تعريف
Urinary incontinence is the loss of voluntary bladder control that can lead to urine leakage. Incontinence can be temporary or long-lasting. It is a symptom, not a condition.
أسباب
The causes may vary with the type of incontinence.
سلس البول الإجهادي
The leakage may be caused by:
- Weakening of the muscles that suspend the bladder
- Weakening of the muscles that control urine flow
- Damage to the muscles that control urine flow following prostate surgery
- السمنة
نحث سلس البول
This is also known as overactive bladder. It may be caused by:
- التهاب المسالك البولية
- مرض السكري من النوع 1 والنوع 2
- Bladder irritation (such as kidney stone or tumor)
- الأدوية (مثل المنومات أو مدرات البول)
- الكافيين
- الكحول
- تلف الأعصاب بسبب:
- اصابة الحبل الشوكي
- سكتة دماغية
- تصلب متعدد
- مرض الشلل الرعاش
- إمساك
سلس البول الفائض
This occurs when the bladder will not empty. The urine builds up and overflows. This leads to leaking of urine. It may be caused by:
- Prostate enlargement
- Bladder that is blocked, such as by a scar in the urethra (stricture)
- Fecal impaction putting pressure on the urethra
- Drugs (such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
- نقص فيتامين ب12
- ضعف عضلات المثانة
- تلف العصب
سلس البول الوظيفي
This is when you have normal bladder control, but you are unable to reach the toilet in time. It may be a result of a condition like severe arthritis. Drugs that cause confusion or sedation can also lead to functional incontinence.
There may be several different causes for incontinence. In some cases, the cause may also be unclear.
عوامل الخطر
Factors that may increase your risk of incontinence include:
- العمر: أكبر من 65 سنة
- تاريخ prostate surgery
- Prostate enlargement due to benign prostatic hyperplasia (BPH), infection, orprostate cancer
- التهاب المسالك البولية
- السمنة
- مرض الرئة المزمن
- التهاب الإحليل
- اكتئاب
- Dementia (including Alzheimer’s disease)
- مرض السكري
- سكتة دماغية
- تصلب متعدد
- إصابة أو مرض الحبل الشوكي
- استخدام بعض المواد أو الأدوية:
- الكافيين
- الكحول
- Beta-blockers
- منبهات ألفا
- العوامل الكولينية
- سيكلوفوسفاميد
الأعراض
سلس البول هو أحد أعراض الحالات الأخرى. أي فقدان للسيطرة على المثانة يمكن اعتباره سلس البول.
With stress incontinence, leakage may happen when there is extra pressure on your bladder. This can happen when you laugh, sneeze, lift heavy objects, or exercise.
With urge incontinence, you may have a loss of bladder control following a strong urge to urinate. You may not be able to hold urine long enough to make it to a toilet.
متى يجب أن أتصل بطبيبي؟
اتصل بطبيبك إذا كنت تعاني من فقدان السيطرة على البول. يمكن أن يساعدك طبيبك في تحديد السبب الأساسي.
التشخيص
Your doctor will ask about your symptoms and medical history. You will be asked about your urine leakage and how often you empty your bladder. A physical exam will be done to look for any physical causes. These include blockages or nerve problems. Your doctor may ask you to keep a diary of your urinary habits.
You may be referred to a specialist. Urologists are doctors who focus on urinary issues.
Tests to help find the cause of the incontinence may include:
- Stress test—you relax, and then cough as your doctor watches for loss of urine (this will confirm if you have stress incontinence)
- اختبارات البول
- Tests to explore problems with your prostate (such as a prostate exam or blood tests)
- اختبارات الدم للكشف عن مرض السكري
- Ultrasound—uses sound waves to examine structures inside the body to determine if any urine remains in your bladder after urinating
- تنظير المثانة - يتم إدخال أنبوب رفيع مزود بكاميرا صغيرة في مجرى البول لرؤية مجرى البول والمثانة
- Urodynamic tests—used to measure the flow of urine and the pressure in the bladder
العلاج
قد تشمل العلاجات ما يلي:
العلاج السلوكي
العلاج السلوكي يشمل:
- Making muscles stronger by doing Kegel exercises
- These strengthen the muscles that hold the bladder in place and control urine flow.
- Painless electrical stimulation is sometimes used. It can strengthen the muscles more quickly. It is helpful for stress incontinence.
- Creating a regular schedule to empty your bladder (called bladder training). This training may also involve drinking fewer liquids
فقدان الوزن
Losing weight may help reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.
الدواء
Medicines may be prescribed to relax the bladder muscles. These types of medicines are called anticholinergics. They are often used in treating urge incontinence. Examples include:
- Oxybutynin (Ditropan)
- Tolterodine (Detrol)
- Darifenacin (Enablex)
- Solifenacin (Vesicare)
- Fesoterodine (Toviaz)
الأجهزة
Absorbent diapers are often used by men with incontinence.
Catheters are sometimes used to treat more severe cases. External (condom) or internal (Foley) catheters may be used.
Another option is a penile clamp. These clamps are padded and have a sleeve to absorb leakage.
رعاية منزلية
- اعتني ببشرتك عن طريق تنظيف نفسك بلطف بعد نوبة سلس البول. دع الجلد يجف في الهواء.
- Make it easier to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night-lights in the hallway and in the bathroom.
- If needed, keep a bedpan or urine canister handy in your bedroom.
تحفيز الأعصاب
Devices like Urgent PC and Inter-Stim may be used to stimulate the nerves. This may involve implanting a thin lead wire with a small electrode tip. This electronic stimulation therapy can be done as a series of treatments in your doctor’s office.
جراحة
In men, surgery may be done to relieve a physical blockage due to an enlarged prostate.
Other procedures involve surgical repair or implants into the bladder sphincter. The sphincter is the gate that allows the urine to flow through.
الوقاية
Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:
- Reduce your intake of substances that lead to incontinence. These include caffeine, alcohol, and certain drugs.
- Lose weight.
- Avoid and treat constipation.