Incontinence in women after childbirth
Urinary incontinence - one of the most unpleasant consequences of childbirth, which prefer to remain silent. According to official statistics, pathology occurs in 15% of women who gave birth for the first time, and more than 40% in mothers with two and three children. A lot of patients are embarrassed to treat this problem to a doctor, which makes it difficult to access information about pathology and methods of treatment.
A delicate problem: why after childbirth does urinary incontinence occur?
The main cause of urinary incontinence, as well as the frequent urge to empty the bladder is to reduce the elasticity of the pelvic muscles after childbirth. During gestation, the excretory system is under pressure, increasing as the fetus develops. When the child passes through the birth canal, the muscles are compressed, as the uterus tone decreases and the tension that is usual for many months disappears.
During the birth of the baby, the muscles of the pelvis experience the greatest strain over the entire period of gestation. Supporting the fetus and forming a “corridor” for the child’s exit from the mother’s womb, the muscles overload and suffer from circulatory disorders and innervation - connections with the central nervous system, which is why the brain does not receive a signal in time to bladder.
Why does urine not hold after cesarean section? It is erroneously considered that urination disturbance occurs only after natural childbirth. A woman who has undergone a cesarean section is also carrying fetus for 9 months, pressing on the pelvic organs. Of course, the degree of atony of the bladder in this case is less, but requires similar treatment.
The risk of lowering the bladder tone after childbirth is increased if there are the following factors in the history of a woman:
- anatomical anomalies of the development of the pelvic organs,
- lack of estrogen
- frequent infectious diseases of the excretory system,
- spinal injuries and pelvic organs and surgical interventions.
Types of urinary incontinence after birth
Depending on the etiology of involuntary urination, the following types of pathology are distinguished:
- incontinence that occurs at the slightest impact on the pelvic floor muscles - sneezing, coughing and blowing your nose, not to mention sports,
- urge incontinence, when it is impossible to endure a sudden urge to urinate,
- urinary incontinence associated with the action of psychological factors - the sound of a babbling brook, laughter or fear,
- residual urination when urine is leaking after emptying the bladder,
- enuresis - involuntary urination during sleep.
Depending on the amount of urine released during the day, the following degrees of pathology are distinguished:
- light - up to 100 ml, resulting in sports, carrying heavy objects and other significant physical exertion,
- medium - up to 200 ml, in which the leakage is associated with laughter or sneezing,
- severe - more than 200 ml, when urine is leaking even to rest.
Ways to solve urination problems
The main problem of urinary incontinence therapy after the birth of a baby is the lack of awareness of women about how to prevent and eliminate this problem. It is erroneously considered that the violation is a payment for the opportunity to have a child, and this must be accepted. In practice, pathologies of mild and moderate severity are easily treated by conservative means.
When treating urinary incontinence, sedative medications are required. Diazepam, Valium, chamomile, mint and lemon balm extracts help the patient cope with the disease faster. In case of bed-wetting, antidepressants are used - Duloxetine and Imiprapin. Preparations of this group eliminate tension in the muscles of the pelvis, but can lead to addiction, and therefore are prescribed exclusively by a doctor.
Women must prescribe drugs that increase blood flow in the pelvic area and increase the tone of blood vessels (Eskuzan, Ascorutin). With a lack of estrogen, provoking a loss of tissue elasticity, hormone replacement therapy is carried out. Be sure to prescribe vitamins of group B, folic acid.
Physiotherapy is indicated for incontinence after a difficult delivery, for an overly relaxed musculature. To strengthen the muscles of the pelvic floor, resorting to electromagnetic stimulation and electrical stimulation. The task of physiotherapy procedures is to restore the process of impulse transmission, signaling the need to empty the bladder, from the excretory system to the brain.
Exercises for pelvic floor muscles and urination
The easiest way to strengthen the muscles of the pelvis are Kegel exercises. At least 100 times you need to quickly compress and unclench the vaginal muscles. The easier classes are given, the more repetitions should be. In case of a violation, it is necessary during urination to delay the flow of urine for a few seconds and continue the process.
To improve the management of the muscles of the pelvis help exercises with weights. At the initial stage, bars with a weight not exceeding 50g are used. A small weight is placed in the vagina, then you need to walk around the room for 1520 minutes, trying to keep it inside. The exercise is repeated 4 times a day. As the therapeutic effect is achieved, the weight of the weight increases.
Surgical intervention - extreme measure
If conservative treatment did not produce results, the woman was diagnosed with a severe form of the pathology or the disease progresses rapidly, and surgical intervention is necessary. To eliminate urinary incontinence, carry out the following operations:
- Introduction of a formative gel. Effective and least painful way to treat pathology. Characterized by the introduction of the drug in the area of the urethra, thereby forming a synthetic sphincter that holds the urinary channel from leaking. Surgery is performed under local anesthesia. The therapeutic effect will last up to 2 years.
- Sling (loop) operation. The most effective and safe option for surgical treatment. Characterized by the introduction in the region of the urethra, between the urethra and the vaginal wall supporting the loop. Within 2 days the patient is under the supervision of a doctor, after which she can return to normal life.
- Implantation of an artificial sphincter. The installation of a prosthesis instead of a natural valve is carried out mainly under stress incontinence of urine. The device is installed through the labia majora and is activated 1.5 months after surgery. During this time, the artificial sphincter should take root in the tissues, and the patient must adapt to the presence of a foreign body in the pelvis.
- Urethrocytocervicopexy. The most difficult, coupled with the risk of complications and requiring a long-term recovery type of surgery. Provides for "pulling up" ligaments that hold the bladder, urethra and uterus. It is performed by open or laparoscopic method through the abdomen under general anesthesia.
Prevention of urination problems before delivery
At the planning stage of pregnancy, one of the most important activities along with laboratory diagnostics and specialist examinations is the preparation of the pelvic muscles for childbirth and childbirth. Kegel exercises increase the elasticity of muscles, which not only facilitates delivery, but also reduces the likelihood of urinary incontinence after childbirth and speeds up the recovery process.
To prevent the development of atony of the bladder, you need:
- do not tolerate urination,
- give up the habit of crossing your legs while sitting,
- do not wear tight clothes
- do not lift weights over 5 kg,
- control body weight, especially for women with a hereditary predisposition to atony of the bladder,
- adhere to an active lifestyle, including daily walks, exercise or at least morning exercises,
- wear a bandage after the fourth month of pregnancy.
If you delay with the treatment of urinary incontinence after childbirth, surgery will be required. Progressive inflammatory disease of the excretory system reduces the tone of the walls of the bladder. In order to prevent urinary incontinence after childbirth, it is necessary to strictly follow all the examinations prescribed by the doctor, allowing to diagnose inflammation at the initial stage.
Causes of urinary incontinence after birth
The main causes of urinary incontinence after childbirth are:
1. During the nine months of gestation, the ileal-sacral and pubic joints gradually change.
2. Closer to the birth in the blood of a pregnant woman there is a significant amount of the hormone relaxin. It helps to weaken the muscles and ligaments of the pelvic floor, which leads to an increase in bone dynamics.
3. During labor, the pelvic bones expand, protecting the child passing through the birth canal from the possibility of injury. It is the expansion of the pelvic tissue that causes spontaneous urination in women who have given birth.
4. Another cause of urinary incontinence after childbirth is tears due to the birth process. Quite often, obstetricians resort to the method of dissecting the perineum to facilitate the passage of the head of the baby. The result - the resulting pathology.
Symptoms of urinary incontinence after childbirth
Uncontrolled urination, urinary leakage, involuntary urination during physical exertion, frequent urge to urinate, situations when “I sharply wanted, but did not reach it,” the sound of water and overexcitement cause urination. The presence of any of these symptoms indicates a problem in the genitourinary system and requires immediate medical attention.
What to do with urinary incontinence after childbirth
The most common occurrence of urinary incontinence after childbirth is characterized as stressful incontinence. To determine the cause of the pathology and treatment, it is necessary to conduct a comprehensive examination of the woman. This must be done, since the cause of this pathology can also be:
• abnormality in the development of the pelvic organs,
• hormonal disorders,
• weight exceeding the norm
• diseases of the nervous system,
• effects of radiation exposure.
Diagnosis of urinary incontinence after childbirth
If you find any signs of pathology associated with urinary incontinence, it is advisable to urgently make an appointment to see a urologist. The sooner a woman does this, the more effective the treatment will be.
The danger of the disease lies in its gradual development. Ignoring this problem, the woman condemns herself to long-term treatment afterwards. In order to avoid the need for surgery, urgent medical aid is indicated when the first signs of incontinence occur.
First of all, the specialist will conduct a full diagnosis of the patient who applied.
Diagnostic measures include determining the type of pathology and the degree of its manifestation. An integral measure is the evaluation of the functional action of the urinary tract.
The doctor is carefully studying the possibility of incontinence. Speaking with the patient, the urologist examines all the possible factors of the onset of pathology. Therefore, talking to your doctor, you can not miss even the smallest details.
When collecting information on a mandatory basis, possible risks are identified:
• complicated childbirth (multiple or single),
• the presence of a hormonal imbalance in a woman’s body,
• available surgical interventions,
• various neurological diseases.
The doctor - urologist can ask not too "convenient" questions related to the purely personal life of a woman. Rejecting the constraint, it is required to give frank answers to them.
Reliable information of the patient - a guarantee of accuracy of the diagnosis.
Physical and laboratory examination
Medical examination of women with urinary incontinence pathology includes three stages.
The initial stage is a gynecological examination. We study the structure of the female reproductive system, check the location of the genital organs (omission or prolapse). It is mandatory to take smears for research:
According to the results of the analyzes made, it becomes clear about the presence (absence) of inflammatory and infectious processes in the patient's urogenital system.
Also, examination using a gynecological chair makes it possible to determine the tumor in the pelvic area. The neoplasm compresses the bladder, thereby causing incontinence.
The bladder neck is examined, its mobility is assessed. To perform the study, samples are carried out - cough and Valsalva.
We study the skin in the perineum and the mucous membrane of the vagina.
A prerequisite is the delivery of urine tests - clinical analysis and seeding of urine for flora.
The patient is encouraged to keep a diary of urination for a couple of days. In it, she points out:
• the amount of fluid consumed during the day,
• one-time amount of urine excreted,
• the number of trips to the toilet for urination during the day,
• the amount of urinary incontinence for the investigated period of time,
• quantitative use of gaskets, the degree of physical activity.
Further, after two days, the patient gives the observation diary to the attending physician. Based on the records made, the urologist receives sufficiently complete information about the existing pathology.
The next stage is instrumental research.
The patient is scheduled for transvaginal ultrasonography. The implementation of this study makes it possible to correctly diagnose the location of the urethrovesical segment and determine sphincter insufficiency. Localization of the bottom of the bladder is diagnosed by scanning the perineum, measuring the length and diameter of the urethra. Estimated bladder neck, urethra.
The use of three-dimensional ultrasound examination helps to explore the inner surface of the mucous membrane and neck of the bladder.
When diagnosing stress urinary incontinence using a two-dimensional scan, the result is an ultrasound symptom complex. During the Valsalva test, mobility of the urethrovesical segment is observed. At the same time, the anatomical length of the urethra is reduced, and in the middle section and proximal it is expanded.
The final stage - urodynamic research in the complex
It is assigned in cases of observation of signs:
• urge incontinence,
• cases of assumptions of the combined nature of the pathology,
• the ineffectiveness of the applied therapeutic treatment,
• inconsistency between the symptoms of pathology and the obtained final examination results,
• urination pathology as a result of past surgeries,
• various neuropsychiatric disorders,
• incessant pathology after the application of surgery.
Comprehensive urodynamic research is the most effective way to diagnose diseases of urinary incontinence in women after labor. This is an opportunity to make an accurate diagnosis and apply a competent therapeutic appointment to patients with overactive bladder, without resorting to surgery.
The complex urodynamic study includes:
1. Uroflowmetry - verification electronic test for urinary dysfunction. It is performed using a measuring device in which the patient urinates.
2. Cystometry - fixing the ratio of the volume of the bladder and the pressure force in it during its filling. In addition, the method allows monitoring by the receptors of the nervous system for urination.
3. The state of the function of urine retention based on the analysis of the profile of urethral pressure.
4. Cystoscopy - the way to eliminate inflammatory and neoplastic lesions of the bladder.
Differential diagnosis of different types of urinary incontinence
Diagnosis is carried out using a special questionnaire P. Abrams, A.J. Wein (1998). This makes it possible to determine the presence of such pathologies of urinary incontinence as stressful and urgent.
The questionnaire identifies eight main symptoms characteristic of these pathologies:
• frequency of urination,
• sudden painful urge to urinate,
• frequency of urination during the night,
• the opportunity to have time to reach the toilet when urging to urinate,
• inability to hold urination when coughing, sneezing, laughing.
A symptom of an increased amount of urination indicates bladder hyperactivity and eliminates the pathology of stress urinary incontinence.
A symptom of unexpected painful urge is also characteristic of an overactive bladder.
The symptom of frequent night urination is common in the overactive bladder, but in rare cases serves as an indication of the symptom of stress urinary incontinence.
Samples that allow you to visually determine the pathology of urinary incontinence
The cough test is performed on a gynecological chair. The bladder of the woman must be filled.The doctor asks the patient to cough several times. If as a result of coughing, urine leakage occurred, the sample gave a positive result. And this indicates the failure of the urethral sphincter.
In the absence of urine leakage during the test for cough, the patient is carried out other tests.
One of these samples is the Valsavy sample. It is also carried out on a gynecological chair with a filled bladder. The patient should be forced to take a deep breath. In the presence of pathology of urinary incontinence, urine excretion will occur during attempts from the urethra.
Stoptest using a tampon - applicator. To perform a vaginal test, a tampon applicator is inserted into the area of the bladder neck. Saline (up to 350 ml.) Fill the bladder and give instructions to highlight the solution. The process of urination is interrupted after two seconds. Conduct a quantitative measurement of the selected fluid. Further, the patient is asked to complete the process of urination. And again conduct a quantitative measurement. This test gives a clear description of the brake reflex mechanisms.
Test using gaskets for one hour. At the initial stage, the initial weight of the gasket used in the dough is fixed. A woman is invited to drink no more than five hundred milliliters of water. Further, she must perform various physical activities for an hour. After the set time, the gasket is weighed. According to the obtained results determine the stage of urinary incontinence.
Specialist specialist consultations
If a woman has problems associated with disorders of the nervous system, an additional examination is scheduled. Most often these are medical consultations of a neurologist, endocrinologist, and psychotherapist. Based on the results, the patient's treatment regimen is compiled.
Treatment of pathologies of urinary incontinence after birth by conservative methods
The most common manifestation of the pathology of urinary incontinence after birth is stress urinary incontinence. More than 40% of women who gave birth face this pathology. There are several training methods to solve this problem.
To achieve the effectiveness of treatment, methods are used to promote the training of the muscles of the pelvic floor and the bladder. To do this, the patient must systematically perform exercises to hold weights with the muscles of the vagina. The weight of weights in the process of training is constantly increasing.
The use of vaginal cones leads to the strengthening of the muscles involved in maintaining the process of urination.
An effective way in the therapeutic process of treatment is Kegel exercise. Their essence lies in the daily tension of the muscles of the vagina and rectum. It is enough just to independently determine the location of the muscles that you need to strain. When urinating need to hold a stream of urine. It is required to remember this feeling. In this way, and it is necessary to strain the muscles.
A sufficient amount of stress - at least two hundred times a day. Exercising helps to normalize the work of the genitourinary system.
The urinary control schedule is developed by a urologist or urologist for each patient individually for a period of two months. It consists in emptying the bladder after a certain amount of time. This means that the patient can empty the bladder only during the period of time agreed with the attending physician. Thanks to this method, the woman learns to keep under control the process of urination.
The use of therapeutic physiotherapy (electromagnet stimulation) in conjunction with
The recommended exercises are a fairly effective method to achieve a positive result in the treatment of urinary incontinence after childbirth.
The treatment is quite long, the term can reach one year. Within two weeks, physiotherapy sessions are held up to four times a year. Exercise can be done daily. After a year of conservative treatment, the achieved result is evaluated.
The use of medications for the treatment of urinary incontinence after birth
Drugs with narrow focus for the treatment of pathology of incontinence does not exist. The exception is the pathology of enuresis. In this case, use drugs targeted action on certain areas of the brain.
For the treatment of pathology of urinary incontinence prescribe drugs anticholinergic series. They can ease the course of pathology. For example, oxybutin is used to treat bladder dysfunction. At the same time, taking these medicines causes side effects. Therefore, treatment with drugs of this series should be under the supervision of a physician.
The most commonly prescribed drugs that affect the nervous system, as a sedative. Also in the appointment of using drugs to improve blood circulation, to strengthen the vascular wall. Mandatory prescribed vitamin course. In cases of hormonal disorders (estrogen deficiency), hormone replacement therapy is used.
Important! During the entire period of treatment must be observed with the attending physician.
Therapeutic treatment of the pathology of urinary incontinence after childbirth is most effective for patients with an easy stage of the disease. In more severe cases, surgery is recommended.
Surgical treatment of urinary incontinence after childbirth
The use of surgical methods of treatment of pathology is an effective tool.
1. Conducting minimally invasive sling (loop) operations. During these operations, the TVT technique is used - the middle third of the urethra is strengthened with a free synthetic loop. In order to design this support, apply synthetic material prolen. This material is not absorbed and retains strength.
The duration of the operation is from thirty to forty five minutes. Local anesthesia is used, general anesthesia is not used. Indications for conducting - in case of any pathology of incontinence. Already on the second day the woman is discharged home. After two weeks, allowed physical exercise.
It is characteristic that relapse after surgery by this method occurs extremely rarely. Although a few years ago, he was up to 30%.
• damage to the bladder,
• damage to the pelvic vessels,
• difficulties in urine outflow, etc.
The main contraindication to the operation is planning a woman's pregnancy.
2. Operational treatment is also applied through the introduction of helium in the area of the urethra, resulting in the formation of the necessary support in the middle of the channel. The operation lasts about thirty minutes, local anesthesia is applied. This surgical intervention is often performed on an outpatient basis, outside the hospital walls.
3. The operative method of urethrocystic cervicopsia is used quite rarely. It is not only technically difficult to perform, but the postoperative recovery period requires a long time.
In the treatment of the pathology of urinary incontinence after birth, the surgical method of treatment is rarely used. In most cases, this method is used to diagnose serious disorders of the bladder.
Pathology of urinary incontinence is treated with the help of folk remedies. Medicinal herbs and individual medicinal herbs assist in the initial stages of the disease. In their application it is necessary to strictly observe the proportions in the preparation of the broth.
Some patients believe that this method of treatment is the only panacea for pathology. They categorically reject medical intervention. As a result, the advanced stage of the disease is the occurrence of infectious diseases of the urinary system as a whole.
How to prevent the occurrence of pathology of urinary incontinence after childbirth
The problem of urinary incontinence after birth will not arise if the necessary preventive measures are applied in time. They are simple and effective. A woman should be careful throughout her life to her health.
Observance of the elementary rules of hygiene and the recommendations of medical professionals are the main points for the prevention of pathologies. Preventive measures include:
1. Gymnastics Skittle - a reliable assistant. Regular training of the pelvic floor and vagina muscles will help not only to avoid the development of the pathology of urinary incontinence, but also make the muscles strong and elastic. Doing exercises is also beneficial for the favorable course of the birth process. Trained vaginal muscles - a guarantee of the absence of tears.
2. It is strictly forbidden to overfill the bladder. "To tolerate" is harmful. This can cause stretching of the muscles and lead to the development of a pathology of incontinence.
3. Exclusion from the use of alcohol, tobacco products. Monitor the quality of food. Do not eat salty, spicy, fatty foods.
4. Control your weight. Increased body weight often leads to problems with incontinence.
5. Regular bowel movements.
6. During the day, take at least one and a half - two liters of liquid.
Studies on the problem of urinary incontinence after birth in women confirm that in most cases this is stress urinary incontinence. That is a psychological problem. Sometimes, this pathology disappears without medical intervention. Such a phenomenon is an exception to the rules.
Unfortunately, many women do not immediately turn to specialists, but try to solve it on their own. This is their worst mistake. The disease process is in disrepair. And this is fraught with the use of the operational method of treating pathology. Therefore, if there is a feeling of discomfort in the vagina or a feeling of failure to empty the bladder after urination, this is a reason to consult a urologist.
Disease of the pelvic organs can lead to the most complicated complications, even serious infectious diseases.
If you experience symptoms of urinary incontinence, it is necessary to urgently consult a urologist or a urologist. In no case can not hope that "maybe pass." This is a pathology and it should be treated. And what methods will be treated, the doctor will tell after a full examination.
Medical science does not stand still, but develops by leaps and bounds. New developments in the treatment of pathology are being introduced. Pharmaceutical companies are doing significant work to help solve the problem of urinary incontinence after delivery. Pharmaceutical scientists are working to obtain drugs that can have a targeted effect on the source of the disease.
Urinary incontinence after birth is a treatable process. Women who are planning a pregnancy, and those who are already waiting for the appearance of the baby, are strongly advised to monitor their health. Do not disregard the process of urination. In order to cope well with the responsibilities of the mother, you should not start the disease. You can not leave "for later" a visit to the doctor, referring to the employment of the baby. The child needs an active healthy mother. Be attentive to your physical condition. With a diagnosis of urinary incontinence follow medical recommendations.
Causes of urinary incontinence after childbirth
The main cause of urinary incontinence after birth is stretching and weakening of the pelvic floor muscles, which provide sufficient support for the uterus throughout pregnancy.
The pelvic floor is a powerful muscle and fascial layer that serves to maintain the internal organs, maintain their normal position, regulate intra-abdominal pressure, and also promotes the expulsion of the fetus during childbirth, forming a birth canal. The stretching of the pelvic floor muscles occurs under the weight of the uterus and the fetus developing in it. Severe labor, large fetus, birth injuries are also causes of weakening of the muscles.
Incontinence after childbirth is determined by the following factors:
- Violation of the innervation of the muscles of the pelvic floor and bladder,
- Violation of the switching function of the urethra and bladder,
- Abnormal mobility of the urethra,
- Instability of the position of the bladder, fluctuations in intravesical pressure.
There are a number of risk factors contributing to the development of urinary incontinence after childbirth:
- Heredity (genetic predisposition to the development of a disorder),
- Features of the anatomical structure of the pelvic organs and pelvic floor muscles,
- Neurological disorders (diseases of the nervous system, multiple sclerosis, Parkinson’s disease, and spinal injuries),
- Surgical intervention during childbirth and birth trauma,
- Large fruit
- Excessive weight gain during pregnancy.
Incontinence after delivery: treatment and prognosis
Treatment of urinary disorders should be handled correctly. Many women ignore the problem and, without going to a doctor, they try to fix the problem on their own or to put up with this pathological condition. In case of incontinence after birth, treatment involves conservative and radical methods.
In case of incontinence, it is not recommended to engage in self-treatment, since this condition requires careful examination to exclude possible inflammations and infectious causes of incontinence.
In case of urinary incontinence after birth, treatment does not involve the use of medical drugs. Drugs are prescribed in cases of complications of urinary incontinence inflammatory process or infection.
Diagnosis of urinary incontinence is made by the following methods:
- Anamnesis (subjective signs of the patient characterizing the violation),
- Examination on the gynecological chair,
- Cystoscopy (endoscopic examination of the bladder),
- Carrying out laboratory tests
- Comprehensive urodynamic study (cystometry, profilometry, uroflowmetry).
Conservative methods of treating urinary incontinence after childbirth are performing physical exercises to strengthen the muscles of the pelvic floor and the so-called step-free therapy, which involves training the muscles by holding certain weights of increasing weight.
The criterion for evaluating the effectiveness of conservative methods is the complete disappearance of episodes of involuntary urination. On average, the normalization of urination takes up to 1 year.
With the ineffectiveness of conservative methods of treatment of urinary incontinence after birth, surgical methods for correcting the problem are used. Currently, minimally invasive surgical techniques are practiced.
The main methods of surgical correction are:
- Urethrocytocervicopexia is a complete surgical intervention for fixing the bladder, urethra and uterus. This method is used extremely rarely with a significant disruption of the structure of the pelvic muscles,
- The introduction of the gel in the paraurethral space - manipulation is carried out both in a hospital and on an outpatient basis. With this method of incontinence correction, the risk of recurrence remains high,
- Sling loopback surgical correction - placement under the middle part of the urethra synthetic loop, providing additional support.
The content of the article
- Incontinence after birth: causes, symptoms, treatment
- Why there is urinary incontinence during pregnancy
- How to treat enuresis in an adult
Urinary incontinence: symptoms
Pathological urinary incontinence is characterized by involuntary release of urine during any physical activity, even insignificant. The same effect produces coughing and sneezing.
Uncontrolled urination can occur in a quiet position, for example, sitting or lying, as well as during sexual intercourse. In this case, the symptoms are accompanied by a sensation of a foreign object in the vagina, and the feeling of complete freedom of the bladder never occurs.
It is especially difficult to control urine excretion after alcohol intake. The volume of this discharge can vary from a few small drops to a continuous flow throughout the day.
Incontinence after delivery: causes
Urinary incontinence is a problem familiar to many women who have given birth. It appears due to dysfunction of the pelvic floor muscles and the anatomical relationships between the organs. During childbirth, the pelvic floor muscles are compressed, the blood circulation is hampered and the supply of organs and tissues with nerves worsens.
Increase the risk of urinary incontinence traumatic childbirth, large fetus, abundant water, fertility. The risk of this problem in women who give birth a second time is 40%.
What is urinary incontinence
Under the incontinence understand the pathological condition, manifested involuntary, uncontrolled excretion of urine. The volume of discharge may vary from a few drops once a day to a constant flow throughout the day.
In women who have given birth, stress incontinence is usually observed. В этом случае непроизвольное мочеиспускание может происходить при любом напряжении мышц живота: при физической нагрузке (наклоне, резком приседании), при смехе, кашле, чихании или половом контакте. При тяжелой форме патологии непроизвольное мочеиспускание может происходить при изменении положении тела и даже во время сна.
Spontaneous urination is most often associated with dysfunction of the pelvic floor muscles. During the carrying of the child, the muscles that support the developing fetus and form the birth canal have a significant load. They stretch, become less elastic, resilient and not able to fully perform their functions.
Urinary incontinence may develop after long and difficult labor, accompanied by ruptures of the perineum or pelvic muscles. At risk are also re-giving birth to women.
Symptoms of pathology
One can speak about urinary incontinence if there is an uncontrolled excretion of urine in any volume during sneezing, laughing, or during a change in body position.
Also, a woman may complain of a feeling of fullness of the bladder after it is emptied or a feeling of the presence of a foreign body in the vagina.
Urinary incontinence: concept
This disease is characterized by spontaneous release of urine. Currently, pathology is not uncommon, most often it is found in the postpartum period and in women over 40 years of age.
The disease does not pose a serious threat to health, but significantly reduces the degree of quality of life and adversely affects the psycho-emotional state. Many women believe that urinary incontinence after childbirth is normal. Contrary to popular belief, it definitely needs to be treated.
It is important to understand that isolated cases of urinary incontinence in women after childbirth do not always indicate pathology. One-time episodes can occur in a completely healthy person.
The basis for the diagnosis are the following symptoms:
- Involuntary discharge of urine occurs regularly, including at night. It is impossible to control.
- The volume of urine flow is usually substantial.
- Episodes of incontinence occur during sports, sexual intercourse, being in a state of stress.
- After bladder emptying, residual discharge continues to flow.
- Frequent and sudden urges.
Nevertheless, even if the involuntary discharge of urine is not regular, it is necessary to consult a doctor in order to confirm or exclude the presence of an inflammatory process in the body.
Which doctor to contact?
At occurrence of the first alarming symptoms, it is necessary to make an appointment with a urologist. He will find out the causes of urinary incontinence after childbirth, and treatment will appoint the most effective.
It is important to understand: the disease is dangerous because it develops gradually. The sooner a specialist is approached, the less time it will take for the treatment period, as well as the probability that the surgical intervention will be avoided will increase many times over.
Incontinence of urine after childbirth in women is a pathology, to get rid of which medications are prescribed extremely rarely. The exception is when the patient is diagnosed with enuresis. To reduce the severity of symptoms, vitamins and drugs are indicated, which have a positive effect on the state of the blood vessels, the blood circulation process and the nervous system.
The main conservative treatment of urinary incontinence after childbirth:
- Strengthening the muscles of the organ itself and the pelvic floor. The doctor may recommend exercises with weights and vaginal cones. The retention of foreign objects contributes to the gradual strengthening of the vaginal muscles and those involved in urination. A good effect is achieved with regular Kegel exercises. They are also based on muscle training. To understand which ones and how you need to strain, it is necessary in the process of urination to stop the jet and remember these sensations. Thus, you need to constantly strain the muscles of the rectum and vagina. To achieve the best result, you must perform at least 200 repetitions per day.
- The implementation of acts of urination on schedule. Its essence lies in the fact that the patient must empty the bladder at a time fixed by the doctor. This method helps to improve the work of the bladder and the emergence of control over the situation. For each woman, the schedule is developed individually. He needs to follow at least 2 months.
- Physiotherapy. As a rule, treatment with electromagnetic waves is prescribed. In combination with the exercises, this method brings the best results.
Upon completion of the course of treatment, the doctor assesses the changes. If they are insignificant or absent altogether, operative intervention is prescribed.
Duration of treatment
Incontinence after childbirth is a complication that requires an individual approach. As a rule, the process of getting rid of the pathology is rather long. The patient should perform exercises regularly throughout the year. During this time, she needs to undergo 4 courses of physiotherapy. After 1 year, the doctor assesses the patient's condition. If the illness has not retreated, the woman goes to the hospital with a referral for surgery.
In practice, there are several methods of getting rid of the pathology. As a rule, the operation takes from 30 to 45 minutes. It is performed under local anesthesia. On the second day, the woman is discharged from the hospital, but if her daily activities are associated with intense physical exertion, the patient can start her work no earlier than 2 weeks after the operation.
Possible complications include: damage to the walls of the bladder, blood vessels, intestines. Appeal to a highly qualified doctor reduces the likelihood of these risks to a minimum.
If not treated?
Urinary incontinence after labor is a complication that is not dangerous at the initial stage. But it significantly impairs the quality of life and the emotional state of each woman. Ignoring this problem leads not only to its progression, but also to the occurrence of inflammatory processes in the organs of the urogenital system.
In most cases, it is favorable. The vast majority of women forget about the problem of urinary incontinence after childbirth. Very rarely, conservative treatment methods do not bring the desired result, surgery is prescribed only in isolated cases. But even after the event, the probability of relapse is minimal.
In order to prevent the occurrence of complications, it is necessary to follow simple recommendations throughout one's lifetime:
- regularly train your pelvic floor and vagina muscles,
- do not tolerate if the bladder is full,
- eat a balanced diet, do not abuse alcoholic beverages, do not smoke,
- keep under control body weight
- regularly empty the bowels,
- observe drinking regime.
Careful attention to your health significantly reduces the risk of pathology.
One third of women face urinary incontinence after childbirth. What to do? First of all - make an appointment with a urologist. Ignoring the problem can lead to serious illnesses. According to the results of diagnosis, an individual treatment regimen will be made. In most cases, it is enough to perform special exercises and go to physiotherapy. With the ineffectiveness of these methods, surgical intervention is indicated.