Incontinence in women

According to the International Continence Society ( ICS ), urinary incontinence is a condition in which "... involuntary discharge of urine leads to social or hygienic problems" ^[1] .

This wording, given in 1988, clearly indicates the social aspect of the disease. The following ICS terminology committee definition describes urinary incontinence as "... any condition leading to involuntary urination." And stress urinary incontinence (NMPN) is defined by ICS as "... a complaint about involuntary urination with effort, tension, sneezing or coughing." The initial definition of the disease covers a group of patients who seek medical attention because of the impact of the disease on their quality of life. But to determine the prevalence of urinary incontinence in the entire female population, one should adhere to the second formulation, approved in 2002.

Epidemiological data provided by ICS show that NSPM is widespread in the USA ^[2] and European countries, somewhere from 34% to 38% of women suffer from this disease ^[3] .

According to domestic studies, about 38.6% of the female population report symptoms of involuntary urine output, and among a group of more than three thousand women surveyed in Russia, 20% of urinary incontinence was manifested regularly ^[4] .

• Stress urinary incontinence - involuntary leakage of urine during exertion, coughing or sneezing
• Urgent urinary incontinence is an involuntary leakage of urine that occurs immediately after a sharp urge to urinate
• Mixed incontinence is an involuntary leakage of urine, accompanied by a sharp urge, as well as a sharp effort, tension, sneezing or coughing.

• Stress urinary incontinence - 49%
• Urgent urinary incontinence - 22%
• Mixed urinary incontinence - 29%

• Lack of support for the urethra and / or neck of the bladder leading to hypermobility of the urethra
• Insufficiency of the internal sphincter of the bladder

• Clinical researches
• Visualization methods
• Comprehensive urodynamic examination

Diagnostic Algorithm

• Are there episodes of involuntary urination?
• What causes urinary incontinence?
• The severity of urinary incontinence.
• Daily urination rate
• Urinary frequency per night
• What treatment was carried out before?
• Gynecological examination
• Assess functional test data and urination diary.
• Fill out the questionnaire
• Conduct urine residue studies, inoculation on flora and sensitivity to antibiotics

The principles for the correction of NUS have changed as the concept of urine retention has progressively developed. The pressure theory presented by Enhörling ^[5] in 1961 led to the emergence of many operational methods aimed at correcting the bladder neck.

Subsequently, McGuire ^[6] , Green ^[7] and others proposed sling operations for the treatment of NID, since they believed that the bladder sphincter weakness was the basis of the pathogenesis of the disease. The “hammock” urinary retention mechanism proposed by DeLancey ^[8] served as the basis for the subsequent development of the integral theory of Ulmsten and Petros ^[9] in 1996, which underlies the development of the so-called “minimally invasive” sling operations. The operation described for the first time by Ulmsten ^[10] for the correction of LUT was performed under the middle urethral prolene loop (TVT technique - Tension-free Vaginal Tape ). In 2001, Delorme ^[11] and then De Leval ^[12] proposed various modifications of transobturator access loop installation. (TOT and TVT-O techniques). Recently, minimally invasive methods of treatment have been most widely used, consisting in the administration of volume-forming media, such as collagen derivatives (for example, Collost drug 7 or 15%) or synthetic volume-forming agents (Urodex derivatives, dextranomeric derivatives, hyaluronic acid derivatives, etc.). The principle is based on stimulating the formation of its own collagen compaction, which prevents the uncontrolled opening of the urethra .

Conservative

• Lifestyle change
• Pelvic floor muscle training
• Electromyostimulation
• Assistive devices
• Pharmacological preparations

Surgical

• Colposuspension
• Sling operations ( TVT , TVT-O, TVT SECUR system)
• Injection treatments (Gel "Collost", Urodex)

• Bladder hyperactivity

• Incontinence in women
• Urinary incontinence in women. Modern treatment methods.
• Urinary incontinence Diagnosis, treatment, exercise, urination diary
• Urinary incontinence training video
• Incontinence in women, causes