Uncontrollable urine

This is the 4588th article of Da Yi Xiao Hu

Many middle-aged and elderly women have an embarrassing experience: they can't control their urine. Medically, this is called "urinary incontinence". Urinary incontinence is a common urological disease. The most common types of urinary incontinence in women are stress urinary incontinence and urge urinary incontinence. Stress urinary incontinence refers to the involuntary leakage of urine when people cough, run, or laugh, which increases abdominal pressure. Urgent urinary incontinence refers to the involuntary leakage of urine when people feel the urge to urinate but don't have time to go to the toilet. Urinary incontinence is generally not life-threatening, but it greatly affects people's social life, so let's talk about the issue of urinary incontinence today.

Although both are urinary incontinence, their pathogenesis is completely different. Stress urinary incontinence is caused by the relaxation of the supporting structure around the urethra, which cannot provide enough pressure to counteract the pressure of increased urine volume in the bladder, and will cause uncontrolled leakage of urine when the abdominal pressure increases. This structural relaxation is due to the natural degeneration of organ tissues with aging, and/or pathological changes in women after childbirth. Therefore, stress urinary incontinence is more common in middle-aged and elderly women or women with a history of multiple childbirths. Its treatment and prevention are aimed at strengthening the strength training of the pelvic floor and surrounding urethral support structures. For example, standardized pelvic floor muscle repair and anal lifting exercises in the early stage after delivery can effectively prevent the occurrence and development of stress urinary incontinence. However, if the symptoms of stress urinary incontinence are severe and conservative treatment is ineffective, we can also perform interventional surgical treatment.

Urgent incontinence has more complicated causes than stress incontinence. It can occur alone or with symptoms such as frequent urination, urgency, pain, difficulty urinating, and increased nocturia. On the one hand, it may be caused by diseases of the nervous system that controls the bladder, leading to bladder dysfunction. On the other hand, it may be caused by lesions of the bladder, urethra, or prostate, such as cystitis, urethritis, prostatic hyperplasia, or bladder tumors. Therefore, when there are symptoms of urge incontinence, we need to further clarify the diagnosis to rule out some serious lesions, such as bladder cancer. Although imaging examinations such as CT and B-ultrasound can screen for bladder cancer to a certain extent, when the lesion is limited to the bladder mucosa (such as carcinoma in situ) or is in a precancerous lesion (such as glandular cystitis), CT and B-ultrasound cannot detect it. At this time, cystoscopy + bladder mucosal biopsy is particularly important.

I believe that through today's popular science, female compatriots will be able to have a rough understanding of the difference when they encounter embarrassing situations such as urinary incontinence. We should neither worry too much nor take it lightly. We should seek medical treatment in time and analyze our own situation with a specialist to find out the "root cause" of the disease so that we can prescribe the right medicine and cure the disease.

Shanghai Public Health Clinical Center

Urology Department