Urinary incontinence after childbirth is considered a pathological condition when involuntary urination occurs that is not controlled by volitional effort.
This is one of the most pressing problems in modern urogynecology. The frequency of occurrence of this pathology is very high and is approximately 30-50%. Nevertheless, women after childbirth often remain 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 a variety of depressive disorders.
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 urinary incontinence after childbirth are the following symptoms:
- Involuntary discharge of urine with minor physical exertion, for example, with a sharp rise, when bending, squats, sneezing and coughing.
- Uncontrolled urination while lying down, as well as during sexual intercourse.
- Sensation of the presence of a foreign object in the vagina.
- Feeling of defective bladder emptying.
- Urinary incontinence after drinking alcohol.
- The volume of urine released can vary from a few milliliters during straining to constant leaks throughout the day. Why does urinary incontinence occur in women after childbirth?
Causes
The main factor in the occurrence of this pathology after childbirth is considered to be 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, and rectum. Even during a successful pregnancy, there is a rather high load on the pelvic floor, which is the support for the fetus, and the muscles located in this area are actively involved in the formation of the birth canal through which the baby passes during childbirth. In the process of labor, there is a strong squeezing and traumatization of this muscle group, their blood circulation and innervation are disturbed.
Difficult birth
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 by ruptured muscles of the perineum, at the birth of a large fetus, polyhydramnios, and multiple pregnancy. 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 are greatly 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 development of the following pathological mechanisms can occur:
- 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.
Background pathology
The risk factors for this pathology include:
- Genetic predisposition.
- Repeated birth and frequent pregnancies.
- The abnormal structure of organs located in the pelvis, muscles of this area.
- Obesity.
- Hormonal imbalance, for example, a lack of certain female sex hormones.
- Surgical manipulations in the field of the pelvic organs, when there was damage to the muscles of the pelvic floor and the violation of their innervation.
- Neurological diseases, which may include spinal injuries.
- A variety of infectious diseases in the urinary tract.
- Exposure to radiation background.
- Mental disorders.
Types of urinary incontinence
There are several types of urinary incontinence after childbirth, which include:
- Urinary incontinence after severe stress - urine excretion occurs most often with coughing, sneezing, and physical exertion. Most often found in women giving birth.
- Imperative incontinence - urine excretion 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 urinary process.
- Incontinence after an act of urination is a phenomenon when, after releasing a major amount of urine from the bladder, it continues to stand out or leak in small amounts over a short period of time.
- Involuntary leakage - uncontrolled release of urine in the form of small portions, drop by drop.
- Bedwetting, or a medical definition of this phenomenon - enuresis - involuntary urination at night in a sleeping state, which is typical for children and is considered a pathology in adults.
- Incontinence due to overflow of the bladder, when urination occurs in small quantities. This kind of incontinence is observed, as a rule, with the development of infectious pathologies of the urinary tract, as well as with pelvic tumor processes that compress the bladder, for example, uterine fibroids.
How to identify the causes of urinary incontinence in women after childbirth?
Diagnostic methods
To solve problems with incontinence, you should contact a urologist. The patient, as a rule, will be offered to keep a diary of urination, which is filled out within 1-2 days, after which the specialist analyzes such data. In this diary every hour information is recorded: the amount of fluid - drunk and excreted, what is the frequency of urination and discomfort during urination, if any. The diary also describes the phenomena of urinary incontinence, namely, under what conditions this happened, and in how much urine was released spontaneously.
In addition, a woman should be examined on a gynecological chair. To exclude infectious and inflammatory diseases, the doctor should take smears on the vaginal flora, as well as on the presence of urogenital infections from the urethra and from the cervix. Vaginal examination helps to detect the presence of various tumor neoplasms, the presence of which can be the main factor in the compression of the bladder and changes in its position. With a similar examination, a so-called cough test is also performed to diagnose incontinence. The doctor asks the patient to cough, and in cases when urine is excreted from the urethra, the test can be considered positive.
Laboratory and instrumental diagnosis of pathology
At the next stage of the diagnostic study, additional methods are prescribed, which, as a rule, are:
- Laboratory - these include a general and biochemical blood test, urine culture on microflora, a general urinalysis, urinalysis to determine the 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 of the genitourinary system and structural abnormalities 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 cavity of the bladder in order to assess the condition of its mucosa, as well as changes that may be the cause of incontinence or in some way complicate the course of the disease. In addition, using this method, some inflammatory processes that occur in this organ are diagnosed - cystitis, as well as all kinds of structural defects - diverticula, polyps, etc.
- Urodynamic studies that directly characterize the act of urination.
- Profilometry is a research method that is performed using pressure measurement in the urethra, in its different areas.
- Cystometry is a technique that determines the relationship between the volume of the bladder and pressure, as well as to assess the condition of the urinary and its contractile activity, the ability to stretch when overflowing, and also to monitor the function of the nervous system over the act of excretion of urine.
- Uroflowmetry is a technique that allows you to measure the volume of urine excreted in a specific unit of time. This study makes it possible to establish graphical images of the urinary process, to evaluate the speed of the urine stream and the duration of this.
So, if after birth urinary incontinence, how to treat this pathology?
Treatment of postpartum pathology
Based on the data of all diagnostic measures, the determination of the optimal treatment method is carried out. Since women after childbirth, it is most often the stressful form of incontinence that is observed, it should be treated.
In case of incontinence observed after childbirth, conservative methods of therapy are used, as a rule, which are aimed at training the pelvic muscles and muscles of the bladder.
Strengthening the muscles of the pelvis
To strengthen the pelvic muscles, a woman is recommended to hold special weights in increasing weight, which have the shape of a cone, with the help of the vaginal muscles. This exercise is performed for 20-25 minutes several times during the day. Such training should begin with weights having the smallest weight, after which the loads should gradually increase, taking into account the results achieved. Kegel exercises, with the help of which the vaginal muscles are effectively strengthened, can give a certain effect.
This is the answer to the question of what to do with urinary incontinence after childbirth.
Kegel exercises must be performed 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, but also the rectum, urethra and vagina are strengthened.
What else is the treatment for urinary incontinence after childbirth?
Various physiotherapeutic methods are used, for example, electromagnetic stimulation. Kegel exercises or weight training can be alternated with courses of physiotherapeutic procedures.
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 should 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, urinates not when the urge arises, but in accordance with the plan. At the same time, it is recommended to restrain strong urges by reducing the anus.
Drug therapy
As adjuvant drug therapy for post-birth incontinence, 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 directly affect 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.
Treatment of urinary incontinence in women after childbirth may not be limited to this.
Operational Methods for Solving the Problem
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 a loop (sling) operation, in which an additional support for the urethra is created by placing a special loop in its middle part.
Post-birth incontinence reviews
According to women, this phenomenon is not uncommon. Usually, the recovery period is different for everyone. In some, all symptoms disappear after 2 weeks, while someone suffers from a problem such as urinary incontinence, for a long time - up to a year. Effective exercises for the bladder and pelvic floor muscles, as well as sedatives. Operation is an extreme measure in the most severe cases.
We examined the causes and treatment of urinary incontinence after childbirth.