Urinary incontinence after childbirth – a violation of the natural functioning of the urinary system, characterized by spontaneous urination. The incontinence is another name of this condition is quite common among women in the postpartum period (38-40%). It often develops after second and subsequent births. The issue of urinary incontinence in women after birth not only affects the physiological aspect of life, but also emotional, affecting her self-esteem in society. Therefore, it requires a mandatory correction.
Postpartum recovery of the female body occurs gradually, including violations of the cellulose also pass with time. But if during the year, a function not fully restored, you should not lose time, as the condition may be complicated and require longer treatment.
For postpartum incontinence include the following condition:
- Spontaneous urination even at low physical load: squat, sudden change in body position, coughing, sneezing;
- Loss of urine during sleep, or sexual contact;
- The constant feeling of not emptying the bladder;
- Involuntary urination after drinking alcohol.
The amount of urine can be varies from a few drops to large volumes during the night.
Causes of postpartum incontinence
The main reason for the development of pathology is dysfunction of the muscles of the pelvis and disturbance of the natural anatomical relationships between organs. The pelvic floor is a powerful muscle-fascial education, which not only supports the internal organs in their physiological position, but also provides a firm support of the pregnant uterus throughout fetal development. During labor, they help the passage of the fetus through the birth canal which they form. Thus, they bear a greater burden during pregnancy and childbirth.
During fetal movements the muscles are squeezed, they blood circulation and innervation, leading to a temporary disorder of the completeness of their functions. If during childbirth trauma to the muscles, it can become subsequently a basis for development of urinary incontinence.
Obstructed labour can cause the following conditions in women:
- A violation of the innervation of the pelvic organs, including the bladder;
- Dysfunction of the sphincter of the bladder and urethra;
- Unsustainable location of the urethra and bladder.
In the development of postpartum incontinence play a role risk factors, which include:
- Hereditary tendency to develop this disease;
- Repeated, multiple and abundant childbirth;
- Congenital abnormalities of the pelvic floor muscles;
- Overweight, obesity;
- Hormonal imbalance – estrogen deficiency;
- Surgical intervention, associated with pelvic organs that could cause muscle damage and cause the breakdown of their innervation;
- Neurological disease, developed on the background of multiple sclerosis, stroke or injuries of the spine;
- Urinary tract infection;
- Radiation exposure;
- Disorders of mental health.
The types of incontinence
In medical practice there are seven main types of this condition:
- Stress occurring during exercise. Most often, this pathology was observed in the postpartum period.
- Imperative and immediate urge to urinate.
- Reflex that occurs under the action of stimuli.
- Iatrogenic, or drug.
- Loss of urine after urination.
- Enuresis – bedwetting.
- Constant urination during the day in the form of drops.
- The inability to hold a full bladder.
To differentiate the pathology of other diseases of urinary system and an accurate diagnosis will help a comprehensive survey. For diagnosis of urinary incontinence after childbirth needed the most complete history. Therefore, the patient requires maximum openness in the answers to the questions of the doctor.
After completion of medical history, the patient fills out a questionnaire, which details his condition in a month. Your doctor may suggest the patient to monitor urination for two days. It is noted the volume of drunk and allocated liquid, the number of urination, a description of the sensations during urination, the volume of involuntary urine. And questionnaire and the diary are carefully analyzed by the doctor that gives you the opportunity to choose methods of diagnosis.
Vaginal examination of women reveals tumors in the pelvic area. In addition to the inspection of the vagina, is the so-called cough test. Positive, if you are coughing from the urethra women urine excreted.
Additional research methods:
- Blood common analysis and biochemistry;
- Urinalysis, urine cultures on flora and sensitivity to antibiotics;
- Ultrasound of the pelvic organs;
- Cystoscopy – examination of the urethra and bladder by cystoscope. It allows us to assess the lining of the bladder to identify structural abnormalities.
In the diagnosis of incontinence includes the whole complex of researches
In addition to these studies, are specific urodynamic tests:
- Profilometry is a measurement of pressure in different parts of the urethra;
- Cystometry – the ratio of volume and pressure in the bladder. It allows to assess the degree of contractility and distensibility of the bladder muscles. Possibilities of the Central nervous system control over urination;
- Uroflowmetry – determine the volume of urine per unit time.
When assigned to the set of diagnostic events completed, the doctor makes a diagnosis and determines the tactics and methods of treatment.
Features of stress incontinence
This type of incontinence is post-partum complication. Its cause is the dysfunction of the urethral sphincter. Urinary incontinence is formed on the background of weakening of this muscle and increased intra-abdominal pressure. The symptoms of incontinence occur more frequently in the first trimester of pregnancy and at the end.
Risk factors for its development are:
- Polyhydramnios and multiple pregnancy;
- Large fruit.
In the process of delivery in pregnancy complicated injuries of the pelvic ligaments and muscles. As a result, the urethral sphincter is weakened and does not function fully. Especially dangerous are the consequences of unprofessional-looking incisions of the perineum.
Treatment of postnatal incontinence
The treatment of urinary incontinence after childbirth may conservative and surgical method. The choice of therapy depends on the degree of development of the state, which defines urologist.
For stress incontinence a good effect give exercise
Methods of conservative therapy aimed at training the pelvic floor muscles and bladder:
- Holding weights. Patient the muscles of the vagina keeps the weights are cone-shaped. Their weight starts with a few grams and is brought to a few dozen grams. You can train the muscles for 15-20 minutes 3-4 times a day, while the load is adjusted depending on results.
- The use of simulators. For example, the PelvicToner, which is based on spring, helping to gradually increase the load on the intimate muscles.
- Kegel exercise is also effective in strengthening the muscles of the perineum. The voltage and hold in this condition of the muscles of the perineum 100-200 times a day. Convenience practice Kegel that their implementation is invisible to others. Lack of training is the inability to check the accuracy of its implementation. Improper execution of an exercise can do not favor, and make the problem worse.
- Physiotherapy. Apply a 14-day course of electromagnetic stimulation of the pelvic floor muscles simultaneously when performing exercises. During the year the course is held 3-4 times.
- The training of the bladder. It is to be coherent with doctor urination during the day. The purpose of training – increase the intervals between urination. Moreover, it is advisable not to urinate in the natural urge, and according to the mode. The desire to urinate is held by the contraction of the muscles of the perineum and anal sphincter. Treatment by this technique be carried out several months.
- The medical treatment. It is effective in cases of intact anatomic structures of the urinary system and pelvic muscles. Used agonists, anticholinesterase drugs, antidepressants.
With the ineffectiveness of conservative treatment, the patient is offered surgery.
The most effective is the surgery to create additional support the urethra in the form of a loop. This operation is performed in the TVT-technique (a free synthetic loop). Under the bladder neck or urethra is sewn a special synthetic mesh in the form of a loop. It supports the urethra in physiologic status, not allowing the urine to flow by increasing intra-abdominal pressure. Operation is feasible at any degree incontinece. The effectiveness of it is that the recurrence of pathological conditions practically do not occur.
Surgery to create additional support of the urethra are different methods
Another type of surgery involves the use of a gel that is injected under the control of the urethra around the cystoscope, that makes her extra support. The operation is performed in a hospital or clinic.
Urethrocystoscopy. This surgical method is rarely used in connection with the volume of surgical intervention and prolonged rehabilitation.
Contraindications to the use of all types of surgical treatments for incontinence are malignant tumors, inflammatory diseases of the pelvic organs, disorders in the blood coagulation system.
As preventive measures, development of incontinence it is recommended that:
- To prevent the stagnation of urine, regular and timely manner to empty the bladder;
- To treat constipation, as they can provoke this pathology;
- To get rid of excess weight. It leads to the development of instability of retention of urine;
- In a timely manner to treat diseases of organs of small pelvis;
- To implement all recommendations of the doctor during pregnancy, time to pass all necessary examinations;
- Wear a bandage for pregnant women, which is supporting the abdomen, reducing load on the muscles of the pelvic floor;
- Give up bad habits (Smoking, alcohol);
- During pregnancy, doing exercises Kegel.
Stress urinary incontinence after childbirth brings to women a lot of troubles associated with constant psycho-emotional stress. No need to hide the problem, because it is completely solved by modern medical methods.