Urinary incontinence after childbirth
Incontinence after delivery - a pathological condition in women that involuntary urination occurs. Postpartum urinary incontinence often referred to as stress incontinence, when the discharge occurs during exercise, laughing, sneezing, coughing, sexual intercourse (in cases of a sharp increase in intra-abdominal pressure).
Incontinence is not a disease, and disruption of the normal functioning of the urinary system. Urinary incontinence - a postpartum complication occurs in 10% of women during their first pregnancy and childbirth, and 21% of women during the second and each subsequent pregnancy. When natural childbirth likely to develop urinary incontinence is slightly higher than for caesarean section.
Postpartum urinary incontinence is not a natural state of women and requires correction. Urethral function is restored an average for the year. In some cases, self-recovery is not happening. Urinary incontinence is not a significant threat to the health of women (in the absence of complications in the form of inflammatory and infectious processes), but greatly reduces the quality of life. With early diagnosis and proper treatment of postpartum urinary incontinence is completely eliminated. If time does not diagnose the problem and take steps to normalize urination, the condition can get worse with time. Advanced cases much more difficult to correct, characterized by frequent relapses.
Causes of urinary incontinence after childbirth
The main cause of urinary incontinence after childbirth is stretching and weakening of the pelvic floor muscles, which provide sufficient support for the uterus during pregnancy.
The pelvic floor - a powerful muscle-fascial layer that is used to maintain the internal organs, the preservation of their normal position, control intra-abdominal pressure, as well as facilitating the expulsion of the fetus during labor, creating the birth canal. Stretching the muscles of the pelvic floor is under the weight of the uterus and the fetus developing in her. Severe birth, large fetus, birth injuries are also causes muscle weakening.
Urinary incontinence after childbirth is determined by the following factors:
- Violation of innervation of the musculature of the pelvic floor and bladder;
- Violation of the closing function of the urethra and bladder;
- Pathological mobility of the urethra;
- The instability of the position of the bladder, intravesical pressure fluctuations.
There are a number of risk factors contributing to the development of urinary incontinence after childbirth:
- Heredity (genetic predisposition to the development of disturbances);
- Features of the anatomical structure of the pelvis and the pelvic floor muscles;
- Violations of neurological (nervous system diseases, multiple sclerosis, Parkinson's disease and spinal cord injuries);
- Surgical intervention during labor and birth injuries;
- Large fruit;
- Excessive weight gain during pregnancy.
The symptoms of urinary incontinence after childbirth
In clinical practice allocate 7 basic types of incontinence:
- Urge incontinence - the sudden arbitrary urination, strong urge, uncontrollable;
- Stress incontinence - urine excretion in all types of physical activity, increased intra-abdominal pressure;
- Ischuria paradox or overfilling incontinence - leakage of urine when full bladder;
- Reflex incontinence - urine under the influence of provoking factors (loud cry, fear, the sound of water);
- Constant involuntary leakage of urine;
- Leakage of urine after the end of a full bladder.
Urinary incontinence after childbirth is often referred to as stress incontinence (SUI). For an accurate diagnosis must be comprehensive survey.
The diagnosis of urinary incontinence after childbirth is placed in the case, if a woman has the following symptoms:
- Regular episodes of involuntary leakage of urine;
- A substantial amount of urine in every episode;
- Increased discharge of urine during physical activity, stress, during intercourse.
When occasional episodes of involuntary urination should also consult a doctor to correct the condition. It is worth noting that isolated cases of involuntary urination in small volumes are also characteristic of a healthy body.
Urinary incontinence after childbirth: Treatment and Prognosis
By the treatment of urination disorders must be approached correctly. Many women ignore the problem, and not going to the doctor, trying to fix the problem or to reconcile with the pathological condition. Incontinence after childbirth treatment involves conservative and radical methods.
When incontinence is not recommended to self, since this condition requires a thorough examination to rule out possible inflammatory and infectious causes of incontinence.
Incontinence after childbirth treatment does not involve the use of drugs. Medications are appointed in cases of complications of urinary incontinence inflammation or infection.
Diagnosis of urinary incontinence is made by the following methods:
- Medical history (subjective symptoms of the patient, characterizing the violation);
- Inspection on a gynecological chair;
- Cystoscopy (endoscopic examination of the bladder);
- Carrying out laboratory tests;
- Complete urodynamic study (cystometry, profilometry, uroflowmetry).
Conservative treatment of urinary incontinence after childbirth is to perform physical exercises to strengthen the pelvic floor muscles and so-called step-free therapy, suggesting muscle training by withholding certain weights increasing weight.
The criterion for evaluating the effectiveness of conservative methods is the complete disappearance of episodes of involuntary urination. The average normalized urination takes up to 1 year.
With the ineffectiveness of conservative methods of treatment of urinary incontinence after childbirth used surgical methods for correcting the problem. Currently practiced minimally invasive surgical methods.
The main methods of surgical correction are:
- Uretrotsistotservikopeksiya - complete surgery to fix the bladder, urethra and uterus. This method is rarely used in the structure of the material breach of the pelvic muscles;
- Introduction gel paraurethral space - manipulation is performed in a hospital or as an outpatient. With this method of correction of incontinence remains high risk of relapse;
- Loop sling surgical correction - placing under mid-urethra synthetic loops, providing extra support.