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[Local Medical]Urinary incontinence is a symptom, not a disease, and can be saved by timely medical treatment

[Local Medical]Urinary incontinence is a symptom, not a disease, and can be saved by timely medical treatment

Text◆He Jianxing Edited by◆Liang Yingxiu

Defecation and urination are often regarded as “little things” by people, but whether urination is normal or not is by no means a “little thing”.

When a person is unable to urinate normally, not only the quality of life is affected, such as frequent trips to the toilet, but in severe cases, it can even cause damage to health, such as bacterial infection and organ damage, and endanger life. Therefore, facing the urination problem in time can avoid unnecessary damage.

(Kuala Lumpur News) Urine refers to the excess fluid in the human body. These fluids include water, salt, uric acid and urea. A person must drink 2 to 2.5 liters of water every day, which is about 6 to 8 glasses of water (an average cup costs 300 to 350 ml), and the bladder can hold about 400 ml of urine. The water a person drinks passes through the body and is eventually metabolized into urine and enters the bladder. When there is more than 150 ml of urine in the bladder, the brain will send a signal to urinate. , at this time, people will go to the toilet to urinate. Under normal circumstances, urine only has a slight odor, but if there is a health condition such as bladder inflammation, in addition to the change in urine color, there will also be odor, and even bacterial infection. So from another perspective, urine can also reflect a person’s health status.

Consultant Urology
Dr. Law Warren
(Dr Warren Lo Hwa Loon)

Most cases of prostate enlargement include nocturia

How often is it normal to urinate? Urological consultant Dr Warren Lo Hwa Loon said that in fact, the correct frequency of urination must be consistent with the frequency of drinking water. For an adult, usually drink a glass of water every 2 to 3 hours during the day, so 2 to 3 It is most normal to urinate once an hour.

“For urology clinics, nocturia,

Frequent urination and urinary incontinence

Considered the 3 most common urinary problems,

It must be emphasized that the relationship between the three is interlocking.

They are not diseases but symptoms. As long as they are diagnosed in time and the problem is found,

And targeted treatment can improve it,

But the premise is that the patient is willing to take the step of actively seeking medical treatment. “

Taking nocturia as an example, it is generally defined as nocturia more than once after falling asleep at night and before waking up to go to the toilet. Taking men as an example, nocturia is the most common problem for men with enlarged prostate (BPH). This is because the urethra passes through the prostate gland. When enlargement occurs, it will affect urination and cause urination. In the case of retention, the retained urine will also stimulate bladder contraction, causing BPH patients to have a constant urge to urinate.

“Finally, it is caused by insufficient secretion of antidiuretic hormone (ADH). ADH is secreted after falling asleep, and its function is to concentrate the normally excreted urine into one-third. However, if a person has insomnia, ADH cannot be produced. In such a situation Under this situation, he will go to the toilet to urinate every 2 to 3 hours as usual during the day, and he will not be able to sleep if he urinates all the time. This continuous vicious cycle will aggravate the problem of insomnia and nocturia.”

There are 3 types of urinary incontinence

He pointed out that frequent urination can be divided into three parts, namely drinking too much water causing constant trips to the toilet, bladder sensitivity and overactive bladder. The first situation is normal and can be improved as long as you can control the amount of water you drink; the most typical example of bladder sensitivity is bacterial infection. When the bladder is infected by bacteria, it will be unable to maintain its capacity. If it is not treated and continues to drink the normal amount of water or drink If you have more water, you will have to go to the toilet all the time. The correct approach at this time is to treat the bacterial infection first, including giving antibiotics, rather than pouring water.

“As for overactive bladder, it can be divided into two types, namely dry overactive bladder and wet overactive bladder. The former refers to the feeling of urgency to urinate, but the degree of urinary incontinence has not yet occurred, while the latter refers to Urinary incontinence is a common form of urinary incontinence, and some patients may even wet their pants every day, seriously affecting their social life.”

“Usually, the detrusor muscle of such patients will contract abnormally. Even if the urine has not accumulated to a certain amount (150 ml), the urination signal has been transmitted to the brain, so the urination may be necessary in 5 minutes, 10 minutes or half an hour. I urinate in the toilet, but the amount of urine each time is very small.”

Urinary incontinence is roughly divided into three types. In addition to the urge incontinence mentioned above, it also includes stress incontinence and overflow incontinence.

He said that as mentioned above, urge incontinence refers to an oversensitive and contracted bladder such as overactive bladder, and even a small amount of urine will cause the patient to rush to the toilet to urinate. In addition, when the temperature is extremely low or you are in an air-conditioned secret room, or you are stimulated by 5 kinds of drinks, namely wine, tea, coffee, soda and acidic drinks, or you are affected by some neurological diseases such as Parkinson’s disease, spinal cord disease, etc. Spine injury and the effects of Alzheimer’s disease can also cause a person to develop urge incontinence.

Removing the prostate can cause incontinence

Stress urinary incontinence refers to a person’s pelvic muscle relaxation and weakness. When the bladder is put under pressure, such as sneezing, straining or coughing, urine will leak out uncontrollably. This is because the pelvic muscles cannot support it. Usually the patient is a female. Most of them include those who have been pregnant for many times and have undergone pelvic surgery. Men who have had their prostate removed sometimes also have this type of incontinence problem. “

Luo Hualun said that overflow urinary incontinence means that the patient’s urinary nervous system has been damaged, resulting in poor bladder muscle contraction or loss of consciousness. Even if the bladder is full but there is no urge to urinate, it will eventually leak out uncontrollably. This Commonly seen in patients with diabetes, spinal nerve injuries or neurological diseases, such as stroke, traumatic brain injury (traumatic brain injury) or incorrect use of some drugs, it can also cause Underactive Bladder Syndrome (UAB). Overflow incontinence eventually develops from the use of sleeping pills, antidepressants, asthma medications, anti-itch and cold medicines.

Therefore, it is recommended to discuss with your doctor and pharmacist before using drugs to avoid unnecessary problems.

What are the consequences if a person has difficulty urinating, especially urinary incontinence, but refuses to seek medical attention? The first and most direct impact is to cause ulcers or bedsores on the skin on the back, but the most worrying thing is the bacterial infection in the ureter, because in addition to affecting the bladder, it may also affect the kidneys and cause multiple organ failure. (Multiple organ failure), which is life-threatening. It is worth noting that the need to use urine bags or catheters due to urinary incontinence is also a huge medical expense.

So how are urinary problems such as urinary incontinence managed or even treated? He directly explained that the problem must first be determined and then targeted treatment can be given according to the situation. For example, if a person drinks too much water and causes frequent urination, then the first step is to control the amount of water consumed. Then, if a person often drinks stimulating drinks such as alcohol or caffeine, Drinks, then reduce them as much as possible, and start improving your daily routine.

Use elastic penis clamp to prevent urine dripping

Luo Hualun pointed out that patients with stress urinary incontinence can undergo physical therapy under the guidance of a physical therapist, such as learning Kegel exercises. This type of pelvic floor muscle contraction exercise can improve muscle contraction strength and is very effective in improving the problem. , if that still doesn’t work, you can consider minimally invasive surgery to implant a tension-free vaginal tape for female patients or a male urethral sling for men. The purpose is to support the pelvic floor muscles to control urination. Nowadays, this technology is continuously improved, including adjusting the tightness of the sling, so that the surgery can achieve better results.

As for patients who have suffered serious accidents, they may also consider implanting an artificial urinary sphincter. Its purpose is to help replace the function of the urethral sphincter. It can be divided into three parts, including a pressure-adjusting reservoir (reservoir) and a sleeve ( cuff) and control pump.

“When the patient wants to urinate, he only needs to press the subcutaneous control pump to drain the saline into the pressure-adjusted water storage bag, which is equivalent to opening the urethra. After urination, the urethra will close again, thereby avoiding urinary incontinence problems, but be careful If problems arise during use, special consultation with a urologist or attending physician is required, otherwise direct damage to the artificial urinary sphincter may occur.”

It is worth noting that if the patient is male and has financial burden, using an elastic penis clamp (cunningham clamp) to block urine dripping may also be one of the methods to improve urinary incontinence, but it must be discussed with a urologist.

Botox injection inhibit muscle contraction

For patients with urge urinary incontinence, if their urinary incontinence still does not improve after adjusting their daily routine and physical therapy, the doctor will give them medication and finally botox injections.

Luo Hualun pointed out that this is because Botulinum toxin can inhibit muscle contraction, so it can reduce the involuntary contraction of the bladder and thereby reduce the occurrence of urinary incontinence. Alternatively, a sacral nerve electrical stimulation therapy device, commonly known as a bladder pacemaker, can also be used. It improves urinary incontinence caused by overactive bladder. It has a similar function to a cardiac pacemaker, and its purpose is to improve bladder function through electrical stimulation of nerves.

Incontinence is the most difficult problem for people with diabetes

“In addition, especially for patients with multiple chronic diseases, percutaneous tibial nerve stimulation (PTNS), which can be performed without medication or anesthesia, is another technology to improve urge urinary incontinence. It uses similar methods TCM acupuncture stimulates specific areas to help patients improve their problems.”

He pointed out that overflow urinary incontinence, or UAB, is defined as low activity of the detrusor muscle. Common symptoms include taking a long time to urinate, a feeling of unclean urine, and slow urinary flow. It is most common in patients with diabetes. It is urinary incontinence. The most difficult one, because there is still no specific drug to treat it, but there are three ways to improve it, including using intermittent self catheterization, long-term insertion of a urinary catheter and urine bag, and the use of Bladder pacemaker.

Self-guided intermittent catheterization uses a catheter inserted from the urethra into the bladder to drain urine retained in the bladder. However, the patient or caregiver must learn how to use it and perform it every 3 to 4 hours. Wearing a urine bag allows urine to flow in on its own, which also results in a lack of activity in the bladder. For long-term use, the former is more suitable and can retain the activity of the bladder to the greatest extent. As for the bladder pacemaker, it is equivalent to ‘waking up’. ‘The bladder has the ability to contract and expand, but price is still a major concern and patients must take it into consideration.

Advanced technology has many ways to improve

In short, thanks to the continuous advancement of science and technology, there are now more and more advanced technologies and methods to improve urinary incontinence. At the same time, the price of equipment has gradually become affordable for the general public. However, patients’ initiative to seek medical treatment is still the key.

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