Urinary Incontinence
Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition. There is also a related condition for defecation known as fecal incontinence. Physiology of continence
Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intra-abdominal pressure increas (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the press
ure differential unchanged, resulting in conti-nence. Normal voiding is the result of changes in both of the pressure factors:urethral pressure falls and blad-der pressure ris.
Types of incontinence
Stress incontinence
Stress urinary incontinence (SUI) is esntially due to pelvic floor muscle weakness. It is loss of small amounts of urine with coughing, laughing, sneezing, exercising or other movements that increa intra-abdominal pres-sure and thus increa pressure on the bladder. Physical changes resulting from pregnancy, childbirth, and meno-pau often cau stress incontinence, and in men it is a common problem following a prostatectomy. It is the most common form of incontinence in men and is treatable.
The urethra is supported by fascia of the pelvic floor. If the fascial support is weakened, as it can be in preg-nancy and childbirth, the urethra can move downward at times of incread abdominal pressure, resulting in stress incontinence.
年度经营计划Stress incontinence can worn during the week before the menstrual period. At that time, lowered e
strogen lev-els may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increas following menopau, similarly becau of lowered estrogen levels. Most lab re-sults, such as urine analysis, cystometry and postvoid residual volume; are normal.
Urge incontinence
Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cau of urge incontinence is involuntary and inappropriate detrusor mus-cle contractions.
Idiopathic Detrusor Overactivity - Local or surrounding infection, inflammation or irritation of the bladder. Neurogenic Detrusor Overactivity - Defective CNS inhibitory respon.
Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Urge incontinence may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder.
Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount o
英杰学校f water, or when they touch water or hear it running (as when washing dishes or hearing someone el taking a shower).
Involuntary actions of bladder muscles can occur becau of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themlves. Multiple sclerosis, Parkinson's dia, Alzheimer's Dia, stroke, and injury--including injury that occurs during surgery--can all harm bladder nerves or muscles. Functional incontinence
Functional incontinence occurs when a person does not recognize the need to go to the toilet, recognize where the toilet is, or get to the toilet in time. The urine loss may be large. Caus of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity, unwillingness to u toilet becau of depres-sion, anxiety or anger, or being in a situation in which it is impossible to reach a toilet.
People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's Dia, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as the are often associated with age and account for some of the incontinence of elderly women and men in nursing homes.
Overflow incontinence
Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have pasd urine. It is as if their bladders were like a constantly overflowing pan - hence the general name overflow incontinence. Overflow incontinence occurs when the patient's bladder is al-ways full so that it frequently leaks urine. Weak bladder muscles, resulting in incomplete emptying of the blad-der, or a blocked urethra can cau this type of incontinence. Autonomic neuropathy from diabetes or other dis-eas (e.g Multiple Sclerosis) can decrea neural signals from the bladder (allowing for overfilling) and may also decrea the expulsion of urine by the detrusor muscle (allowing for urinary retention). Additionally, tumors and kidney stones can block the urethra. In men, benign prostatic hyperplasia (BPH) may also restrict the flow of urine. Overflow incontinence is rare in women, although sometimes it is caud by fibroid or ovarian tumors. Spinal cord injuries or nervous system disorders are additional caus of overflow incontinence. Also overflow incontinence in women can be from incread outlet resistance from advanced vaginal prolap causing a "kink" in the urethra or after an anti-incontinence procedure which has overcorrected the problem.健康的饮食英文
Early symptoms include a hesitant or slow stream of urine during voluntary urination. Anticholinergic
春节的由来和习俗medica-tions may worn overflow incontinence.
Bedwetting (enuresis)
Bedwetting is episodic UI while asleep. It is normal in young children.
Other types of incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence - and this combina-tion in particular - are sometimes referred to as "mixed incontinence."
"Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (vere constipation), which can push against the urinary tract and obstruct outflow. Incontinence can often occur while trying to concentrate on a task and avoiding using the toilet.
Diagnosis
Patients with incontinence should be referred to a medical practitioner specializing in this field. Urologists spe-cialize in the urinary tract, and some urologists further specialize in the female urinary
tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinence in women. Family practitioners and internists e patients for all kinds of complaints and can refer patients on to the rele-vant specialists.
A careful history taking is esntial especially in the pattern of voiding and urine leakage as it suggests the type
宣传片策划方案of incontinence faced. Other important points include straining and discomfort, u of drugs, recent surgery, and illness.
The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or nsations, which may be evidence of a nerve-related cau.
A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly func-tioning bladder muscles.
Other tests include:
Stress test - the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
Urinalysis - urine is tested for evidence of infection, urinary stones, or other contributing caus.
Blood tests - blood is taken, nt to a laboratory, and examined for substances related to caus of incontinence. Ultrasound - sound waves are ud to visualize the kidneys, ureters, bladder, and urethra.
Cystoscopy - a thin tube with a tiny camera is inrted in the urethra and ud to e the inside of the urethra and bladder.
到目前为止Urodynamics - various techniques measure pressure in the bladder and the flow of urine.
Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.
Urinary incontinence in women
Urinary Incontinence is highly prevalent in women across their adult life span and its verity increas linearly with age. However a wide range of prevalence estimates exists for urinary incontin
ence among women in the United States. The lack of specificity is due to at least two factors. The first is lack of a volume of data. The c-ond is that urinary incontinence is one of a few issues that women feel uncomfortable talking about. This leads to under-reporting.
Bladder symptoms affect women of all ages. However, bladder problems are most prevalent among older women. Up to 35% of the total population over the age of 60 years is estimated to be incontinent, with women twice as likely as men to experience incontinence. One in three women over the age of 60 years area estimated to have bladder control problems.
Bladder control problems have been found to be associated with higher incidence of many other health problems such as obesity and diabetes. Difficulty with bladder control results in higher rates of depression and limited ac-tivity levels.
Further, urinary incontinence often goes undiagnod and untreated by primary care physicians. In fact more than half of all women with incontinence never discuss their problem with their health care professional. Bladder control remains one of a few subjects that are still taboo among family and friends. Urinary incontinence can have devastating psychological, social, emotional conquences as women may avoid friends and family and live in shame and fear.
Incontinence is expensive both to individuals in the form of bladder control products and to the health care sys-tem and nursing home industry. Injury related to incontinence is a leading cau of admission to assisted living and nursing care facilities. More than 50% of nursing facility admissions are related to incontinence. Rearch has found that bladder control can be successfully addresd by educational and fitness programs de-signed to empower women to take control. Community-bad wellness programs, in fact, rve an important role in bridging the gap between consumers and the health care delivery system and enabling women to improve their health and wellness.
Urinary incontinence in men
Men tend to experience incontinence less often than women, and the structure of the male urinary tract accounts for this difference. But both women and men can become incontinent from neurologic injury, congenital defects, strokes, multiple sclerosis, and physical problems associated with aging.
While urinary incontinence affects older men more often than younger men, the ont of incontinence can hap-pen at any age. Incontinence is treatable and often curable at all ages.
Incontinence in men usually occurs becau of problems with muscles that help to hold or relea urine. The body stores urine - water and wastes removed by the kidneys - in the urinary bladder, a b
alloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.
During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the ure-thra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incon-tinence will occur if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Treatment
Exercis
One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exer-cis may strengthen a portion of the affected area. According to many industry specialists, the pelvic floor is actually a group of muscles and connective tissues running side-to-side and front to back along the bony ridges of the pelvis. Visualize the pelvic floor as a “hammock” or “bowl”. For everything to be working properly, this hammock should be worked out like every other muscle in the body.
Kegel exercis to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stres
s leakage. Patients younger than 60 years old benefit the most. The patient should do at least 24 daily contractions for at least 6 weeks.
Increasingly there is evidence of the effectiveness of pelvic floor muscle exerci (PFME) to improve bladder control. For example, urinary incontinence following childbirth can be improved by performing PFME
Vaginal cone therapy
A more recently developed exerci technique suitable only for women involves the u of a t of five small vaginal cones of increasing weight. For this exerci, the patient simply places the small plastic cone within her vagina, where it is held in by a mild reflex contraction of the pelvic floor muscles. Becau it is a reflex contrac-tion, little effort is required on the part of the patient. This exerci is done twice a day for fifteen to twenty min-utes, while standing or walking around, for example doing daily houhold tasks. As the pelvic floor muscles get stronger, cones of increasing weight can be ud, thereby strengthening the muscles gradually.
The advantage of this method is that the correct muscles are automatically exercid by holding in the cone, and the method is effective after a much shorter time. Clinical trials with vaginal cones hav
e shown that the pelvic floor muscles start to become stronger within two to three weeks, and light to medium stress incontinence can resolve after eight to twelve weeks of u.
Electrical stimulation
Brief dos of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabi-lize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be ud to re-duce both stress incontinence and urge incontinence.女人来自金星
Biofeedback
Biofeedback us measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over the muscles. Biofeedback can be ud with pelvic muscle exercis and electrical stimulation to relieve stress and urge incontinence.
Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that u biofeedback. In timed voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwi leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. The techniques are effective for urge
and overflow incontinence.
Medications:
Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder, others relax muscles, leading to more complete bladder emptying during urination, and yet others tighten muscles at the bladder neck and urethra, preventing leakage. Some hormones, such as estrogen, are believed to cau muscles involved in urination to function normally.
Pharmacological treatments of urinary incontinence include:
topical or vaginal estrogens - ud in cas of vaginal atrophy
tolterodine (Detrol)
oxybutynin (Ditropan, Oxytrol)
propantheline
darifenacin (Enablex)
solifenacin (Vesicare)
trospium (Sanctura) - ud in urge incontinence
imipramine - ud in mixed and stress urinary incontinence
pudoephedrine
duloxetine (Cymbalta) - ud in stress urinary incontinence
Some of the medications can produce harmful side effects if ud for long periods. In particular, estrogen ther-apy has been associated with an incread risk of cancers of the breast and endometrium (lining of the uterus). A patient should talk to a doctor about the risks and benefits of long-term u of medications.
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Pessaries
A pessary is a medical device that is inrted into the vagina. The most common kind is ring shaped, and is typi-cally recommended to correct vaginal prolap. The pessary compress the urethra against the symphysis pubis and elevates the bladder neck. For some women this may reduce stress leakage. If a pessary is ud, vaginal and urinary tract infections may occur and regular monitoring by a doctor is recommended.
Surgery
Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many sur-gical options have high rates of success. Urodynamic testing ems to confirm that surgical restoration of vault prolap can cure motor urge incontinence.
Bladder repositioning
Most stress incontinence in women results from the bladder dropping down toward the vagina. Therefore, com-mon surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon rais the bladder and
cures it with a string attached to mus-cle, ligament, or bone. For vere cas of stress incontinence, the surgeon may cure the bladder with a wide sling. This not only holds up the bladder but also compress the bottom of the bladder and the top of the ure-thra, further preventing leakage.
Marshall-Marchetti-Krantz
The Marshall-Marchetti-Krantz (MMK) procedure, also known as retropubic suspension or bladder neck suspen-sion surgery, is performed by a surgeon in a hospital tting. Developed in 1949 by doctors Victor F. Marshall (urologist), Andrew A. Marchetti (OB/GYN), and Kermit E. Krantz (OB/GYN) is the standard by which new procedures are measured.
The patient is placed under general anesthesia, and a long, thin, flexible tube (catheter) is inrted into the blad-der through the narrow tube (urethra) that drains the body's urine. An incision is made across the abdomen, and the bladder is expod. The bladder is parated from surrounding tissues. Stitches (sutures) are placed in the
