Signs of hypotension of the intestines, muscles, gall and bladder, uterus

general information

Normally, urination is a voluntary act. When the bladder is filled, nerve receptors located in its wall send a signal to the central nervous system, or rather to the reflex pathways of the spinal cord and the supraspinal center. As a result, a person feels the urge to empty, during which the muscle layer (detrusor) of the bladder contracts while the sphincters relax.

If the functioning of one of the links in the innervation system of the urinary reservoir is disrupted, it goes into a mode of autonomous (independent) operation, regulated only by the reflex arc of the spinal cord, that is, neurogenic dysfunction of the bladder occurs.

The disease is characterized by various types of disruptions in the process of urination: the bladder partially or completely loses its ability to perform reservoir (accumulate and retain urine) and evacuation (excrete urine) functions. All forms of the disease are united by a lack of control over the urinary tract.

Neurogenic bladder can be the result of congenital anomalies and acquired pathologies. According to statistics, it occurs in 17% of the population, but less than half of them seek medical help.

This problem is very relevant at a young age - neurogenic bladder in children is diagnosed in 10% of children. It is found more often in girls than in boys due to estrogenic activity, which increases the sensitivity of the receptors.

Types of disease

Neurogenic hyperreflex organ - this disease appears after malfunctions of the nervous system of the brain occur. As a result, urine is not retained in the body, even if a minimum of fluid has accumulated in the organ, the person feels the urge to urinate. Such hypotension in the fair half is accompanied by acute inflammation.
Neurogenic hyporeflex type - this disease occurs due to disorders in the nervous system in the sacrum area. Reflex urination does not occur, and the size becomes larger. As a result, the sphincter relaxes, and then spontaneous urination occurs.
Neurogenic dysfunction. This pathology most often appears in adults, as mental disorders or somatic disorders occur. The fair half experience problems with the bladder after the birth of a baby, surgery on the genitals, and others. And in men, pathology can appear after wearing heavy objects for a long time or in the presence of prostate adenoma. In adolescents and children, pathology appears due to concomitant pathologies or under the influence of provoking factors.

Causes

The causes of neurogenic bladder in men and women are usually divided into 4 groups:

brain and spinal cord injuries;
diseases of the same organs;
congenital anomalies of the lower spine and spinal cord;
damage to the receptors of the urinary reservoir.

Neurogenic bladder dysfunction usually results from spinal cord and brain injury associated with:

stroke;
difficult childbirth or operations that resulted in the destruction of peri-vesical nerve fibers;
spinal fracture;
rupture, compression and other types of destructive effects on tissue.

A neurogenic bladder can be a consequence of inflammatory, degenerative and oncological pathologies that disrupt the functioning of the central nervous system, including:

encephalitis;
encephalomyelitis;
polyneuropathy, toxic or post-vaccination origin;
polyradiculoneuritis;
neoplasms localized in the brain or spinal cord;
choleastomy;
tuberculoma and so on.

Damage to the nerve receptors (intramural system) of the bladder, as a rule, occurs as a result of obstructive uropathy - diseases that are accompanied by impaired outflow of urine. These include neoplasms, strictures, and infectious pathologies. Sometimes a defect in the intramural system is associated with underdevelopment of the vesical ganglia.

Congenital defects of the lower spine, spinal cord, and brain are the leading cause of neurogenic bladder dysfunction in children. The most common anomalies:

myelodysplasia – underdevelopment of the spinal cord;
spina bifida;
agenesis (absence) and dysgenesis (underdevelopment) of the sacrum and coccyx.

Trauma (including birth), tumors and inflammatory-degenerative pathologies can also lead to the disease.

In young children, urinary function is regulated by the reflex arc of the spinal cord. The child cannot 100% control the functioning of the urinary system. The formation of the voluntary urination reflex occurs from 1.5 to 3-4 years.

Neurogenic bladder in children can be caused by insufficiency of the hypothalamic-pituitary complex, delayed development of voiding centers and dysfunction of the autonomic system.

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Symptoms

The clinical picture of a neurogenic bladder is determined by the level and extent of pathological changes in the functioning of the nervous system. There are two main forms of the disease: hyperactive (hyperreflex) and hypoactive (hyporeflex).

Neurogenic bladder with hyperactivity occurs with damage to the suprasegmental nervous system (nuclei of the hypothalamus, limbic-reticular complex), as well as dysfunction of the suprasacral zone of the spinal cord. This condition is associated with hyperreflexivity (increased tone) of the detrusor, as a result of which intravesical pressure increases and the urge to urinate occurs with a small amount of urine - up to 250 ml.

Symptoms of an overactive neurogenic bladder:

increased frequency of urination and small volume of discharge;
very strong urges leading to incontinence;
– excretion of the main volume of daily urine at night;
urine leakage;
difficulty starting and the entire act of urination;
absence or small volume of residual urine;
interruption of the urine stream, accompanied by pain in the lower abdomen;
autonomic disorders before urination - increased blood pressure, sweating.

A neurogenic bladder with hypoactivity is caused by damage to the segmental-peripheral apparatus (sacral zone of the spinal cord). Its manifestations are associated with detrusor hypotension, due to which intravesical pressure does not increase enough to overcome the resistance of the sphincter, even when urine accumulates in volumes exceeding 1.5 liters.

Signs of neurogenic bladder dysfunction with hypotension:

lack of urge to urinate when the bladder is full;
delay in the emptying process or its sluggish course;
the need to strain when urinating;
large volume of residual urine – up to 400 ml;
urinary incontinence due to bladder overflow - paradoxical ischuria.

The forms and symptoms of neurogenic bladder in children are similar to those described. At a young age, phenomena such as:

postural disorder - frequent urge to urinate only during the day - in an upright position;
stress incontinence is the involuntary excretion of small volumes of urine during physical activity, characteristic of teenage girls.

How the disease manifests itself in children, men and women

In men, bladder atony is quite rare. Basically, this disease manifests itself after injury to the lumbar region, resulting in damage to the spinal cord. Men may also be prone to diseases of this type in the following cases:

elderly age;
Alzheimer's disease;
injury to the genitourinary organs.

Treatment of bladder atony in men is carried out therapeutically, with medications.

Bladder atony is more common in women due to natural hormonal changes. This mainly occurs after pregnancy and childbirth.

Bladder atony after childbirth manifests itself in the form of urinary incontinence and is observed for a short period of time. Treatment in this case can include special gymnastic exercises for the muscles in the pelvic area. If symptoms do not go away within a couple of months, then you should definitely consult a doctor.

In addition to labor, the following factors may be the causes of pathology:

inflammatory processes in the form of cystitis;
overweight;
hormonal imbalances;
stressful situations;
disorders in the nervous system.

Symptoms of bladder atony in women:

repeated and strong desire to defecate;
disappearance of desire;
incontinence;
emptying only as a result of pushing.

Treatment of bladder atony in women is carried out using several methods:

special therapy with forced emptying according to a certain schedule;
gymnastic procedures;
therapeutic treatment of symptoms using medical equipment;
physiotherapeutic procedures;
special diets;
medication treatment;
the use of surgery.

To treat female atony, different methods can be used in combination.

For children, the manifestation of atony is mainly associated with pathologies at birth. Such pathologies cannot be completely cured; the condition can only be alleviated with the help of medical devices. If a child's central nervous system is damaged, urethral incontinence may occur.

Code	Neurourology department prices	Price
03.05	Initial appointment with a neurourologist (candidate of medical sciences)	3,000 rub.
03.06	Repeated appointment with a neurourologist (candidate of medical sciences)	1,500 rub.

Diagnostics

Diagnosis of a neurogenic bladder in children and adults is complicated by the need not only to determine dysfunction, but also to identify its root cause, as well as to identify changes in all organs and systems.

First of all, an anamnesis is taken, during which all symptoms associated with urination, accompanying pathological manifestations, as well as existing neurological diseases are established. Then the doctor examines the patient, palpates the abdomen and kidneys.

Further diagnosis of a neurogenic bladder is based on the use of a complex of instrumental and laboratory methods.

Lab tests:

general urine examination - shows low density, the presence of pus, bacteria, protein;
Zimnitsky test - demonstrates a change in the qualitative composition of urine;
clinical blood test - anemia, increased ESR;
blood biochemistry - indicates a violation of electrolyte metabolism.

Instrumental methods:

X-ray of the urinary system and lower spine - may show enlargement of the kidneys and bladder, deformation of the spinal canal, the presence of hernias;
urethrocystography - a contrast study of the urinary reservoir and canal, which demonstrates various structural anomalies and diverticula;
Ultrasound - shows expansion of the calyces and pelvis, reduction of the kidneys.
cystoscopy is an endoscopic examination that allows you to detect inflammatory changes in the walls of the bladder, diverticula, residual urine, and so on.

In addition, a detailed diagnosis of a neurogenic bladder requires a series of studies to assess the functioning of the urinary system. Among them:

uroflowmetry – demonstrates the flow rate and volume of urine excreted;
cystometry - shows the volume of the urinary reservoir in different states and the tone of the detrusor;
sphincterometry – evaluates the work of the sphincters.

If a pathology of the central nervous system is suspected, then an X-ray of the skull, an MRI of the brain, and an electroencephalogram are performed.

Neurogenic bladder dysfunction in children requires mandatory consultation not only with a neurologist, but also with a psychologist.

How to diagnose hypotension?

To make a correct diagnosis, the doctor must study the medical history and perform a series of diagnostic procedures. To exclude an inflammatory process in the patient’s body, a blood and urine test is taken, including a Zimnitsky functional test.

The patient is also prescribed modern advanced examination methods:

Magnetic resonance imaging;
ultrasonography;
cystoscopic diagnosis;
urethrocystography;
ascending pyelography.

If the studies did not reveal any changes, the doctor may recommend undergoing an examination of the brain and spinal cord. The patient’s age is also taken into account, as age-related diseases such as prostate hypertrophy may occur. But there are also cases when it is not possible to find the cause of hypotension. But even in this case, a diagnosis can be made – neurogenic bladder of unknown etiology.

Treatment

Treatment of a neurogenic bladder is carried out jointly by a neurologist and a urologist. Treatment tactics are determined by the cause, form and severity of the disease. The complex of measures includes taking medications, physiotherapeutic procedures and surgical interventions.

When treating the hyperactive form, muscle relaxants are used:

anticholinergics (buscopan, oxybutynin, propantheline);
alpha-blockers (Regitin);
calcium antagonists (nifedipine);
tricyclic antidepressants (melipramine).

In addition, intravesical administration of capsaicin and injection of botulinum toxin into the wall of the urethra or reservoir are practiced. These substances block the functioning of nerve fibers. L-carnitine, vitamins, succinic acid and other medications are used to improve local blood circulation and tissue nutrition.

Pharmacological hypoactive form includes:

m-cholinomimetics - drugs that enhance bladder motility (bethanechol chloride, aceclidine);
beta-blockers - drugs that increase detrusor tone and, as a result, intravesical pressure;
antibacterial substances for the prevention of infections (nitrofurans, sulfonamides).

In any form, compliance with the urination regime is key: with hypertension, patients should strive to increase the intervals between them, and with hypotension, void in a timely manner. In the latter case, forced methods can be used - continuous or episodic catheterization, stimulating emptying by pressing on the lower abdomen.

When treating a neurogenic bladder in women, gymnastics is prescribed to strengthen the pelvic floor muscles (Kegel system). In addition, electrical stimulation, hyperbaric oxygen therapy, heat applications, ultrasound, laser and other physical therapy methods have a positive effect.

In severe cases, surgical intervention is performed: removal of a segment of the bladder neck, its enlargement, incision of the external sphincter and other types of operations to normalize the process of urination.

Treatment options for neurogenic bladder in children do not differ from those used for adult patients. But more attention is paid to psychological aspects and normalization of the daily routine.

Treatment of the disease

The main directions of therapeutic treatment in cases of dysfunction of the urinary system are:

non-drug therapeutic treatment;
treatment with medications;
surgical intervention.

An experienced specialist will try to prescribe less traumatic treatment so that the number of side effects is minimal.

The safest treatment for urinary dysfunction is considered a non-drug method, which includes:

sleeping according to a schedule, walking outside;
organ training, during which the patient tries to adhere to the urination plan established by the doctor, in which the intervals between visits to the toilet gradually increase;
gymnastic exercises that strengthen the muscles of the bladder and pelvis;
physiotherapeutic procedures;
psychotherapy;
healing baths with the addition of sea salt, forced urination after two to three hours.

If physiotherapy does not give the expected results, it begins to be combined with the use of medications:

In case of hyperreflex changes in urea, anticholinergic drugs, tricyclic antidepressant compounds, antispasmodics, Valerian, Motherwort can be prescribed.
For hyporeflex bladder, treatment is performed with Cytochrome, vitamin compounds, and Glycine.

When there are no results from a conservative treatment course, the issue of surgical intervention should be considered, with the help of which one can strengthen and restore the smooth muscles of the urinary sphincter, create or strengthen an external type of sphincter from the transverse muscles.
In this case, collagen is injected into the ureteral orifice and the bladder is enlarged. To speed up recovery, the patient’s social adaptation should be provided for. In most patients, after carrying out a therapeutic course and following all medical recommendations, the functions of the bladder are restored in full; you just need to wait a little. This applies to carrying a child or developed hypotension caused by prolonged wearing of a catheter.

Forecast

Neurogenic bladder in children and adults has a favorable prognosis with adequate therapy and behavior correction. As they grow, many children completely get rid of this problem. When the disease occurs in adulthood, lifelong therapy and constant monitoring of the condition of the urinary system are most often required. The hypoactive form is more difficult to treat than the hyperactive form.

Without treatment, the disease can provoke various pathologies of the urinary system - cystitis, pyelonephritis, urolithiasis, ureterovesical reflux, bladder shrinkage, chronic renal failure. In addition, problems with urination negatively affect the emotional state of patients and can lead to psychological problems, especially in childhood.

Causes of muscle hypotension in children and adults

Muscle hypotonia means a persistent decrease in muscle tone.

The main causes of the pathology:

congenital disorders of neuromuscular complexes;
muscle dystrophy;
lack of protein in the diet (this is one of the most common causes of muscle hypotension in children);
decreased physical activity;
action of toxins (poisons);
traumatic brain injuries;
lack of thyroid hormones.

The main symptoms of muscle hypotension:

deterioration in motor activity;
drooling and problems pronouncing words and sounds;
rapid onset of fatigue during active movements.

The diagnosis is made based on symptoms and additional methods (CT, MRI, electromyography), which are used to analyze the severity of the pathology.

The basis of treatment is eliminating the cause. An important role is played by therapeutic exercises, physiotherapy, and massage for muscle hypotension.

Sources

Concise Medical Encyclopedia. Ch. ed. acad. B.V. Petrovsky “Soviet Encyclopedia” 1989

Release form, method of administration and dosage
For what pathological conditions is Betak indicated for use?
Side effects and contraindications
Special Recommendations
Interaction with other dosage forms
Patient reviews on the consequences of using the medicine

Modern pharmacology and practical medicine offer a wide range of drugs that can effectively fight hypertension, restore and maintain heart rhythm. Betak (betaxolol hydrochloride) is gaining popularity among cardiologists and heart patients due to its quality characteristics and long-term treatment effects.

The main effect of the drug is to lower blood pressure with normalization of heart rate by reducing sympathetic stimulation of blood vessels. Betak has weak membrane stabilizing activity.

The mechanism of pharmacological action is associated with

Blocking beta-adrenergic receptors of the heart;
Reducing the intracellular current of potassium ions.

The drug prevents the formation of the influence of norepinephrine and adrenaline circulating in the body. The influence of the sympathetic nervous system and circulatory pressure is reduced. This means that there is not only a decrease in the strength and frequency of contractions, but also in the stroke and minute volume of the heart. Heart rate decreases due to inhibition of beta-adrenergic receptor formations in the sinus nodes.

The hypotensive effect of betaca lies in its ability to influence the activity, communication of the central nervous system and activate the work of peripheral vessels. The chemical composition does not affect the metabolic processes of glucose and does not change the bronchodilator ability. This property distinguishes the drug from other beta-agonists.

The antianginal effect is achieved by reducing oxygen consumption by the heart muscle. At the same time, a decrease in vascular tone occurs due to relaxation of smooth muscles. But this effect is not primary. Research shows that tone may even increase initially.

This increases end-diastolic pressure in the left ventricle and increases the load on the myocardium. Increased elasticity of the heart muscle leads to an increase in oxygen demand in patients with CHF.

Betak has little effect on carbohydrate metabolism and organs containing β2-adrenergic receptors. It is not able to retain Na+ in the body and inhibits the bronchodilatory effect of β-adrenergic stimulants.

Release form, method of administration and dosage

Betak are white or almost white, biconvex, coated tablets with a score line on one side for easy division. The active substance is betaxolol hydrochloride.

Auxiliary ingredients: lactose monohydrate, microcrystalline and hydroxypropyl methylcellulose, sodium starch glycolate, colloidal silicon, magnesium stearate, titanium oxide, polyethylene glycol 400.

The positive effect of Betac is noticeable an hour or two after taking it and lasts for a day, so it is usually prescribed once a day. You need to swallow the pill whole, wash it down with water. The daily dose is initially 5-10 mg. The body must adapt and after 10-15 days it can be increased to 20, maximum to 40 mg.

A stable hypotensive effect is achieved within one to two months.

For what pathological conditions is Betak indicated for use?

Cardiologists point to such diseases of the cardiovascular system as:

Arterial hypertension;
Cardiac ischemia:

a) asymptomatic angina at rest, causing no complaints;

b) angina pectoris with signs of shortness of breath and chest pain during physical activity or stress;

c) unstable – when the attack exceeds the previous ones or with the appearance of new alarming symptoms, harbingers of a heart attack.

These diseases can be combined, overlap, and aggravate the general condition of the patient. According to the famous Russian cardiac surgeon L.A. Bokeria, almost all people over 30 years old have cardiac pathologies (almost all women and two thirds of men), that is, we are all at risk. Therefore, it is so important to receive timely diagnosis and qualified treatment.

The chemical composition of the tablets preserves glucose metabolism, the bronchodilator ability of beta-adrenergic agonists, and does not retain fluid with sodium ions.

Side effects and contraindications

Betak is a long-acting medicine. Prolonged or uncontrolled use can lead to negative or alarming effects. There are also direct contraindications:

Sometimes negative symptoms are observed in the digestive tract - indigestion, vomiting, diarrhea, abdominal pain, dry mouth, swallowing disorder, hepatitis.

If the patient begins to complain of increased fatigue, suffers from dizziness, drowsiness or emotional stress, then this is a direct indication of an inadequate response of the central nervous system. A feeling of anxiety, neuralgia, and sometimes hallucinations complement the picture indicating an overdose or the need to cancel the course of treatment with Betak.

In this case, it is necessary to take urgent measures:

Having detected atrioventricular block, administer atropine or epinephrine intravenously;
In case of arterial hypotension (without pulmonary edema), a drip infusion of plasma substitutes is prescribed;
Bronchospasm is eliminated by inhaled beta2 adrenergic agonists;
For seizures, diazepam is recommended.

Direct contraindications for Betaka: heart failure, atrioventricular or synarticular block, hypotension, cardioshock, cardiomegaly, diabetes mellitus, bronchial asthma, pulmonary emphysema, obstructive bronchitis, obliterating endarteritis.

A minimum dose of 5 mg is recommended for the elderly or patients with renal failure, as they are at increased risk of psychiatric complications, decreased body temperature (hypothermia), and heart rhythm disturbances.

When treating with Betak, especially during the first month, you should be under constant medical supervision. In the initial period, the body may not react quite adequately - in patients with a predisposition to heart failure, the unpleasant sensations described above sometimes occur.

For example, betak sometimes provokes symptoms of hypoglycemia, so careful monitoring of blood glucose levels in patients with diabetes is required. The dose should be discontinued or reduced if the heart rate decreases.

An absolute contraindication for Betak treatment is the consumption of alcoholic beverages. The drug is prescribed with caution to patients with a predisposition to allergic manifestations (skin rash, nausea, dry eyes, itching, psoriasis).

Drivers of vehicles and people in activities that require high precision and speed of psychomotor reactions should be extremely careful. The developers warn against abrupt withdrawal of the drug. It should be withdrawn gradually over one to two weeks, 5 mg every three to four days. Then withdrawal syndrome will be excluded and the deterioration of the patient’s condition will be avoided.

Betak is produced in tablets of 10 pieces in each of three blisters, packaged in cardboard boxes. Each pill contains 20 mg betaxolol hydrochloride. Also sold as drops in 5.0 bottles with an eye dispenser.

Store in a cool place, protected from light, out of reach of children for no more than two years.

Interaction with other dosage forms

It must be remembered that when combined with other medications, betak can change its properties to varying degrees.

The instructions for use draw attention to the following features of simultaneous use with other medications:

In combination with amiodarone, verapomil, diltiazem and beta-blockers in eye drops, the inhibitory effect of betaxalol is manifested, which can increase the contractile load of the myocardium and affect cardiac conduction.
The use of betac with other antihypertensive drugs enhances its hypotensive function.
The use of betaxolol during inhalation anesthesia can inhibit the contractile and rhythmic activity of the myocardium.
Estrogens and non-steroidal anti-inflammatory drugs, cocaine reduce the effect of betaca.
Phenothiazines increase the concentration of drug components in the blood plasma.
The removal of theophylline and lidocaine from the body is delayed.
Concomitant use with the anti-inflammatory sulfasalazine increases the concentration of betaxolol in the blood.

Thus, for the treatment of diseases of the cardiovascular system, Betak should be prescribed carefully, strictly individually and under medical supervision.

The instructions for use prohibit the use of the drug after two years from the date of production.

In case of individual intolerance to the drug or its components by some patients, the attending physician may recommend its analogues betoptik, betalmik, xonef, betofan, lokren, obtibetol.

Betak tablets or eye drops are sold in Russian pharmacies with a doctor's prescription; their prices vary depending on the region and pharmacy rating. On our portal you can order at a discount and buy with delivery a domestic drug or its imported analogues from the Slovak Republic, Belgium, USA, Romania, Cyprus.

Bladder hypotension is a condition in which the process of urine excretion is disrupted, caused by decreased tone of the smooth muscles of the walls. Normal bladder tone is manifested by the fact that muscle tone ensures proper retention of urination and full contraction of the bladder during the evacuation of its contents.

Arterial hypotension

Arterial hypotension is a decrease in blood pressure. The diagnosis is made if blood pressure is reduced from normal by 20% or more. Treatment of arterial hypotension presents the same problem as arterial hypertension - increased blood pressure. Pathology can be primary and secondary. The secondary form often occurs against the background of:

heart failure;
arrhythmias;
fasting;
lack of vitamins;
stomach ulcer;
endocrine shifts.

Main symptoms:

weakness and lethargy;
drowsiness;
often - apathy;
absent-mindedness;
headache.

The use of low blood pressure medications is not necessary. It is possible to normalize blood pressure if you adhere to a healthy lifestyle, including exercise, proper nutrition, and stress prevention. If there is no effect, you should look for the cause - the provoking disease - and eliminate it.

Read more about arterial hypotension (for example, about the symptoms of drug-induced hypotension that occurs while taking certain medications) on our website https://www.dobrobut.com/.

Causes of bladder hypotension

Many factors lead to disruption and decrease in the tone of the bladder walls. Below are the most common and common causes of bladder hypotension:

Inflammation of the walls of the bladder (cystitis), in which in the initial stages of the disease muscle hypertonicity is often observed, which without timely treatment smoothly turns into hypotension and.
Long-term forced overstretching of the walls of the bladder, which leads to weakness of the sphincter that holds urine in the bladder and hypotension. This condition can occur with obstruction of the urethra (urethra), which remains even after the elimination of the cause that caused it.
Bladder catheterization, which causes sphincter distension and hypotension. This condition occurs in the postoperative period or after childbirth, especially when the catheter is not removed for an extended period of time.
Acute, chronic infections caused by bacteria, viruses and fungi, and the state of intoxication after them. The accumulation of toxins in the muscles of the bladder leads to disruption of the mechanisms of nervous regulation of the urinary system.
Age-related changes, due to which hypotension of the bladder or sphincter may also develop.
Mechanical injuries to the bladder, resulting in disruption of the innervation of the bladder.
Injuries to the brain and spinal cord, as a result of which the regulation of bladder emptying is disrupted.
Disturbance in the rhythm and frequency of bladder emptying, which occurs, for example, with prostate adenoma or prostatitis.
The period of pregnancy and a large fetus, when during the 1st stage of labor the fetus presses the walls of the bladder to the womb, causing atony in the postpartum period.
Urolithiasis (if there is urethral obstruction).

Hypotension of the gallbladder

Hypotension of the gallbladder is a deterioration in its ability to contract. It is fraught with deterioration in bladder emptying, leading to digestive disorders in the duodenum. Its main reasons:

violation of a healthy diet, abuse of “bad” foods - fatty, fried, spicy;
malnutrition of the tissues of the bladder wall;
failure of the nervous system;
parasitic infection.

Main symptoms:

periodic attacks of pain in the right hypochondrium;
bloating;
alternating constipation and diarrhea;
nausea and vomiting.

To confirm the diagnosis, duodenal intubation is performed.

In most cases, help with gallbladder hypotension consists of dietary nutrition. In some cases, the prescription of choleretic drugs will be required. In case of severe hypotension, the gallbladder is removed.

Symptoms and signs

In this condition, contractility is reduced or absent when the bladder fills or even overflows with urine, resulting in urinary retention or sluggish urination. During urination, patients strain hard to empty the bladder, and in the end they have the feeling that there is residual urine in the bladder.

With prolonged hypotension, a distended bladder may occur, which entails the appearance of urinary incontinence, which is called paradoxical ischuria. Urine may be released in streams or drops, which inevitably causes a lot of trouble for patients.

Congestion can cause many complications, which manifest themselves in the form of stones, salts, and infection in the bladder. In some cases, congestion in the bladder provokes vesicoureteral reflux, when urine flows back up the ureters, causing inflammation. Retention of urine in the bladder can cause a condition called ureteral hypotension.

Disturbances in urinary excretion in children, which occur after acute or chronic infectious diseases, as well as after forced long-term retention of urination, are considered especially dangerous. Hypotension of the bladder in a child is manifested by the fact that the child stops asking to go to the potty (adults), and small children do not urinate for a long period of time.

Renal hypertension: treatment with tablets

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Types of renal hypertension

It’s hard to imagine, but a third of all hypertensive patients have problems with the functioning of the kidneys, a paired organ that helps remove toxic substances and metabolic products from the body.

According to the International Classification of Diseases (ICD), nephrogenic, or renal, hypertension is a pathology in which there is a persistent increase in blood pressure due to an abnormal process in the filtering system of the organs and its vascular structure.

Hypertension and kidneys are two interrelated concepts, since any malfunctions in their work lead to a deterioration in blood composition and the accumulation of toxic substances, which negatively affects the arteries and heart. As a result, this entails loss of ability to work, and even death is possible.

Depending on the etiopathogenesis of the disease, renal hypertension is classified into:

Renal parenchymal (renoparenchymal) type is a disease that is formed as a result of inflammatory processes in the kidney tissues such as polycystic disease, chronic pyelonephritis, trauma, renal tuberculosis, glomerulonephritis, kidney stones. Pressure increases with the formation of chronic renal failure.
Vasorenal (renovascular) type is a syndrome that forms as a result of damage to the vascular structures of the kidneys. In approximately 75% of cases, the renovascular type of pathology is formed due to atherosclerotic plaques, which lead to impaired renal nutrition and narrowing of the renal artery. Other possible occurrences are renal artery embolism or thrombosis.

Some doctors identify a third type of renal hypertension - mixed, in which a combination of parenchymal and vascular damage to the urinary system is noticed.

Nowadays, nephrogenic hypertension is diagnosed in a large number of young patients under 45 years of age.

The genesis of the disease is associated with a polluted environment, bad habits and an inactive lifestyle.

Reasons for the development of the disease

The etiology of the disease is not fully understood.

The pathology is caused by many factors that have both congenital and pathogenic origin.

Each case of detection of a disease requires an individual approach to identifying the causes of the disease and choosing methods of treatment.

Congenital factors include:

arteriovenous fistula (joint of the renal artery and vein);
abnormal development of the aorta and renal artery;
pathological processes of the bladder, ureters and urethra;
congenital kidney diseases;
renal artery thrombosis and embolism;
damage to the renal vascular network;
hypoplasia and dysplasia.

Acquired lesions can be:

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Renal artery aneurysm (sac-like bulging of the artery wall).
Malignant process, cysts, hydronephrosis, adhesions compressing the artery.
Thrombosis or atherosclerotic plaques in the renal artery.
Kidney prolapse, or nephroptosis.
Arteriovenous fistula.
Aortoarteritis affecting the renal artery.

The pathogenesis of the disease has a very complex mechanism, but boils down to one process. It is caused by a violation of the water-electrolyte balance, inhibition of the depressor hormonal system and activation of the pressor system. Because of this, there is an increase in the mass of affected nephrons.

As a result of abnormal processes, excess fluid and sodium accumulating in the body leads to tissue swelling and increases the sensitivity of blood vessels to elements of the renin-angiotensin-aldosterone system.

Negative factors narrow the arteries, which leads to the occurrence of nephrogenic hypertension.

Clinical picture of the pathology

Renal hypertension of the parenchymal or vasorenal form is not particularly different in symptoms from other types of arterial hypertension.

With these types of disorders, there is a general severe malaise, decreased ability to work and loss of strength.

In addition, there are a number of characteristic features.

You need to pay attention to the following signs in order to identify the disease in time:

flashing “flies” before the eyes (black dots);
increased heart rate and arterial pulse;
irritability and disturbance of night sleep;
frequent dizziness and migraines;
blood pressure often fluctuates;
sensation of tinnitus.

The main symptom of the disease is increased blood pressure, at which the diastolic (lower) value rises significantly. The clinical manifestation of this pathology is very similar to typical arterial hypertension. However, there are certain signs that distinguish renal hypertension from other diseases:

Formation of retinal angiopathy. Its precursor may be hyperemia, thinning or pathological tortuosity of the vascular structure of the fundus, retinal hemorrhages and damage to the eyeball.
A sharp vascular crisis not associated with stressful situations or excessive physical exertion.
There is no genetic predisposition to cardiovascular diseases such as heart failure, coronary heart disease, etc.
Accompanying symptoms of kidney damage are swelling, dysuria, pulling sensations in the lumbar region, etc.
As a rule, the development of the disease occurs in young patients (30-40 years old).
Asymmetry of blood pressure of the left and right arms.

The development of renal hypertension against the background of chronic diseases can be characterized by very slow progression. For many years, the patient experiences anxiety attacks, aching pain and irritability.

The pressure remains quite high, but rapid jumps are not observed. In addition, diastolic pressure reaches a critical value, and there is practically no difference between systole and diastole.

In this case, the patient's complaints are aimed at attacks of nausea and vomiting, as well as pain in the occipital region.

Diagnosis and drug treatment

High blood pressure and constant complaints associated with regular migraines, irritation and fatigue should be the reason to seek medical help from a specialist.

The indication should be a reason to visit a cardiologist, therapist and nephrologist.

A differential examination is carried out, which includes a number of examinations:

kidney biopsy;
radioisotope renography;
consideration of patient complaints and medical history taking;
ultrasound examination (ultrasound) of the kidneys;
general laboratory tests: biochemical, UAC, OAM, samples (Zimnitsky or Nechiporenko);
excretory urographic examination;
renal angiography.

Renal arterial hypertension leads to rapid damage to the vascular structures of the brain and heart. The typical treatment regimen cannot influence the patient's recovery. Moreover, the invasive method of treatment turns out to be the most effective.

The medicinal principle of treatment is to use the following drugs:

Beta blockers are medications that block beta adrenergic receptors, which helps lower blood pressure. These include drugs such as Carvedilol, Betaxolol, Acebutolol, Anaprilin, Propranolol. The use of the drug is prohibited for patients suffering from asthma, diabetes mellitus, liver dysfunction, bradycardia, decompensated heart failure, as well as pregnant women, nursing mothers and children under 18 years of age.
Thiazide diuretics are diuretics used for swelling and hypertension. Since the product helps remove excess fluid from the body, it thereby reduces blood pressure. These include Indapamide, Arifon, Acripamide, Pamid, Lorvas. The main contraindications are gout, allergies, hypotension, hypokalemia, diabetes mellitus, severe renal failure, lithium therapy.
Angiotensin II receptor blockers, or sartans. The most popular drugs are Eprosartan, Valsartan, Telmisartan, Losartan. Main contraindications: hyperkalemia, hypersensitivity to the components of the drug, dehydration, childbearing, lactation, children under 18 years of age.

If you notice similar symptoms, treatment for renal hypertension should be immediate. Otherwise, the disease may cause an undesirable complication, but in no way a hemodynamic stroke, as many believe.

Prevention and folk remedies

In addition to medications, there are many ways to combat high blood pressure.

Some of the traditional medicine methods are no less effective than drug treatment.

To prevent a secondary case of hypertensive crisis, it is necessary to adhere to simple preventive measures:

Maintain a balanced diet. The diet involves excluding fatty, salty, pickled, fried and smoked foods. The diet should include low-fat dairy products, fresh juices, fresh fruits and vegetables, dietary meat and fish, and wholemeal products.
Maintain moderate physical activity. Your whole life is on the move, so even with such a disease you cannot give up walking, swimming and playing sports. In this case, there should be no grueling training. Yoga for hypertension will be very useful.
Control body weight. Obesity or excess weight can negatively affect the functioning of the heart, kidneys and other organs.
Alternate rest and work, since heart disease requires good rest.
Give up harmful habits - smoking and drinking alcohol.

Treatment with folk remedies should be discussed with the treating specialist, since not every diuretic herb is safe for the functioning of the vascular system. The basis of herbal teas are medicinal herbs such as hop cones, bearberry, adonis, mint, fragrant rue, St. John's wort, mistletoe. A tincture based on walnuts or oregano helps reduce blood pressure. It is worth remembering that treatment at home alone will not contribute to the patient’s complete recovery.

There certainly is a relationship between blood pressure and kidneys. The problem affects a third of hypertensive patients, and the pathophysiology of the disease is quite complex. The main condition for restoring normal internal pressure is taking all the necessary medications and a healthy lifestyle.

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Treatment of bladder hypotension

First of all, it is necessary to find out the reason that caused the disruption of the urination process and the possibilities of eliminating it. Sometimes this can be very difficult to do, since advanced stages of prostate adenoma, for example, can only be treated surgically. In addition, there is no guarantee that bladder and sphincter functions will be restored after removal of a benign tumor.

It is difficult to restore the nervous regulation of the bladder, especially with injuries to the brain and spine. It is also not possible to completely restore function in older people who experience age-related degenerative changes in the smooth muscles of the bladder walls.

It is important to monitor the condition of the bladder during pregnancy and childbirth, and to prevent the occurrence of viral, fungal and bacterial damage. Usually, after the birth of a large fetus, after a short time, all functions of the bladder are restored, as, indeed, after forced catheterization.

The following medications are prescribed for hypotension:

Relieving intoxication and having an anti-inflammatory effect.
Drugs that have an antispasmodic effect.
Drugs with diuretic and urolitic effects.
Means that restore hormonal levels.
Medicines to enhance immunity.
Means that normalize metabolic processes.
Medicines for tissue regeneration.

is bladder dysfunction caused by congenital or acquired pathology of the nervous system. Depending on the condition of the detrusor, hyper- and hypo-reflex types of pathology are differentiated. The disease may manifest itself as pollakiuria, urinary incontinence, or pathological retention. Diagnosis of the syndrome consists of a complete neurological and urological examination (tests, urography, ultrasound of the kidneys and bladder, urofluorometry, cystography and cystoscopy, sphincterometry, radiography and MRI of the spine, MRI of the brain, etc.). Treatment may include non-drug and drug therapy, bladder catheterization, and surgery.

Hypotension of the renal pelvis

Hypotension of the renal pelvis is a decrease in its tone. Main reasons:

congenital malformations;
prolonged forced lying position (for example, after heavy operations);
hormonal changes in the body (puberty, menopausal wilting);
disruptions in nervous support;
damage to the wall of the pelvis (for example, a stone).

The nosology is manifested by stagnation of urine and worsening of its discharge.

How to treat hypotension of the renal pelvis? In mild cases, it is enough to eliminate its cause; in severe cases, it will be necessary to involve surgical intervention to narrow the “loose” pelvis.

General information

Neurogenic bladder is a fairly common condition in clinical urology, associated with the inability to carry out voluntary reflex accumulation and excretion of urine due to organic and functional damage to the nerve centers and pathways that regulate this process. Urinary disorders have a social aspect, since they can limit a person’s physical and mental activity and create a problem for his social adaptation in society.

The pathology is often accompanied by myofascial syndrome, pelvic venous congestion syndrome (venous stagnation). In more than 30% of cases, the development of secondary inflammatory-dystrophic changes in the urinary system is observed: vesicoureteral reflux, chronic cystitis, pyelonephritis and ureterohydronephrosis, leading to arterial hypertension, nephrosclerosis and chronic renal failure, which can threaten early disability.

What symptoms indicate the disease?

Disturbances in the functioning of the urinary tract can be expressed by a disorder in the process of urine excretion. The complete clinical picture will depend on the type of pathology. With hyperreflex changes, the following signs may be observed:

urges of an imperative nature, which are so noticeable that a person is able to restrain them for only a second;
pollakiuria during the day - increased frequency of urination at the usual volume;
incontinence and enuresis.

Urinary hypotension is characterized by symptoms of the opposite nature:

the desire to urinate is weakened or completely absent;
urination occurs rarely even if the bladder is full;
the presence of a sensation of emission of not all urine;
there is still a lot of urine left in the bladder;
excessive tension of the abdominal walls during sluggish emission of urine;
uncontrolled urine output due to strong pressure on the bladder;
constipation;
infectious lesions of the ureteral canals;
innervation of the urea.

Causes

A failure that occurs at any stage of the complex multi-level regulation of the urination process can lead to the development of one of the many clinical variants of a neurogenic bladder. In adults, the syndrome is associated with damage to the brain and spinal cord (stroke, compression, surgery, spinal fracture), as well as inflammatory, degenerative and tumor diseases of the nervous system - encephalitis, disseminated encephalomyelitis, polyneuropathy, polyradiculoneuritis, tuberculoma, cholesteatoma, etc. d.

Indirect and M-cholinomimetics (bethanechol chloride, distigmine bromide, aceclidine, galantamine) are used as drug therapy to enhance bladder motility, reduce its effective volume and the amount of residual urine. Alpha-adrenergic blockers (phenoxybenzamine - for internal detrusor-sphincter dyssynergia, diazepam and baclofen - for external detrusor-sphincteric dyssynergia), alpha-sympathomimetics (midodrine and imipramine - for stress urinary incontinence) are prescribed individually.

When drug therapy for a neurogenic bladder prevents urinary infections, it is necessary to control the amount of residual urine and take antibacterial drugs (nitrofurans, sulfonamides), especially for patients with vesicoureteral reflux.

Surgical endoscopic intervention for hypotension of the organ consists of transurethral funnel-shaped resection of the bladder neck, which subsequently provides the possibility of emptying with gentle pressure from the outside. In the hyperreflex variant (with pelvic floor spasticity and detrusor-sphincter dyssynergia), an incision is made in the external sphincter, which reduces the pressure of urination, and subsequently the hyperreactivity of the detrusor, increasing the capacity of the bladder.

It is also possible to surgically enlarge the bladder (using tissue plastic surgery), eliminate vesicoureteral reflux, and install a cystostomy drainage to empty the bladder. Pathogenetic treatment of neurogenic bladder syndrome can reduce the risk of damage to the urinary organs and the need for surgical intervention in the future.

The process of removing urine from the body can be disrupted for various reasons. One of them is bladder hypotension. The normal condition of the bladder is manifested in normal muscle tone. It is he who ensures urinary retention when necessary, and full contraction of the bladder when it is necessary to remove its contents.

Causes provoking the disease

The most common cause of neurogenic changes in the bladder are considered to be neurological deviations at various levels, which are a consequence of the problem of coordinating the functioning of the detrusor or external sphincter of the bladder at the time of filling it with urine or the process of releasing it. Such violations lead to:

myelodysplasia - congenital defects that can cause damage to the central nervous system;
brain injury to the back or head;
dysfunction of the autonomic system;
abnormalities in neuroendocrine regulation;
difficulties with sensory senses;
the appearance of tumors in the central zone of innervation of the detrusor;
Parkinson's disease;
multiple sclerosis;
pressure from tumors on nearby organs;
atherosclerosis;
growing up and the associated changes that occur in the body.

Causes of bladder hypotension

Cystitis, that is, inflammation of the walls of the bladder, quite often leads to a decrease in the tone of its muscles. At the initial stage of cystitis, increased tone is often observed, but with a long-term disease or when it is repeated, the walls of the bladder seem to get tired, and hypotension or atony gradually develops.
Obstruction of the urethra, as a result of which the walls of the bladder are overstretched.
Bladder catheterization in the postoperative period.
Acute and chronic infections caused by various pathogens. The accumulation of toxins secreted by these pathogens leads to disruption of the nervous regulation of the bladder and often to the development of hypotension.
Age-related changes.
Mechanical injuries of the bladder.
Spinal cord and brain injuries.
Prostatitis and prostate adenoma.
Urolithiasis disease.
Large fetus during pregnancy.

How is the disease diagnosed?

To know how to treat bladder atony, you need to diagnose the disease. To begin with, a special medical examination is performed by a urologist. You may also need to visit specialists in a narrow profile. During diagnosis, the following examinations are performed:

ultrasound examination of the genitourinary organs;
CT scan;
taking urethral tests.

Diagnostics are carried out in special medical centers.

Symptoms of bladder hypotension

The main problem that arises with this disorder is a decrease in contractility when the bladder fills and overflows. As a result, urinary retention and sluggish urination are observed. The patient has to push to empty the bladder. At the same time, there remains a feeling of remaining urine. In this case, stagnation occurs, which can cause many complications.

Complications caused by stagnation of urine:

Stone formation, salt deposition,
Bladder infection
Vesicoureteral reflux (reflux of urine up the ureters).
Hypotony of the ureter.

Urinary disorders are especially dangerous in children, which often occur after infections or as a result of prolonged urinary retention. Bladder hypotension in a child manifests itself in the fact that he does not urinate for a long period of time and does not ask to go to the potty.

Prolonged hypotension can lead to bladder distension. What are the consequences of this phenomenon? They are very unpleasant: urinary incontinence appears. In this case, urine can be released in drops or streams completely involuntarily.

Predisposing factors to overactive bladder

These include:

age;
overweight and obesity;
chronic nicotine intoxication;
dysfunction of the intestines of the hypotonic type with constipation;
persistent microbial flora;
hormonal instability.

What to do?

Treatment begins with identifying the reasons that caused disturbances in the process of urination. Once the cause is known, it can be eliminated in many cases. Although, for example, with advanced prostate adenoma, there is no guarantee of restoration of normal bladder functions even with successful treatment of the underlying disease.

It is especially difficult to restore the nervous regulation of the bladder in cases of spinal or brain injuries. It is often impossible to restore normal urination in older people. The fact is that they experience degenerative-dystrophic changes in the muscles of the walls of the bladder.

Physiotherapy, therapeutic exercises, and medications for bladder hypotension are prescribed as treatment. When prescribing medications, the causes of the disease are taken into account.

You may need drugs that have an anti-inflammatory effect, relieve intoxication, increase immunity, and normalize metabolic processes in the body. In some cases, antispasmodics, diuretics, or urolitic drugs are prescribed. If there is a hormonal imbalance, measures are taken to restore it. For older people or patients who have suffered bladder injuries, it is recommended to use drugs that help tissue regeneration.

In many cases, bladder function is completely restored. Sometimes this does not require treatment, but only time. This applies to cases of pregnancy or the development of hypotension of the bladder due to its catheterization in the postoperative period.

Hypotony of the uterus

With this pathology, the contractility of the uterus is impaired. Hypotony of the uterus in women during pregnancy is not as fraught as during childbirth. Factors contributing to the development of uterine hypotension:

malformations of its development;
neoplasia;
scars (for example, after surgery);
multiple births or polyhydramnios;
numerous births.

Hypotony of the uterus is manifested by weakened labor.

Treatment is carried out with drugs that increase uterine tone - these are Oxytocin, Methylergometrine, Dinoprostone.

Atrophic vaginitis

It develops due to a lack of estrogen, which causes:

sharp thinning of the vaginal mucosa;
rapid decline in proliferative actions in the vaginal epithelium;
decline in glycogen production by epithelial cells;
reduction in the number of lactobacilli or their complete death;
increase in pH of vaginal fluid.

Atrophic vaginitis is manifested by severe dryness and itching in the vaginal area, excessive discharge of blood-streaked discharge, and pain before and after sexual intercourse.

Vaginal atrophy

UROGENITAL DISORDERS IN THE CLIMATERIC PERIOD

Urogenital disorders (UGD) in the menopause are a set of symptoms associated with the development of atrophic and dystrophic processes in estrogen-dependent tissues and structures of the lower third of the genitourinary tract: bladder, urethra, vagina, pelvic ligaments and pelvic floor muscles.

Overactive bladder is a condition characterized by involuntary contractions of the detrusor during its filling, which can be either spontaneous or provoked.

An imperative urge to urinate is the appearance of a strong, unexpected urge to urinate, which, if it is impossible to implement, leads to UI (imperative or urgent UI).

True stress urinary incontinence (UI) (so-called stress UI) is an involuntary loss of urine associated with physical stress, objectively demonstrable and causing social and/or hygienic problems.

Mixed NM is a combination of stress and imperative NM with a predominance of one of them.

SYNONYMS

EPIDEMIOLOGY

UGR occurs in 30% of women over 55 years of age and in 75% of women over 70 years of age. 70% of women with an overactive bladder note a relationship between the appearance of UGR and the onset of menopause.

Specific risk factors for the development of UGR during menopause include:

estrogen deficiency;
hereditary predisposition (for various types of NM).

CLASSIFICATION

There is no unified classification of UGR. According to severity they are distinguished:

UGR of mild course;
UGR of moderate course;
severe UGR.

ETIOLOGY AND PATHOGENESIS

The development of UGR in the menopausal period is based on a deficiency of sex hormones, primarily estrogens. It has been proven that receptors for androgens, ER and PR are present in almost all structures of the urogenital tract, such as:

lower third of the ureters;
bladder;
muscular layer of the choroid plexus of the urethra and urothelium;
uterus;
muscles and epithelium of the vagina;
vaginal vessels;
pelvic floor muscles and ligamentous apparatus of the small pelvis.

Their distribution is not the same everywhere, and their density is much lower than in the endometrium.

The simultaneous development of atrophic processes associated with progressive estrogen deficiency in these tissues causes such a frequent combination of symptoms of AV and cystourethral atrophy in most patients.

The main links in the pathogenesis of UGR:

impaired proliferation of the epithelium of the vagina and urethra, decreased glycogen synthesis, changes in the nature of vaginal secretions (disappearance of lactobacilli, increased pH), possible addition of a secondary infection;
impaired blood supply to the wall of the bladder, urethra, vaginal wall, development of ischemia of the detrusor, urethra, vagina, decreased extravasation;
disturbances in the synthesis and metabolism of collagen in the ligamentous apparatus of the small pelvis, destructive changes in it, loss of elasticity, fragility. As a consequence, prolapse of the vaginal walls and impaired mobility and position of the urethra, development of urinary incontinence with tension;
a decrease in the number of α and β adrenergic receptors in the urethra, neck and bottom of the bladder;
changes in the sensitivity of muscarinic receptors to acetylcholine, decreased sensitivity of myofibrils to norepinephrine, decreased volume of muscle mass and contractile activity of myofibrils, their atrophy.

The combination of these changes leads to the development of symptoms of AV, cystourethral atrophy, UI with stress and an overactive bladder. They contribute to the formation of a state of psychosocial discomfort, which is characterized by a combination of external (social) and internal (psychological) factors that develop against the background of the development of disorders in the genitourinary area.

Danger and prognosis

To eliminate this disease, it is necessary to resort to a set of treatment procedures aimed at the cause of the condition and act directly on the organ.

First of all, you should avoid overfilling your bladder, as this aggravates the situation. For this purpose, a urethral catheter is installed in the patient.

A catheter is a device in the form of a rubber tube that is inserted through the urethra along the urinary tract into the bladder.

Due to the fact that the pathology does not resolve overnight, it is rational to use a catheter, which is installed for 3-5 days. This will avoid unnecessary trauma to the organs and will prevent further stretching of the bladder. Catheters are also made from various materials, such as:

Silicone.
Latex.
Polyvinyl chloride.
Brass.

Metal devices are not suitable for long-term use and significantly injure the walls of the urinary tract. The inner walls of the catheter are coated with silicone, which avoids the development of allergic reactions to a foreign body and reduces the accumulation of salts on the device, excreted in the urine.

The silver coating has an anti-inflammatory effect and allows you to use the tool for a long time.

The most functional in this situation is the Foley catheter.

Congenital atony (including as a genetic pathology) is a rather rare phenomenon that is almost impossible to treat. In such a situation, the patient is recommended to have a stable bowel movement schedule, medication and the use of diapers.

The acquired disease can be successfully cured if all recommendations are followed, but in advanced cases, surgical intervention becomes necessary.

For prevention, timely treatment of inflammation and preventive measures in relation to traumatic situations are important. It is not recommended to self-medicate; excessive stretching of the bladder walls can result in a deterioration in well-being.

To cure any disease, you must find out the cause of its occurrence and eliminate it. If the cause is identified and it can be eliminated within a certain time, then the prognosis for recovery is positive. In other cases, if the cause of atony cannot be eliminated, for example, if there was a serious injury or the disease is a genetic disorder, then you will have to use modern hygiene products that will eliminate the consequences of the disease.

If conservative therapy does not have a positive effect, then you will have to resort to the services of a surgeon.