In detail about the causes and treatments of urinary incontinence in men

Urinary incontinence in men is currently one of the most acute and complicated problems of urology.

According to official statistics, around the world, this hygienic and social problem affected about 200 million adults and elderly men, accounting for about 7% of men of the globe, whose age does not exceed 65 years.

Male urinary incontinence can affect men of any age – from boys to adults and older men, however, most often the relevance of this pathology increases with increasing age men. Urinary incontinence in men is the cause of their severe emotional disorders and deep social exclusion up to exclusion in severe cases.

Incontinence is called involuntary release of urine that can be identified visually.

Classification

Urinary incontinence is divided into two types:

1. True.
2. About.

Under a true understand incontinence the involuntary loss of urine, which can be visually identified, and also causes social and hygienic problems. Depending on the nature of the causes of pathology, distinguish the following types of true incontinence:

• Stress

This phenomenon occurs mainly in older men because of age-related changes in muscle and ligaments of their internal organs. In older men tone the pelvic floor muscles is substantially reduced, which in combination with increased intra-abdominal pressure when laughing, sneezing, coughing, physical exertion or as a result of changes in body position can cause involuntary urine output. Urination are lacking.

• Urgent

Feature of this pathology is the lack of any connection with the active or passive load on the genitourinary tract. Urgent incontinence differs from stress by the presence of intolerable urge to urinate. As the cause of the problem in this case is a pathological hyperactivity of the muscle wall of the bladder.

• Mixed

Urinary incontinence is the result of a combination of urgent reasons from stress.

• Enuresis

Any involuntary urination.

• Nocturnal enuresis

Bedwetting in men, implying the loss of urine during sleep.

• Paradoxical ischuria

Involves the loss of urine because of the overflow and, as a consequence of passive distension of the bladder. The reason for this phenomenon mayto be lesions of the lumbosacral spinal cord, surgery on the pelvic organs and diseases, accompanied by disturbance of outflow of urine.

Under the false incontinence understand the involuntary allocation in the absence of urination. As the causes of this pathology can be congenital or acquired defects of the urinary system, often as a result of injury, whereby the integrity of the urinary tract is disturbed and the formation of urinary fistula, opening into the lumen of the rectum or on the skin.

Predisposing factors

Urinary incontinence can be caused by the following reasons:

• Unhealthy lifestyle: sedentary, sedentary work, poor diet leading to chronic constipation and a weakening of the pelvic floor muscles, prolonged physical labor.
• Diseases of the Central nervous system, leading to disruption of neuroregulatory activities of the urinary system: Parkinson's disease, multiple sclerosis, strokes, spinal injury and brain, epilepsy, neurosis and psychosis.
• Long-term use of diuretics and drugs with psychotropic effects.
• Age-related deterioration of the structure of smooth muscles of the urinary tract in elderly men, or as a consequence of, diabetes mellitus.
• Mechanical injury to urinary tract with rude or inept catheterization, trauma to the pelvic ring or after removal or resection of the prostate when the tumor lesions.
• The syndrome of hyperactive urinary bladder.
• Urinary tract infection, accompanied by their inflammation.
• Infravesical obstruction of the urinary tract of any origin, accompanied by obstruction of urine outflow.
• Benign and malignant tumors of the genitourinary system.
• Inflammation of the prostate gland and its tumor.
• The course is undergoing chemotherapy.

How to fix the problem

The treatment of urinary incontinence in men is dependent on factors that caused the disease. On this basis, activities aimed at the treatment of urinary incontinence in men can be represented in the form of an integrated system, which includes conservative and radical treatment methods, as well as General and local treatment:

• Physiotherapy.

Among adults and older men, suffering from incontinence, well established method of treatment exercises Kegel.

Its essence lies in the regular performance of special physical exercises aimed at strengthening muscle tone of the pelvic floor. It is necessary to train the muscles of the pelvis by contractions similar to how they bend to stop a stream of urine. Exercises should beperform throughout the day in three or more sets of 5-10.

• Behavioral therapy.

Often used in conjunction with Kegel exercises. The essence of this method of treatment is to identify patients rough schedule of urination and targeted training the pelvic floor muscles method to meet this schedule, and subsequently the gradual increase of the intervals between acts of urination. In cases of bedwetting in men, the experts advised to limit fluid intake before bedtime.

• Physiotherapy (electrophoresis, UHF, etc.).

Has a strengthening effect on the muscles of the pelvic floor. Especially useful this will be when the issue occurs after surgical interventions on the prostate gland.

• Medication.

Prescribes medications, with different impacts on the urinary organs and the whole body. Selection of medicines is carried out by the physician depending on the cause of dysfunction of the genitourinary tract:

1. Drugs from the group of alpha-blockers used for the treatment of urinary incontinence in benign tumors of the prostate and intravesicularly obstruction of the urinary tract: Tamsulosin, Terazosin, Alfuzosin and Doxazosin. These drugs have relaxing effect on smooth muscles of prostate and bladder sphincter, resulting in normal flow of urine.
2. Blockers 5-alpha reductase, providing a depressing effect on the hormone that triggers the development of tumors of the prostate: Finasteride and Dutasteride.
3. Psychotropic drugs that have a relaxing effect on the muscles of the urinary tract and blocks nerve impulses that spazmiruet their walls: Depsonil, APO-Imipramine, Pryleugan, Tofranil.
4. Antispasmodics: Propantheline, Tolterodine, Darifenacin, Oxybutynin.

• Surgical treatment.

Is the main in cases of violation of neuroregulation urinary output in spinal patients or after removal of the prostate gland. Well proven the following methods of radical treatment of urinary incontinence in adults and elderly men:

1. Installation of an artificial urinary sphincter: it is shown with the weakening of his tone.

The syndrome of hyperactive urinary bladder, this method is not applicable. The artificial sphincter is a device consisting of an inflatable cuff, wrapped around the urethra, located in the belly of the tank, and the pump is the pump located in the scrotum. The effect of this device is that filled with water, the cuff squeezes the urethra until until a man urinate. To empty your bladder, you should pressfinger on the pump so water will flow from the cuff to the reservoir, the artificial sphincter to relax and urine comes out. After urination the cuff is again gradually filled with water, pressing the urethral canal and preventing involuntary urination.

2. Install the male hinges, or sling.

Shown in the Genesis of stress urinary incontinence and weakness of the sphincter of the bladder. Male sling looks like a synthetic mesh tape is designed for fixation of the urethra. Sling, fixing the urethra, to avoid involuntary loss of urine during physical exertion and stress. A male sling may be of fixed or adjustable: in the first case, the tape is implanted around the urethral channel and is fixed to the pubic bone with titanium screws, adjustable sling allows to regulate the tension of the belt and is more successful from a practical point of view of therapeutic manipulation. Mounted sling can cause complications such as erosion of the mucous membrane of the urethral canal, inflammation, tenderness, imperative urge to urinate and delay.

3. Urinary diversion in an artificial reservoir from part of the small intestine.

Shown at the upcoming cystectomy or violation of neuroregulation urinary tract. The urine from the ureters enters the artificial reservoir, and from there into a special urinal or catheter located in the abdomen.

Timely access to a doctor at the first signs of incontinence, will enable men to obtain an adequate comprehensive treatment, to avoid potential more serious complications in the future and also greatly enhance the quality of their lives, improve their self-esteem and well-being.