Stress urinary incontinence

Going to the toilet to urinate is a common thing, but there is a group of people who urinate involuntarily when laughing, coughing, or running. It is difficult to control, embarrassing, and difficult to speak. What is going on? This is because they have pelvic floor muscle dysfunction and stress urinary incontinence. You may think this is not worth mentioning, but according to statistics, the prevalence of urinary incontinence in adult women is over 40%, and it is increasing year by year. The prevalence in the elderly over 65 years old is as high as 70%. If not handled in time, it will accompany most women throughout their lives and cause troubles in daily life. Today, the editor will take you to learn about urinary incontinence.

According to the definition of the International Continence Society (ICS), urinary incontinence refers to the phenomenon of urine overflow caused by the bladder pressure exceeding the urethra pressure during bladder filling. Due to different physiological structures, the incidence of this disease in women is much higher than that in men. Of course, in addition to the embarrassment of urine leakage and the social and psychological problems caused by it, urinary incontinence can also lead to more serious health problems such as genital rash and urinary tract infection, which require early prevention, early detection and early intervention.

01What are the types of urinary incontinence? There are many types of urinary incontinence, including stress incontinence, urge incontinence, and mixed incontinence . In addition, there are also functional incontinence, overflow incontinence , and reflex incontinence .

Among them, stress urinary incontinence is the most common type. When the fingertip pressure increases (coughing, laughing, sneezing), urine involuntarily flows out of the urethra. Statistics show that 80% of patients with stress urinary incontinence also have pelvic organ prolapse. Many postpartum women will have varying degrees of stress urinary incontinence. The main reasons are changes in hormone levels during pregnancy, the gradual enlargement of the uterus, changes in the pelvis and pelvic structure and function; during delivery, the pelvic floor muscles are stretched and injured. In addition, with the increase of age, changes in hormones in the body, and decreased muscle mass, the proportion of middle-aged women with stress urinary incontinence is gradually increasing.

The severity of stress urinary incontinence is divided into three degrees: mild, moderate, and severe. Mild: occasional urine leakage when coughing, sneezing, or laughing, without the need for a urinal pad; moderate: occurs during daily activities such as running, jumping, and brisk walking, requiring the use of a urinal pad; severe refers to urinary incontinence during slight activities or changes in body position.

2 Why does stress urinary incontinence occur?

The currently popular mechanism theories are the pressure conduction theory and the "hammock" hypothesis. The pressure conduction theory means that when the intra-abdominal pressure increases, the bladder pressure increases, the pelvic floor muscles reflexively contract, and the same pressure is transmitted to the proximal urethra to maintain the balance of pressure in the bladder and urethra; when the pelvic floor muscles are insufficient, the force generated is insufficient to counteract the increased bladder pressure, resulting in the bladder pressure being greater than the urethral pressure, causing overflow urine. The "hammock" hypothesis was proposed by Delancy in 1994. He compared the pelvic fascia of the urethra and bladder neck and the anterior vaginal wall to a hammock-like structure. When the intra-abdominal pressure increases, the pelvic floor muscles contract, tighten the "hammock", and the urethra is flattened, effectively increasing the urethral pressure; when the pelvic floor muscles are dysfunctional, the "hammock" structure is destroyed, and the abdominal pressure increases, the urethra cannot close normally, and the urethral pressure is insufficient to counteract the bladder pressure, which causes urinary incontinence.

3 How to treat urinary incontinence?

From the above theory, it can be seen that pelvic floor muscle weakness and dysfunction of the various structures of the pelvic floor can lead to urinary incontinence. Therefore, rehabilitation treatment is needed to restore the normal position and function of the pelvic floor tissue.

Treatment

Non-surgical treatment is the first-line treatment for stress urinary incontinence, and is mainly effective for mild and moderate patients. For severe patients, surgical treatment is still recommended, but bladder training and pelvic floor muscle function training can also be used as auxiliary treatments before and after surgery. Here are the common methods of non-surgical treatment:

l Lifestyle intervention : lose weight, quit smoking, reduce the intake of caffeinated beverages, maintain a regular daily routine, avoid heavy physical labor (lifting heavy objects, etc.), and avoid activities that increase abdominal pressure.

l Bladder training : Change urination habits and regulate bladder function. By instructing patients to record their daily drinking and urination, and consciously prolonging the urination interval, patients can learn to delay urination by suppressing urgency and train bladder muscle contraction function.

l Pelvic floor muscle training : also known as Kegel training, was proposed by American doctor Kegel in 1948. It refers to the patient's conscious contraction and relaxation exercises of the pelvic floor muscles (mainly the pubococcygeus muscle group). It can usually be understood as the movement of contracting the anus in coordination with breathing, with continuous contraction for 2-3 seconds, relaxation for 5-10 seconds, 10 times/group, and more than 3 groups. In the later stage, the continuous contraction time can be gradually increased to 5-10 seconds, and relaxation for 5-10 seconds, and repeated to gradually increase the strength and control ability of the pelvic floor muscles.

l Physical factor therapy : including electrical stimulation, magnetic stimulation and biofeedback therapy, which are commonly used methods of pelvic floor muscle training. Biofeedback is a method of providing feedback on the patient's pelvic floor activities to guide the patient to perform correct functional exercises; electrical stimulation is a method of using pulse waves with specific parameters to stimulate the muscles. Low-frequency electrical stimulation of the pudendal nerve and pelvic nerve can awaken the proprioceptors, inhibit the contraction of the bladder detrusor muscle and stimulate local blood circulation; magnetic stimulation is the use of magnetic pulses to activate the perineal nerve pulses, causing the pelvic floor muscle contraction, enhancing the pelvic floor muscle strength and improving urinary control ability.

The above is some basic knowledge about urinary incontinence. I hope it can help pregnant women, postpartum mothers, and middle-aged female friends with urinary incontinence build confidence, seek professional evaluation and intervention in a timely manner when encountering problems, and restore their confidence and beauty as soon as possible!

The popular science content of this platform has been funded by the China Association for Science and Technology's Science Popularization Department's 2022 National Science Literacy Action Project "National Society Science Popularization Capacity Improvement Project-Rehabilitation Science Popularization Service Capacity Improvement Action Plan"