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- Urology Clinic
- Conservative urology
- Treatment of urinary incontinence in men
Medical urologists treat urinary incontinence in men using a conservative method and carry out diagnostics.
Description of the disease
Treatment of urinary incontinence in men must be carried out competently as it is a delicate problem. The mechanism of the disease is the involuntary release of urine from the urethra - a process that is not controlled by the patient. There is a primary and secondary development of the disease. In the first case, this is a violation of the development of the bladder sphincter, in the second, the disease develops against the background of a number of other pathologies or appears with age.
The disease does not pose a threat to life, but significantly worsens its quality: the patient cannot leave the house without a diaper, plus, an unpleasant odor emanates from a person with such a diagnosis, and this affects his mental state and interferes with recovery. The socialization of the patient is disrupted, which gradually leads to his disability.
Enuresis - symptoms and treatment
Enuresis is a disease whose main manifestation is urinary incontinence. In this case, the ability to control bladder emptying is either lost or has not yet been formed [2].
This disorder can occur at any age. It significantly affects the patient's mental state and mood. The inability to carry out even relatively short trips, the presence of a “secret” about involuntary urination at night - all this and much more complicates a person’s life and causes him a lot of inconvenience. That is why the doctor needs to schedule a timely examination, clarify the causes of the disease and select adequate treatment.
Etiology
The causes of enuresis are not well understood. Until now, doctors of various specializations are conducting a huge amount of research in this regard. So far, only a few theories of the occurrence of this disease can be indicated. Although it is immediately worth noting that in the treatment of enuresis it is preferable to use a systematic approach that takes into account each of the theories proposed below [8].
One of them is maturation dysfunction - a delay in the development of the nervous system due to organic pathology or functional (psychogenic) disorders. This dysfunction is a violation or lag in the formation of certain functions with morphologically immature brain structures. Proponents of this theory believe that when the development of the nervous system is delayed, conscious control of urination becomes significantly more difficult. For example, this is observed in the pathological course of pregnancy or neuroinfections.
The theory of heredity suggests that children whose parents had this disease suffer from enuresis much more often than children whose family did not have this disease.
Proponents of the hormonal theory point to a disruption in the production of vasopressin, a hormone associated with water retention in the body. Its amount is inversely proportional to the amount of urine. Normally, the production of this hormone increases at night, so the volume of urine decreases. However, in the case of critically low secretion of the hormone at night, there is a high probability of nocturnal enuresis. A decrease in vasopressin levels is observed in diabetes insipidus, including its nephrogenic (renal) form.
Psychogenic theory suggests that children who are more exposed to stress factors are more likely to experience bedwetting. Such stress factors include an unfavorable family environment, poor or unstable relationships with peers, fears, bullying, ADHD, inadequately low self-esteem, etc. These psychological disorders are usually considered only a factor in the development of bedwetting, since they A direct connection with enuresis has not yet been proven. For example, in children with resolved enuresis and remaining psychological problems, the majority do not have relapses [6]. In addition, nephrologist E.I. Chernorutskaya notes that after resolving the situation with enuresis, the patient’s psychological state significantly improves. All this may indicate the occurrence of psychological problems due to enuresis, and not vice versa [12].
Risk factors
As for the causes of enuresis in adults , studies show that most often this is associated with various pathologies:
- diseases of the nervous system - stroke, neurogenic bladder, spinal cord injury, multiple sclerosis;
- diseases of the urinary system - renal diabetes insipidus, chronic renal failure, infections leading to cystitis, prostatitis, urethral stricture (narrowing of the urethra), weakness of the pelvic floor muscles (more often occurs in women after childbirth), weakening of the tone of the bladder muscles (more often formed with age) [4].
Enuresis can also be caused by taking antiallergic or contraceptive medications.
The causes of enuresis in pregnant women include a strong increase in the size of the uterus, loss of tone and overstretching of the pelvic floor muscles, active movements of the fetus, as well as its weight, the amount of amniotic fluid and the presence of multiple pregnancies.
The prevalence of enuresis in children aged 4 to 15 years is 2.3-30%. At the age of 5 years, nocturnal enuresis occurs in 15-20% of children, and by the time the child enters school - in 7-12% of children. For 18-year-olds and adults, nocturnal enuresis is typical in 1-1.5% of cases. It is important to note that 15-17% of children recover spontaneously by adolescence [6].
Causes of urinary incontinence in men and methods of treating the disease
- Congenital anomalies of the genitourinary organs, genetics.
- Stress, mental disorder.
- Taking strong sedatives, including in the treatment of prolonged depression with tranquilizers, when all muscle groups relax.
- Stones in the kidneys or ureters.
- Neurogenic bladder dysfunction.
- Tumor processes of the genitourinary system, including malignant ones.
- Urinary system infections.
- Prolapse or displacement of internal organs, resulting in pressure on the bladder.
- Age-related changes associated with insufficient blood supply to the pelvic organs.
- Postoperative complications, unsuccessful operations.
- CNS disorders: disease, injury, intoxication.
Treatment of urinary incontinence in older men, younger men, and men following surgery and trauma may include exercise, medication, neuromodulation, and surgery.
Causes of urinary incontinence in men
Enuresis manifests itself in different forms: an acute urge to urinate, leakage of drops, discharge of small portions when coughing, laughing, or a sudden change in position. Depending on the cause of incontinence, other symptoms may be observed: a feeling of incomplete emptying of the bladder, frequent urges, pain when urinating, discomfort in the lower abdomen and perineum.
What types of incontinence are most common:
- After removal of the prostate gland. Urinary incontinence after prostatectomy occurs in 87% of men who have undergone this operation. The reason is damage to the posterior urethra, which disrupts the mechanism of urinary continence. Recovery takes about 6 months. During the rehabilitation period, a man is recommended to use urological pads.
- After the TOUR. During transurethral resection of the prostate, the bladder neck may be affected. Because of this, drip incontinence may occur for 2-4 weeks, i.e. urine leaks in drops.
- Night. If urinary incontinence in men occurs during sleep at night, the causes are alcohol abuse, sleep problems, severe stress or too deep sleep. At the same time, during the day everything is fine with urination.
- Senile. Urinary incontinence occurs in older men over 70-80 years of age. This is due to weakening and sagging of the pelvic floor muscles and disruption of nervous regulation. This form of enuresis develops gradually and begins with dripping drops. It cannot be considered normal as a result of aging. Even at age, men are given adequate treatment.
- After removing the catheter. The problem arises due to injury and irritation of the affected nerve endings. Urinary incontinence after a catheter persists in men for several days, but in some it can last up to 2 months.
- After a stroke. In this condition, certain areas of the brain are damaged. This is caused by their acute oxygen starvation. A stroke causes bladder paralysis. A person does not feel its filling, therefore he cannot control himself. Urinary incontinence in men after a stroke occurs in 2 out of 3 cases. Rehabilitation within 1 year helps to get rid of this condition in 85% of cases.
Other causes of enuresis may include tumors that disrupt the transmission of nerve impulses from the bladder to the brain. In addition to stroke, the problem can arise with other lesions of the central nervous system and the diseases that cause them: Parkinson's disease, multiple sclerosis, brain or spinal cord injuries, chronic intoxication (alcohol, drugs, diabetes).
Urologists
Erkov Igor Viktorovich Urologist andrologist
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Fomenko Alexander Pavlovich Urologist andrologist
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What are the symptoms of the disease?
Symptoms of urinary incontinence are different for all men, depending on the cause of the disease. Regarding the stressful nature:
- Urine leakage when changing position during sleep or rest.
- During physical activity.
- While laughing, sneezing, coughing.
The urgent nature of the disease has the following symptoms:
- Bedwetting in men, frequent urination.
- Sudden, causeless discharge of a large portion of urine.
- Regular, strong urge to urinate.
If your bladder becomes full, symptoms of incontinence may include:
- Spontaneous urination during night sleep.
- Sudden urge, including at night.
- Constant feeling of a full bladder, the need to strain the pelvic muscles during urination.
- Lack of normal flow during the process.
- Urine leakage.
- The process of urination occurs intermittently.
Most often, urinary incontinence is a consequence of removal of the prostate or TUR (transurethral resection) of the prostate adenoma. In this case, surgical intervention is indicated. An operation to eliminate the problem of urinary incontinence in men is the implantation of an implant, which, according to doctors, has been working successfully for at least 10 years.
Symptoms of urinary incontinence
Pathology can manifest itself as follows:
- involuntary release of a small amount during exercise or coughing, without the urge to urinate, pain or discomfort;
- the release of a small amount of urine, which is preceded by frequent urges;
- leakage after urination;
- complete uncontrolled emptying of the bladder.
If such symptoms appear, you should contact a urologist for detailed diagnosis and medical help. This may be a sign of another disease.
Contraindications
Contraindications include the impossibility of performing an operation due to serious disturbances in the patient’s heart function, vascular pathologies, if it is impossible to perform surgical intervention due to the development of an inoperable tumor process in the pelvis, as well as in case of a blood clotting disorder, when the risk of complications after surgery exceeds the possible benefits of surgery . Surgical treatment of urinary incontinence in elderly men may be excluded due to their age, as well as the presence of concomitant and chronic diseases.
Complications of untreated urinary incontinence in men
Depending on the causes of incontinence, complications such as:
- impotence;
- hydronephrosis - stretching of kidney tissue by accumulated urine due to a violation of its outflow;
- renal failure.
In addition, do not forget about psychological health. The problem negatively affects the patient’s emotional state, his ability to work, and his personal life. Therefore, among the possible complications, the first place is taken by the deterioration of the quality of life.
