Enuresis in women is pathological condition, during which a certain amount of urine is released involuntarily. Urinary incontinence causes a strong sense of shame and terrible discomfort and significantly worsens a woman’s quality of life. More recently, enuresis was considered a “faithful” companion for older women. But now urinary incontinence is also observed in women over thirty years of age.

Causes of urinary incontinence in women

On this moment There are two main factors that lead to enuresis in women. In the first case, due to coughing, sneezing, jogging, laughter, pressure occurs on the bladder. This situation occurs in most cases. In the second case, a woman suddenly and without any particular reason has a sharp and completely sudden urge to urinate. Moreover, this urge can also be felt if the bladder is filled with a small volume of liquid. Enuresis can generally occur without any urge; for this, a woman just needs to touch the flowing water with her hand or simply drink.

Some women may experience enuresis mixed type, which is a combination of several types of bladder dysfunction. This type of urinary incontinence is most often observed in women over the age of fifty.

There are several reasons that lead to enuresis in women.

As mentioned earlier, involuntary leakage of a certain portion of urine can occur during jogging, coughing, sneezing and other similar actions.

Enuresis may appear due to stretching muscle fibers, which partially lose the ability to support the bladder in correct position. This often happens in women after childbirth or when they are overweight. Enuresis in women with involuntary urge may occur with involuntary and sudden contraction of the muscle fibers of the bladder. At the moment of contraction of these muscles, a woman may feel a strong urge to urinate.

Enuresis in women. The main symptoms and development of this disease

The most a clear sign The appearance of enuresis is sudden and uncontrollable urination when laughing, coughing, sneezing and other sudden movements. At such moments, an average or very small volume of urine is released.

Most often, urinary incontinence occurs due to the presence of any diseases, for example infectious lesion genitourinary system. Once the underlying cause is treated, bedwetting usually goes away on its own.

In the absence of proper treatment, enuresis in women becomes chronic or prolonged, and the symptoms of the disease intensify. Enuresis progresses to a more severe or prolonged stage due to the fault of women who are ashamed to contact specialists. As soon as enuresis enters a chronic or long-term stage, the patient’s habits and behavior may change. Thus, patients become less active, and out of shame they diligently avoid being in public or in company.

Moreover, with constant contact skin groin area With urine, severe irritation of the skin occurs, which becomes more defenseless against various infections.

The problem can only be controlled if the patient is given the correct treatment.

The following diseases can contribute to the occurrence of enuresis:

Overweight or obesity;
- removal of the uterus (hysterectomy);
- childbirth or pregnancy;
- blockade in the bladder;
- anomalies of the genitourinary system;
- stones in the bladder;
- elderly age;
- infectious diseases of the genitourinary system in the chronic stage.

Enuresis in women can also be caused by some serious diseases:

Parkinson's disease;
- diabetes;
- Alzheimer's disease;
- bladder cancer;
- prolapse of the pelvic bones;
- damage spinal cord;
- strokes;
- bladder cancer;
- multiple sclerosis.

Alcoholic drinks, black tea, coffee, soda, smoking, antidepressants, anticholinergic drugs and diuretics relax the bladder and increase urine production several times.

Enuresis in women. Treatment

To begin, the specialist conducts a series of different tests that will help confirm the diagnosis. After this, the reason that led to the development of urinary incontinence in women is identified.

If the patient experiences a sudden and irresistible urge to urinate, the bladder will need to be trained in a special way so that it begins to function fully. In addition to this, the doctor may prescribe special medications.

In addition, the doctor prescribes the patient a whole range of exercises to strengthen pelvic muscles(Kegel exercises). If urinary incontinence is due to excess weight, a specialist may recommend therapeutic diet aimed at sustainable and harmless weight loss.

If you have enuresis, you should also avoid certain foods that stimulate bladder activity. Spices, dairy products, citrus fruits, vinegar, tomatoes, chocolate products, alcoholic and coffee drinks should be removed from the diet, at least temporarily.

In particular severe cases the doctor prescribes surgery enuresis, which will help restore the anatomical position of the bladder.

Female enuresis is a form of dysuria (urinary disorder) in women, which is characterized by urinary incontinence at any time of the day. Urinary incontinence has detrimental effects both physically and psychological state: a woman cannot play sports, be in in public places communicate freely with people. This problem is not a separate disease, but only its manifestation. Therefore, enuresis is treated by various specialists: urologists, gynecologists, neurologists.

Enuresis is more common in the weaker sex

Today, more than half of the fair sex suffer from urinary incontinence. This urinary disorder affects both the elderly and average age. Women over 60 years old suffer from enuresis due to any diseases or age-related changes in the urinary system, and in young girls it often occurs after several births.

Types of enuresis

Depending on the pathogenesis (mechanism of development) there are the following types urinary incontinence in adults:

• Stressed look. The cause of this form is a disruption of the normal activity of the urethral sphincter. The pathogenesis is an increase intra-abdominal pressure, which is provoked by laughter, coughing, and heavy lifting. With this process, weakened sphincter muscles are unable to hold urine. Risk factors for the development of stress incontinence include genetic predisposition and obesity; infectious diseases genitourinary problems suffered by women in the past.
• Imperative or urgent appearance. The mechanism of development of this form of female enuresis is a disruption of the activity of the central nervous system (CNS). The cause here can be considered to be hyperactivity of the bladder, which develops as a result of a violation of its innervation. During such processes, a woman is bothered by a sudden urge to urinate up to 10 times a day. Their appearance is facilitated by bright light, the sound of rushing water, etc. In this case, urine leakage cannot be controlled. Risk factors for the development of urge incontinence are: age over 60 years, multiple births, hormone imbalance, bladder tumor, neurological pathologies.

It happens that a woman does not have time to run to the toilet

• Permanent incontinence. The causes of this type of enuresis are abnormalities in the structure of the urinary organs and dysfunction of the urethral sphincter. Persistent incontinence most often occurs in older people.
• Bedwetting (sleep incontinence). Nocturnal enuresis in adults, this is the uncontrolled excretion of urine during sleep. The causes of this form are hypotonia of the perineal muscles and pelvic floor due to several births, episiotomy (dissection of the perineum during delivery).

Among adults, the most common forms are stressful and imperative. In addition to the above, there are iatrogenic (dysuric disorder due to taking diuretic and other medications) and unconscious urinary incontinence.

Causes of enuresis

In general, this urination disorder in women is a consequence of hypotension of the pelvic muscles, its bottom, as well as dysfunction of the urethral sphincter. The following diseases can lead to these pathologies:

• urolithiasis disease;
• diabetes;
• stroke;
• spinal cord injury;
• multiple sclerosis;
• Parkinson's and Alzheimer's diseases;
• chronic infectious diseases of the female genitourinary system;
• benign and malignant formations in the pelvic organs;
• prolapse of the pelvic organs.

Other conditions leading to enuresis include:

• period of pregnancy, delivery (prolonged or rapid labor);
• overweight or obesity;
• old age;
• chronic cough due to smoking;
• drinking alcohol;
• taking diuretics.

Diagnosis of enuresis

Differential (comparative) diagnosis is mainly carried out between the stress and imperative types of this urination disorder. To do this, it is necessary to compare the frequency of symptoms in the patient:

Symptoms	Imperative view	Stressed look
Urinary incontinence after urge	Often	Very rarely
The connection between enuresis and physical activity, cough	Absent	Always present
The connection between enuresis and alcohol intake	Present	Absent
Nocturia (nighttime urge to urinate that disrupts sleep)	Often	Rarely
Pollakiuria (frequent urination)	Almost always	Rarely

To make a final diagnosis and prescribe appropriate treatment for an adult, the doctor prescribes basic and additional types research. They consist of clinical, laboratory, and instrumental methods diagnostics

If enuresis occurs, you should immediately seek help from a doctor.

Clinical researches:

• Collection of complaints.
• Anamnesis collection.
• Filling out a special questionnaire (ISQ questionnaire). It usually contains questions regarding the following complaints and symptoms:
  • the period of time from the onset of the first symptoms;
  • change in the volume of leaking urine from the onset of symptoms to the day of treatment;
  • frequency of urine leakage;
  • the presence of factors (coughing, laughter, heavy lifting, the sound of pouring water, etc.) that provoke uncontrolled urination;
  • the presence of an irresistible urge to urinate;
  • urinary retention time when urinary;
  • frequency of incontinence;
  • the period of the day during which uncontrolled urination most often occurs;
  • presence of urge to urinate at night;
  • the impact of enuresis on the quality of life (assessment on a 5-point scale).

The doctor asks the woman to fill out the Urinary Incontinence Symptoms Questionnaire.

• Keeping a urination diary. The diary states:
  • time;
  • amount of fluid consumed (in ml);
  • number of calls per hour;
  • volume of urine excreted (in ml);
  • presence of an irresistible urge (yes/no);
  • presence of involuntary urination (yes/no);
  • volume of urine excreted during uncontrolled urination (in ml);
  • provoking factor of involuntary urination (sports, laughter, cough, bright light, etc.).
• PAD - test. This test is used to determine the amount of urine leaking. During this procedure, the woman wears special pads, which she weighs before and after use. All data must be recorded on paper for subsequent examination by a doctor.

Laboratory and instrumental studies:

1. General urine analysis.
2. Bacterial culture of urine according to indications.
3. Examination of the genital organs using vaginal speculum.
4. Ultrasound examination (ultrasound).

Carrying out ultrasound examination

Treatment of enuresis

After making a final diagnosis, the doctor prescribes appropriate therapy. Enuresis can be treated conservatively and surgically. TO surgical treatment resort after unsuccessful drug treatment during a year.

Conservative treatment:

• Normalization of lifestyle:
  • body weight control;
  • eliminating bad habits;
  • reducing the consumption of caffeinated drinks;
  • limiting salt intake.

The above methods also serve preventive measures to reduce the risk of developing enuresis in adult women.

Herbal remedies can be used to treat enuresis

• Phytotherapy:
  • infusion of dill seeds (1 tbsp. 1 r/day);
  • infusion of sage herb (1 tbsp. 3 times a day);
  • infusion of yarrow (½ tbsp. 3 r/day);
  • tincture of corn silk (1 tbsp. 2 times a day);
  • plantain juice (1 tbsp. 3 times a day).
• Kegel exercises.

The essence of these women's exercises is alternating tension and relaxation of the pelvic floor muscles in order to gradually strengthen them.

• Psychological training.

The point of the training is to carry out various activities (reading a book, listening to music) when the urge appears. Using this method, a person “trains” the central nervous system to restrain the urge to urinate.

At strong urges before urinating, you can try to distract yourself from the thought of it

• Medications:
  • Antidepressants are prescribed to eliminate stress as one of the causes of enuresis in women.
  • Agents acting on peripheral nervous system used to normalize the tone of the pelvic floor muscles and urethral sphincter.
  • Estrogens are prescribed to restore the balance of sex hormones, the imbalance of which caused enuresis.

It is advisable to use medications for the treatment of stress type enuresis only in the absence of structural anomalies of the urinary organs.

Surgery:

• sling surgery (placing a loop on the ureter);

Carrying out sling surgery for urinary incontinence

• laparoscopic colposuspension (“suspension” of the urethra due to the vaginal walls);
• colporrhaphy (suturing of the vagina).

Conclusion

Female enuresis is a fairly common problem among women. To reduce the risk of developing this pathology, it is recommended to follow correct image life, carry out exercises to strengthen the pelvic muscles. When the first signs of urinary incontinence appear, you should consult a doctor to find out the causes and prescription. rational treatment. Remember, enuresis does not go away on its own, so timely contact with a specialist will help avoid the development of adverse consequences.

To understand this disease, it is necessary to become familiar with the anatomy and function of the bladder. Urine is produced in the kidneys and discharged through the ureter into the bladder, where it accumulates. The bladder is a hollow muscular organ that serves as a reservoir for urine before urination through urethra(a tube that runs from the bladder to the outside). The bladder empties when the detrusor muscle, located in the wall of the bladder, contracts and pushes urine out of the body. At the same time, when the bladder contracts, the urinary sphincter relaxes. A relaxed sphincter acts as a door that opens, allowing urine to exit the body. For proper urination, contraction of the detrusor muscle and relaxation of the sphincter must occur simultaneously. Nerve endings in the muscle wall of the bladder produce acetylcholine, a substance found in muscle cell receptors that helps contract. Signals by nerve endings enter the cerebral cortex, signaling that it is time to empty the bladder. This process is vegetative, i.e. not independently controlled. Overall, proper communication between nerves, muscles and the brain is a very complex process.

Causes

Many factors influence the occurrence of nocturnal enuresis in adults. Most adults with symptoms of enuresis may also experience urinary incontinence. daytime. It is necessary to know the symptoms associated with nocturnal enuresis, as they may precede urological diseases.

Firstly, nocturnal enuresis can be transmitted at the genetic level. Although not all people have enuresis hereditary disease. Studies have shown that if both parents have enuresis, the risk of bedwetting in children increases to 77%. If one parent suffers from urinary incontinence, then in 40% of cases the child has a risk of developing this disease.

ADH, or antidiuretic hormone, tells the kidneys to reduce the amount of urine produced. Typically, the body produces more ADH at night, which causes the kidneys to produce less urine. Reducing urine production at night allows people to sleep without having to urinate. However, in some people this hormone is not produced in the required quantities, leading to frequent urination at night time. This condition resembles the symptoms of diabetes mellitus 2 types.

Similar symptoms may occur in people with various diseases. You should consult a doctor if you suffer from diabetes or nocturnal enuresis.

Another cause of primary nocturnal enuresis is a “small” bladder. However, this does not mean that the bladder size of patients with nocturnal enuresis is actually smaller than that of other people. Instead, it means that the functional bladder capacity (FBC) is less, meaning the amount of urine the bladder can hold before sending a signal to the brain to urinate, is less than that of other people with the condition. Overactive contractions of the detrusor muscle mean that the muscle never fully relaxes, and therefore the bladder capacity is small.

Along with FEMP, overactivity or involuntary contraction of the detrusor muscle also causes nocturnal enuresis. Detrusor overactivity is an involuntary contraction of the muscle that can lead to an episode of enuresis. Many studies have shown that increased level Detrusor contractions cause nocturnal enuresis. Detrusor overactivity is diagnosed in 70-80% of patients suffering from nocturnal enuresis. Bladder irritants such as alcohol and caffeine may also contribute to malfunction detrusor. Additionally, other supplements that are used as diuretics also increase urine production.

Some drugs have been registered for which side effect is nocturnal enuresis, for example, sleeping pills, drugs for insomnia or drugs used in psychiatric practice. Also, obstructive sleep apnea or sleep disorders can cause nocturnal enuresis. Be sure to discuss any prescribed medications and their side effects with your doctor.

Many studies confirm that secondary enuresis in adults is common serious symptom underlying disease that needs to be examined. This type Enuresis is accompanied by other symptoms and often manifests itself as daytime urinary incontinence.

In adults, primary nocturnal enuresis is often the result of problems with the urethra, such as prostatic or general bladder outlet obstruction. These problems may be related to the prostate in men or pelvic prolapse organ in women.

Additional causes of secondary enuresis may be diabetes mellitus, infection urinary tract, urinary tract stones, neurological disorders, anatomical disorders, prostate enlargement, bladder cancer and obstructive syndrome. IN in rare cases severe anxiety or emotional disorder may cause enuresis in adults.

Diagnostics

Most informative method diagnostics - history of your disease and information about habits. Write down your daily activities and established routine for the duration of the day. at least, two days before medical examination. These details will help your doctor determine the cause and severity of the condition.

Record your daily urination times, day and night.

• When do enuresis episodes occur (time of day)?
• Amount of urine excreted?
• Do you drink a lot of fluids before bed?
• What drinks do you drink? (sweet coffee, caffeinated or artificially sweetened, or carbonated, alcoholic drinks etc.)
• How does urination occur? (is the urine stream strong and continuous, or is there any difficulty?)
• Are there any recurrent urinary tract infections?
• Number of “wet” and “dry” nights?

Also, note any other signs associated with nocturnal enuresis, such as night sweats.

Any information can help the doctor make a diagnosis and prescribe appropriate treatment.

When you see a doctor, you must provide full information and all details related to personal and family history of the disease, as well as information about taking any medications. In addition, you should consult a doctor to rule out other serious problems, which may cause nocturnal enuresis as a side effect.

The doctor's appointment includes:

• Medical checkup
• Neurological assessment
• Urinolysis and bacteriological culture urine tests are various tests that determine the content of urine.

Additional methods:

• Uroflowmetry: a method of testing urination, which is performed in a specialized tube that measures the speed, amount of urine and time of urination.
• Residual urine volume: Ultrasound is used to determine the volume of urine after urination.

For other problems it is possible additional methods diagnostics

Treatment

For primary (persistent) nocturnal enuresis, treatment is used at any age.

Pharmacological therapy

There are various medications available to treat nocturnal enuresis. They can be used alone or in combination with behavioral treatment, which is mentioned above and is the most effective. Many studies have shown that medications can be effective in reducing wet nights. long-term use. In other words, as soon as treatment is stopped, the disease recurs because medications are aimed at eliminating the symptoms and not the causes of the disease. You should consult a doctor before starting any treatment.

Surgical treatment methods

Apply surgery necessary in cases of severe detrusor overactivity, or if other treatments have failed. All treatment methods should be discussed with your doctor.

Help during treatment

Help is available to help treat bedwetting.

Mattress Covers: There are many items available to protect your bed, such as vinyl, waterproof and absorbent mattress covers, or sheet protectors that can make cleaning easier.

Absorbent Briefs: Specially designed underwear that absorbs liquid and prevents involuntary leakage of urine. Reusable and accessible to anyone. For those with skin prone to irritation, best choice are absorbent swimming trunks.

Skin care products: There are many products available to protect the skin from the irritation and sensitivity that occurs with bedwetting. There are soaps, lotions and cleansing wipes for various types skin.

Doctors call urinary incontinence mainly at night enuresis. The frequency of its occurrence in men is quite high. The situation when an adult man peed himself in a dream is not immediately brought to the attention of doctors.

But repeated cases force the patient and his relatives to think about the seriousness of the problem and contact a specialist. After a thorough diagnosis, the causes are identified and treatment is prescribed. The disease cannot be treated on its own, especially since it may be the result of another, more serious problem.

Nocturnal urinary incontinence in men is called “incontinence.” The process of urination in this pathology is absolutely not controlled by the person. There are two groups of the disease:

1. Primary incontinence. The cause is weakness of the bladder muscles and developmental defects.
2. Secondary incontinence. It is not considered an independent disease, but is a consequence of other diseases, injuries, inflammatory processes. Often occurs in older men, as they accumulate with age chronic pathologies, leading to weakening muscle tone and disruption of the innervation of the bladder.

The problem of lack of urge to urinate attracts attention great attention from doctors, psychologists, sociologists. This occurs due to psychological and physiological discomfort in patients, which leads to depression, complexes, and in some cases leads to disability. Doctors define 4 types of enuresis in men:

1. Urgentny. The patient realizes that he has a desire to urinate, but is unable to control it. Observed in diabetes mellitus, stroke, Parkinson's disease.
2. Stressful. One of the common types of urinary disorders. Appears during laughter, coughing, lifting weights. The process is triggered by excessive pressure on the walls of the bladder.
3. Mixed. Combines the symptoms of the first two types, when due to bladder overflow, uncontrolled urination occurs and the contractility of the sphincters is impaired.
4. Transitional. Impaired urine output at night in men is temporary due to medications, acute infectious diseases of the genitourinary system, and constipation.

The effectiveness of treatment for any type of enuresis depends on timely contact with a doctor, who will prescribe an examination and identify the main causes of the pathology.

Causes of nocturnal enuresis in men

Bedwetting is typical for men over 45-50 years old. In addition to age, doctors call various reasons involuntary urination:

• low stress resistance of a person, susceptibility to panic attacks;
• neurological disorders, Parkinson's disease or multiple sclerosis;
• developmental abnormalities of the urinary system organs;
• injuries of the spine, pelvic organs;
• infectious diseases of the genitourinary organs;
• disturbances in the bladder emptying reflex;
• neoplasms of various etiologies in the organs of the urinary and reproductive systems, as well as in the spinal cord;
• metabolic disease;
• structural changes in the tissues of the genitourinary system due to age;
• taking medications with diuretic, relaxing and sedative effects;
• infectious processes in the body, manifested severe cough, sneezing;
• alcohol and drug addiction.

Urinary incontinence in men during sleep can be recurrent in nature, when cases of enuresis are replaced by dry periods. Persistent urination problems can occur due to prostate diseases. At successful treatment the root causes are eliminated and the symptoms of enuresis are eliminated.

Diagnostics

Involuntary urination in men during sleep requires careful examination.

Diagnosis of the disease includes:

• initial examination by a urologist in order to identify the characteristics of the disease, the correspondence of the number of urinations to the volume of fluid consumed;
• ultrasonography;
• radiography;
• laboratory urine tests.

If necessary, the urologist prescribes additional research methods:

• profilometry - measuring pressure in the urethra;
• uroflowmetry - the study of various parameters of the urination process.

Based on the examination results, the doctor determines accurate diagnosis and prescribes a course of treatment.

Treatment of nocturnal enuresis in men

Treatment of enuresis is prescribed by a urologist. The course of therapy is aimed at reducing the contractile activity of the bladder and increasing its volume. To achieve results, the patient must strictly follow all the doctor’s recommendations, take medications, and adhere to the treatment regimen.

Helps relieve a patient from sleep incontinence complex therapy, Which includes:

1. Regular physical exercise. Designed to strengthen the muscles of the perineum and pelvis. It is recommended to master Kegel exercises for this.
2. Taking medications. Drugs are prescribed that normalize the contractile function of the bladder. When found infectious disease recommend the course antibacterial drugs, antispasmodics. Depressive state the patient is considered an indication for taking tranquilizers.
3. Physiotherapy methods.
4. They normalize the transmission of nerve impulses from the brain to the pelvic organs and back. Electrosleep, electrophoresis, and magnetic therapy help to cope well with the problem.
5. Surgery.

In some situations, treatment of enuresis in adults is only possible surgically. This method allows you to perform a sling operation, expand the urethra using a special balloon, sew a valve into the bladder, and so on.

The effectiveness of treatment of enuresis in adult men increases by quitting smoking and drinking alcohol.

Treatment of primary and secondary urinary incontinence has its own characteristics.

Treatment of primary enuresis

Uncontrolled urination at night in men, diagnosed with early age, doctors call primary. This phenomenon is rare, detected in no more than % of representatives of the stronger sex.

Patients are prescribed treatment aimed at stabilizing the functioning of the nervous system:

• forced awakening during night sleep at three-hour intervals;
• taking antidiuretics;
• surgery in special cases.

Treatment of acquired secondary enuresis

Spontaneous urination during sleep in men is called secondary if it is a consequence of the development of another disease. The decision on treatment is made only after the cause is determined.

After diagnosis, treatment is prescribed:

• taking medications that slow down the growth of prostate tumors when they are detected;
• drugs that reduce the activity of the bladder detrusor for diabetes mellitus;
• oxygen therapy in the diagnosis of sleep apnea, as well as the use of special devices;
• taking medications that normalize hormonal background, with thyrotoxicosis and other endocrine disorders.

If there is leakage of urine after the main urination, exercises developed by Kegel are prescribed. They are aimed at increasing muscle tone and normalizing work genitourinary organs. In this case, you need to strain the pelvic muscles 10 times and hold in this position for at least 3 seconds. Each time the tension duration is increased to 10 seconds. Doctors advise doing exercises at least three times a day.

Prevention

Involuntary urination during sleep negatively affects the self-esteem of men and their personal life. Therefore, it is important to maintain health and prevent the development of pathology. To do this you need:

• quit smoking and alcohol;
• lead active image life;
• observe drinking regime;
• enrich the diet with fruits, vegetables, cereals;
• exclude fried, spicy and smoked foods from the menu;
• normalize sleep.

Many men are embarrassed by the problem of bedwetting, which leads to aggravation of the situation. Timely seeking help will help avoid possible complications and defeat enuresis in the initial stage.