Frequent urination, urgent urination, urgency urinary incontinence and nocturia

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The frequent micturition, urgency, urgency urinary incontinence and nocturia are nonspecific symptoms may have a variety of causes.First, th

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The frequent micturition, urgency, urgency urinary incontinence and nocturia are nonspecific symptoms may have a variety of causes.

First, the basic concept:

24h refers to frequent micturition of more than 8 times. A strong sense of urgency, eager to urinate difficult to suppress.

Urgency urinary incontinence -- that can not control with urgent urgency symptoms, urine flow.

Nocturnal urine - the need to interrupt sleep at night to urinate. Normal 0 ~ 1 times, the 2 time has clinical significance.

Bladder transitional activity syndrome (ICS definition) - urgency, with or without incontinence, but at the same time there are frequency and nocturia.

Not all frequent micturition, urgency, urgency urinary incontinence and nocturia patients are overactive bladder.

The epidemiology of urinary incontinence is not accurate because of the different definitions, and in a few years, it has been unable to control the overflow event. II, to objectively confirmed involuntary leakage of urine, and lead to social and health problems.

The incidence of urinary incontinence was 10 to 40%, and the urge incontinence was from 7 to 49%. The incidence of urge incontinence increased with the increase of age. The prevalence of urinary incontinence was higher in the elderly than in the community.

Frequent micturition, urgency and nocturia and urinary incontinence compared to epidemiological study less, what reason is there a clear definition of "normal". The average 24h of the average number of urinary frequency difference is very large (4 ~ 19 times), different patients with this view is different. Some doctors think frequency have been causing trouble for them when it should be diagnosed as abnormal symptoms.

Nocturia is a very common situation, especially in the elderly, with the increase in age, if the impact of sleep, is the problem.

Pathophysiology - to explain the occurrence of symptoms:

Lower urinary tract function: storage and emptying of urine. Normally, urine is injected continuously at a rate of about 1ml a day for a day. The urine storage period with bladder capacity increased pressure unchanged, despite the change in abdominal pressure, regulating detrusor smooth muscle and connective tissue with adaptability, passive elastic and viscoelastic.

Urinary bladder dysfunction can cause frequent micturition, urgency of urination, urgency urinary incontinence and nocturia. Urinary abnormalities include:

The functional bladder capacity reduced bladder capacity decrease - night

The over - sensitive bladder outlet obstruction of bladder - (feeling)

The detrusor overactivity (movement) - urogenital atrophy

Non urinary dysfunction caused by nocturnal urine: polyuria, nocturia, sleep disorders can cause symptoms of nocturia.

Polyuria: 24h urinary volume > 40ml/kg (body weight). Diabetes, diabetes insipidus.

More than 20% of the total amount of 24h in the urine of young people at night, the elderly can be defined as more than the night of polyuria urine.

In patients with heart failure and peripheral venous insufficiency, insomnia or obstructive sleep apnea syndrome showed abnormal bladder function.

Evaluation:

Medical history

The number of day and night.

The new hair, a long time

3 fluid intake properties, quantity and frequency of urination relationship

The symptoms of dysuria, hematuria, intercourse pain, back pain

When sexual intercourse urine overflow in one of two ways: at the climax of the urine overflow related to detrusor transition activities, and activities of the insertion of the urine overflow prompts urinary continence mechanism (stress urinary incontinence)

The drugs, diuretics

Physical examination

The activity will result in a reduction or exacerbation of lower urinary tract symptoms.

The measurement of residual urine

Generally, > 100ml is abnormal, the clinical significance of 150ml.

The urogenital atrophy: labia and atrophy of the vulvar tissue, thin and pale, thin and short vaginal stenosis, epithelial folds disappear. Biopsy for other abnormalities.

The vertical support, the most distance measurement level supporting organizations of the hymen vertical length (cm).

Treatment

According to the specific symptoms of different patients to achieve individualized treatment plan. In most cases, the combination of drugs in order to achieve satisfactory results.

Based on the regulation of the diary, including fluid intake adjustment and control of the bladder. Frequent urination at night or more urine of patients, to avoid the dinner drinking alcoholic beverages.

The bladder training, also known as behavioral therapy, exercise habits, bladder retraining, refers to the change of its correction voiding behavior, to regain control of urine or urine control part, patients should fill in the voiding diary every day, according to the schedule of urination. In theory, this helps to strengthen the cortical pathway of the lower urinary tract and to establish a normal micturition reflex. The bladder control includes: guiding the patients to gradually extend the time interval, design scheme, application of distraction and voiding micturition, relax control strategy of self monitoring voiding behavior and consolidate the favorable factors. Application of baseline urinary diary were determined at the time of urination interval. When the patient has a urinary interval of 3H, he has returned to normal voiding patterns.

This "corrective treatment" of urgency, frequent urination, and incontinence has better curative effect, although there are many different behavioral therapy techniques, but the techniques are all need to rely on "education" patients to regain control of the bladder and sphincter. First line treatment for urinary incontinence.

Control of the normal bladder function is a complex learning behavior, need the central and peripheral nervous system, bladder (as sensorimotor unit), the interaction between the urethra and the pelvic floor muscles complicated physiological aspects.

Complete normal urination requires two conditions, namely urethral and support structure relaxation, accompanied by a sustained contraction of detrusor muscle.

 

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