This is an uncontrolled leak of urine. Depending on the age in men and women, the causes of urinary incontinence differ. IN childhood girls develop bladder control faster than boys, so bedwetting, or enuresis, is more common in boys. Adult women are much more likely than adult men to suffer from urinary incontinence. Urinary incontinence in women is associated with the anatomical features of the pelvis and the changes that occur during pregnancy and childbirth. However, urinary incontinence also occurs in adult men. Urinary incontinence in men is associated with age, but is not an inevitable companion of aging.
This is a treatable disease. Your doctor will help you determine the treatment for urinary incontinence.
There are three forms of urinary incontinence:
- stress urinary incontinence, manifested by leakage of urine during coughing, sneezing, lifting weights, that is, during activities during which intra-abdominal pressure rises.
- urge incontinence, manifested by leakage of urine after a strong urge to urinate, which cannot be stopped.
- overflow incontinence, which is manifested by the constant involuntary outflow of urine.
To keep urine and release it from the bladder at the right time, the coordinated work of the muscles and nerves of the urinary system is necessary.
Nerves conduct signals from the brain to the bladder and sphincters. Any disease, condition, or injury that damages the nerves can lead to urinary problems.
Nerve damage
Nerve damage can occur at any age. In men with diabetes, damage to the nerve fibers can lead to impaired bladder control, i.e. urinary incontinence.
Stroke, Parkinson's disease and multiple sclerosis affect the brain and nervous system, thus, these diseases are the cause of problems with emptying the bladder.
overactive bladder is a condition that is characterized by frequent, urgent urge to urinate and urinary incontinence. The cause of an overactive bladder may be damage to the nerve pathways, but there may not be an exact cause for its development. Patients with an overactive bladder have two or three of the following symptoms:
- frequent urination - urinating more than 8 times during the day or two or more times at night
- urgency - a sudden, very strong, urgent urge to urinate
- Urinary incontinence is the leakage of urine that follows a sudden, strong urge to urinate.
spinal cord injury can lead to urinary incontinence, as the nerve pathways necessary to control the functioning of the bladder are damaged.
Prostate is a gland of the male reproductive system, which in size and shape resembles Walnut. The prostate gland surrounds the urethra below the bladder and secretes seminal fluid before ejaculation.
In older men, the prostate gland often enlarges. An enlarged prostate is called benign prostatic hyperplasia (BPH) or prostate adenoma. As the prostate gland grows in size, it compresses the urethra, disrupting the normal flow of urine. Lower urinary tract symptoms associated with the development of BPH are rare in men under 40 years of age, but occur in more than half of men over 60 years of age and more than 90% of men aged 70 to 80 years. The symptoms of BPH can vary, but the most common ones are associated with impaired urination: sluggish, intermittent urine stream, urgency, urinary incontinence or oozing, more frequent urination (especially at night), and urge incontinence. Urination disorders do not always indicate blockage of the outflow of urine caused by BPH.
Radical removal of the prostate
Complete surgical removal of the prostate gland (radical prostatectomy) is one of the treatments for prostate cancer. In some cases, after surgery, the development of erectile dysfunction and urinary incontinence in men is possible.
External beam radiation therapy
External beam radiation therapy is also a treatment for prostate cancer. Treatment results in temporary or permanent bladder dysfunction.
Prostatic Symptoms Scale
If the cause of urinary incontinence in a man is a disease associated with the prostate gland, the doctor will ask you a series of standard questions from the International Prostatic Symptom Scale or the American Urological Association Prostatic Symptom Scale. Here are some questions from the Prostatic Symptoms Scale:
- In the past month, how often have you urinated at intervals of less than 2 hours?
- During the last month, how many times did you get up to urinate during the night, from the moment you fell asleep until the morning?
- Over the past month, how often have you had the sensation of not emptying your bladder completely after you finished urinating?
- During the last month, how often have you had a weak urine stream?
- How often in the past month have you strained before urinating?
Your answers to these questions can help identify the problem and determine which diagnostic tests are needed. Your score on the Prostatic Symptom Scale is used as a baseline for determining the effectiveness of treatment and reducing symptoms.
Diagnosis of urinary incontinence in men
Disease history
The first step in treating urinary incontinence in men is to see a doctor. Your complete medical history, including any underlying illnesses or surgeries, and details related to urinary incontinence will help your doctor determine the cause of male urinary incontinence. You should tell your doctor about the amount of fluid you drink during the day and whether you drink too much alcohol or coffee. You should tell your doctor about all medications you are taking, including over-the-counter medications (vitamins, herbs), as these can also lead to urinary incontinence.
Urination diary
You will be asked to keep a voiding diary, which should record the amount of fluid you drink, as well as the number of times you urinate per day and the amount of urine you pass, including any episodes of urinary incontinence. Reviewing your urinary diary will help your doctor gain a better understanding of your urinary incontinence problem and help you schedule additional tests.
Urologist examination
On examination, the doctor will determine whether there is an increase in the size of the prostate gland or damage to the nerves. In a digital rectal examination, the doctor inserts a gloved finger of the right hand into the rectum and feels the prostate gland. A digital rectal examination helps your doctor get a general idea of the size and condition of your prostate. In order to determine nerve damage, the doctor will conduct a neurological examination: check for sensory disturbances, changes in muscle tone and reflexes.
Electroencephalography (EEG) and electromyography (EMG)
Your doctor may order an electroencephalogram (EEG), a test that uses special electrodes attached to your head to record electrical activity in the brain and look for abnormalities in the brain.
In electromyography (EMG), wires are placed in the lower abdomen to measure nerve activity in the muscles and muscle contractions that can lead to urinary incontinence.
Ultrasound examination (ultrasound)
In an ultrasound examination, the doctor uses a special transducer that sends ultrasonic waves into the body. Ultrasonic waves are reflected from the internal organs and returned to the transducer. Special equipment creates an image of the internal organs on the monitor. To obtain images of the bladder and kidneys, the doctor performs an ultrasound scan, in which a transducer moves across the surface of the skin of the abdomen. In a transrectal ultrasound (TRUS) to obtain an image of the prostate, the doctor uses a special transducer that is inserted into the patient's rectum.
During urodynamic studies, the function of the bladder and urethral sphincter is determined. Urodynamic studies reveal violations of the contractile function of the bladder, the causes of urinary incontinence. Urodynamic studies include pressure measurements in bladder after filling it with liquid using a special catheter. A urodynamic study helps to detect decreased bladder capacity, overactive or underactive bladder, weak urethral sphincter, or urinary tract obstruction. If a urodynamic study is performed simultaneously with electromyography (EMG), then abnormal nerve signals and uncontrolled bladder contractions can be detected.
The article is informational. For any health problems - do not self-diagnose and consult a doctor!
V.A. Shaderkina - urologist, oncologist, scientific editor
Table of contents
Dribbling is the term used for the symptom when men experience inadvertent loss of urine immediately after urinating, usually after leaving the toilet. These symptoms are present in 17% of healthy adult men and in 67% of patients with lower urinary tract symptoms (LUTS). Leakage of urine after urination does not threaten the life of patients, but leads to a sharp deterioration in its quality.
Etiology
Leakage of urine after urination is caused by insufficiency of the bulbocavernosus muscle (m.bulbocavernosus), which surrounds the middle and proximal parts of the urethra (urethra). Normally, after urination, m.bulbocavernosus reflexively contracts and contributes to the "evacuation" of urine from the urethra. Urinary leakage is associated with retention of urine in the bulbar urethra, followed by the release of the latter during movement or under the influence of gravity.
Men often have problems with urination, especially later in life. One of the main problems is that a man does not pass urine well. In medical terms, this condition is called ischuria.
Urinary retention is usually caused primarily by psychological difficulties and physical discomfort. Moreover, in a man with such congestion, the general condition of the body worsens. If timely measures are not taken to eliminate the problem, complications may occur. That is why the treatment of pathologies that cause urinary retention should be timely.
Urinary retention in men: types of pathology
Ischuria is a disease that can develop at different rates. As a rule, depending on this symptom, pathology is divided into two main types
acute form
As a rule, acute urinary retention in men is quite unexpected for a man. At the same time, he experiences a number of symptoms that accompany the disease. These signs include pain in the lower abdomen and the urge to go to the toilet more often than usual.
In addition, a man may feel an unpleasant feeling that the bladder is not completely empty. At the beginning of the development of the disease, the patient's urine is excreted in small portions, however, over time, even with stress, urine ceases to be excreted at all. At the same time, urine accumulates in the bladder, causing an increase in the abdomen in a man, which becomes very noticeable externally. This condition is dangerous for the body, and therefore it is necessary to urgently consult a doctor..
Chronic form
The chronic form, in which urine is poorly discharged in a man, usually proceeds for a long time. In this case, a man may not notice the signs of the disease and not pay attention to the difficulties that have arisen when urinating. However, sooner or later the urinary canals will narrow so much that it will begin to cause a certain discomfort to the man. Chronic urinary retention in men can, under the influence of external factors, turn into acute.
Incomplete urinary retention allows a man for a long time not to notice the appearance of a problem at all. With the full form of pathology, a man feels a sharp deterioration in well-being, and therefore, as a rule, urgently seeks medical help. In such cases, when a man cannot urinate outside on his own, the doctor uses a catheter.
It is possible to determine the development of ischuria by a characteristic feature - the need to strain to go to the toilet. In this case, urination often occurs intermittently. Sometimes in men there is a so-called paradoxical ischuria, in which the patient is not able to empty the bladder voluntarily, but drops of urine are involuntarily released from the urethra. In any case, the pathology requires medical intervention, and therefore it is highly not recommended to delay the problem.
Causes of urinary retention in men
Ischuria can develop in a man under the influence of many factors. The most common reasons are the following:
Urinary obstruction in men can occur due to various reasons and in different ages. Even some disturbances in the central nervous system injury or damage to the brain or spinal cord. Frequent violations in urination after operations on the spine or abdominal organs.
- Sometimes the abuse of alcohol or drugs leads to ischuria in men.
- In some cases, urinary retention appears as a result of prolonged use of drugs, for example, sleeping pills or sedatives, antidepressants have a strong effect.
- Sometimes urine can stop being excreted after severe hypothermia of the body, after serious stress or heavy physical exertion.
The chronic form of the disease, as a rule, appears in elderly men.. If for a long time a man has experienced various or problems with the organs of the genitourinary system, pathology may appear over time.
One of the most dangerous causes of ischuria is neoplasms in the prostate, including benign hyperplasia. As a rule, in most cases, urination becomes difficult due to the enlargement of the prostate gland. In this case, the gland on both sides squeezes the urethra, making the urethra narrower, which is why the urine does not pass completely, or does not come out at all.
In addition, diseases that occur in other organs near the genitourinary system can cause urinary retention. For example, fibrosis and sclerosis, as well as inflammatory processes in the intestines, can affect. In older men, neurogenic dysfunction in the bladder is sometimes observed.
Signs of ischuria in a man
The main symptom of ischuria is, of course, a violation of the normal process of urination. In the acute form, such symptoms are more noticeable, because due to the accumulation of urine in the bladder, its walls are greatly stretched, which causes quite severe pain and a lot of discomfort.
Sometimes, if the cause of urinary retention is a blockage of the urinary canal, then a man may also feel pain in the urethra due to stones that linger there. If the cause of urinary retention is an injury to the penis, then discharge in the form of blood clots from the urethra is possible.
The acute form of ischuria can be seen even with the naked eye, since the man's belly increases significantly in size. In addition, the man experiences, but no urine is excreted. If the cause of urinary retention lies in inflammatory processes, the man will feel sharp pains in the lower abdomen and lower back.
If the chronic form of ischuria is caused by prostate adenoma, then the man will experience the following signs of the disease:
- Frequent urge to go to the toilet.
- Constant feeling that the bladder is not completely emptied. As a rule, only a small portion of urine is excreted during urination.
- The stream of urine is sluggish.
- Frequent urination at night.
In the absence of proper medical care intoxication can occur in the body due to harmful substances that are in the urine. In addition, due to the strong overflow of the bladder with urine, rupture of its walls may occur. At the same time, the man has symptoms of an "acute abdomen", in which irritation occurs in the abdominal cavity.
In order to make a correct diagnosis, the doctor may prescribe an additional urine test, ultrasonography, cystoscopy, or computed tomography. These studies help to determine the presence of neoplasms in the organs of the genitourinary system, as well as other disorders and pathologies.
Poor urine output - how to treat
With an acute form of urinary retention in order to alleviate the patient's condition and prevent intoxication or rupture of the bladder. However, the use of a catheter to remove urine is a one-time procedure that cannot be used on an ongoing basis. Therefore, to improve the patency of urine, complex therapy is needed to eliminate the cause of the disease:
There are also folk recipes, which help to improve the process of urination and get rid of diseases. However, if symptoms of ischuria are detected, the first thing to do is to consult a doctor and conduct an examination.
Deciphering the indicators of a general urine test
General urine analysis refers to mandatory diagnostic procedures that are assigned to all patients who apply to a healthcare institution.
Here we will tell you what indicators of urine are measured in a general urine test, and what diseases are indicated by certain deviations of these indicators from the norm. And also about how to properly collect urine for general analysis, analysis of daily urine and for urine analysis according to Nechiporenko.
In the general analysis of urine, parameters such as specific gravity (relative density), color, transparency, odor, pH (acidity), protein content, glucose content, content of ketone bodies and bile pigments and some other indicators are examined.
The results of the urine test are given to the patient in the form of a table with incomprehensible letters, which can only be read by a specialist. Below is a transcript of those same "incomprehensible letters", as well as the norms and possible deviations for individual indicators.
Deciphering the indicators of a general urine test
BLd - erythrocytes,
Bil- bilirubin,
Uro - urea,
KET ketones,
PRO protein,
NIT - nitrites (in the usual sense - bacteriuria),
GLU - glucose,
pH - acidity,
S.G - density,
LEU - leukocytes,
UBG - urobilinogen.
The table shows the main indicators of the general analysis of urine in the norm. Some of them will be discussed in more detail below:
The norm of a general urine test (table)
| General urine analysis(norm) |
|
| urine color | various shades of yellow |
| Urine clarity | transparent |
| The smell of urine | indistinct, nonspecific |
| Urine reaction or pH | acidic, pH less than 7 |
| Specific gravity (relative density) of urine | 1,018 or more per morning serving |
| Protein in the urine | absent |
| glucose in urine | absent |
| Ketone bodies in urine | missing |
| bilirubin in urine | absent |
| Urobilinogen in urine | |
| hemoglobin in urine | absent |
| Erythrocytes in urine (microscopy) | 0-3 in sight for women; 0-1 in sight for men |
| White blood cells in urine (microscopy) | 0–6 in the field of view for women; 0–3 in sight for men |
| Epithelial cells in urine (microscopy) | 0-10 in sight |
| Cylinders in urine (microscopy) | missing |
| Salts in urine (microscopy) | missing |
| bacteria in urine | missing |
| Mushrooms in urine | missing |
| missing |
|
Interpretation of urinalysis indicators
The rate of urine analysis in adults and children (table)
Normal values (in the field of view)
| sediment element | 0 to 18 years old | over 18 years old | |||
|---|---|---|---|---|---|
| boys | girls | men | women | ||
| erythrocytes | single in the preparation | 0 - 2 | |||
| leukocytes | 0 - 5 | 0 - 7 | 0 - 3 | 0 - 5 | |
| altered leukocytes | missing | ||||
| epithelial cells | flat | single in the preparation | 0 - 3 | 0 - 5 | |
| transitional | 0 - 1 | ||||
| renal | missing | ||||
| cylinders | hyaline | missing | |||
| grainy | |||||
| waxy | |||||
| epithelial | |||||
| erythrocyte | |||||
Acid-base reaction of urine is normal
The urine reaction (pH) of urine in a healthy person on a mixed diet is acidic or slightly acidic.
Table: Urine acidity in children and adults is normal
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The specific gravity of urine (g / l) is normal
The specific gravity of the urine of a healthy person during the day can fluctuate in a fairly wide range, which is associated with periodic food intake and loss of fluid through sweat and exhaled air.
Table: The specific gravity of urine in adults and children is normal
The specific gravity of urine depends on the amount of substances dissolved in it: urea, uric acid, creatinine, salts.
- A decrease in the specific gravity of urine (hypostenuria) to 1005-1010 g / l indicates a decrease in the concentration ability of the kidneys, an increase in the amount of urine excreted, and drinking plenty of water.
- An increase in the specific gravity of urine (hyperstenuria) more than 1030 g / l is observed with a decrease in the amount of urine excreted, in patients with acute glomerulonephritis, systemic diseases, cardiovascular insufficiency, may be associated with the appearance or increase edema, large fluid loss (vomiting, diarrhea), toxicosis of pregnant women.
Protein in the urine, protein in the urine
Fine protein in urine absent. Appearance protein in urine is one of the most important symptoms of kidney and urinary tract disease. The appearance of protein in the urine is called proteinuria. Proteinuria is possible in healthy people after taking a large amount of food rich in proteins, after strong physical stress, emotional experiences.
Pathological proteinuria divided into renal (prerenal) and extrarenal (postrenal):
- Extrarenal proteinuriadue to the admixture of protein excreted by the urinary tract and genital organs; they are observed at cystitis, pyelitis, prostatitis, urethritis, vulvovaginitis. Such proteinuria rarely exceeds 1 g / l (except in cases of severe pyuria - the detection of a large number of leukocytes in the urine).
- Renal proteinuriamost often associated with acute and chronic glomerulonephritis and pyelonephritis, nephropathy of pregnancy, febrile conditions, severe chronic heart failure, kidney amyloidosis, lipoid nephrosis, kidney tuberculosis, hemorrhagic fevers, hemorrhagic vasculitis, hypertension.
Glucose (sugar) in urine (normal)
Carbohydrates (glucose) in urine a healthy person are contained in insignificant concentrations, their presence is almost always a sign diabetes. So, normally, urine contains glucose in the form of traces not exceeding 0.02%, which, like protein, is not detected by ordinary quality tests.
Urinalysis for red blood cells (normal)Source: http://med..php/%D0%B0%D0%BD%D0%B0%D0%BB%D0%B8%D0%B7%D1%8B/193-%D0%B0%D0%BD %D0%B0%D0%BB%D0%B8%D0%B7-%D0%BC%D0%BE%D1%87%D0%B8.html
Erythrocytes (red blood cells)normally, there are no urine sediments or single ones are found in the preparation. A general urine test in a healthy person should show no more than 2 erythrocytes in the microscope field of view, and no more than 3 leukocytes in men and 5 in women.
An increased number of red blood cells is characteristic of many diseases: pyelonephritis, urolithiasis, glomerulonephritis, urinary tract infections, systemic lupus erythematosus or poisoning(especially poisonous mushrooms, snake venom, benzene and aniline derivatives).
Urinalysis for leukocytes (normal)
Fine leukocytes in the urine are absent, or single ones are detected in the preparation and in the field of view. An elevated leukocyte count is indicative of possible pathologies kidneys or urinary tract: glomerulonephritis, pyelonephritis, urethritis, cystitis, prostatitis.
Leukocyturia (more than 5 leukocytes per field of view) can be infectious (bacterial inflammation of the urinary tract) and aseptic (with glomerulonephritis, amyloidosis, chronic renal transplant rejection, chronic interstitial nephritis). pyuria consider the detection in the sediment during microscopy of 10 or more leukocytes in the field of view.
Urinalysis for epithelium (normal)
squamous epithelium: in men, only single cells are normally detected, their number increases with urethritis and prostatitis. In the urine of women, squamous cells are present in greater numbers.
Transitional epithelial cells may be present in significant amounts acute inflammatory processes in the bladder and renal pelvis, intoxication, urolithiasis and neoplasms of the urinary tract.
