Urinary incontinence is the involuntary induction of urine from the urethra that can not be controlled by will. This disease can be primary, in which the cause is a defect of the sphincter of the bladder and secondary.
Urinary incontinence in men is a rather delicate problem with which the stronger sex does not always rush to go to the doctors. In urology, this condition is more commonly known as incontinence, which is not an independent disease, but develops against other pathological processes occurring in the human body or as a result of age-related changes.
This problem is not only medical, but also social. Although incontinence does not threaten life, it is accompanied by serious mental and emotional disabilities, which ultimately lead to social maladjustment( unpleasant odors, the need to use diapers, the lack of access to the house for a short period), and sometimes to disability.
There are several types of urinary incontinence in men, depending on which the scheme of treatment of the disease will be determined:
- Urgent( urgent, imperative) urinary incontinence is a condition where a man knows that he has a urge to urinate, but he can notcontrol it and "endure to the toilet."This type is characteristic of Parkinson's disease, diabetes, and also occurs in men after a stroke.
- Urinary incontinence is the most common form of incontinence that occurs with physical activity, laughter, coughing, trying to lift a heavy thing, which leads to an increase in pressure in the bladder and involuntary discharge of urine.
- Mixed urinary incontinence .It is determined by a combination of urgent and stressful components. Incontinence in overflow is a consequence of a decrease in the detrusor's contractile ability, overstimulation of the bladder, and the sphincter insufficiency that arises against this background.
- Transient urinary incontinence .Men appear under the influence of some external factors and disappear after the end of their impact. The most frequent causes of this condition are acute cystitis, alcohol intoxication, taking diuretics, taking drugs with anticholinergic action( antihistamines, antidepressants, antipsychotic and antiparkinsonistic drugs), taking alpha-adrenoblockers and alpha-adrenomimetics, calcium antagonists, violation of bowel emptying.
Also, urinary incontinence is also divided into primary incontinence, resulting from defects in the anatomy of the ring muscles( sphincters) that regulate the processes of urination, and secondary, as a result of the inadequacy of sphincter function without compromising their anatomy. At the first symptoms of incontinence it is necessary to address in clinic of urology, as the qualified consultation of the urologist is necessary.
Causes of urinary incontinence in men
In the case of urinary incontinence in men, the causes of this symptom are quite diverse and can be related to both age-related changes in the urinary system and internal diseases.
Among the main causes of urinary incontinence in adult men, we can distinguish:
- consequences after surgery on the prostate gland - a radical prostatectomy for prostate cancer;
- prolonged use of diuretics and funds affecting muscle tone and neuromuscular transmission;
- trauma to the brain or spinal cord with loss of control of the bladder;
- neurological diseases such as multiple sclerosis or Parkinson's disease;
- weakness of the musculature of the pelvic floor as a result of chronic constipation, sedentary lifestyle, sedentary work, prolonged physical labor;
- infection of the bladder and lower urinary tract;
- intoxication, including alcohol;
- benign prostatic hyperplasia or adenoma;
- is a malignant tumor of the gland;
- medication with high doses of sedatives;
- emotional stress or mental illness.
There are other reasons for uncontrolled urination, but it is important to note that if urinary incontinence in older men is associated with age-related changes, in young people, this condition is manifested as a result of internal disorders in the body. The probability of development of incontinence increases with age. According to medical indicators, about 7% of men face this problem, however, the older the person, the more likely they are to develop this ailment.
To understand how to treat urinary incontinence in men, it is necessary not only to diagnose a symptom, but also to determine the cause of its development. Therefore, to identify the disease, the following studies are carried out:
- "cough" test, given with a filled bladder;
- instrumental examinations, including radial, endoscopic, urodynamic and functional;
- is the most effective combined urodynamic study, during which uroflowmetry, intraurethral pressure profilometry, cystometry is performed and the abdominal pressure threshold is determined. This technique allows the most effective evaluation of the functional state of the lower urinary tract.
The main objective of diagnostic measures is objective confirmation of the presence of incontinence, the detailed characterization of its symptoms, the determination of the type of disease and the identification of factors contributing to the development of these pathological processes.
Treatment of urinary incontinence in men
In the case of urinary incontinence in men, treatment directly depends on the specific causes that caused the inconvenience. After consultation and examination, the doctor prescribes this or that kind of therapy. Treatment can be medicated, include physiotherapy, as well as surgical.
The medication is selected by the doctor depending on the cause of the dysfunction of the genito-urinary tract:
- Drugs from the alpha blocker group used for the treatment of urinary incontinence in benign prostate tumors and infravesicular obstruction of the urinary tract: Tamsulosin, Terazosin, Alfuzosin and Doxazosin. These drugs have a relaxing effect on the smooth muscles of the prostate and urinary sphincter, resulting in a normal outflow of urine.
- Blockers of 5-alpha reductase : drugs containing dutasteride or finasteride. They are used to inhibit the production of dihydrotestosterone - a hormone, the excess of which often becomes the cause of benign prostatic hyperplasia. Assign to reduce the size of the prostate gland, which, in turn, helps to reduce the incontinence frequency and decrease the time of its retention in the bladder.
- Psychotropic drugs , having a relaxing effect on the muscles of the urinary tract and blocking nerve impulses that spasmodiruet their walls: Depsonil, Apo-Imipramine, Priloygan, Tofranil.
- Anticholinergic and antispasmodic drugs , such as oxybutynin and tolterodine, can soothe the nerves that control the muscles of the bladder. Admission of alpha-blockers with anticholinergic drugs can help with symptoms of urinary incontinence and bladder hyperactivity better than drugs alone.
- Tricyclic antidepressants : medications based on imipramine, relaxing the muscles of the bladder and blocking nerve impulses that cause its spasms.
As a rule, begin treatment with conservative therapy, which includes therapeutic gymnastics, physiotherapy, behavioral factors, medications. In more severe cases, which are not amenable to conservative treatment, surgical intervention can be performed.
Surgical treatment is the main one in cases of violation of urinary neurodevelopment in spinal patients or after removal of the prostate gland.
The following ways of radical treatment of urinary incontinence in adults and elderly men are not bad:
- Artificial urinary sphincter;
- System ProACT;
- Self-locking sling - UroSling male( Lintex);
- "Functional" retrourethral sling;
- Adjustable sling systems;
- Sling systems fixed to the bone;
- Injection therapy.
Due to the wide variety and availability of treatment methods, the prognosis for men with incontinence in general remains positive. Even if the problem can not be completely cured, the degree of impairment of the urinary function can be significantly reduced in most cases.
Artificial urinary sphincter( AUS), despite the new surgical methods, is the gold standard for the surgical treatment of male urinary incontinence. Since AS-721 was first implanted in 1972, the artificial sphincter was modified several times to the modern AS-800.Implantation is costly, requires invasion and experienced surgeons. In this case, a high degree of infection and urethral atrophy due to prolonged exposure to high pressure on the urethra. In addition, the patient must be mentally and physiologically able to handle the sphincter.
The essence of the method is that the cuff of the artificial sphincter is filled with water, it clamps the urethra until the patient wants to urinate. To do this, he presses the control pump in the scrotum and the sphincter "relaxes" due to the fact that the liquid flows from it into the reservoir. After a while, sufficient for emptying the bladder, the sphincter spontaneously fills with water and again clamps the urethra. Thus, urine is retained, and the patient remains "dry".
Urinary incontinence in men treatment includes necessarily specific gymnastics for strengthening the musculature of the pelvis - Kegel's gymnastics. The most accessible way of doing them is to stretch the pelvic musculature to the account - "three".Strain, count up to 3 - relax, count to three - strain. To repeat reception five-ten times. Every day, you need to do kegel gymnastics - in three ways.
In some cases, avoiding the incontinence problem allows a simple restriction of the consumed liquid. In this case, drinking is prescribed in a certain amount only at the appointed time, and also the time for emptying the bladder is planned in advance. This method of treatment is called "planned urination" or "training of the bladder."Therapy also involves performing Kegel exercises to strengthen the pelvic muscles.
The result of its use is:
- improvement in muscle activity, due to the reduction of which urine retention between the processes of urination is ensured.
- muscle tone enhancement that helps to hold urine in the event of sudden increase in intra-abdominal and intravesical
- pressure caused by physical exertion, coughing, sneezing, laughing.
In the treatment of impaired urinary excretion, like any other disease, you need to get rid of all the causes that caused the disease. The folk remedy prescribed by the doctor helps to support the body of a man with enuresis and prevent recurrences of the disease.
- Plantain .Two small spoons of herbs pour a glass of boiling water, and let it brew for an hour. At the same infusion with grass should be closed and wrapped. Take a potion half an hour before meals on a tablespoon.
- Treatment for hyperactive bladder is successfully carried out due to the unique properties of fennel seeds .They take on the task of preventing inflammation in the genitourinary area, exerting spasmolytic effect on the musculature of the wall of the bladder.
- Salvia .5 small spoons of herbs pour a liter of boiling water, leave to infuse for several hours, then take 200 m3 three times a day.
- Onion husks possesses a magical power in the fight against enuresis in men, the treatment is based on the bactericidal properties of the broth. The use of herbal drinks should be combined with deep heating of the pelvic organs, using such a folk remedy as wormwood. This is an excellent and sparing way to improve urination.
Correctly chosen folk remedy will improve the quality of drug therapy and eliminate functional disorders in men.