Urinary incontinence

Urinary incontinence is a condition in which involuntary leakage of urine occurs.

Urinary incontinence affects almost all aspects of patients’ lives, significantly worsening their social, everyday, professional and family adaptation, that is, what is commonly referred to as “quality of life.”

The problem of urinary incontinence is at the intersection of several areas of medicine. Patients are treated by urologists, gynecologists and neurologists. In addition, urinary incontinence is not an independent disease, but a manifestation of various pathological processes, the approaches to treatment of which differ significantly.

There are several types of urinary incontinence:

• Stress urinary incontinence is the involuntary leakage of urine during coughing, laughing, running and other physical activities, leading to an increase in intra-abdominal and, consequently, intravesical pressure. A characteristic feature of stress urinary incontinence is the absence of the urge to urinate.
• Urge urinary incontinence is characterized by involuntary leakage of urine associated with an irresistible strong urge to urinate. This urge is called “imperative” or “imperative.” Patients complain that they do not have time to run to the toilet when the urge arises. Sometimes leakage of urine occurs almost suddenly, with a very short or even no previous urge.

The presence of several types of urinary incontinence in the same patient is referred to as mixedurinary incontinence. Most often, doctors are faced with a combination of symptoms of stress and urge urinary incontinence, which is especially typical for older women. In this case, patients complain of urine leakage, which is either preceded by an uncontrollable urge to urinate, or incontinence occurs in the absence of urge against the background of significant physical activity. A rare form of urinary incontinence, usually found in older men with prostate disease, is overflow incontinence. It is associated with overfilling and overstretching of the bladder, most often due to a violation of the outflow of urine.

Etiology and pathogenesis. Stress incontinence can be of two main types: a disease associated with dislocation and weakening of the ligamentous apparatus, the unchanged urethra and urethrovesical segment, which refers to anatomical urinary incontinence, and a disease associated with changes in the urethra itself and the sphincter apparatus, leading to disruption of the function of the closure apparatus.

Urine retention is ensured by the interaction of urethral and extraurethral factors, as well as the correct anatomical position of the internal genital organs.

The conditions for urinary retention are:

• full condition of the urothelium and the presence of mucus in the lumen of the urethra;
• elasticity of collagen structures that make up the connective tissue of the urethra;
• preserved tone of the smooth muscles of the urethral wall;
• full vascularization of the urethra