When it is cold, there are uninvited guests who come to see middle-aged and elderly men and women. One problem that cannot be easily talked about is urinary dysfunction. During a conversation with friends, urine may leak out without you realizing it, or the need to urinate continuously may leave you running around looking for a bathroom. Let’s learn about urinary disorders.
Urinary dysfunction is a comprehensive term for all types of abnormalities that can occur during the urination process. These symptoms appear when there is an abnormality in the bladder, prostate, or urethra and are the most common disease found in middle-aged people.
■ Prostatic hypertrophy
The prostate is a type of hormonal organ found only in men. It is located just below the bladder and surrounds the urethra. When the prostate enlarges, it can press on the urethra and interfere with urination. As can be seen from the prevalence of 50% in 50-year-olds, 60% in 60-year-olds and 70% in 70-year-olds, it is no exaggeration to say that it affects more than half of middle-aged men. Symptoms of benign prostatic hyperplasia include symptoms caused by narrowing of the urethra due to enlargement of the prostate (sensation of residual urine after urination, interrupted urine flow, weakened urine flow, urine does not come out quickly and requires force, etc.) and symptoms of benign prostatic hyperplasia. bladder irritation (after urination). It can be divided into the need to urinate again within 2 hours, difficulty holding the moment of urination, frequent waking up at night to urinate, etc.) These symptoms reduce the quality of life and interfere with a good night’s sleep, especially if you often wakes up at night to urinate, which requires appropriate diagnosis and treatment.
Diagnosis requires a discussion with your doctor, medical history, and a simple physical exam. If you are over the age of 50 and have the symptoms mentioned above, you may suspect benign prostatic hyperplasia and the size and hardness of the prostate should be determined through a digital rectal examination. This test is also needed to distinguish between urinary tract infections and prostate cancer. In addition, urine and blood tests are required, and in older adults, the level of prostate specific antigen (PSA) is also tested, since prostate cancer can occur. For a more detailed examination, uroflowmetry is performed to determine the presence and degree of urinary outflow obstruction, and the amount of urine remaining in the bladder after urination is measured. Ultrasound, bladder function tests, and endoscopy to view the prostate through the rectum are also performed. Treatment methods include medical treatment and surgical treatment. Indications for medical treatment include those with mild symptoms, patients for whom surgery is difficult due to a medical condition, or those who do not wish to undergo surgery. Surgical treatment is performed when drug therapy alone is ineffective. It is performed in cases of secondary urinary tract infection due to chronic urinary retention, severe hematuria or recurrent benign prostatic hyperplasia. With the advancement of machinery, endoscopic surgery is performed through the urethra without skin incision. In most cases, patients can be discharged after being hospitalized for 4-5 days after surgery.
■ Stress incontinence
Stress urinary incontinence occurs primarily in middle-aged and older women and refers to cases in which urine leaks against one’s will during situations in which abdominal pressure increases, such as lifting heavy objects, coughing, or sneezing. Although it can be sufficiently treated based on an accurate diagnosis, the number of people who actually visit hospitals and receive treatment is extremely small. The cause is frequent childbirth and pelvic surgeries, which weaken the support structure of the pelvis, cause the bladder-urethral area to lower downwards and the loss of voluntary self-control.
For diagnosis, a detailed questionnaire on symptoms and evaluation of nervous system anomalies is essentially conducted, while the degree of urinary tract infection and bladder relaxation are evaluated respectively through urinalysis and radiographic examinations (lateral cystography). If bladder dysfunction is suspected, a urodynamic test is performed to evaluate bladder function (contractility).
Treatments are largely divided into non-surgical and surgical methods, and non-surgical treatments include Kegel exercises and biofeedback. Kegel exercises, also called pelvic floor muscle exercises, are a way to strengthen your sphincter muscles. It is a movement that continuously contracts and relaxes the pelvic muscles for 5-10 seconds and is recommended to be repeated 8 to 10 times, 10 times a day. Biofeedback is a method that allows you to perform correct pelvic floor muscle contraction exercises by installing a device that detects the contraction of the pelvic floor muscles and visually checks whether the pelvic floor muscles are contracted correctly and their strength during the exercise through a computer monitor.
There is no effective and defined method for drug treatment. In the past, surgical treatment involved lifting the bladder neck through open or laparoscopic vaginal or abdominal surgery. Recently, a midurethral sling is mainly performed by attaching an artificial tape (mesh) under the central urethra during sedation or local anesthesia.
■ Neurogenic bladder
The bladder has two functions: storing urine and expelling it when you feel the need to urinate. These functions are controlled and controlled by the nervous system and when the above functions are abnormal due to abnormalities in the nervous system or disharmony in regulatory function, it is called neurogenic bladder. The cause is loss of bladder function and bladder outflow due to neurological disorders. These neurological disorders are caused by neurological diseases (cerebrovascular diseases: stroke, Parkinson’s disease, multiple sclerosis), spinal damage (especially lumbar and sacral damage) caused by various injuries such as recent traffic accidents, and secondary damage to the nervous system caused by spinal diseases. adult like how diabetes and hypertension do. The goal of treatment is, first, to manage and maintain bladder function well to prevent kidney damage such as reflux. Secondly, to prevent urinary tract infections, and thirdly, to prevent urinary incontinence so that you can maintain a good daily life. Treatment of neurogenic bladder usually requires consultation with a specialist.
Urination disorders are one of the diseases that cause discomfort in daily life and reduce the quality of life. Nowadays, with the increase of the elderly population, urination-related diseases are also increasing, so not only medical professionals but also the general public need to understand the disease problem.
2024-01-08 00:13:08
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