Incontinence after cesarean section. Urinary incontinence is a major problem after childbirth

Urinary incontinence after childbirth is a pathological condition in women in which involuntary urination. Postpartum involuntary urination is more often attributed to stress urinary incontinence, when the discharge occurs during physical activity, laughter, sneezing, coughing, sexual intercourse (in cases of a sharp increase in intra-abdominal pressure).

Urinary incontinence is not a disease, but a disruption of the normal functioning of the urinary system. Urinary incontinence is a postpartum complication that occurs in 10% of women during the first pregnancy and childbirth, and in 21% of women during the second and each subsequent pregnancy. At natural childbirth the likelihood of developing urinary incontinence is slightly higher than with a caesarean section.

Postpartum urinary incontinence is not natural state women and requires correction. Urinary function is restored on average within a year. In some cases, spontaneous recovery does not occur. Urinary incontinence does not pose a significant threat to a woman’s health (in cases where there are no complications in the form of inflammatory and infectious processes), but it significantly reduces the quality of life. With timely diagnosis and proper treatment, postpartum urinary incontinence is completely eliminated. If the problem is not diagnosed in time and measures are not taken to normalize urination, the condition may worsen over time. Neglected cases are much more difficult to correct and are characterized by frequent relapses.

Causes of urinary incontinence after childbirth

The main cause of urinary incontinence after childbirth is stretching and weakening of the pelvic floor muscles, which provide sufficient support for the uterus throughout pregnancy.

The pelvic floor is a powerful muscular-fascial layer that serves to maintain internal organs, maintaining their normal position, regulating intra-abdominal pressure, and also promoting the expulsion of the fetus during childbirth, forming the birth canal. Stretching of the pelvic floor muscles occurs under the weight of the uterus and the fetus developing in it. Difficult birth large fruit, birth injuries are also causes of muscle weakening.

Urinary incontinence after childbirth is caused by the following factors:

• Disruption of the innervation of the pelvic floor muscles and Bladder;
• Impaired closing function urethra and bladder;
• Pathological mobility of the urethra;
• Instability of the position of the bladder, fluctuations in intravesical pressure.

There are a number of risk factors that contribute to the development of urinary incontinence after childbirth:

• Heredity ( genetic predisposition to the development of a disorder);
• Features of the anatomical structure of the pelvic organs and pelvic floor muscles;
• Neurological disorders (diseases) nervous system, multiple sclerosis, Parkinson's disease, as well as spinal injuries);
• Surgical interventions during childbirth and birth injuries;
• Large fruit;
• Excessive weight gain during pregnancy.

Symptoms of urinary incontinence after childbirth

IN medical practice There are 7 main types of urinary incontinence:

• Urgent urinary incontinence – voluntary urination with a sharp, strong urge that is uncontrollable;
• Stress urinary incontinence – urination during any type of physical activity, increased intra-abdominal pressure;
• Paradox ischuria or overfill incontinence - urine leakage when the bladder is full;
• Reflex incontinence – urination when exposed to provoking factors (loud scream, fear, sound of water);
• Bed-wetting;
• Involuntary constant leakage of urine;
• Urine leakage after complete urination.

Urinary incontinence after childbirth is often referred to as stress incontinence (SUI). To make an accurate diagnosis, a comprehensive examination is necessary.

The diagnosis of urinary incontinence after childbirth is made if a woman experiences the following symptoms:

• Regular episodes of involuntary loss of urine;
• Significant volume of urine during each episode;
• Increased urine output with physical activity, stress, during sexual intercourse.

If you experience irregular episodes of involuntary urination, you should also consult a doctor to correct the condition. It is worth noting that isolated cases of involuntary urination in small volumes are also typical for a healthy body.

Urinary incontinence after childbirth: treatment and prognosis

The treatment of urinary disorders should be approached correctly. Many women ignore the problem and, without consulting a doctor, try to fix the problem on their own or come to terms with it pathological condition. For urinary incontinence after childbirth, treatment involves conservative and radical methods.

In case of urinary incontinence, it is not recommended to self-medicate, since this condition requires a thorough examination to exclude possible inflammation and infectious causes of incontinence.

For urinary incontinence after childbirth, treatment does not involve the use of medications. Medications prescribed in cases of complications of urinary incontinence due to inflammation or infection.

Diagnosis of urinary incontinence is carried out using the following methods:

• Anamnesis collection ( subjective signs patient characterizing the disorder);
• Examination on a gynecological chair;
• Cystoscopy (endoscopic examination of the bladder);
• Conducting laboratory tests;
• Complex urodynamic study (cystometry, profilometry, uroflowmetry).

Conservative methods of treating urinary incontinence after childbirth are: physical exercise to strengthen the pelvic floor muscles and so-called step-free therapy, which involves training muscles by holding certain weights of increasing weight.

The criterion for assessing the effectiveness of conservative methods is the complete disappearance of episodes of involuntary urination. On average, normalization of urination takes up to 1 year.

If conservative methods of treating urinary incontinence after childbirth are ineffective, surgical methods are used to correct the problem. Currently, minimally invasive surgical techniques are being practiced.

The main methods of surgical correction are:

• Urethrocystocervicopexy is a full-fledged surgical procedure to fix the bladder, urethra and uterus. This method used extremely rarely when there is a significant violation of the structure of the pelvic muscles;
• Introduction of the gel into the paraurethral space - manipulation is carried out both in a hospital setting and on an outpatient basis. With this method of incontinence correction, it remains high risk development of relapses;
• Sling loop surgical corrections involve placing a synthetic loop under the middle part of the urethra to provide additional support.

Video from YouTube on the topic of the article:

Hello, dear readers!

Urinary incontinence after childbirth is an extremely delicate topic, rarely discussed, however. and no less urgent. Rarely does this issue pass by. To one degree or another, most women who give birth face this problem.

Urinary incontinence with a small child in your arms is a very unpleasant phenomenon. On the Internet, as always, there is a lot of contradictory and incomplete information. Let's try to figure it out and add something.

There are several types of urinary incontinence. The most common of them are:

• stressful (when coughing, sneezing, laughing, running, jumping...)
• urgent (the urge to urinate occurs suddenly and is extremely demanding, while it is impossible to hold urine)
• mixed type

Stress incontinence develops due to weakness of the pelvic floor muscles.

Urgency is a neurological problem - the innervation of the muscles that contract the bladder is disrupted.

The mixed type includes the reasons already listed, and not only.

Urinary incontinence also occurs:

• With changed hormonal background women (including after childbirth).
• Against the background of inflammatory diseases genitourinary system.

It is for these reasons that an examination with your gynecologist is simply irreplaceable for making a correct diagnosis.

After pregnancy and childbirth, stress urinary incontinence most often occurs.

In our culture it is not customary to pay great attention intimate muscles, and during pregnancy and childbirth they perform tremendous work. The result is overload and, as a result, their weakness after childbirth. Weakened and overstretched muscles are simply unable to hold the pressure of urine and it begins to flow out at the most inconvenient moment.

• Rapid course of labor.
• Large fruit.
• Breaks.
• Vacuum extraction.
• Application of obstetric forceps.

These reasons can negatively affect the health of even the most trained pelvic floor muscles and provoke urinary incontinence.

Another reason is the congenital characteristics of connective tissue.

During complicated childbirth, not only stress, but also other types of urinary incontinence can develop, and they have their own methods of treatment. That is why a visit to the doctor will be useful.

2. Treatment methods

Modern medicine offers a fairly wide range of treatments for urinary incontinence, including after childbirth. This type of incontinence can be affected, perhaps, only by physical methods:

• Pelvic floor training - effectiveness depends on the regularity of exercise.
• Injection of collagen into the submucosal layer of the urethra lasts for about a year.
• Sling operations (TVT or TVT-O) and other types of surgical interventions.

The last point, in addition to the high price, has one peculiarity - a subsequent pregnancy will negate the effectiveness of the operation. And which of us can say with confidence that we will no longer give birth? In life there are the most unusual and unexpected turns events.

The high effectiveness of any type of exercise has been clinically proven:

• On one's own.
• With a special Kegel exercise machine.
• With feedback trainers.

IN early period After giving birth, it is advisable to train independently without using a simulator. Let's take a closer look at them.

3. Exercises to strengthen the pelvic floor

If there are no seams or tears, you can start training on the first day after birth. The main goal is to learn to control the functioning of the pelvic floor muscles. Consciously contract and relax them. Here are some tips for mastering this technique:

• Find the right muscles. To identify the pelvic floor muscles, you need to stop urinating. Once you succeed, consider that the necessary muscles have been found. This action can be performed only 1 time per 1 urination. Stop the thread at the beginning of the process. Repeat this action no more than 2-3 times a day.

• Improve your technique. Once the target muscles are identified, empty your bladder and sit on a hard surface with your legs spread wide. Tighten your pelvic floor, hold it for 5 seconds, then release and pause for 5 seconds. Repeat these steps 4-5 times in a row. Our goal is to hold tension for 10 seconds, followed by relaxation for 10 seconds.

• Repeat 3 times a day. Optimal training frequency: 3 approaches daily. Each set contains 10 repetitions.

Do not use Kegel exercises while urinating. Training while emptying your bladder can lead to:

• Weakening of muscles.
• Incomplete emptying of the bladder.

We don't need either one or the other.

4. The secret that no one talks about!

To prevent stress urinary incontinence, use deep squats in parallel with Kegel exercises. You can also find names for this pose such as “tailor’s pose,” “malasana,” “garland frog pose,” but the essence remains the same.

At correct execution this pose carries whole line health benefits, especially for women. This is both stretching and breathing exercises, and beautiful posture, and a healthy pelvic floor, and beautiful hips… All in one!

It is necessary to abandon this exercise in the first time after childbirth and during prolapse of the pelvic organs! If you have minor urinary incontinence, you should refrain from any exercises with wide legs!

The practice of malasana is also limited when there is a threat of premature birth.

But malasana will be extremely useful for difficulties during urination or bowel movements. And for preventive purposes for people who do not have problems with the pelvic floor and incontinence.

So let's get started! Stand straight, feet shoulder-width apart, or slightly wider, toes apart. The back is straight, the chest is turned out, the chin is parallel to the floor. Stretch your arms in front of you, bend your knees. Don't lift your heels off the floor! If that doesn’t work, place some support under your heels.

Spread your knees, place your hands palms together and place them between your knees. We look straight ahead, straight back, pull the top of the head up, shoulders down, keep your shoulder blades straight.

For nine long months a woman carries a child, it seems that the birth will pass and everything will be over. But sometimes unpleasant surprises They are waiting for a young mother after she is discharged from the hospital. This is urine leakage after childbirth. Many women are embarrassed by this situation and do not try to solve it with the help of a doctor, believing that over time the problem will go away on its own.

Urine leakage after childbirth is disconcerting beautiful time motherhood. It occurs in approximately 12% of primiparous women, and in 20% of multiparous women. Occurs during natural childbirth with a higher probability than during delivery by caesarean section. Why does urine not hold after the birth of a child and what to do in this case?

A little about the anatomy of the pelvic floor muscles

The pelvic floor is a kind of layer, which consists of three muscle layers. There are two types of pelvic floor. The anterior perineum (front of the pelvic floor) is located between the anal sphincter and the back of the labia, and the posterior perineum is between the tailbone and the anus. The main role of the perineal muscles is to support the organs located in the pelvic cavity (including the bladder and urethra), control the act of defecation, and the birth of the fetus. The circular muscles of the pelvis tightly cover the final section of the large intestine and the urethra, thus forming sphincters.

Organs that support the pelvic muscles

How is urine retained in a healthy body?

The retention of urine in the normal state of the body occurs due to the interaction of four main mechanisms:

• stable location of the bladder in the pelvic cavity;
• fixed fixation of the urethra;
• normal innervation of the muscular corset of the perineum and bladder;
• proper functioning of the sphincters of the bladder and urethra.

The main cause of the disease is weakness of the muscles that are located at the entrance to the bladder, these muscles are called sphincters. In a normal state they are closed, and when urinating they are in a state of relaxation. Weakness occurs as a result of the fact that during pregnancy the pressure on the perineal muscles increases. They are an excellent support for the uterus, which grows with the baby inside it.

Also during childbirth, mainly during pushing, tissue overstretching occurs, especially if the child has large sizes. Overstretching and compression of muscles causes disruption of innervation and blood supply in this area. In addition, trauma to the pelvic floor leads to the fact that the bladder does not have a stable position, i.e. shifts.

The main risk factors for urinary incontinence are:

• increased body weight;
• second and subsequent births;
• infectious diseases of the genitourinary system;
• hormone imbalance (low estrogen);
• surgical interventions on the pelvic muscles;
• heredity;
• episiotomy (cutting the perineum and back wall vagina during childbirth in order to avoid complications on the part of the mother and child);
• neurological diseases;
• atypical presentation of the fetus (breech);
• multiple pregnancy;
• narrow pelvis both anatomically and clinically.

Types of Urinary Incontinence

Medicine distinguishes seven types of the above pathology:

• stress-related urinary incontinence. At the same time, urine flows unconsciously when a woman coughs, laughs, or sneezes. This type occurs after the birth of a child;
• imperative - leakage of urine during a very strong urge to urinate.
• reflex incontinence - urine flows when triggered, for example, the sound of water pouring;
• involuntary leakage of urine - uncontrolled leakage of urine in the form of drops during the day;
• incontinence with a full bladder - urine leaks in the form of drops when the bladder is full. This type can be found in the presence of fibroids in the uterus;
• leakage of urine at night;
• leakage after the end of urination.

There are also three degrees of incontinence, they were identified to facilitate the choice of treatment method.

• light (manifests itself during intense physical activity);
• moderate (symptoms occur with slight stress - coughing, laughing, sneezing);
• severe (incontinence can manifest itself even during sleep).

How does this disease manifest itself?

A woman notices urinary incontinence after childbirth in certain situations. Coughing, laughing, slightly straining, walking at a brisk pace: all this leads to embarrassment. Incontinence during sex while lying down is also possible. Alcohol intake aggravates these symptoms. These manifestations do not pose any threat to the patient’s health, but they negatively affect her quality of life, causing psychological discomfort, fear of sex, and self-doubt.

When postpartum urinary incontinence occurs, the sphincter is not closed enough, this is the main cause of the disease

What to do in this situation? And how can a doctor help?

First of all, you need to understand which doctor to go to. A urologist will help in this situation. At the first visit, he will offer a questionnaire aimed at finding the cause of the disease. It will also give you a diary in which you should note how much liquid you drank per day, how many times you urinated and how much urine was released, and whether there were uncontrollable urges. This diary needs to be kept for three days.

To establish the final diagnosis, a cough test is performed, in which the woman is asked to cough. If urine is released during this, the sample is assessed as positive.

Among the diagnostic instrumental procedures, cystoscopy (examination of the bladder) is prescribed to exclude inflammatory and tumor processes.

It is imperative to undergo general blood and urine tests. According to indications, the woman undergoes urine culture for microflora.

An appointment is usually required. ultrasound examination bladder and kidneys, so the presence of residual urine is examined.

In hospital settings, if necessary, uroflowmetry, cystometry and profilometry are performed.

How to treat?

If infectious, neurological and other causes are excluded, then the urologist does not prescribe invasive method treatment. It consists of performing exercises to restore the muscles of the perineum. This technique bears the name of its author, Kegel. The effect of this therapeutic measure assessed after a year.

The essence of these exercises is to alternately tense and relax the pelvic muscles at different speeds. This brings them into good shape. The Kegel technique must be practiced for many months every day, only then can you achieve success. To feel the muscles of the perineum, it is enough to hold the stream of urine while urinating. Also an excellent exercise is pushing out, in which you need to strain the muscle corset of the perineum as if labor activity. Many women note an improvement in their condition after 3-4 months of regularly performing the Kegel method. The more often the exercises are performed, the it will pass faster disease.

Electrical muscle stimulation is a great addition to Kegel exercises. And also electromagnetic therapy.

In case of weak dynamics, surgical treatment is possible, during which a special support is created for the urethra, thus fixing it. The main types of surgical intervention include:

• applications special gel which is inserted into the urethra;
• fixation of the urethra, cervix and bladder different ways(urethrocystopexy);
• fixation of only the middle part of the urethra using a polypropylene loop (synthetic material).

Most often, minimally invasive loop operations are performed, which have the least complications and short recovery period.

As for drug correction, only sedatives (calming) can be noted here. There are no medications to relieve urinary incontinence.

Yoga trains all muscle groups, including the perineal muscle corset

From common methods The doctor usually recommends the following measures:

• avoid constipation;
• lose weight;
• drink sufficient quantity water;
• do not consume spicy and salty foods, as well as alcohol;
• Empty your bladder in a timely manner.

Prevention

Preventive measures should be taken before pregnancy and continued while the baby is pregnant. Among the “working” techniques, the above-mentioned Kegel exercises, swimming in the pool, and walking at a moderate pace should be noted. IN Lately Fitball exercises and yoga became widespread.

Conclusion

Urinary incontinence requires the help of a specialist; you should not self-medicate. On this moment this condition is completely curable. Don't deprive yourself of a full, vibrant life.

Urinary incontinence is one of the the most pressing problems modern urogynecology. Firstly, the frequency of this pathology is quite high and amounts to 38–40?%. Secondly, women often prefer to remain silent about their illness and do not have information about possible ways solutions to this problem, which significantly reduces the quality of life of such patients and leads to the development of depressive disorders in them.

Urinary incontinence is common in women who have given birth: in 40?% of cases - after repeated births, 10–15?% - after the first.

What is urinary incontinence

• Involuntary release of urine during minor physical activity (for example, when standing up suddenly, squatting, bending), when coughing, sneezing.
• Uncontrolled urination when lying down, during sexual intercourse.
• Feeling foreign body in the vagina.
• Feeling of incomplete emptying of the bladder.
• Urinary incontinence when drinking alcohol.
• The volume of urine released can vary: from a few drops when straining to constant leakage throughout the day.

Causes of urinary incontinence after childbirth

The main factor in the occurrence of urinary incontinence after childbirth is dysfunction of the pelvic floor muscles and normal anatomical relationships between the pelvic organs (bladder, urethra, uterus, vagina, rectum). Even during a successful pregnancy, it is noted increased load on the pelvic floor muscles, which serve as support for developing fetus, they also take part in the formation of the birth canal through which the child passes. During childbirth, compression of the pelvic floor muscles occurs, disruption of blood circulation and innervation (supplying organs and tissues with nerves that provide communication with the central nervous system).

The development of urinary incontinence is facilitated by traumatic childbirth (for example, with the use of obstetric forceps, with ruptures of the pelvic floor muscles, perineum), large fetus, polyhydramnios, multiple births. A large number of childbirth in a patient is also a provoking factor for her subsequent development of urinary incontinence.

As a result of exposure to traumatic factors, the following pathological mechanisms can develop:

• disruption of the normal innervation of the bladder and pelvic floor muscles;
• pathological mobility of the urethra (urethra) and bladder;
• functional disorder of the sphincters (locking muscle formations) of the bladder and urethra.

Risk factors for developing urinary incontinence include:

• genetic factor (the presence of a hereditary predisposition to the development of this disease);
• pregnancy and childbirth, especially repeated ones;
• developmental anomalies of the pelvic organs, incl. pelvic floor muscles;
• overweight;
• hormonal disorders(lack of estrogen - female sex hormones);
• surgical interventions on the pelvic organs when there was damage to the pelvic floor muscles or disruption of their innervation;
• neurological diseases (as a result of spinal injury, multiple sclerosis);
• infections urinary tract;
• exposure to radiation;
• mental illness.

Types of urinary incontinence

• Stress urinary incontinence is the involuntary release of urine when coughing, sneezing, or physical activity. Most common in women after childbirth.
• Urgent urinary incontinence is the release of urine with a sudden, strong, “imperative” urge to urinate.
• Reflex urinary incontinence - the release of urine when loud sound, sounds of pouring water, i.e. when exposed to any external provoking factor.
• Urinary incontinence after completion of the act of urination is a condition when, after emptying the bladder, urine continues to be released drop by drop or leak for a short period of time (up to 1–2 minutes).
• Involuntary urine leakage is the uncontrolled release of urine in small portions, drop by drop, throughout the day.
• Bedwetting (enuresis) is involuntary urination during sleep, typical for children and very rare in adults.
• Overflow incontinence is the leaking of urine in drops when the bladder is full. It is observed with urinary tract infections, pelvic tumors that compress the bladder, for example, uterine fibroids.

Diagnosis of urinary incontinence

To solve the problem of urinary incontinence, you should consult a urologist or urogynecologist. During a visit to a doctor, a woman should be extremely frank, not hide or hush up anything, since maximum openness will help make the correct diagnosis and choice effective method treatment.

During the first consultation, the doctor asks the patient in detail about complaints, previous illnesses, operations and injuries, the course and number of births, the weight of children at birth, injuries during childbirth, and complications after them. The specialist will also inquire about the health status of the closest relatives and whether they have symptoms of urinary incontinence.

Next, as a rule, the woman is given several questionnaires to fill out. They should describe how you felt on the day you visited the doctor and during the previous month. All questions are aimed at clarifying the current state of the genitourinary system, choosing additional research methods and making the correct diagnosis.

In addition to the questionnaire, the patient is asked to start keeping a urination diary at home. It is filled out within 24–48 hours, after which the doctor analyzes the data obtained. In this diary, the following information is recorded every 2 hours: the amount of fluid drunk and excreted, the frequency of urination and the presence (absence) of discomfort in the process of emptying the bladder, a description of episodes of urinary incontinence is kept: what the woman was doing at the moment, how much urine was involuntarily released.

Next, an examination is performed on a gynecological chair. To exclude infectious inflammatory diseases genitourinary organs, the doctor can take smears for flora and urogenital infections from the urethra, cervical canal and vagina. Also, a vaginal examination can reveal the presence of tumor formations in the pelvic organs that compress the bladder and change its position (for example, uterine fibroids).

When examined on a gynecological chair, a “cough test” is performed to diagnose urinary incontinence. The doctor asks the patient to cough, and if urine is released from the external opening of the urethra, the test is considered positive.

At the next stage of diagnosis, additional research methods are prescribed. Typically this is:

Laboratory research(general and biochemical tests blood, general analysis urine, urine culture for flora and sensitivity to antibiotics).

Ultrasound of the kidneys and bladder, using ultrasound you can determine the volume residual urine, indirect signs inflammatory processes in the genitourinary system, structural changes in the kidneys and bladder.

Cystoscopy– a study during which a special optical device, a cystoscope, is inserted through the urethra (urethra) into the bladder. This diagnostic method allows you to examine the bladder from the inside, assess the condition of its mucous membrane, identify changes that can cause urinary incontinence or complicate the course of the disease (inflammatory diseases of the bladder - cystitis, protrusions of the mucous membrane - diverticula, polyps of the bladder and urethra).

Urodynamic studies characterizing the act of urination:

• profilometry is a study used to measure pressure in the urethra, sequentially at different points;
• cystometry is a study of the relationship between bladder volume and pressure in it, allowing to assess the condition and contractile activity the muscular wall of the bladder, its ability to stretch when filled, as well as the control of the central nervous system over the act of urination;
• uroflowmetry - measurement of the volume of urine excreted per unit of time. The study makes it possible to obtain a graphic image of the act of urination, estimate the maximum and average speed of the urine stream, the duration of the process of emptying the bladder, and the volume of urine excreted.

During the second visit to the doctor, the information received is analyzed, the doctor prescribes additional examinations necessary to clarify the diagnosis and select therapy - for example, cystoscopy, profilometry, cystometry, uroflowmetry. If the diagnosis is clear, tactics and treatment methods are discussed.

Treatment of urinary incontinence after childbirth

Based on the survey data, a choice is made optimal method treatment. Since stress urinary incontinence almost always occurs in women after childbirth, we will dwell in detail on the treatment of this disease.

Conservative methods. For stress urinary incontinence that occurs after childbirth, conservative treatment methods are most often used, aimed at training the muscles of the pelvic floor and bladder.

Retention of weights. To strengthen the pelvic floor muscles, a woman is asked to hold vaginal muscles weights of increasing weight in the shape of a cone (from several grams to several tens of grams). The exercise is performed for 15–20 minutes 3–4 times a day, starting with weights that have minimal weight, then the load can be adjusted by the attending physician, taking into account achieved result. Kegel exercises also have a certain effect - in both cases, the vaginal muscles are trained.

Kegel exercise. It is necessary to strain and hold the muscles around the bladder and rectum in a contracted state for several seconds 100–200 times a day. To detect these muscles, you need to try to stop the stream during the act of urination. The muscles that become tense during this process should be trained. The convenience of the Kegel exercise is that it can be performed anywhere without anyone noticing.

Physiotherapy. Physiotherapeutic techniques are also used (for example, electromagnetic stimulation of the pelvic floor muscles). Exercises can be alternated with physiotherapy courses. For example, the exercises are performed for 1 year and in parallel with them, 3-4 courses of physiotherapy are additionally prescribed for 14 days each. During treatment, the patient must periodically visit the doctor (on average once every 3 months) to assess the dynamics of the disease and adjust therapy if necessary. The effectiveness of treatment is assessed after 1 year.

Bladder training. The main point of this technique is to comply with a urination plan drawn up in advance and agreed upon with the doctor. The patient must urinate at regular intervals. A woman suffering from urinary incontinence gradually develops a stereotype according to which she strives to empty her bladder even when it is only slightly full for fear of not retaining fluid. The bladder training program is aimed at increasing the intervals between urinations. In this case, the patient should urinate not when the urge occurs, but in accordance with the developed plan. It is recommended to restrain a strong urge to empty the bladder by contracting the anal sphincter. Thus, as a result of treatment, the time interval between acts of urination gradually increases to 3–3.5 hours. At the same time, the woman develops a new psychological stereotype of urination. This treatment is carried out over several months.

Medicines. It is possible to prescribe auxiliary drug therapy (sedatives, improve blood circulation, strengthen the vascular wall, vitamins, etc.). However, there are currently no medications that directly address the cause of urinary incontinence. An exception is enuresis (bedwetting), in which it is possible to prescribe courses of drugs that affect certain areas of the brain.

Surgical methods. If conservative therapy is ineffective, the woman is offered surgical treatment.

Loop (sling) operation. The most common method is to perform a loop (sling) operation. In this case, an additional reliable support for the urethra is created by placing a loop under its middle part, which can be made of different material(skin with inner surface thigh, labia minora, tissue taken from the anterior wall of the vagina).

Currently, operations are often performed using TVT techniques(free synthetic loop). In this case, to create support in the middle part of the urethra, a synthetic non-absorbable material, prolene, is used, which does not lose its strength over time. This operation is performed within 30–40 minutes under local anesthesia. It is low-traumatic and is done through small incisions in the skin. Indicated for any degree of urinary incontinence.

Patients are discharged already on the 1st–2nd day after the procedure. TO active life women return after 1–2 weeks, sexual intercourse and sports are allowed after 4–6 weeks. The chance of relapse is very low.

A contraindication for performing TVT surgery is a planned pregnancy, since during subsequent pregnancy and childbirth the effect of the operation may be lost.

Surgery using gel. Another type of surgical intervention is the introduction of a gel into the space around the urethra, which creates the necessary additional support in its middle part. The operation can be performed either on an outpatient or inpatient basis, most often under local anesthesia. Its duration is 30 minutes.

Urethrocystocervicopexy. During this operation, the pubovesical ligaments, which hold the bladder in a normal position, are strengthened. After this surgical intervention, long-term rehabilitation is required. Firstly, this is a technically difficult manipulation. Secondly, it takes time to restore ligament function after surgery.

Currently, urethrocystocervicopexy is rarely used.

Prevention of urinary incontinence after childbirth

Make sure you have regular bowel movements: constipation can worsen clinical manifestations urinary incontinence. With constipation, when attempting to have a bowel movement, excessive tension occurs in the pelvic floor muscles, which can worsen the symptoms of the disease. To prevent this from happening, it is recommended to eat more vegetables and fruits (as they contain fiber), fermented milk products, wholemeal bread.
It is advisable to maintain a normal body weight, because excess body weight puts additional stress on the bladder and aggravates urinary incontinence.

It is important to promptly treat cystitis, urethritis and other inflammatory diseases of the pelvic organs, which are one of the factors contributing to the development of uncontrolled urination.
It is imperative to carry out all recommended examinations during pregnancy, since with their help it is possible to promptly identify diseases of the genitourinary system and prescribe effective treatment.

A bandage should be worn during pregnancy to support the abdominal muscles and reduce stress on the pelvic floor muscles. Kegel exercises can be used to prevent urinary incontinence.

Women should know that this urogenital problem can be solved. A timely visit to a specialist will help you quickly and competently cope with the disease, thereby improving your overall quality of life.

Urinary incontinence is the spontaneous release of urine that cannot be controlled. This condition is most often observed in women after childbirth, especially after the second. If after the birth of the first child the disease is observed in approximately 10% of women, then after the second pregnancy, the number reaches 40%. The reason for this is dysfunction of the muscles of the pelvic floor area, which, even when successful pregnancy there is an increased load. The consequence of this is often the inability to control the sphincters (muscles) of the bladder and the occurrence of urinary incontinence after childbirth.

Symptoms of the disease

Let's call characteristic symptoms, which confirm the development of the disease:

• Uncontrollable urine output during physical activity, coughing, sneezing, laughing;
• A feeling of incomplete emptying of the bladder when urinating;
• Unconscious leakage of urine when drinking alcohol;

It is also possible to have uncontrolled urine leakage during sexual intercourse while lying down.

Causes of urinary incontinence

The disease is caused by changes in the relationships of the internal organs of the small pelvis that occur during pregnancy and dysfunction of the muscles in this area, which serve as support for the fetus and also take part in the formation of the birth canal. During childbirth, compression of the pelvic floor muscles occurs, sometimes leading to disruption of their blood circulation and innervation, resulting in the inability to regulate urination. Also, unfavorable factors leading to urinary incontinence after childbirth include:

• Traumatic childbirth using obstetric instruments;
• Large fruit, polyhydramnios;
• Repeated births;
• Hormonal disorders;
• Urinary tract infections;
• Overweight.

Epidural or spinal anesthesia performed during childbirth also leads to urinary incontinence. In some cases, the disease is eliminated as genitourinary functions normalize, but if the anomaly does not self-limit in short terms, urgent assistance from a specialist is needed.

Types of urinary incontinence after childbirth

There are several types of urinary incontinence:

• Imperative. Spontaneous release of urine with a sudden urge to urinate;
• Stressful. Uncontrolled leakage of urine during physical activity, coughing, laughing;
• Incontinence after urination. Involuntary release of urine in the first minutes after completion of urination;
• Leakage of urine when the bladder is full;
• Reflex. Urine production under the influence of external factors.

Urinary incontinence after childbirth is usually classified as stress incontinence. At the first signs of the disease, you need to promptly contact a urogynecologist or urologist, since initial stage the disease is easier to treat.

Diagnosis of the disease

After an initial examination in a gynecological chair, with a so-called cough test, in which the specialist determines the presence of urine leakage when coughing, blood tests, urine tests, urine cultures, smears from the vagina and cervix (to exclude the possibility of tumors) are prescribed. For a full diagnosis, the patient is recommended to keep a diary for several days indicating the number of uncontrolled urinations, their intensity and the reasons leading to this. The following may also be prescribed: ultrasound of the bladder and kidneys, cystoscopy, cystometry, uroflowmetry. Based on these studies, the volume and pressure of the bladder and urethra, assessment of the mucous membrane, distensibility and degree of contraction of the walls, as well as the volume of urine released per unit of time will be determined. After all the studies have been carried out to most accurately diagnose the disease, the necessary treatment method is prescribed.

Treatment of urinary incontinence after childbirth

Treatment of urinary incontinence after childbirth primarily depends on the causes of the disease and its type. For stressful types of incontinence, conservative treatment methods are usually prescribed, consisting of a set of physical exercises to strengthen the muscles of the bladder and pelvic organs. For this purpose, exercises using the Kegel method and a set of vum-building exercises are used, which allow you to train the muscles of the vagina, strain and hold in a contracted position the muscles surrounding the bladder and rectum. To train the bladder sphincters, a urination schedule is developed for the patient, making it possible to increase the time intervals between them to three hours, thanks to the gradually developed habit of regular emptying. Also positive effect gives a combination of exercise and physiotherapy. Drug therapy for this disease is used as helper method treatment, since it cannot affect its cause.

If, after a year, conservative treatment of urinary incontinence after childbirth is considered ineffective, the doctor may suggest surgical methods fight the disease. When surgically correcting the disease, the most commonly used procedure is a sling (loop) operation, in which a synthetic loop is used as a support to support the urethra. Has also proven itself well surgical method treatment using gel. Both of these methods are minimally invasive and can be used for any severity of the disease.

Prevention of urinary incontinence after childbirth

To prevent the disease, timely prevention of inflammatory processes in the organs of the pelvic area is extremely important. It is necessary to follow the recommendations of doctors given during pregnancy, which will help identify diseases of the genitourinary system. You should not neglect wearing a bandage, this helps reduce the load on the pelvic organs. For preventive purposes, it is recommended to perform Kegel exercises to help improve muscle tone. Try to monitor your diet, eat more fruits, vegetables, and dairy products to prevent constipation, which can contribute to excessive muscle tension during bowel movements and increased urinary incontinence.

Urinary incontinence after childbirth should not be your problem. constant problem, if any of the symptoms of the disease occur, you should consult a doctor. Timely treatment will help you get rid of discomfort as quickly as possible and improve the quality of your life.