Male urinary incontinence: causes, treatment,the symptoms | Medical Online Journal

Update: October 2018

Urinary incontinence is a condition characterized by
uncontrolled leakage of urine due to dysfunction or
innervation of the urinary system.

Incontinence in men is less common than in women, since
in the structure of female morbidity significant predisposing
factor is pregnancy. The risk of developing incontinence rises
with age but this disease is not an inevitable condition
for the elderly.

In modern society, urinary incontinence is not enough
accurately diagnosed disease, resulting in reduced
the effectiveness of his treatment. In most cases, doctors and patients
mistakenly believe that such a condition is a sign of aging.
This opinion is shared by more than 1/3 of patients. In the world of incontinence
More than 200 million people suffer from urine, 20–25% of them are men.
According to statistics, more than 1/3 of men who have problems with
incontinence, pour twice a night or even more often to
go to the toilet. Every eighth of them states that sometimes
he urinates before he reaches the toilet.

The problem of treating men with such a diagnosis is that they
not inclined to talk with anyone on this topic. Accurate diagnosis
проводится лишь каждому восьмому мужчине с недержанием urine. Two
Thirds of people who have urination problems do not get
no treatment and do not use special devices
способных улучшить их качество of life.

Treatment недержания мочи у мужчин имеет высокую эффективность и
is selected individually depending on the shape of the flow
diseases:

Stress incontinence characterized by uncontrolled
leakage of urine under increased load (weight lifting or even
coughing and sneezing), accompanied by an increase in intra-abdominal
pressure;
Imperative incontinence due to impossibility
control the urge to urinate;
Incontinence due to bladder overflow. By signs
this form of the disease is frequent urination small
порциями urine.

In some men, incontinence may occur in two or three.
forms.

The reasons

Among the causes of urinary incontinence in men are two types
disorders: damage to the nervous system and diseases of the prostate
glands.

Any condition, illness or injury occurring or
resulting in damage to the nerves, can lead to the development
недержания urine. Such diseases do not depend on age and
men and young men are equally affected. AT
at risk are men:

Diabetes patients for a long time. AT данном
case there is a high likelihood of developing diabetic
angiopathy, leading to malnutrition of internal organs, in
including the brain. One of the symptoms of a nervous lesion.
system is the loss of control of the pelvic organs;
Stroke, Parkinson’s disease and multiple sclerosis are
diseases directly damaging the nervous system. AT
Therefore, under these conditions, the probability of
urination disorders;
Overactive bladder is a condition in which
an uncontrolled contraction of urinary smooth muscle occurs
a bubble. This is believed to be due to damage.
nervous system or disease can occur without visible
problems. The overactive bladder is accompanied by the following
symptoms:
- Frequent urination (8 or more times a day or 2 or more
  once during the night);
- The appearance of sudden strong urge to urinate;
- Imperative urinary incontinence – urine flow immediately after
  the emergence of strong urges.
Spinal cord injury may cause uncontrolled
bladder emptying due to impaired transmission of controlling
nerve impulses to the bladder.

A common cause of urinary incontinence in men are
prostate diseases:

Symptoms

Incontinence is manifested by various symptoms, depending on
on the type of flow. Symptoms of stress incontinence include
uncontrolled urination during:

Coughing, sneezing
Laugh
Weight lifting
Change of position

Symptoms императивного недержания включают:

Sudden occurrence of strong urge to urinate without
any reasons
Sudden, not associated with any muscle activity
large quantities of urine
Frequent urination, including at night

Symptoms недержания вследствие перенаполнения
characterized by:

Intermittent jetting during urination
Sudden outflow of small portions of urine
Weak urine tension during urination
The need to strain the muscles of the pelvis when urinating due to
lasting bladder sensation
Acute urination, including at night
time
Недержанием мочи во time сна

Immediately seek medical attention should
the following symptoms:

Weakness and numbness in the buttocks, legs and feet

Fever, chills

Pain in the abdomen or side

The appearance of blood in the urine, burning during urination

Bowel dysfunction

In addition, you must go through a repeated unplanned reception,
If you:

You notice worsening of the course of the disease.
The volume of urine released is so large that it requires
use of special urinals
Incontinence in any other way impairs quality.
of life

Do not neglect the advice of a specialist. Incontinence not
is an age problem. In most cases, patients
respond well to treatment if it was started on
early stage of the disease.

Diagnostics

A number of tests are used to diagnose urinary incontinence and
analyzes. The amount of research required is determined by the doctor in
depending on the symptoms and type of the disease.

Urination diary

Keeping a diary allows you to control the number and composition
fluid intake and frequency of urination during the day. Besides
In addition, the diary indicates incontinence.

Analysis of urine

This study allows you to determine the presence of bacteria in the urine
or blood impurities, as well as suspect the presence of diabetes.

Blood test

The determination of the biochemical composition of blood is used for
detection of diseases that cause urinary incontinence.

Ultrasound

Ultrasound examination of the pelvic organs is non-invasive.
a test by which a physician can determine a structure disorder
bladder and kidneys. Also, ultrasound is used for
detection of diseases of the prostate gland.

Stress test (cough)

A visual test evaluating the incontinence rate.
urine when coughing.

Urodynamic studies

These tests allow you to assess the degree of dysfunction.
bladder, its sphincter and urethra. There are three types
urodynamic tests:

Uroflowmetry – a study to determine the amount
выделенной мочи при мочеиспускании, ее скорость и time,
necessary for complete emptying of the bladder;
Investigation of the effect of pressure in the bladder on the flow rate
urine. Based on the data obtained, the doctor can determine the degree
bladder obstruction;
Measurement of residual volume after urination allows
determine the amount of urine remaining in the bladder.
The test is performed using a special catheter or when
ultrasound aid.

Treatment

Treatment недержания мочи подбирается индивидуально для каждого
patient depending on the type and severity of the disease.
Therapy begins with the most simple principles, gradually moving
to receive special drugs in the absence of effect.

In many patients, bladder function returns to normal.
after giving up bad habits, as well as observing sleep patterns
and wakefulness and doing special exercise.

If the treatment does not bring a positive result, the method
maintenance therapy is the use of special devices –
artificial sphincter or catheter. For some patients
The only treatment is surgery.

Образ of life

In some cases, avoiding the problem of incontinence allows
simple limiting fluid intake. In this case
назначается питье в определенном объеме только в назначенное time,
а также заранее планируется time опорожнения мочевого a bubble.
This treatment is called “planned urination” or
�”Bladder training”. Therapy also involves performing
Kegel exercises to strengthen the muscles of the pelvis.

Drug therapy

Medications for the treatment of incontinence have different
mechanisms of action:

Alpha blockers (terazosin, tamsulosin, uroxatral)

used to treat incontinence caused by an increase
prostate gland and obstruction of the urinary tract. They
promote relaxation of the muscles of the prostate gland, providing
normal urine flow and preventing abnormal urinary contractions
bladder leading to the development of imperative incontinence.

5-alpha reductase inhibitors (finasteride, dutasteride)

inhibit the production of male hormones causing an increase
prostate gland. Taking these drugs helps to avoid
urination problems due to size reduction
prostate to normal.

Imipramine (Tofranil)

is a drug from the group of tricyclic antidepressants.
It acts relaxingly on the muscular system and blocks the transmission
impulses causing spasms of the bladder.

Neuromodulation

This is one of the innovative methods of imperative therapy.
incontinence and overactive bladder. The basis of treatment is
application of electrical impulses to change the transmission of nerve
signals along the fibers regulating bladder contraction.
There are two types of neuromodulating treatment: peripheral and
sacral. Peripheral neuromodulation involves the transmission
weak electrical signals to the sacral nerves through a small
needle installed in the ankle area. This procedure is carried out
weekly and called percutaneous stimulation of the tibial
the nerve. The sacral method involves the installation of a special
stimulant. This device sends signals directly to
nerves of the sacral through a special implantable
electrode.

Antispasmodics. Relax the muscles of the bladder.

Botox (onabotulinumtoxin A). This is a new treatment method, with
botox is injected into the bladder muscle layer for
prevent spastic contractions.

Surgery

Surgery является методом выбора для пациентов, у
which bladder dysfunction is caused by damage
nerves (spinal injury, total prostatectomy).

Artificial sphincter

Это устройство позволяет опорожнять мочевой пузырь в любое time
at the request of the person. This sphincter implanted in the urethra
and ensures its closure until the moment when the patient will
ready to urinate.

This method helps to cope with incontinence caused
sphincter muscle weakness or nerve fiber damage,
responsible for their reduction. He does not have a positive
effects on the course of the disease in patients with uncontrolled
bladder contractions.

The sphincter consists of three parts: a cuff mounted around
urethra, a small reservoir installed in the abdominal cavity and
pump, which is installed in the scrotum. Cuff
is filled with water, which provides a density of compression for
предотвращения подтекания urine.

If you need to urinate enough fingers squeeze the pump
to blow off the cuff. AT это time жидкость из манжеты перетекает в
reservoir, and urine flows freely into the urethra. When the bladder
emptied, the cuff is automatically filled within 2-5
minutes, closing the urethra again;

�”Straps”

This surgical method can improve the patient’s condition.
при некоторых формах недержания urine. Installing the “strap” is
in tensioning a strip of elastic material around the urethra and
pinning its ends on the pelvic bone. This allows you to maintain
constant pressure on the urethra.

Urine diversion

If necessary, remove the bladder, as well as
bladder function is completely lost due to
nerve damage, surgical treatment may be
создании отводящего канала для urine. Operation is to
formation of a reservoir from the site of the intestine and leading to it
urethra Separate stage is in the formation of the stoma – holes
down the abdomen through which the urine through the catheter is going to
special urinal

Supporting tools

Besides описанных методов существуют также специальные
поддерживающие средства, способные повысить качество of life
пациентов с недержанием urine. One of them is absorbing
pads for men specially designed to be worn with
men’s underwear. All secretions are absorbed by them and turn into
gel that provides dryness and lack of smell. As
alternatives to gaskets are also diapers, special
absorbent inserts and linens of absorbent material. For men
Several types of linen are produced, including swimming trunks,
boxers, pants and disposable pants.

Clamps

To external devices that allow you to save on constant
purchasing gaskets include clips for the penis. They
installed on the penis and squeeze the urethra. Their application
prevents the appearance of wet spots and allows you to control
urination process.

Forecast

If untreated, urinary incontinence causes a change.
physical and mental condition. Incontinence patients
suffer from severe and long-term current infectious diseases
genitourinary system, as well as skin infections in the groin. Often such
patients begin to feel inferior and become
closed uncommunicative. However, due to the wide
diversity and accessibility of treatment methods, the prognosis for patients in
overall remains positive. Even if incontinence does not give in
full recovery, degree of urinary function disorders
can be significantly reduced in most cases.

Автор: Коробов Никита Александрович врач-анестезиолог