Conversely, due to the relaxation of the pelvic floor in patients with stress urinary incontinence, 2/3 of the proximal urethra moves outside the abdominal cavity, at rest the urethral pressure is reduced (still higher than the intravesical pressure), but when the intra-abdominal pressure increases, the pressure can only be transmitted to the bladder and cannot be transmitted to the urethra, so the urethral resistance is not enough to resist the pressure of the bladder, leading to urinary leakage. This explains the pathogenesis of the high mobility of the bladder neck in stress urinary incontinence.

　　(3) The anatomical relationship between the urethra and bladder: The posterior angle of the normal urethra with the bladder bottom should be 90° to 100°, the axis of the upper urethra is perpendicular to the vertical line of standing, and the urethral inclination angle is about 30°. In patients with stress urinary incontinence, due to the relaxation of the pelvic floor tissues, the bladder bottom moves downward and backward, gradually making the posterior angle of the urethra and bladder disappear and the urethra shorten. This change is like the initial stage of urination, once the intra-abdominal pressure increases, it can induce involuntary urination. In addition to the disappearance of the posterior angle of the urethra and bladder, the urethral axis also rotates, making it increase from the normal 30° to more than 90°, as shown in Figure 1. This also explains the pathogenesis of the high mobility of the bladder neck in stress urinary incontinence from one side.

　　(4) Petros elaborated on the pathogenesis of stress urinary incontinence from the hypothesis of the normal urethra and bladder neck closure mechanism: The closure of the urethra is caused by the contraction of the anterior part of the pubococcygeus muscle to form what is called a ' hammock '. The formation of the ' hammock ' is transmitted by the posterior part of the vagina behind the pubourethral ligament. The closure of the bladder neck, known as 'knotting', is mediated by the posterior part of the vagina behind the pubourethra, and is completed by the common contraction of the 'lifting support structure'. The 'lifting support structure' refers to the transverse muscles of the rectum and the longitudinal muscles around the anus. The measurement of the vaginal fornix muscle electrogram confirmed this hypothesis. In women without urinary incontinence, the contraction of the 'lifting support structure' makes the vagina reach the X point, the contraction of the pubococcygeus muscle pulls the vagina forward to form a ' hammock ' and close the urethral cavity. If there is vaginal wall relaxation, the contraction of the pubococcygeus muscle exceeds the fixed distance and cannot reach the transition point Ⅺ, then the urethra cannot be closed and urinary incontinence occurs.

　　Since the patient has gone through menopause, the endocrine system is usually disordered, which can lead to the symptoms of menopausal syndrome, such as headache, nausea, irritability, insomnia, and so on. Due to the reduction in secretion of the Bartholin's glands, sexual life may show symptoms such as vaginal dryness and pain. Infections of the urinary system and perineal skin may also occur. Urinary pain and hematuria are rare. Stress urinary incontinence often occurs with cystocele.

　　Unintentional urination under increased abdominal pressure is the most typical symptom, while urgency, frequency, urgent urinary incontinence, and a feeling of fullness after urination are also common symptoms. Over the years, in order to standardize the diagnosis and classification and guide the formulation of treatment plans, various clinical classification systems for urinary incontinence have been formed. According to the pathogenesis of urinary incontinence, clinical classification is as follows:

　　1. Urinary incontinence related to bladder

　　It includes reduced bladder capacity, unstable bladder, detrusor reflex hyperactivity, low compliance bladder, incomplete bladder emptying, and various combinations of the above.

　　2. Urinary incontinence related to urethral sphincter

　　It is caused by the inability of the internal urethral sphincter and/or the external urethral sphincter to function normally, which can be due to damage to sphincter contraction, incomplete function of the surrounding support tissue of the urethra, frozen urethra, and various combinations of the aforementioned abnormalities.

　　3. Urinary incontinence related to both bladder and urethra

　　It is a different combination of the aforementioned bladder and urethral lesions. According to the standardized nomenclature definitions formulated by the International Continence Society meeting, the classification of urinary incontinence is:

　　1. Stress urinary incontinence (SUI): Urine leakage occurs under circumstances where abdominal pressure increases, such as coughing, sneezing, laughing, or carrying heavy loads, and is often not accompanied by the sensation of needing to urinate. However, within a few seconds, even 10 to 20 seconds, 10 to 20 ml of urine is involuntarily expelled. Urinary incontinence is realized only after urine wets the clothing. Female patients often have a slow onset and a history of childbirth, pelvic and gynecological surgery. With the increase of age, the degree of urinary incontinence worsens. Its occurrence is due to anatomical abnormalities such as excessive urethral peristalsis, pelvic floor prolapse, defects in the internal sphincter, or incomplete function of the urethral support tissue, and atrophy of the urethral mucosa. About 80% of patients with stress urinary incontinence have cystocele, but about half of the patients with cystocele also have stress urinary incontinence.

　　3. Urgency urinary incontinence: Also known as

　　4. Overflow urinary incontinence: Also known as overflow incontinence or pseudo-incontinence, spontaneous overflow of urine occurs when the bladder is overfilled. This condition is not common in postmenopausal women and is usually caused by urinary retention due to lower urinary tract obstruction or detrusor weakness paralysis, leading to overfilling of the bladder, neurogenic dysfunction, mainly due to undamaged lower motor neurons regulating the bladder, which can be seen in sacral reflex arc lesions such as congenital malformations (congenital spinal bifida); traumatic lesions (sacral or pelvic nerve injury); tumor and inflammatory lesions (diabetic peripheral neuropathy), elderly urinary incontinence is an 'active' urinary incontinence caused by unexplained bladder distension or bladder contraction, which may be the result of weakened inhibitory function in the brain.

　　5. Complete urinary incontinence (true urinary incontinence due to urethral sphincter defect): Often due to congenital incomplete or missing development of the urethral sphincter, such as urethral cleft, bladder exstrophy, trauma, birth injury, iatrogenic urethral sphincter injury, or occasionally complete urinary incontinence may also be manifested due to severe sphincter function defect.

　　6. Reflex urinary incontinence (neurogenic urinary incontinence, also known as active true urinary incontinence): Urinary incontinence caused by detrusor reflex hyperactivity due to nerve lesions, in addition to varying degrees of detrusor reflex hyperactivity, there is also low compliance of the bladder, the bladder leakage pressure measurement pressure is all > 40cmH2O column, and the relative bladder capacity is relatively small.

　　1. The incidence of urinary incontinence in postmenopausal women is very high. Data shows that up to 55% of the elderly have urinary incontinence, about 40% of postmenopausal women have urinary incontinence, about 50% of women have occasional urinary incontinence, 10% of women have frequent urinary incontinence, and the incidence of urinary incontinence increases with the increase in the number of deliveries and age. About 20% of women over 75 have urinary incontinence every day. The incidence of female urinary incontinence is twice that of males. A survey on urinary incontinence in Sweden showed that 6% of the population sought medical attention due to urinary incontinence. The incidence of stress urinary incontinence (tension urinary incontinence) varies among different reports. Samulsson's epidemiological survey results in 2000 show that the incidence rate of postmenopausal women is 17.1%.

　　2. Prognosis: Urinary incontinence not only affects the physical and mental health of patients, but also has a significant impact on families and society. With the aging of the population and the improvement of medical level, people's requirements for the quality of life have also increased accordingly. Stress urinary incontinence is a disease that can be cured. Surgery is considered to be the standard treatment for stress urinary incontinence. Successful surgery for patients strictly selected can reach 80% to 90% correction rate. If there is improvement after medication or the possibility of standard surgery is not high, the modified surgery will achieve a higher success rate.

　　The size of the posterior urethral angle and the degree of urethral prolapse can be measured by a simple cotton swab method:

　　I. Method

　　1. Urethra without anatomical defects: the cotton swab maintains the original horizontal level of -5° to +10°.

　　2. If the posterior angle of the urethra-bladder has disappeared, but the posterior urethra has not moved downward, the free end of the cotton swab can still maintain the original level or slightly upward, but not more than 10°.

　　3. If the urethral supporting tissue has been severely weakened, the posterior urethra is significantly prolapsed, indicating that the urethra has moved away from the pubic symphysis, then the free end of the cotton swab will rise significantly, forming an angle of 45° or more with the horizontal line.

　　II. Urethral pressure measurement

　　Urethral pressure profile can often prove that the urethral sphincter function of patients with stress urinary incontinence is weakened in a resting state, and the urethral pressure profile can clearly determine whether it is an internal sphincter obstruction type of stress urinary incontinence.

　　III. Urodynamics testing

　　1. Urinary flow rate measurement: It is a non-invasive, easy, and inexpensive examination method. The patient urinates on the urinary flow rate meter at the maximum bladder capacity to understand the maximum urinary flow rate, average urinary flow rate, urination time, and urine volume.

　　2. The clinical significance of this test includes:

　　(1) If the bladder capacity is 800ml, do not perform stress urinary incontinence surgery.

　　(2) Decreased urinary flow rate, longer urination, indicating the possibility of postoperative urinary retention.

　　(3) Bladder pressure measurement: after urine flow measurement, residual urine measurement is first performed. Under sterile conditions, a catheter is inserted into the bladder to the bladder neck level from the urethral orifice, used to measure bladder pressure. At the same time, a rectal catheter is inserted from the anus to measure abdominal pressure. Room temperature normal saline is infused into the bladder through the bladder catheter at a flow rate of 10-100ml/s, and the bladder volume at the first sense of urination is recorded. At the same time, the patient is asked to cough and listen to the sound of water, and observe for any leakage. At the maximum sense of urination, record the bladder volume at this time and observe the leakage during coughing and listening to the sound of water.

　　(4) Normal results of bladder pressure measurement: residual urine 400ml; bladder intrapressure increases with water injection and does not return to baseline when water injection stops; there is no detrusor muscle stable contraction, and the diagnosis of stress urinary incontinence is the absence of stable contraction of the detrusor muscle with increased abdominal pressure, resulting in leakage.

　　IV. Cystourethroscopy

　　It can directly observe the bladder, urethra, diverticulum, urethral fistula, tumor, calculus, inflammation, measure residual urine, observe the position and variation of the urethral orifice, bladder neck shape, understand the length of the urethra, tension, and exclude bladder mucosal lesions.

　　I. Dietary therapy for menopausal urinary incontinence

　　1. Yam turtle soup:15 grams of yam, 10 grams of Chinese wolfberry, one turtle, an appropriate amount of ginger, salt, and yellow wine. After the turtle is slaughtered and cleaned, it is cooked with yam and Chinese wolfberry. After cooking, add ginger, salt, and yellow wine to taste. Benefits: nourish Yin and补肾, benefit Qi and strengthen the spleen. Suitable for patients with urinary incontinence due to Yin deficiency and weak physique.

　　2. Lamb and glutinous rice porridge:500 grams of lamb, 100 grams of green beans, 200 grams of glutinous rice, and an appropriate amount of salt, monosodium glutamate, and pepper. Wash the lamb and cut it into small pieces, then add green beans, glutinous rice, and a sufficient amount of water. Boil with strong heat and then simmer with low heat until tender. Add salt, monosodium glutamate, and pepper to taste. Benefits: tonify the middle-jiao and Qi, prevent and treat urinary incontinence due to middle-jiao Qi deficiency.

　　3. Astragalus and black chicken soup:50g of astragalus, one whole black chicken, scallions, ginger, wine, and salt in appropriate amounts. Season with scallions and salt after boiling the ingredients. Effect: Tonify the spleen and kidneys, suitable for patients with incontinence due to long-term illness and physical weakness. Adding glutinous rice makes it Astragalus and black chicken porridge, with the same effect. Experimental research has proven that astragalus has estrogen-like effects and can effectively prevent and reduce urinary incontinence in postmenopausal women due to lack of estrogen.

　　4. Astragalus honey drink:30 grams of astragalus and 10 grams of honey. Soak astragalus in boiling water, cool it down, and mix with honey. Effect: Prevent and treat senile weakness, incontinence, and urinary incontinence in elderly women.

　　Second, dietary therapy for senile incontinence

　　1. Lychee meat stewed sheep bladder:30g of lychee meat, 30g of glutinous rice, and 1 sheep bladder. First, clean the sheep bladder to remove the smell of urine, cut into strips; clean the lychee meat, and put it in a pot with the cleaned glutinous rice, add an appropriate amount of water, bring to a boil over high heat, add the sheep bladder strips and cooking wine, and then simmer over low heat until the sheep bladder and glutinous rice are tender and the soup is thick. Take it warm at night. It is especially suitable for elderly people with incontinence due to lung and spleen deficiency and frequent urination at night.

　　2. Astragalus and cocklebur seed porridge:30g of astragalus, 15g of cocklebur seed, and 100g of glutinous rice. First, clean and wash the astragalus and cocklebur seed, cut the astragalus into slices, and chop the cocklebur seed. Put them in a cloth bag, tie the mouth, and put them in a pot with the cleaned glutinous rice, add an appropriate amount of water, bring to a boil over high heat, and then simmer over low heat for 30 minutes. Remove the medicine bag, continue to simmer over low heat until the glutinous rice is soft and cooked. Take it twice a day in the morning and evening. It is suitable for elderly people with incontinence due to lung and spleen deficiency.

　　3. Codonopsis walnut decoction:Take 20g of codonopsis and 15g of walnut meat, add an appropriate amount of water, boil, and take it all in one day. This recipe has the effect of invigorating the qi and consolidating the kidneys, and is effective for elderly people with incontinence due to kidney deficiency.

　　4. Ginseng and yam stewed mutton:10g of white ginseng, 30g of yam, and 200g of mutton. First, clean and dry the white ginseng and yam, cut into slices for later use; clean the mutton, cut into thin slices with a sharp knife, put into a pot, boil over high heat, add scallion, ginger, cooking wine, and add white ginseng and yam slices, then simmer over low heat until the mutton is tender. Add a little salt, monosodium glutamate, and five-spice powder, mix well, and pour in sesame oil. It can be eaten as a dish with meals. It is suitable for elderly people with incontinence due to lung and spleen deficiency and frequent urination at night.

　　5. Codonopsis and su leaf decoction:Take 20 grams of codonopsis, 10 grams of su leaf, and 7 grams of dried tangerine peel, add an appropriate amount of water, boil and strain the juice, add a little sugar and drink as tea. Take it all in one day. This recipe has the effect of strengthening the lungs, reducing urine, smoothing the breath, and opening the chest. It is effective for elderly patients with weak lung qi, cough with incontinence.

　　6. Walnut kidney rice porridge:Two sheep kidneys, 30g of walnuts, and 100g of glutinous rice. First, clean and cut the sheep kidneys, remove the fat, and cut into thin slices or small cubes. Then, mix them with the cleaned walnuts and glutinous rice in a pot, add an appropriate amount of water, bring to a boil over high heat, and then simmer over low heat to make a thick porridge. It can be taken as breakfast once a day or divided into two servings for morning and evening. It is especially suitable for elderly people with incontinence due to kidney deficiency.

　　7, Osseous Fruit and Jujube Seed Soup:Osseous fruit 20 grams, sauteed Jujube seeds 15 grams, Euryale ferox 12 grams, add an appropriate amount of water, boil and take the juice, take it all at once in one day. This recipe has the effects of nourishing blood and calming the mind, benefiting the kidney and consolidating essence, and reducing urine.

　　8, White-berry Walnut Cake:White-berry kernel 120g, walnuts 120g, honey 250g. After picking and cleaning the white-berry kernel and walnuts, wash them with warm water, beat them into a paste, add honey, and make honey cakes. Take 15g twice a day, as a tea snack. Suitable for senile urinary incontinence with kidney Qi instability.

　　9, Lianzi Stewed Fish Bladder:Lianzi 3g, fish bladder 15g. First, fry the fish bladder with soybean oil, then soak it in water, put it in a bowl; wrap Lianzi in a cheesecloth bag and put it in the bowl with fish bladder, add an appropriate amount of chicken soup or boiling water, steam it until the fish bladder is tender, and it is ready. Eat it the same day. Suitable for senile urinary incontinence with kidney Qi instability.

　　10, Semen Ziziphi spinosae Stewed Pork Kidney:Semen Ziziphi spinosae 20g, porcine kidney (porcine kidney) 1. First, cut open the kidney, remove the smell gland, wash it clean, slice it, and add it to the pot with cleaned and selected Semen Ziziphi spinosae. Add an appropriate amount of water, boil it with high heat, add cooking wine, scallion, and ginger, then simmer it over low heat until the kidney slices are tender, add a little salt and monosodium glutamate, and simmer for a while. Eat the kidney slices and drink the soup, take it all at once. Especially suitable for senile urinary incontinence with kidney yang deficiency.

　　11、Eucommia ulmoides and Euryale ferox Powder:Eucommia ulmoides 200g, Euryale ferox 300g. Wash and dry or bake Eucommia ulmoides and Euryale ferox separately, grind them into fine powder, prevent dampness, and reserve them. Take twice a day, 10g each time, with dilute salted warm water. Two months as a course of treatment. Suitable for senile urinary incontinence with kidney yang deficiency.

　　Patients with this disease should pay attention to strengthen their physical fitness, enhance their physique, and can do anal exercises. This exercise method is of great significance in increasing the elasticity and strength of the muscles in the pelvic cavity, and has the potential to reduce the occurrence of urinary incontinence. At the same time, develop good urinary habits, maintain the hygiene of the external genitalia, and avoid infection caused by urinary incontinence. For patients who have been infected, they can clean the vulva locally with potassium permanganate solution. Severe infections should be treated with oral or intravenous antibiotics.