Urinary incontinence after childbirth is considered a pathological condition when involuntary urination occurs, not controlled by willpower.
This is one of the most urgent problems in modern urogynecology. The incidence of this pathology is very high and is approximately 30-50%. However, women after childbirth are often silent about their problem and do not have enough information about possible ways to solve it, which greatly reduces the quality of life of such patients and leads to the development of various depressive disorders in them.
This pathology occurs in women giving birth in almost 30% of cases after the second birth, in 10% after the first.
Symptoms
The main symptoms of postpartum urinary incontinence are:
- Involuntary excretion of urine duringminor physical exertion, for example, when standing up abruptly, bending over, squatting, sneezing and coughing.
- Uncontrolled urination while lying down and during intercourse.
- Sensation of the presence of a foreign object in the vagina.
- Feeling of inadequate bladder emptying.
- Incontinence after drinking alcohol.
- The volume of urine excreted in this case can be different - from a few milliliters, during straining, to constant leaks throughout the day. Why do women experience urinary incontinence after childbirth?
Reasons
The main factor in the occurrence of this pathology after childbirth is a violation of the functions of the pelvic muscles and the optimal anatomical ratio between the organs located in the small pelvis - the bladder, urethra, uterus, vagina, rectum. Even during a successful pregnancy, there is a rather high load on the pelvic floor, which is a support for the fetus, and the muscles located in this area are actively involved in the formation of the birth canals through which the child passes during childbirth. In the process of labor activity, this group of muscles is strongly compressed and traumatized, their blood circulation and innervation are disturbed.
Difficult delivery
The development of pathological urinary incontinence after childbirth is also facilitated by difficult childbirth, when specialists are forced to resort to the use of obstetric forceps, or childbirth accompanied byruptures of the muscles of the perineum, at the birth of a large fetus, polyhydramnios, multiple pregnancies. Frequent childbirth in a woman is also a provoking factor for the occurrence of this pathology in her. This is due to the fact that the muscles become very stretched, become weak and flabby and do not have time to recover between frequent pregnancies.
The causes of urinary incontinence after childbirth are of interest to many women.
As a result of exposure to various traumatic factors, the following pathological mechanisms may develop:
- Violation of the innervation of the bladder, as well as the muscles of the pelvis.
- Pathological mobility of the canal and bladder.
- Functional disorders of the urethral sphincter.
The causes of urinary incontinence in women after childbirth can be very diverse.
Prerequisites for the occurrence of pathology
Risk factors for this pathology include:
- Genetic predisposition.
- Repeated births and frequent pregnancies.
- Anomalous structure of the organs located in the small pelvis, the muscles of this area.
- Obesity.
- Hormonal imbalance, such as lack of certain female sex hormones.
- Surgical manipulations in the area of the pelvic organs, when the muscles of the pelvic floor and their innervation are damaged.
- Neurological diseases, which may include spinal injuries.
- Various infectious diseases in the urinary tract.
- Impact of background radiation.
- Mental disorders.
Varieties of Urinary Incontinence
There are several types of urinary incontinence after childbirth, which include:
- Urinary incontinence after severe stress - the excretion of urine occurs most often when coughing, sneezing, physical exertion. Most common in women who have given birth.
- Imperative incontinence - passing urine with a strong and sudden urge to urinate.
- Reflex incontinence - when there is a loud sound, the sound of pouring water, that is, when exposed to some external factor that provokes the urination process.
- Post-urination incontinence is a phenomenon when, after the release of the main amount of urine from the bladder, it continues to stand out or leak in small amounts for a short period of time.
- Involuntary leakage - uncontrolled release of urine in small portions, drop by drop.
- Bedwetting, or the medical definition of this phenomenon - enuresis - involuntary urination at night while sleeping, which is typical for children and is considered a pathology in adults.
- Incontinence due to overfilling of the bladder, when urine is passed in small amounts. This kind of incontinence is observed, as a rule, with the development of infectious pathologies of the urinary tract, as well as with tumor processes of the small pelvis, which compress the bladder, for example, fibroidsuterus.
How to identify the causes of urinary incontinence in women after childbirth?
Diagnostic methods
For incontinence problems, see a urologist. The patient, as a rule, will be asked to keep a diary of urination, which is filled out within 1-2 days, after which the specialist analyzes such data. In this diary, information is recorded every hour: the amount of fluid - drunk and excreted, what is the frequency of urination and discomfort in the process of urination, if any. The diary also contains a description of the phenomena of urinary incontinence, namely under what conditions this happened, and in what amount of urine was involuntarily excreted.
Besides this, a woman should be examined on a gynecological chair. To exclude infectious and inflammatory diseases, the doctor should take swabs for the vaginal flora, as well as for the presence of urogenital infections from the urethra and cervix. Vaginal examination helps to identify the presence of various tumor neoplasms, the presence of which can be the main factor in squeezing the bladder and changing its position. With such an examination, a so-called cough test is also performed to diagnose incontinence. The doctor asks the patient to cough, and in cases where urine is excreted from the urethra, the test can be considered positive.
Laboratory and instrumental diagnostics of pathology
At the next stage of the diagnostic study, additional methods are prescribed, which, as a rule, are:
- Laboratory - these include general and biochemical blood tests, urine culture for microflora, general urinalysis, urinalysis to determine sensitivity to antibacterial drugs.
- Ultrasound of the bladder and kidneys. Using this diagnostic technique, it is possible to establish the volume of residual urine in the bladder, as well as indirect signs of the presence of inflammatory processes in the genitourinary system and structural anomalies of the kidneys and urinary tract.
- Cystoscopy, which is a study during which a special diagnostic device called a “cystoscope” is inserted through the urethra into the bladder cavity. This diagnostic method allows you to examine the bladder cavity in order to assess the condition of its mucosa, as well as changes that may cause incontinence or somehow complicate the course of the disease. In addition, using this method, some inflammatory processes occurring in this organ - cystitis, as well as all kinds of structural defects - diverticula, polyps, etc. are diagnosed.
- Urodynamic studies that directly characterize the act of urination.
- Profilometry is a research method that is performed by measuring the pressure in the urethra, in its different parts.
- Cystometry is a technique that determines the relationship between bladder volume and pressure, as well as assessing the state of the urinary bladder and its contractile activity, the ability to stretch when overfilled, and also control the function of the nervous system over the actexcretion of urine.
- Uroflowmetry is a technique that allows you to measure the volume of urine excreted in a certain unit of time. This study makes it possible to establish graphic images of the urinary process, evaluate the speed of the urine stream and the duration of this.
So, if there is urinary incontinence after childbirth, how to treat this pathology?
Treatment of postpartum pathology
Based on the data of all diagnostic measures, the optimally effective method of treatment is determined. Since it is the stress type of incontinence that is most often observed in women after childbirth, it should be treated specifically.
Incontinence observed after childbirth, as a rule, conservative methods of therapy are used, which are aimed at training the pelvic muscles and the muscles of the bladder.
Strengthening the pelvic muscles
To strengthen the muscles of the pelvis, a woman is recommended to hold with the help of the vaginal muscles special weights in increasing weight, which have the shape of a cone. This exercise is performed for 20-25 minutes several times during the day. Such training should begin with weights that have the smallest weight, after which the loads should gradually increase, taking into account the results achieved. Kegel exercises can give a certain effect, with the help of which the vaginal muscles are effectively strengthened.
This is the answer to the question of what to do with urinary incontinence after childbirth.
Kegel exercises are essentialexercise daily, and they should contain 100-200 muscle contractions per day. The convenience of these exercises is that they can be done anywhere and at any convenient time. They are carried out by means of maximum compression and tension of the muscles of the perineum and their relaxation. Through such training, not only the muscles of the urinary tract are strengthened, but also the rectum, urethra and vagina.
What else is the treatment for postpartum urinary incontinence?
Various physiotherapeutic methods are used, for example, electromagnetic stimulation. Kegel exercises or weight training can be alternated with courses of physiotherapy.
Bladder training
Urinary training, the main point of which is to follow the urination plan in advance, also helps to achieve a positive effect. In this case, the patient must urinate at strictly specific intervals. In this case, the training program should be aimed at increasing the time intervals between acts of urine output. The patient, as a rule, does not urinate when the urge arises, but according to the plan. At the same time, strong urges are recommended to be restrained by contracting the anus.
Drug therapy
As an auxiliary drug therapy for incontinence after childbirth, women are usually prescribed sedatives that help improve blood circulation and strengthen the walls of blood vessels, as well as various vitamin complexes. There are no medications that act directly on the cause of this pathology. An exception is a disease such as enuresis, when a patient is prescribed a course of taking certain medications that affect certain parts of the brain.
The treatment of urinary incontinence in women after childbirth may not be limited to this.
Prompt methods for problem solving
In the absence of a therapeutic effect after the application of conservative treatment methods, a woman is offered surgical intervention. The most common of these methods is the loop (sling) operation, in which additional support is created for the urethra by placing a special loop in its middle part.
Feedback on urinary incontinence after childbirth
According to women, this phenomenon is not uncommon. The recovery period is usually different for everyone. For some, all symptoms disappear after 2 weeks, and someone suffers from such a problem as urinary incontinence, for a long time - up to a year. Effective exercises for the bladder and pelvic floor muscles, as well as sedatives. Surgery is a last resort in the most severe cases.
We looked at the causes and treatment of postpartum urinary incontinence.
