Urinary incontinence is a phenomenon of involuntary leakage of urine through the urethra, thus causing trouble in the patient’s life, and this symptom can also be objectively confirmed.
Urinary incontinence is not an independent disease. Urinary incontinence is a group of syndromes, which are involuntary leakage of urine caused by various reasons. It is a common symptom
of urination disorders. Urinary incontinence occurs mainly because the pressure in the bladder exceeds the resistance of the urethra during the bladder storage period, and the urine will lose
control. In many diseases, it can be seen in all ages and genders.
cause of symptoms
1. Congenital malformations of the urinary system: such as epispadias, bladder eversion, ectopic ureteral opening, and urachal fistula.
2. Urinary system and pelvic floor muscle injury: including urethral sphincter and pelvic floor muscle injury, relaxation, bladder, urethrovaginal fistula and ureterovaginal fistula caused by pelvic, rectal, prostate surgery or childbirth.
3. Bladder inflammation: Severe bladder inflammation or other pathologies cause excessive contraction of the detrusor muscle.
4. Lower urinary tract obstruction: such as benign prostatic hyperplasia, urethral stricture, etc.
5. Nervous system diseases: including the diseases of the nervous system itself, such as thrombosis, inflammation, trauma, tumors and external compression, as well as complications of diabetes.
6. Drug effects: including α-blockers, diuretics, long-acting sedatives, anticholinergics, calcium channel blockers, etc.
Epispadias, bladder eversion, heterotopic ureteral opening, urachal fistula, pelvic, rectal, prostate surgery, urethral sphincter and pelvic floor muscle injury, laxity, bladder, urethrovaginal fistula, ureterovaginal fistula, bladder inflammation, thrombosis , inflammation, trauma, tumor compression, diabetic complications.
(1) The medical history inquiry should pay attention to whether there are any of the following conditions
1. Age of onset.
2. Whether there is a premonition of urination before the occurrence.
3. Is urinary incontinence intermittent or continuous.
4. The relationship between urinary incontinence and increased abdominal pressure.
5. Whether there is a long-term history of urinary tract infection or diabetes.
6. Whether there is a history of pelvic, bladder, urethra, vagina, and prostate surgery.
7. History of neurological disease and spinal cord injury.
(2) Physical examination should pay attention to the following situations
Suprapubic bladder emptying and filling, spine development, neurological examination, degree of anal sphincter relaxation, female urethral length, anterior vaginal wall bulge, penile cavernous reflex,
(3) Specialist test
1. Stress test: catheterize the bladder to empty the bladder and measure the residual urine volume, inject 250ml of normal saline into the bladder, the patient stands to clamp the anterior vaginal wall
mucosa with the Aeris clip, gently pull the clip downward to aggravate the urinary incontinence, and push it upward. prevent leakage of urine.
2. Induction test: the patient takes the lithotomy position, and the examiner separates the labia by hand. The patient coughs, and urine can flow out of the urethra immediately; when the increased
abdominal pressure is relieved, the flow of urine stops immediately. This is a positive induction test.
3. Bladder neck elevation test: On the basis of the provocative test, the examiner uses the middle and index fingers of the right hand to elevate the bladder neck from both sides through the vagina, and
then the provocative test is performed. If urinary incontinence no longer occurs, the bladder neck elevation test is positive. .
4. Cotton swab test: measure the posterior angle of the urethra and bladder with a cotton swab inserted into the urethra to determine the severity of urethral prolapse.
Post time: Jan-12-2022