Urinary incontinence and enuresis
Introduction
Introduction Urinary incontinence and enuresis refer to both urinary incontinence and enuresis. Incontinence of urine is the loss of urinary self-control ability due to bladder sphincter injury or neurological dysfunction, causing urine to flow involuntarily. Enuresis includes two cases, one refers to enuresis, commonly known as bedwetting; the second refers to enuresis, which refers to children over the age of 3 without neurological or urogenital systemic diseases, unconsciously urinating at night. Inadequate control of urination by infants should be considered normal. Enuresis can be divided into nocturnal enuresis and enuresis during the day, with nocturnal enuresis at night.
Cause
Cause
First, the cause classification
1. True urinary incontinence: Debridement of stones, tuberculosis, tumors, etc., causing excessive contraction of the detrusor muscle, relaxation or paralysis of the urethral sphincter, so that the bladder loses the function of storing urine, and the urine is discharged, also known as the autonomic bladder.
2. Pseudo urinary incontinence: lower urinary tract obstruction, chronic urinary retention, bladder over-expansion, increased intravesical pressure, causing urine to be forced to overflow, called pseudo-urinary incontinence, also known as enuresis. Found in congenital recessive spina bifida; urinary retention caused by various causes. Also seen in healthy children under the age of 5, children due to poor physical development, urinary nerve reflex arc is not established, when the night is asleep, the urine is automatically discharged, called the bedwetting, with growth and development, can stop by themselves, does not mean pathological.
3. Stress urinary incontinence: due to relaxation of the urethral sphincter, when the patient coughs, laughs, sneezes, etc., the abdominal pressure suddenly rises, a small amount of urine can be involuntarily discharged, seen in the elderly urethral sphincter degeneration; young adult women Functional urethral sphincter relaxation; also seen in the uterus compression of the pregnancy; tumor compression of the bladder.
4. Congenital urinary incontinence: seen in congenital urinary tract malformation, urethral ectopic opening, umbilical ureteral rupture, urethral fissure, bladder vaginal fistula.
Second, the mechanism
The normal urethral sphincter has a certain tension, the detrusor muscle is in a relaxed state, the urine is stored in the bladder, and a series of nerve reflexes occur during urination, causing the detrusor to contract, the sphincter to relax, and the urine to be discharged. If the urinary muscles continue to sputum, or the sphincter is excessively loose, the urine can not be accumulated in the bladder and automatically flow out. This is urinary incontinence, called true urinary incontinence. If the lower urinary tract is obstructed, or the detrusor muscle is weak, the urine stays in the bladder, causing the overfilled bladder pressure to gradually increase, and the urine can overflow at any time, resulting in "filling urinary incontinence" or pseudo urinary incontinence. Called enuresis.
Examine
an examination
Related inspection
Tissue polypeptide antigen urine routine
Urinary incontinence, especially urinary incontinence caused by the neurogenic bladder, should be checked as follows:
1 Determination of residual urine volume to distinguish between urinary incontinence caused by excessive urethral resistance (lower urinary tract obstruction) and low resistance.
2 If there is residual urine, urinary bladder urethra angiography, obstruction in the bladder neck or external urethral sphincter.
3 bladder pressure measurement, to observe whether there is no inhibition of contraction, bladder sensation and detrusor no reflection.
4 Standing bladder angiography to observe whether the urethra is filled with contrast agent. Contrast agents in the urethral function are blocked by the bladder neck. If the sympathetic function of the urination is damaged, the smooth muscle of the posterior urethra is relaxed. On the contrast film, the contrast agent is filled in the proximal side of the posterior urethra 1 to 2 cm, because there is no striated muscle in this part of the urethra.
5 Close the urethral pressure map.
6 Synchronous examination of bladder pressure, urinary flow rate, and electromyography should be performed as necessary to diagnose cough-urgent urinary incontinence, detrusor sphincter dysfunction, and urinary incontinence caused by sphincter non-inhibitory relaxation.
7 dynamic urethral pressure map: a special double lumen tube, two holes at the end. One hole is placed in the bladder and the other hole is in the posterior urethra. In patients with normal urinary tract function, the urethral pressure also rises when the intravesical pressure increases (such as coughing) to prevent the outflow of urine. There are a few patients with stress urinary incontinence. When the intravesical pressure is increased, the urethral pressure does not rise, and the urine is outflowed.
Diagnosis
Differential diagnosis
1. Neurogenic bladder: It is a disease that occurs in a certain part of the nervous system involved in urinary reflex. Attention should be paid to peripheral neuritis, myelitis, encephalitis, brain trauma, and spinal cord injury during neurological examination. Some patients may be accompanied by anal sphincter relaxation, and even paraplegia.
2, due to detrusor tendon caused by urinary incontinence: pay attention to find the cause, the common is inflammation, especially urinary system tuberculosis, at this time intravenous pyelography, the bladder is a table tennis-like change is the characteristics of bladder tuberculosis. In addition to the bladder stones, tumors can also arise, B-ultrasound, CT examination can help diagnose. Cystoscopy can confirm the diagnosis.
3, urinary tract malformation caused by urinary incontinence: visible urine is discharged from the abnormal channel, the general diagnosis is not difficult. Urinary tract angiography or cystoscopy should be used to confirm the diagnosis in special circumstances.
4, pseudo urinary incontinence: pay attention to check the lower urinary tract obstruction, pubic symphysis, the lower abdomen can touch the swelling of the bladder is a feature. Bladder pressure measurement is helpful for diagnosis when necessary. Including medical history, physical examination, laboratory examination and device-assisted examination, see Urine dysuria and urinary retention in this section.
