Urinary incontinence is a serious problem that leads to social maladaptation of a man, limits the possibilities of his work and everyday activities, leads to psycho-emotional stress and, as a consequence, forced isolation from society. But what’s much worse is that this problem in men is quite difficult to treat. Of course, the disease is not life-threatening, but it significantly reduces its quality.
Perhaps the main problem in the treatment of uncontrolled urine output is too late contacting a urologist. Statistics show that less than 30% of men suffering from this disease go to the doctor, and the reason for this is the so-called false shame. But it should be noted that some forms of urinary incontinence can be treated very easily if you start therapy on time and do not self-medicate.
Indications for surgery
Adenoma is a benign tumor that gradually develops against the background of chronic inflammation of the organ. If you start treatment in a timely manner, you can get rid of the disease with the help of medications. But sometimes the disease develops rapidly, various aggravating factors influence, then surgery cannot be avoided.
Prostate adenoma often develops into a malignant formation. To prevent the development of cancer , doctors suggest removing a benign tumor immediately. Other indications for surgery are:
- severe pain;
- complete absence of urination;
- absolute urinary incontinence;
- significant tumor growth.
Before the operation, the patient must be hospitalized for preliminary preparation. In many cases, antibacterial therapy is carried out to minimize the negative consequences and complications after the intervention. A complete examination of the patient is necessary. Based on its results, the tactics of radical treatment, type of operation, and type of anesthesia are determined. Epidural anesthesia is increasingly used in surgical practice. Unlike general anesthesia, it does not have such a negative effect on the functioning of the cardiovascular system of elderly patients.
The choice of doctor and hospital where the operation is performed is of no small importance. Specialists with extensive experience know how to minimize the negative consequences of surgery, including urinary incontinence.
Features of the operation
Radical removal of an adenoma is carried out by modern surgeons in several ways. With complete excision of a benign tumor, an incision is made in the scrotum and the surgeon removes all damaged tissue, sometimes including nearby healthy tissue. This is done in order to prevent further development of cancer.
Transurethral resection of the prostate (TUR) is becoming increasingly common in our country . This is a minimally invasive intervention. A special long needle is inserted through the urethra, the tumor is “sucked out” through it. The entire operation is performed under ultrasound guidance. The likelihood of complications after TUR is minimal, but in the later stages of the disease such interventions are not performed.
The duration of the operation, regardless of how it is performed, is 30-60 minutes. The patient remains in the hospital for two weeks after the intervention, but full recovery takes several months.
During a full-fledged operation with an incision, stitches are required. Today, self-absorbable surgical suture material is used in medical practice. There is no need to remove such sutures, but the doctor must constantly monitor the healing process.
The very next day after the operation, the patient is raised to his feet and must walk. This contributes to the speedy restoration of the excretory system.
Moderate physical activity is the main method of combating uncontrolled urine output after removal of an adenoma. The patient receives full treatment aimed at a speedy recovery.
Gymnastics
To restore urination after a catheter in men and women faster, the patient can perform the following exercises:
- Take a supine position. Raise your legs one at a time, and then simultaneously for 3 minutes.
- Sit with emphasis on your heels and place your fists in the area of the bladder. As you exhale, you need to bend forward all the way, and as you inhale, return back. Repeat 8 times.
- Get on your knees, place your hands behind your back. While exhaling sharply, you need to bend over 6 times.
It is worth saying that restoration of urination after a catheter is only possible if the patient performs the exercises regularly.
After class, you need to lie on your back, stretch your legs forward and arms along your body. You need to start relaxing from your toes and further up. Having reached maximum relaxation, you need to lie down for a few minutes.
Quite often, during the rehabilitation period, patients begin taking diuretics. Doing this is contraindicated.
Before starting any exercises, the patient should consult with their doctor, as in some cases they may be contraindicated.
You should seek medical help after removing the catheter in the following cases:
- increase in body temperature to 38° C or more;
- difficulty urinating (especially if the problem gets worse); absolute retention of urine.
It is important to remember that postponing a visit to the doctor until later and doing it on your own can lead to serious consequences. Only a qualified specialist can accurately determine the cause of the problem and explain to the patient how to restore urination after a catheter.
Causes and conditions of incontinence
Incontinence occurs in 95% of patients after excision of an adenoma or other surgery on the genitourinary system. Some people do not feel the urge to go to the toilet at all, while other patients involuntarily release only a few drops of urine. Doctors traditionally monitor the situation, but take a wait-and-see approach. The causes of incontinence are of no small importance. There may be several of them:
- consequences of forced catheterization;
- consequences of anesthesia;
- excision during surgery of the muscle layer surrounding the urethra.
The patient must have a reusable catheter installed immediately after surgery. It lasts for several days. Urine is released into a special urine collector without the slightest urge to go to the toilet. In this way, inflammatory processes in the bladder are prevented. This tactic is applicable for all types of surgical interventions. Due to prolonged catheterization, the urethra expands and loses its elasticity. After removing the catheter, urine continues to be released without the urge to go to the toilet.
Sometimes anesthesia has this relaxing property. It does not work this way for all patients, but urinary incontinence is one of the common consequences of using some anesthetics. After the substances are completely removed from the body, its functions return to normal.
Another common cause of urinary incontinence is due to muscle excision during surgery. It is impossible to remove a tumor without affecting nearby tissue.
It is the muscles surrounding the urethra that act as a sphincter, restraining the urge to go to the toilet. When the integrity of the muscle layer is compromised, urinary incontinence is an expected and inevitable complication. You can deal with such consequences if you stock up on patience and support from professionals in advance.
Technique of the procedure
In order to carry out the catheterization procedure, in accordance with all the rules of asepsis and antisepsis, it is necessary to carry it out in a specialized hospital, using modern antiseptics, sterile devices, medical disposable gloves, etc.
Bladder catheterization in a woman
The manipulation algorithm is as follows:
- The woman is placed on her back and asked to bend her knees and spread them apart.
- The female genital organs are thoroughly cleaned using antiseptic solutions, after which the vaginal opening is covered with sterile napkins.
- With the right hand, a well-lubricated catheter for urine is inserted until urine appears (approximately 4-5 cm).
- If urine suddenly stops flowing, this may indicate that the device has hit the wall of the bladder, so you need to pull the catheter back a little.
- After the manipulation is completed and the urine has completely drained, it is necessary to carefully remove the catheter and treat the lumen of the urethra again with an antiseptic solution.
- The patient is required to remain in a horizontal position for an hour.
The procedure is carried out only by qualified specialists
During pregnancy, situations arise when a woman requires catheterization, for example, when a calculus is advancing and it blocks the lumen of the urinary tract, which leads to acute urinary retention, as well as before an upcoming cesarean section.
The condition requires immediate hospitalization and observation of the woman only in a specialized hospital.
Bladder catheterization in a man
In men, catheterization is complicated by the anatomical structure of the urethra, namely its small diameter, significant length, tortuosity and the presence of physiological narrowings.
Flushing the bladder at home
The procedure algorithm is as follows:
- The man is placed on his back (there is no need to bend his legs at the knees).
- The penis and groin area are covered with sterile napkins around the entire perimeter.
- With his left hand, the doctor pulls back the foreskin, exposing the lumen of the urethra, and at the same time extends the penis perpendicular to the surface of the patient’s torso. The head of the penis and other male genital organs are carefully treated with antiseptic solutions.
- A pre-lubricated catheter is inserted with the right hand, all movements should be smooth and uniform, and the doctor should apply only a slight force in places of anatomical narrowing (the patient is asked to relax as much as possible).
- Periodic palpation of the tip of the catheter is recommended, especially if there are obstacles in its path, until urine flows through it (evidence that it has reached the lumen of the bladder).
- When the procedure is completed, the catheter is removed, and the lumen of the urethra is re-treated with an antiseptic solution. The patient is required to remain in a horizontal position for an hour.
Abducting the penis perpendicular to the male body allows you to maximally straighten the anterior urethra
Bladder catheterization in a child
In general, the technique of catheterization in children does not differ significantly from the procedure performed in adults. It is carried out with the aim of restoring normal urine flow and eliminating all signs of acute urine retention.
Inserting a catheter into a child requires special care and precision, since there is a high risk of damage to the mucous membranes, up to complete rupture of the wall of the urethra or bladder. That is why a smaller diameter device is used for catheterization of children, and if such a possibility exists, the procedure is carried out under ultrasound or x-ray control.
Restoring normal urination
Doctors always insist and emphasize that incontinence is an expected phenomenon when such a benign tumor is removed. Such manifestations can last up to several months, but it is within your power to quickly restore all functions of the excretory system. training the perineal muscles gives a positive result. The doctor will tell you about the technique of the training process. The point is to periodically tense and relax the muscles in this area. Over time, the muscle layer will build up and you will be able to control the urge to go to the toilet.
Physiotherapy also gives good results. The patient is prescribed sessions of magnetic therapy, ultrasound therapy, and exposure to infrared radiation. Sometimes medications are also offered, the action of which is aimed at restoring the functions of the urinary system.
