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Video: Urinary Incontinence: Medications, Physiotherapy, Exercise, Surgery
Urinary incontinence: medications, physiotherapy, exercise, surgery
Often after giving birth, a woman is faced with the problem of urinary incontinence. According to statistics, to one degree or another every fifth woman aged 35–45 suffers from this. With age, there are more of them. Most often, urinary incontinence occurs due to the prolapse of the pelvic organs, which is explained by the weakness of the connective tissue. And being overweight and chronic illnesses exacerbate the problem.
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Often after giving birth, a woman is faced with the problem of urinary incontinence. According to statistics, to one degree or another, one fifth of all women aged 35–45 suffer from this. With age, there are more of them. Most often, urinary incontinence occurs due to the prolapse of the pelvic organs, which is explained by the weakness of the connective tissue. Overweight, chronic diseases accompanied by coughing and sneezing are also among the culprits of the problem. Marina Nakryzhskaya, head of the Center for Pelvic Floor Surgery, Head of the Gynecological Department of the City Clinical Hospital No. 17, Moscow, told about whether this problem has a solution.
A delicate problem
Many women are embarrassed to talk about this delicate issue. Coughing, sneezing, sex, any - even the most insignificant - physical activity leads to the fact that the bladder "does not obey". This problem doctors call stress urinary incontinence (or stress urinary incontinence). A characteristic feature of stress urinary incontinence is the absence of the urge to urinate.
Fearing embarrassment, the woman becomes a recluse. Sports, travel, visiting parties are now prohibited. Ladies are forced to shy away from sex. A woman develops an inferiority complex, depression. If at first the problem was solved by panty liners, then you have to switch to “night” ones, used on critical days, and finally buy special urological pads at the pharmacy.
7 ways to solve the problem without surgery
Treatment begins with conservative methods
1. The simplest thing is training to strengthen the pelvic floor muscles.
For this there is a special Kegel gymnastics complex named after its author. Here's one workout option. Imagine that your vagina is an elevator car going up to the 5th floor. Smoothly squeeze the muscles, starting from the "first floor" - the entrance to the vagina. Having risen to the "second floor", delay the contraction for a few seconds. Then climb to the "third floor". Again - a pause … When you find yourself at the very top of the cervix, in the same way go down in the "lift" down, making stops at each "floor".
At first glance, it looks simple.But, in fact, when doing these exercises, you must follow the rule - the muscles of the press and buttocks when doing gymnastics should rest, and only the vaginal muscles work. You are training intimate muscles, not abdominals. To check if the first ones are not cheating, put one palm to your stomach, and the other palm to your buttock. Hands should not feel movement, otherwise gymnastics is useless and even harmful - it aggravates age-related prolapse of organs and hemorrhoids.
2. The biofeedback apparatus, which will act as a kind of trainer, will help to avoid mistakes when performing gymnastics.
One electrode from this device is attached to the vagina, the others to the muscles that cannot be strained. A woman, looking at the monitor, begins to perform Kegel exercises correctly and very quickly reaches the optimal work of the vaginal muscles. It is clearly visible on the screen how they work, and it is easy to achieve that the muscles of the abdomen and buttocks did not interfere with the exercises.
3. Another option for training is using the so-called vaginal cones (a kind of weights of different weights).
They are sold in pharmacies and can be ordered online. First, the lightest cones are inserted into the vagina for a few minutes a day. Having got used to the load, you can take the next weight. Thanks to such "strength" exercises, the desired group of pelvic floor muscles is "pumped", and it is now easier to control the urination process.
4. Microcurrents, electromagnetic impulses from the arsenal of physiotherapy will help to strengthen muscles and make tissues more elastic by improving the blood supply to the small pelvis.
After exposure to currents of magnetic waves, the lost strength and elasticity return to the tissues, they "remember their youth" and again begin to work as expected - only at the request of the hostess, and not when sneezing, laughing or coughing. It will take several courses. But physiotherapy helps only at the initial stage of the problem.
5. The easiest option is to use local hormone replacement therapy.
Candles or cream with estrogen are injected into the vagina according to a certain scheme - first daily for a certain period of time, then reducing the dose to 1 time per week. But recently there have been studies by scientists who prove that there are many more side effects than benefits from HRT.
6. Someone is using drugs to reduce the incidence of urinary incontinence.
Sometimes urinary incontinence is associated with depression, so antidepressants can help. Having left the psychological problem, the woman forgets about incontinence. But here we must remember that the self-administration of some drugs (for example, m-anticholinergics) is dangerous, since the drugs cause many side effects. For example, they can provoke retinal detachment and cause blindness.
7. Injection of hyaluronic acid into the tissue coming from the urethra. But the effect of such injections is not always sufficient, moreover, short-lived. Injections need to be done regularly, which is not cheap.
If all the previous methods did not help, or you abandoned them for your own reasons, there is only one way out - surgical intervention
The weakened urethra will be supported by a loose synthetic loop. During the operation, a sling is implanted made of synthetic bioinert material. To install this tape, an incision is made about 1 centimeter long in the anterior vaginal wall. And also 2 punctures with a diameter of less than 5 millimeters - on the skin in the area above the pubis or in the groin folds. A thin ribbon is inserted under the urethra, its ends are removed, a small loop is obtained, which, like a hammock, supports the urethra in a normal state. After a while, the sling grows with its own connective tissue. It becomes part of the body itself and supports the urethra in case of any sharp increase in intra-abdominal pressure that the body experiences when coughing, sneezing, or exercising.
Today, the operation technique has been worked out to the smallest detail. She has no age restrictions. It is performed under spinal or intravenous anesthesia for 10 minutes. In the absence of complications, the woman is discharged the next day after the operation. The recovery is very fast. The loops are soft, usually the patients do not feel them, but occasionally, immediately after the operation, a woman feels a foreign body. This feeling passes quickly. Within a month after installing the sling, the woman returns to her usual full-fledged lifestyle without restrictions.
If the problems are more serious - prolapse of the internal genital organs or even prolapse - modern medicine is ready to cope with them the same. At the initial degree of prolapse, special synthetic threads with notches are installed, which create a "tightening effect". And when omitting, you will need special mesh implants-prostheses, they will strengthen the organs' own tissues.
It is important that women of any age do not tolerate discomfort at the first manifestations of incontinence, do not struggle with complexes, but seek help from specialists.
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