Stress incontinence , also known as stress urinary incontinence or incontinence is a form of urinary incontinence. That's because of the inadequate strength of the bladder closure.
Video Stress incontinence
Pathophysiology
This is the loss of a small amount of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thereby increase the pressure on the bladder. Urethra is supported by pelvic floor fascia. If this support is not enough, the urethra may move downward as the abdominal pressure increases, allowing urine to pass.
Most lab results such as urine analysis, cystometry and normal postvoid residual volume.
Some sources distinguish between urethral hypermobility and intrinsic sphincter deficiency. The latter is less frequent, and requires a different surgical approach.
Men
Stress incontinence is rare in men. The most common cause is as a post-surgical complication after prostatectomy.
Female
In women, physical changes due to pregnancy, childbirth, and menopause often contribute to stress incontinence. Stress incontinence may worsen for a week before the menstrual period. At that time, lowering estrogen levels can cause lower muscle pressure around the urethra, increasing the chance of leakage. Incontinence incidence of stress increases after menopause, similarly as estrogen levels decrease. In high-grade athletes, power incontinence occurs in all sports involving a recurrent increase in recurrent intra-abdominal pressure that may exceed perineal floor resistance.
Maps Stress incontinence
Treatment
Behavior change
Some behavioral changes can increase stress incontinence. It is recommended to reduce overall fluid consumption and avoid drinking caffeinated beverages because they irritate the bladder. Spicy foods, soft drinks, alcohol and oranges also irritate the bladder and should be avoided. Quitting smoking can also increase the stress of incontinence because smoking irritates the bladder and can cause cough (put stress on the bladder).
Weight
Weight loss in overweight women reduces stress incontinence, in women with a Body Mass Index (BMI) above 25 and at least 10 episodes of urinary incontinence per week. With exercise and limited diet, they have a 70% or greater reduction in overall incontinence episodes.
Exercise
One of the most common treatment recommendations includes exercising the pelvic muscles. Kegel exercises to strengthen or train pelvic floor muscles and sphincter muscles can reduce stress leakage. Patients younger than 60 years benefit greatly. Patients should perform at least 24 contractions daily for at least 6 weeks. It is possible to assess pelvic floor muscle strength using a Kegel perineometer.
The more there is evidence of the effectiveness of pelvic floor muscle exercises (PFME) to improve bladder control. For example, urinary incontinence after delivery may be increased by performing PFME.
Clinical trials of Progressive Resistance Vaginal Exerciser conclude that this tool is as effective as Supervised Pain Muscle Training Vessel.
Incontinence pad
Incontinence pads are multi-layered absorbent sheets that collect urine from urinary incontinence. Similar solutions include absorbent underwear and adult diapers. The absorbent product may cause side effects from leakage, odor, skin damage, and UTI. Incontinence pads may also come in the form of small sheets placed under patients in the hospital, for situations where it is not practical for patients to wear diapers.
Electrical stimulation
Electrical stimulation in short doses can strengthen the muscles in the lower pelvis in the same way as muscle training. The electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabilize the overactive muscles and stimulate urethral muscle contractions.
Clinical studies published in the British Medical Journal compare pelvic floor exercises, vaginal weight and electro stimulation in a randomized trial. The study recommends that pelvic floor exercises should be the first choice of treatment for genuine stress incontinence because simple exercises prove far more effective than electro stimulation or vaginal cones.
This situation is confirmed in a comprehensive review of stress incontinence treatment published in the British Journal of Urology International in 2010. The report's authors note that the weighted vaginal cone device and vaginal cones are not recommended by the National Institute of Clinical Excellence UK (NICE). ) and "not universally supported by doctors because they have not produced sufficient evidence of success".
Biofeedback
Biofeedback uses gauges to help patients become aware of their body functions. Using an electronic device or diary to track when the bladder and urethral muscles contract, the patient can control these muscles.
Pessaries
Pessary is a medical device inserted into the vagina. The most common type is the shaped ring, and is usually recommended for improving vaginal prolapse. Pessary presses the urethra in the symphysis pubis and lifts the bladder neck. For some women this can reduce stress leakage, but it is unclear how well this mechanical device helps women with stress urinary incontinence. If pessary is used, vaginal and vaginal canal infections can occur and regular monitoring by the doctor is recommended.
Surgery
Doctors usually recommend surgery to reduce incontinence only after other treatments have been tried. Many surgical options have a high success rate. Cochrane's review of the study found that a less invasive variant of surgery operation is equally effective in treating stress incontinence as a surgical sling operation.
One such operation is urethropexy.
The introduction of the vaginal sling (not by opening the lower abdomen) is called intravaginal slingplasty (IVS). IVS has a low complication rate and takes about 25 minutes. Objectively, it has a lower healing rate than the alternative insertion surgery sling technique, but it has the same level of patient satisfaction.
Slings
The procedure of choice for urinary incontinence stress in women is what is called a sling procedure. Sling implants usually consist of synthetic mesh materials in the form of narrow bands but sometimes biomaterials (bovine or porcine) or patients have tissues placed under the urethra through a single vaginal incision and two small abdominal incisions. The idea is to replace defective pelvic floor muscles and provide support boards under the urethra. Transvaginal mesh has recently been under scrutiny, as patients accuse long-term damage and suffering as a result of mesh being planted.
Transvaginal tension-free record
The transvaginal tape-free tensioning (TVT) sling procedure handles urinary stress incontinence by positioning a polypropylene mesh band under the urethra. Complications, such as bladder perforation, may occur in the retropubic chamber if the procedure is not performed properly. However, recent advances have proven that the minimally invasive TVL sling procedure is considered a common treatment for SUI. There are many other complications associated with Tension Free Transvaginal (TVT) Sling including mesh erosion, which leads to a large number of lawsuits around the world against its makers, Johnson & Johnson.
Transobturator band
The transobturator sling procedure (TOT or Monarc) aims to eliminate urinary stress incontinence by providing support under the urethra. The minimally invasive procedure removes the retropubic needle part and involves inserting a mesh band under the urethra through three small incisions in the groin area.
Reusable sling
Adjustable sling consists of a standard synthetic sling mesh combined with stitches attached to the implant holders that are permanently under the skin on the abdominal wall. Once implanted, the Readjustable Mechanical External (RemEEX) device can be re-accessed with local anesthesia to refine the sling that incontinence should reappear some months or years after the initial surgery.
Mini-sling
The mini-sling procedure was released in the United States at the end of 2006 by Gynecare/Johnson and Johnson under the name TVT-Secure. AMS has released a similar version called MiniArc. TVT-SECUR is designed to address two perioperative complications reported with use of TVT-Obturator: thigh pain and urinary tract obstruction. TVT-SECUR is designed to minimize as many surgical procedures as possible to reduce unwanted complications. The new device consists of 8 cm long cut polypropylene mesh lasers and is introduced into the internal obturator muscle (Hammock position) by metal inserter, while no cutting out the skin is required. MiniArc is also quite simple and again eliminates the need for a skin incision other than a vaginal incision. Short-term cure rates reported from minislings ranged from 67% to 90%.
Unnecessary sling
The needleless sling is a single transobturator incident tape (TOT) tape. It is planted through a unique incision. This sash has about 136% more surface area than the mini sling, which can better support the pelvic floor and urethra, and there is no sharp instrument needed to implant a sling other than a scalpel used to make an incision, which can improve patient comfort.
Bladder re-positioning
Most stress incontinence in women occurs as a result of the urethra falling toward the vagina. Therefore, a common operation for stress incontinence involves pulling the urethra to a more normal position. Working through an incision in the vagina or stomach, the surgeon lifts the urethra and secures it with a strap attached to the muscles, ligaments, or bones. For cases of severe incontinence stress, the surgeon can secure the urethra with a wide sling. It not only suppresses the bladder but also presses the lower part of the bladder and the top of the urethra, preventing further leakage.
Marshall-Marchetti-Krantz
The Marshall-Marchetti-Krantz (MMK) procedure, also known as retropubic suspension or bladder neck suspension surgery, is performed by a surgeon at the hospital. Developed in 1949 by physicians Victor F. Marshall (urologist), Andrew A. Marchetti (OB/GYN), and Kermit E. Krantz (OB/GYN), it is the standard by which new procedures are measured. In 1961 Dr. Burch reported modifications of the MMK operation (Burch modification).
The patient is placed under general anesthesia, and the catheter is inserted into the bladder through the urethra. Incisions are made throughout the abdomen, and the bladder is exposed. The bladder is then dissected from the surrounding tissue. The stitches are placed in this tissue near the bladder neck and urethra. The urethra is then removed and the stitches are attached to the pubic bone itself, or the fascia behind the pubic bone. The sutures support the bladder neck, helping the patient gain control over the flow of urine. Burch modification involves placing a surgical suture in the bladder neck and tying it to a pectin ligament.
About 85% of women undergoing Marshall-Marchetti-Krantz procedure recover from their stress incontinence.
Injection of peri/trans urethra
Various ingredients have been historically used to add bulk to the urethra and thereby increase the resistance of the outlet. This is most effective in patients with a relatively fixed urethra. Blood and fat have been used with limited success. The most widely used material, glutomerized crosslinked collagen (GAX collagen) has proved beneficial to many patients. The main downfall is the need to repeat the procedure from time to time.
Artificial urine sphincter
In rare cases, a surgeon infuses an artificial urinary sphincter, a donut-shaped sac that surrounds the urethra. The fluid fills and expands the sac, which suppresses the closed urethra. By pressing the valve that is planted under the skin, the artificial sphincter can be deflated. It removes the pressure from the urethra, allowing urine from the bladder to pass.
Acupuncture
No useful study has been done to determine whether acupuncture can help people with urinary incontinence stress.
References
External links
Source of the article : Wikipedia
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