Voluntary and involuntary urination. How to treat uncontrolled urination (enuresis) in men? Kegel exercises

Involuntary loss of urine (urinary incontinence) is a problem for many women, and not only in old age. Although the problem is often associated with urogenital aging, modern medicine claims that young women who are simply accustomed to living with it also suffer from this and go to medical institutions only after reaching a certain age. To treat conditions such as urinary incontinence or the need to urinate too frequently, there are very effective solutions - from changes in eating habits to pharmacological and surgical treatments.

Causes and types of incontinence

More than 50% of women never talk about this problem. This fact was confirmed by Dr. Milan Stankovic, an American gynecologist from Messina (New York, USA). Dr. Stankovic, an expert in minimally invasive laparoscopic and vaginal surgery and surgical treatment of urinary incontinence and pelvic organ prolapse with synthetic implants, warns that sometimes symptoms of urinary incontinence can indicate some serious diseases (neurological, for example, multiple sclerosis or the presence of malignant tumors). Involuntary leakage of urine can occur at any age (both sexes and children). Milan Stankovic also points out that in cases with young women, a comprehensive examination is necessary in order to establish the causes of the disease. At the same time, in older people, this disease usually causes a complex syndrome caused by numerous factors (neuro-urinary pathology, age, the presence of other diseases, side effects of certain drugs...).

The willingness and awareness of the need to urinate, part of the natural cycle of filling and emptying the bladder and some nerve reflexes. Individual characteristics certainly exist, and experts continue to debate the limits of what can be described as "normal", but it may still be said that it is a sign that there is a problem if a person has the need to urinate more than twice during a period of time. nights, and eight times during the day.

There are several types of urinary incontinence. Emergency (stimulant) and stress urinary incontinence were the most common, and together they can appear as mixed urinary incontinence, and there are rare forms such as drug-induced overflow or neurogenic reaction.

Incontinence or stimulant also known as overactive or "nerve bubble" occurs in 22% of cases. Patients describe it as an unpredictable, urgent and pressing need (“you have to go, you have to go”) that is often ignored when leaving the house or near the toilet, as they assume that coping is not a problem.

As it is very important for the diagnosis and treatment of urinary incontinence, said Dr. Milan Stankovic to check the patient's dietary habits. In cases where urinary incontinence is due to infection, be sure to check the patient's diet because some foods and drinks can be irritants to the bladder. These are alcohol, coffee and other drinks containing caffeine (cola), tomatoes, ketchup, lemon, orange and other citrus fruits. Our source reported that such patients had no irritating symptoms after surgical treatment of urinary incontinence, but six months later there were repeated episodes of involuntary urination. The results of the study showed that the patient began to drink Pepsi-Cola regularly, the problem was solved simply by eliminating the caffeinated drink from his diet.

Stress urine is a problem in half of people with urinary incontinence (49%), and occurs when the muscles and tissues around a full bladder fail to contract due to increased pressure ("stress") in the abdomen. In such cases, involuntary release of urine was caused by coughing, sneezing, laughing, running, or getting up. The amount of urine discharged can vary from a few drops to a large amount.

Pathophysiology of involuntary urination

Typically, urinary retention can be achieved as long as the urethra (urethra) then increases pressure from fluid into the bladder. Decreased ability to maintain necessary urethral pressure is usually the result of an anatomical or neurological disorder.

Anatomical continence is a vital condition for the anterior vaginal wall and connective tissue, consisting of a stable pillar on which the urethra lies. When pressure increases in the bladder or stomach, the urethra takes on its post, which closes the lumen of the urethra and keeps the pressure in it. However, if the supporting structures are weakened, the urethra loses traction and the mechanism of normal continence is compromised. Contributing to the weakening of the urethra are pregnancy support (and childbirth), aging and repetitive stress of the pelvic floor (heaving, chronic cough, obesity), and possibly a genetic factor (lack of collagen in connective tissue).

Among the simple diagnostic tests that are used when considering the practice of urogynecology include the cough test (the patient coughs so that the doctor determines the potential of controlled urine output) and the so-called Q-Tip test, which is based on the "tendency" of the ear with a regular stick placed in the urinary sphincter , as well as a cough, the doctor notes, the “behavior” of the bladder. Urinalysis (urine culture) usually indicates whether a urinary tract infection is suspected, while urodynamic testing, which records the number of parameters in the filling and emptying phase of the bladder, is performed before surgery or in diagnostic equivocal cases. The assessment of residual urine (the urine that remains in the bladder after urination) is also very important for diagnosis, since normal retention is from 10 to 15% of urine.

Treatment

Depending on the type of urinary incontinence, treatment may be non-pharmacological, pharmacological or surgical. Dr. Stankovic notes that in many cases, pharmacological or surgical treatment can be avoided through lifestyle changes (weight control and avoidance of smoking, alcohol, and caffeine) and dietary changes.

A good therapy for stress incontinence is the so-called Kegel exercises for the lower pelvic muscles, which can be performed discreetly even in public. Dr. Stankovic also recommends “training” the bladder in the form of a gradual increase in the intervals between urination, from one to two and, if possible, as much as three hours. Stress incontinence is cured by vaginal suppositories, flexible silicone devices that are placed in the vagina, but our source claims that a large number of patients, especially young ones, are not satisfied with their results. In case of emergency (irritant) urine, electrical stimulation is also used. There are several types, and one of them is the creation of an ambulatory spinal implant, which stimulates the nerves in the lower back and thereby affects the urethra.

Surgical treatment of involuntary urinary leakage is the most effective treatment, even in old age, Stankovic notes, but should be reserved for periods after childbirth, pregnancy and childbirth, because they can compromise performance. Most often, these are joint symptoms of prolapse (fall) of the pelvic organs and urinary incontinence. In such cases, surgical treatment includes placement of a synthetic mesh and “Sling” - TVT (Tensions without vaginal tape) and TVT (Trans-Vaginal-Tape), MMC (Marshall-Marchetti-Kranz) procedures. These operations, which establish a normal relationship between the urethra and the bladder, can be invasive (MMK) or minimally invasive (TVT). According to recent studies in the USA, TOT slings within a year after surgery, subjectively assessed by patients, achieved significant improvements in 80% of cases, and TVT in 60% of cases.

Among women who consult a doctor, a significant proportion are patients with spontaneous urination. At the same time, other complaints are made: cramps, pain above the pubis and in the groin, urinary retention or, conversely, copious discharge, especially at night.

Similar symptoms in urology belong to a single dysuric syndrome. The doctor’s task is to distinguish true urinary incontinence from other manifestations of concomitant diseases. Pathology can occur both at a young age and in the elderly.

Urinary incontinence occurs much more often in women than in men. This is due to the anatomical and physiological characteristics of the female body.

What predisposes women to incontinence?

Incontinence is considered to be the voluntary release of urine (enuresis), independent of desire. To understand why it occurs, it is necessary to remember the structural features and relationships of the pelvic organs, physiological fluctuations in a woman’s body throughout her life.

In childhood, the expectant woman has a high risk of inflammation of the urinary tract (urethra and bladder), since the outlet lies next to the anus. The urethra is short and wide. The absence or improper implementation of hygiene procedures leads to chronic infection obtained from the intestines.
Upon reaching puberty, young girls still have the opportunity to get an infection during defloration and sexual activity. Even a sufficient hormonal background does not protect against infection.
During childbearing age, fluctuations in estrogen and progesterone occur during the next pregnancy. The enlarged uterus puts pressure on the bladder, creating an artificial increase in intravesical pressure. At the same time, with each pregnancy and childbirth, the pelvic muscles relax. They allow you to press the sphincter of the bladder and create an additional obstacle to urination.

As a result, an imbalance in the regulation of the urination process is formed due to a disruption in the joint functioning of the endocrine system, the part of the spinal cord responsible for the functioning of the pelvic organs, and muscles.

Urinary incontinence in women after 50 years is associated with a gradual loss of estrogen protection, decreased immunity, and weight gain (first of an endocrine nature, and then due to overeating).

In old age, all previously hidden foci of chronic infection and diseases that occur in a latent form are activated

Causes affecting urination

The above factors are present in almost all females, but involuntary urination is observed in women if a combination of circumstances allows the conditions to be combined.

The most common causes of urinary incontinence in women:

inflammatory diseases of the bladder and urethra (cystitis, urethritis) against the background of chronic gynecological diseases, enterocolitis, severe constipation;
overactive bladder due to disruption of connections with the nerve fibers of the spinal cord;
previous surgical interventions on the uterus and appendages, cesarean section, leading to interruption of the nerve branches that ensure sufficient contraction of the bladder sphincter, effective treatment of fibroids by amputation of the uterus causes urinary incontinence (considered a complication of the operation, but practically not taken into account by gynecologists);
when the pelvic organs are damaged by a traumatic nature, urinary syndrome often complements serious fractures, bruises, and internal bleeding;
bedwetting in women often occurs with neurological diseases, neuroses, and mental disorders; the pathology appears in girls, the age limit of 5 years is of clinical significance, when the child should already control urination;
incontinence is one of the symptoms of a stroke;
involuntary leakage of urine at night and during the day is promoted by diseases of the bronchi and lungs, accompanied by a severe cough (for example, chronic bronchitis of a smoker), it creates constant tension in the muscles of the peritoneum and increases intravesical pressure.

In the case of a stroke, the occurrence of involuntary urination is central in nature and is caused by impaired communication with the cells of the cerebral cortex and subcortex; alcoholism leads to the same result

The reasons that arise in a particular case are often mixed. To prescribe the correct treatment, the doctor must understand the previous clinical manifestations and conduct an examination.

Incontinence as a symptom of the disease

The above mechanisms take part in the formation of urinary incontinence in the following chronic diseases of women:

stones in the urinary organs;
obesity;
congenital anomalies of the urinary tract;
chronic cystitis and urethritis;
diabetes;
pelvic organ prolapse;
Parkinson's and Alzheimer's diseases;
, uterus;
multiple sclerosis;
damage to the brain and spinal cord;
chronic alcoholism.

There is evidence that impaired urinary control is caused by:

smoking;
long-term use of diuretics, antidepressants,
passion for strong coffee and carbonated drinks.

Types of pathology

Signs of incontinence may occur temporarily, for example, in acute respiratory disease complicated by tracheobronchitis with severe cough or urinary leakage in acute cystitis. After getting rid of an infection of viral or bacterial origin, unpleasant symptoms disappear. Another option is a permanent and long-term pathology, which must be treated using complex methods.

It is customary to highlight:

Stress incontinence- urine flows out of the bladder during any sudden stress (laughing, coughing, sneezing, doing physical work, exercise, excitement). There is a violation of the relationship between the work of the internal and external sphincters of the bladder and muscle tension (abdominals, pelvic floor). It is observed in half of the identified cases.
Urgent urinary incontinence in women- caused by a sudden urge so strong that the woman is unable to hold in her urine. More typical for bladder overactivity, tumors, neurological and endocrine diseases, pathology of the spinal cord and brain. Caused by a sharp increase in detrusor activity. Patients often note a connection with the sound of flowing water. Registered in 20% of patients.
Mixed appearance - symptoms appear both during coughing and suddenly for no reason, most typical for women in old age. It occupies 30% of the overall structure.

More severe forms include:

functional;
anatomical;
incontinence due to bladder overflow;
total look.

Clinical signs of incontinence

Symptoms of urinary incontinence in women are manifested by one painful property - loss of the ability to control urination. When visiting a doctor, patients complain of:

mild or heavier involuntary urination;
it occurs against the background of coughing, laughter, physical stress;
uncontrollable sudden urges without any reason, when a woman does not have time to reach the toilet;
skin irritation in the groin area due to frequent contact with urine.

Such symptoms make a woman’s life significantly more difficult, especially at working age. Constant trips to the toilet do not go unnoticed at work, causing embarrassment and isolation. Urine leakage stains your underwear and contributes to an unpleasant odor.

As a result of chronic urinary incontinence, a woman feels helpless, suspicious of colleagues, and condemns herself to loneliness

This behavior leads to a nervous breakdown, insomnia, and increases the risk of any disease.

Meanwhile, treating the condition of incontinence is quite possible. Even if it does not disappear completely, it will decrease significantly and teach the patient to treat her illness correctly.

You can learn about treatment options for urinary incontinence.

What examination should I undergo?

For a complete diagnosis, every woman needs a consultation not only with a urologist, but also with a gynecologist. The connection with the pathology of the genital organs, the treatment of hormonal disorders during menopause can significantly alleviate the patient’s condition.

An experienced doctor will definitely ask:

how long ago the incontinence began;
previously suffered infectious diseases, including kidneys and bladder;
frequency of urination during the day and at night;
bad habits of a woman;
nature of work and stress resistance;
total amount of fluid consumed;
the presence of concomitant diseases;
suffered injuries to the spine and head.

A comprehensive examination includes mandatory tests:

blood - accelerated ESR, leukocytosis indicate an inflammatory process, the presence of urea, creatinine, decreased protein - may be signs of kidney failure and latent course of the lesion;
urine - color, transparency are examined;
urine culture for bacterial flora, sensitivity to antibacterial drugs allows you to prescribe the most effective antimicrobial drugs;
detection of sexually transmitted infections indicates the route of entry of infectious agents and requires simultaneous treatment of the partner.

The presence of leukocytes, bacteria, erythrocytes, crystals, and protein in urine sediment indicates varying degrees of inflammation of the urinary tract and a tendency to stone formation.

Additional tests:

Stress or Bonnie test - the patient is injected with a certain amount of sterile liquid through a catheter, then asked to cough. In a classic Bonnie exam, the doctor inserts fingers into the vagina and lifts the neck of the bladder.
Pad test - a record is kept of the pads used during the day, which characterizes the abundance of involuntary urination.

Urodynamic studies are carried out in specialized departments to diagnose the cause of incontinence. These include the following.

Cystometry - other slightly modified methods cystometrography and uroflowmetry, presents several tests that allow you to isolate and study individual indicators of pressure in the bladder against the background of its different filling. The most significant parameters:

leakage pressure - shows the strength of the sphincter muscle apparatus, which is necessary to retain fluid inside the bladder;
maximum force compressing the urethra - indicates the level of pressure required to completely block the lumen of the urethra.

X-ray and ultrasound examinations allow:

determine the size of the bladder and kidneys;
their location;
identify shadows of stones;
detect the amount of residual urine volume after emptying;
identify the connection between leakage and cough, tension in the abdominal muscles.

Modern equipment allows you to display the image from the cystoscope on the monitor

Examination of the bladder mucosa using endoscopic technology introduced through the urethra visually confirms the suspected pathology in the form of a tumor, inflammation, or stone.

Cystourethrogram- X-ray method using a contrasting solution, the resulting X-ray images allow you to examine the walls of the bladder and urethra, its filling defects, and structural anomalies.

What are the ways to get rid of urinary incontinence?

Urinary incontinence in women is treated comprehensively depending on the identified cause. If chronic inflammation is the main cause, then only through long-term anti-inflammatory therapy can results be achieved.

alcoholic drinks (including beer);
sweet sparkling water;
spicy seasonings;
kebabs;
rich fatty broths;
salted fish and marinades;
tomatoes;
citrus.

Most suitable:

dairy products (cottage cheese, mild cheese, kefir);
porridge;
boiled potatoes;
vegetables and fruits (except for tomatoes and citrus fruits, which irritate the bladder);
pasta at normal weight;
boiled meat and fish.

Drinking one cup of weak coffee per day is acceptable for women with urinary incontinence.

If you are overweight, you should try to eat a low-calorie diet, give up flour and sweets.

It is equally important to learn how to do special exercises to train the muscles of the perineum and pelvis. They were proposed by the gynecologist Kegel as a way to increase the potency of women. But it turned out that the testimony is not limited to this. Exercises can not only increase lost muscle tone, but also restore nerve connections with the nodes of the spinal cord. This has a significant supporting effect on any type of incontinence.

How to master the technique of strengthening the pelvic muscles and correctly apply it to treat incontinence is described.

Behavioral training methods

The technique of behavioral methods consists of attempts to restore volitional control. For this purpose, three training options have been developed:

bladder training - an adult woman re-trains her body to control the urge to urinate, it is suggested to take breaks between visits to the toilet, and try to achieve control over the urge;
urination on a schedule - a technical technique involves setting a schedule for visiting the toilet and strictly following the schedule, even if you don’t feel like urinating;
stimulated urination - the method is suitable for paralyzed patients who cannot move; stimulation is performed by pressing in the suprapubic area.

Medicines and folk remedies

Depending on the type of disorder, antidepressant or anticholinergic drugs are used. You cannot take these pills on your own; they have various side effects. Only a doctor will correctly prescribe the dosage and determine the course of treatment.

Antibiotics, nitrofurans, sulfonamides or combinations thereof are used as anti-inflammatory drugs.

Alternative treatment should be approached with caution after consultation with your doctor. Different herbal remedies in decoctions are recommended depending on the connection with the cause of incontinence.

For the stress type, healers consider the following mixture to be indicated:

St. John's wort,
hop cones,
valerian root,
knotweed.

For the imperative type, an infusion of dill seeds has a beneficial effect.

In cases of bedwetting:

sage grass,
bird cherry bark during flowering.

For older women, fresh carrot juice in the morning is good.

If incontinence bothers you when coughing, the mixture:

St. John's wort,
centaury,
coltsfoot.

lingonberry berries and leaves,
St. John's wort herb.

In the postpartum period:

blackberries,
blueberries

For cystitis:

corn silk,
birch leaves.

Plant materials are brewed in a thermos for 1.5–2 hours. After straining, you need to drink 0.5 liters in three doses before meals. To improve the taste, it is recommended to add honey.

Surgical treatment options

Doctors talk about surgery only if they are absolutely sure that anatomical defects or a sharp weakening of the pelvic floor muscles are to blame for urinary incontinence. When the normal position of the bladder and urethra is restored, urine leakage is reduced or completely disappears. Coughing and laughing no longer cause involuntary urination.

The method of electrical stimulation of the sacral nerve trunk allows you to restore the regulatory function of the spinal cord. Treatment may require more than one course.

What hygiene products are there?

A woman with urinary incontinence has to use hygiene products and methods more often, and wash herself several times a day. To make care easier, the medical industry produces:

urological pads with markings in the form of drops (they indicate the degree of incontinence), the sticky side is glued to the panties, the accumulated urine turns into a gel, there is no smell;
disposable hygiene panties are convenient for caring for paralyzed, sedentary patients;
waterproof reusable underpants prevent urine from getting on the bed linen; inside they have a layer that absorbs liquid well, and at the bottom there is a polyurethane membrane that retains it in the fabric. Reusable panties wash well and do not lose their properties.

Disposable briefs are often used in women with incontinence in the postoperative period

A medical pessary is a rubber device inserted through the vagina to the cervix. Its effect is additional pressure on the urethra, closing its exit and retaining fluid in the bladder. Indicated for occasional use: for running, dancing. The danger is vaginal infection.

Women with urinary disorders should definitely consult a doctor. It is impossible to get rid of the problem on your own. There are means of assistance in the therapeutic arsenal; their correct and timely choice will help prolong active life at any age.

The process caused by malfunctions of the urinary system, and more specifically by the inability to control bowel movements, is called involuntary urination. The symptom is characteristic of many diseases and can occur in any person of any age category, but is often diagnosed in women in old age.

Varieties

Spontaneous urine loss is divided into the following types:

Urgent type of urine output. Provoked by strong contractions of the bladder muscles. Urgent urination is characterized by the patient having a sudden urge to urinate.
Night. Uncontrolled urine loss occurs at night.
Stressful. It is characterized by a malfunction of the bladder sphincter, which causes urine to be released when laughing and sneezing.
Mixed. It is characterized by the presence of several of the above types at once. The patient may experience urinary incontinence at night and when coughing.

Causes of spontaneous urination

Experts identify a number of factors that cause involuntary urine loss in women and men:

genitourinary system infections;
intoxication of the genitourinary system, for example, due to abuse of alcoholic beverages;
surgery in the pelvic area;
neurological diseases;
use of sedatives;
nervous tension.

Involuntary release of urine in men

In males, spontaneous urine discharge is diagnosed much less frequently than in females. This is due to gender differences in the structure of the urinary systems. Often, involuntary urine discharge in men occurs for the following reasons:

prostate tumors;
prostate adenoma;
prostate surgery;
stressful situations;
neurological diseases;
infections in the urethra;
brain injuries;
use of certain medications.

A prostate tumor can cause spontaneous urination in men.

The imperative urge to urinate brings with it a number of inconveniences. Urine may be released involuntarily even when laughing, sneezing or coughing. However, men do not pay due attention to these symptoms and rarely seek help from a doctor, hoping that the problem will resolve itself. This is a serious misconception, since it is important to quickly diagnose the origin of spontaneous urination and determine a treatment regimen in order to avoid the development of complications.

Involuntary release of urine in women

Involuntary leakage of urine in women is observed quite often. The etiological reasons for the appearance of this condition include:

Climax. At this time, the body’s production of estrogen decreases, which has a detrimental effect on the organs, in particular the genitourinary system.
Advanced age. In older women, the muscle tone of the urinary cavity is weakened, making complete urinary retention impossible. Urine can be excreted even during laughter or coughing.
Pregnancy with multiple fetuses.
Surgical intervention in the pelvic organs.
Injury to the pelvic organs.
Uterus removal.
Obesity.
Childbirth (during which complications were observed).
Trauma to the brain and spinal cord.
Frequent lifting of heavy objects.
Diabetes.
Chronic inflammation of the bladder.
Constant cough.
Diseases of the central nervous system.

Treatment of urinary incontinence

After the examination, the doctor prescribes treatment to eliminate the pathology.

Treatment of involuntary urination is prescribed based on the cause that caused the pathology. Drug therapy is often effective. After the specialist conducts a survey, prescribes the necessary examination and makes a diagnosis, the patient is prescribed adrenergic agonists, which increase the muscle tone of the bladder sphincter. The most common medications are Spazmex, Vesicare and Detrusitol. There are also cases when drug treatment is ineffective, then doctors prescribe surgical interventions.

Treatment with folk remedies

Traditional healers recommend treating involuntary urination using various medicinal herbs. There are many recipes for involuntary urination, the most popular of which is dill tincture. To prepare it, you will need to crush a spoonful of dried dill in a mortar and pour it into a thermos. Then add a glass of boiling water and leave the liquid for 2 hours. The resulting tincture should be used on an empty stomach before bedtime for 14 days.

Sage is also common in the treatment of involuntary urination. To prepare an infusion, take 3 tablespoons of sage, add them to a liter of water and boil for 5 minutes. Then leave the liquid for 2 hours and strain through a sieve or cheesecloth. The resulting infusion should be taken several times a day. You can also make tea from sage; to do this, add 50 grams of the plant to a liter of hot water, pour into a thermos and leave for 2 hours. You should take tea 3 times a day before eating.

Spontaneous urination in men is a problem that not every member of the stronger sex dares to talk about out loud. Ignoring the symptoms of the disease leads to limitations in everyday, work and social opportunities and causes psycho-emotional disorders. The situation is further complicated by the fact that urinary incontinence can only be eliminated through long-term, complex therapy. Treatment will be delayed indefinitely if you contact a urologist too late.

Medical statistics show that approximately 6.5% of men under the age of 65 experience symptoms of urinary incontinence. If they manage to overcome the feeling of shame and consult a specialist in time, then the treatment will be successful.

Uncontrolled urination in men is characterized by the following manifestations:

Enuresis or bedwetting. It is more common for children or teenage boys to not hold urine while sleeping.
Incontinence is actually “incontinence.” Classified according to types and causes of occurrence.
Leakage of a small amount of urine after urination. This phenomenon is often caused by purely physiological features of the structure of the genital organs (in men, the channel through which urine passes is 10-15 cm longer than the female one).

The choice of drug therapy and preventive measures should be based on the reasons for voluntary urination in men. All possible reasons are grouped as follows:

Pathological deviations in the functioning of the central nervous system. They are caused by various diseases (urinary problems after a stroke, multiple sclerosis), head or back injuries, chronic intoxication (after alcohol, drugs).
Urinary incontinence that occurred during the postoperative period. Occurs if surgical or other medical manipulations on the bladder, prostate, pelvic organs or urethra were performed unskillfully and unsuccessfully.
Age-related changes. Manifested in a decrease in local blood supply. In older men, incontinence occurs several times more often than in middle-aged men.
Infectious diseases of the urinary system (urethritis, cystitis).
Tumor neoplasms in the genitourinary system and pelvic organs.
Disturbances in the natural functioning of the ureters, bladder and urinary tract (so-called dysfunction).
Displacement or prolapse of internal organs in the pelvic area and peritoneum, which “press down” the tissues of the bladder and prostate with their weight. Similar phenomena are diagnosed in patients with weakened muscle fibers, with significant physical activity or, conversely, with a sedentary lifestyle.
Stressful and depressive conditions of a chronic nature.
The use in medical therapy of drugs with a number of side effects that affect muscle tone and the process of urination (diuretics, antidepressants, antihistamine tablets, tranquilizers).
Formation of stones in the renal pelvis and bladder.
Radiation therapy for cancer.
Pathologies of development of the genitourinary organs, congenital abnormalities.

Classification and symptoms of the disease

The classification is based on the causes of incontinence. Based on these characteristics, there are 6 main types of uncontrolled urine discharge from the urethra.

Stress incontinence. 50% of the population consult a urologist with this form of spontaneous urine loss. It is observed with a sharp change in body position, with coughing, laughing, sneezing. Both men and women suffer from this disease. Increased abdominal pressure and incontinence can also occur as a result of exercise or heavy lifting. In this case, the patient does not feel any urge to urinate.
Urgent form. It is characterized by the opposite picture: the patient feels a strong desire to “go to the toilet,” which is difficult or even impossible to put off until later. The urge to urinate occurs at least every 2-3 hours. Even when the bladder is partially filled, spasm occurs and uncontrolled loss of urine occurs. Such bladder overactivity can be caused by various infectious processes in the genitourinary system or the advanced age of the patient.
Combined (or mixed) incontinence. Such involuntary loss of urine suggests the presence of two or more types of incontinence. For example, stressful and urgent.
Postoperative uncontrollable urine leakage. It occurs as a result of performing various surgical or medical manipulations with the urethra and prostate gland of a man. This may be the removal of benign tumors, the removal of strictures in the urethra or injuries to the urethra. There are cases when this form of incontinence goes away on its own (after a certain time after surgery).
Incontinence due to overflow. If a neoplasm has developed in the urethral canal, it will partially block the passage for fluid. Urine is excreted consistently often, but in small quantities. In medicine, such incontinence is also called drip incontinence. The bladder never empties completely, which can lead to inflammation, burning and discomfort.
Temporary (transient) urinary incontinence. Uncontrolled urine leakage is temporary. Its causes are all kinds of intoxication, diseases of infectious etiology, malfunctions of the intestines, and the use of certain medications. If the patient manages to quickly cope with the provoking factor, then incontinence will go away on its own.

Diagnosis of the disease

Test with urological inserts. It is carried out throughout the day to determine the most accurate volume of urine loss.
Clinical analysis of urine (general) and blood.
Ultrasound examination of the genitourinary system.
Examination using an endoscope. This analysis will collect information about the condition of the mucous membranes of the bladder and urethral canal.
Diagnosis of urodynamic parameters. Through such testing, it is possible to determine the speed of urine flow (uroflowmetry), the residual volume of biological fluid after emptying, the presence of signs of channel blockage, and the ability of the organ muscles to hold and release urine.

Treatment of urinary incontinence

Incontinence refers to diseases that can be treated with conservative or surgical methods. It all depends on the stage of the disease, its causes and the general health of the patient.

Conservative treatment is represented by the following methods:

Training muscle groups that are responsible for the process of urination. If the bladder sphincter does not work or has lost tone, then special exercises will help return this muscle group to its previous state. Treatment of the bladder sphincter is carried out using the Kegel complex for men. In addition to physical exercise, the patient is prescribed a therapeutic diet.
Drug therapy. Drugs that delay urination and improve blood flow in the external and internal genital organs help combat incontinence. Anti-inflammatory and antimicrobial drugs have an excellent effect. The urologist may also prescribe hormonal medications to regulate the levels of hormones responsible for the rate and amount of urine accumulation. In no case should you choose the dosage and type of drug yourself. Treatment should be carried out under the supervision of a specialist.
Physiotherapeutic treatment. This may be electrical stimulation or magnetic influence on the genitourinary system.

Surgical intervention

The operation is prescribed to the patient if all conservative methods have not given a positive result. The main goal of surgery is to return the bladder to its anatomically correct (working) position.

To do this, the doctor uses a small piece of tissue (the so-called sling), which will support the organ and eliminate additional pressure on the bladder. In the postoperative period, installation of a catheter is indicated to ensure the exit of urine from the bladder. After removing the catheter, urination occurs naturally.

Hygiene for incontinence in men

As mentioned earlier, with urinary incontinence in men, problems arise due to psycho-emotional and physical discomfort. Therefore, patients should learn to live a normal, fulfilling life. For this purpose, special urological hygiene products have been developed.

Today there are the following hygiene products for men:

Special underwear. Comfortable, excess-absorbing incontinence pants are made of a special material that allows you to use them every day. Effective for moderate to severe incontinence.
Pads for patients with urinary incontinence. They accurately replicate the structural features of the male body and are securely held using an adhesive strip. Urological inserts are used in cases of drip or moderate incontinence.
Pants made of elastic material that reliably fix urological pads (inserts).
Diapers, or men's diapers for night use and for particularly severe forms of urinary incontinence.

Involuntary urination in men (incontinence) is a phenomenon that seriously affects the quality of life, especially if the problem occurs during working age. Urinary incontinence is not an independent disease, but a consequence of pathological processes of various etiologies.

Forms of urinary incontinence

Uncontrolled urination in men can be of a different nature depending on the reasons that caused it.

Uncontrolled urination due to stress

This type accounts for half of all cases of incontinence. Urine is released in drops or in small quantities without any preliminary urge under various provoking factors associated with a sharp increase in pressure:

laughter;
coughing;
lifting weights;
sudden change in body position.

The outflow of urine is controlled by the circular muscle - the sphincter. If it is damaged, functionality is impaired, the hole is clamped weakly, and even with a slight increase in intravesical pressure, urine leaks.

Urinary urgency - urge incontinence

This type is otherwise called imperative (from the English imperative - obligatory, imperative). It is recorded in 14% of cases of urinary incontinence in men. The urge to urinate in this type is so strong that it is impossible to control it: sometimes a person does not have time to run a few meters. However, it happens that with a very strong urge, urine is not always released.

Bladder spasm occurs even with insignificant fullness, especially in the presence of provoking factors acting on visual, auditory and tactile receptors: flowing water, gurgling, washing hands. Reducing the volume of fluid consumed does not affect imperative urination in any way. The cause of the problem is often an overactive bladder. The condition develops as a result of infectious diseases, tumors, and neurogenic lesions. An imperative urge to urinate can occur with hyperreflexia and detrusor, urethral instability (spontaneous relaxation).

Postoperative uncontrolled urination

After operations on the prostate and bladder, in some cases the recovery period is prolonged; complications in the form of varying degrees of urinary incontinence can persist for a year. Usually, urination is eventually restored, but drug therapy and medical supervision significantly speed up the process.

Postoperative incontinence in men can appear after such types of surgical interventions as:

complete removal of the prostate gland during an oncological process;
enucleation of prostate adenoma using the open method using transvesical or retropubic access;
parts of the prostate gland due to benign or malignant tissue growth;
operations for injuries and adhesions of the urethra.

Complications occur more often when surgery is performed in an advanced form of the disease.

Parkinson's disease is also often accompanied by urinary problems such as incontinence.

Uncontrolled urination due to damage to the central nervous system

Neurological incontinence occurs after a stroke. The functioning of the bladder is impaired in 30% of cases. When a stroke occurs, certain areas of the brain are affected, resulting in damage to signal transmission pathways. As a result, the person is unable to control bladder emptying. Incontinence also occurs due to paralysis of the lower limbs and muscles of the urinary tract. For treatment, drugs are prescribed that help restore the conduction of nerve impulses, as well as regulate metabolism and maintain the vascular system. Parkinson's disease and multiple sclerosis are also often accompanied by incontinence. As a result of injury to the brain and spinal cord, signals from the bladder become obstructed. In diabetes mellitus, the nerves responsible for controlling the closing and opening of the bladder neck are damaged, causing spontaneous urination to occur.

Involuntary urination due to prostatitis and adenoma

Impaired urination in men can occur against the background of prostate diseases such as prostatitis and prostate adenoma.

With chronic prostatitis, scar tissue forms on the walls and neck of the bladder, which prevents the organ from contracting and relaxing normally, and also interferes with the conduction of nerve impulses. Sclerosis may develop, in which parts of the tissue die and no longer perform their functions.

Prostatitis is characterized by overactive bladder syndrome. Normally, receptors located on its walls signal fullness, and nerve cells control the activity of the bladder: at the appropriate time, it relaxes along with the sphincter and urine outflows. In a state of hyperactivity, this connection is disrupted, since the walls of the bladder with prostatitis are inflamed, the pressure inside is constantly high. As a result, urgency and urge incontinence occur.

With an adenoma, the overgrown tissue puts pressure on the ureter, as a result of which the bladder overflows, urine begins to leak in small portions - paradoxical ischuria. Drip discharge occurs involuntarily at any time of the day. It is not possible to completely empty the bladder; in such cases, catheterization is often resorted to.

Uncontrollable urination due to kidney and bladder stones

If stones are found in the kidneys or bladder, urinary incontinence may also occur for this reason. Kidney stones descend through the ureter into the bladder and in some cases, when they enter its neck, they block the work of the sphincter: the muscle does not contract, and urine spontaneously flows out.

Temporary incontinence

Temporary (transient) incontinence occurs as a result of the influence of external factors: taking certain medications (tranquilizers, antidepressants, diuretics, narcotic painkillers), intoxication, infectious diseases (for example, interstitial cystitis). Temporary spontaneous outflow of urine can be caused by drinks that irritate the bladder: tea, coffee, citrus juices, alcohol.

Diagnosis and treatment methods

the doctor collects anamnesis when interviewing the patient, filling out a special questionnaire that determines the degree of influence of urinary problems on the quality of life;
conducting a urological examination;
keeping a diary for 3 days, recording the number of daily hours and their nature;
test with pads, which determines the volume of involuntary urine excreted during the day;
blood and urine tests;
Ultrasound, X-ray, endoscopic and urodynamic examination.

Based on the results of the examination and tests, treatment is prescribed, including physical therapy, medications, and, if necessary, surgery.

For incontinence, exercises to strengthen the pelvic floor muscles (for example, the Kegel complex), as well as neuromuscular stimulation, help to learn to control involuntary urination.

There are a number of medications that can affect the amount of urination in men; alpha 1-blockers are used, which relax the muscles of the lower urinary tract. For infectious lesions, antibiotics are used.

With the help of surgery, a special support device for the neck of the bladder and urethra - a sling - can be installed. It is a self-fixing synthetic loop in relation to the internal organs. Such adjustable systems can eliminate incontinence in 80% of cases with minimal risk of complications.

The problem can be solved by installing an artificial sphincter: a system of a cuff, a reservoir and a pump. When the urge to urinate occurs, the patient presses the pump located in the scrotum, the cuff around the urethra relaxes and releases urine. For those for whom surgery is contraindicated, it is possible to use an external urination control device - a penile clamp. In some cases, collagen injections are used, but the effect is short-lived.