{"id":5732,"date":"2019-12-10T09:54:30","date_gmt":"2019-12-10T09:54:30","guid":{"rendered":"https:\/\/jurmed.ro\/pacienti\/?p=5732"},"modified":"2019-12-10T09:54:49","modified_gmt":"2019-12-10T09:54:49","slug":"incontinenta-urinara-la-femei-cauze-diagnostic-tratament","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/pacienti\/incontinenta-urinara-la-femei-cauze-diagnostic-tratament\/","title":{"rendered":"Incontinen\u021ba urinar\u0103 la femei \u2013 cauze, diagnostic, tratament"},"content":{"rendered":"
\"\"<\/a>
Dr. Andrei Manu Marin\u00a0 Medic primar urolog, doctor \u00een \u015ftiin\u0163e medicale, specialist \u00een neuro-urologie <\/strong><\/em><\/figcaption><\/figure>\n

Cauze. Cauzele pierderii de urin\u0103 la femei includ afec\u0163iuni ale vezicii urinare, sau afec\u0163iuni ale mecanismului sfincterian (pierderea de urin\u0103 la efort). Cele dou\u0103 situa\u0163ii men\u0163ionate mai sus pot fi eviden\u0163iat \u015fi diferen\u0163iat u\u015for prin \u00eentreb\u0103rile: pierde\u0163i urin\u0103 \u00een drumul spre toalet\u0103 atunci c\u00e2nd apare senza\u0163ia, brusc\u0103 \u015fi intens\u0103, de a urina, sau, respectiv pierde\u0163i urin\u0103 c\u00e2nd tu\u015fi\u0163i, c\u00e2nd ridica\u0163i greut\u0103\u0163i, c\u00e2nd alerga\u0163i? Cele dou\u0103 situa\u0163ii, pierderea de urin\u0103 \u00een drum spre toalet\u0103 cu senza\u0163ia de grab\u0103 la urinare \u015fi pierderea de urin\u0103 la efort au cauze diferite \u015fi solu\u0163ii terapeutice diferite, de aceea este important s\u0103 se l\u0103mureasc\u0103 de la \u00eenceput ce tip de pierdere de urin\u0103 are pacienta. C\u00e2nd pacienta urineaz\u0103 des, simte la urinare o senza\u0163ie de urgen\u0163\u0103, greu de controlat \u015fi pierde p\u00e2n\u0103 s\u0103 ajung\u0103 la toalet\u0103, cauza este o hiperactivitate a vezicii urinare \u015fi vezica este cea care trebuie tratat\u0103, calmarea ei put\u00e2nduse face prin medicamente, stimularea electric\u0103 a centrilor care controleaz\u0103 relaxarea ei, re\u00eenv\u0103\u0163area controlului asupra senza\u0163iei de urinare. C\u00e2nd pacienta pierde doar la tuse, efort, r\u00e2s, str\u0103nut, alergat, urcat sc\u0103ri, cauza este o deficien\u0163\u0103 a sfincterului care nu se \u00eenchide eficient. Aceast\u0103 deficien\u0163\u0103 poate fi mo\u015ftenit\u0103, mai multe femei din familie put\u00e2nd avea simptomul acesta, ceea ce se mo\u015ftene\u015fte fiind un \u0163esut conjunctiv mai slab, persoanele respective fiind predispuse \u015fi la varice sau hemoroizi. Deficien\u0163a de \u00eenchidere a sfincterului poate fi \u00eens\u0103 \u015fi favorizat\u0103 de na\u015fterile multiple sau cu fe\u0163i cu greutate mare, de afec\u0163iunile cu tuse cronic\u0103, de constipa\u0163ie \u015fi de obezitate, deci de orice cre\u015fte presiune a abdomenului asupra mu\u015fchilor perineului. \u00cen toate aceste cazuri ajut\u0103 sc\u0103derea \u00een greutate, tratarea constipa\u0163iei, re\u00eent\u0103rirea perineului, prin exerci\u0163ii specifice, sau prin stimulare electric\u0103 a musculaturii \u015fi \u00een cazul \u00een care acestea nu sunt suficiente se poate recurge \u015fi la metode chirurgicale. Diagnostic. A\u015fa cum am precizat, diagnosticul este sugerat de discu\u0163ia cu pacienta asupra simptomelor ei. De asemenea, completarea cu un Calendar Mic\u0163ional ajut\u0103 foarte mult la eviden\u0163ierea acestor simptome. \u00cen acest Calendar Mic\u0163ional pacienta noteaz\u0103 pe 2-3 zile volumele eliminate la fiecare urinare c\u00e2t \u015fi pierderile de urin\u0103. O pacient\u0103 cu urin\u0103ri dese cu volume la urinare de c\u00e2te 150 ml \u015fi cu pierderi ce preced urinarea este o pacient\u0103 cu probleme de vezic\u0103, \u00een timp ce o pacient\u0103 care urineaz\u0103 cu volume de 300-400 ml, iar pierderile nu sunt legate de momentul urin\u0103rii, este o pacient\u0103 care are probleme de \u00eenchidere a sfincterului. Tratamentul \u00een ambele cazuri poate fi ini\u0163iat dup\u0103 stabilirea diagnosticului prin discu\u0163ia cu pacienta, examinarea calendarului mic\u0163ional, un examen local efectuat de medic (examen ginecologic al perineului, cu vezic\u0103 plin\u0103, pentru a constata starea uretrei, pozi\u0163ia vezicii, existen\u0163a unui prolaps) \u015fi un examen de urin\u0103. \u00cen cazurile \u00een care simptomele nu sunt clar interpretable, cum ar fi cazul \u00een care pacienta are at\u00e2t simptome de vezic\u0103 hiperactiv\u0103 c\u00e2t \u015fi pierderi de urin\u0103 la efort, c\u00e2nd pacienta a fost deja operat\u0103 pentru pierdere de urin\u0103 \u015fi aceasta a reap\u0103rut, cazurile \u00een care pacienta are un istoric cu afec\u0163iuni neurologice, sau diabet zaharat, pentru a stabili diagnosticul corect este nevoie de probe urodinamice.<\/p>\n

Tratament. Este important de subliniat c\u0103 cel mai important aspect \u00een luarea deciziei de tratament, at\u00e2t pentru pacient\u0103 c\u00e2t \u015fi pentru medic, este s\u0103 l\u0103mureasc\u0103 \u015fi s\u0103 decid\u0103 care este simptomul cel mai sup\u0103r\u0103tor pentru pacient\u0103, pe care aceasta \u00eel dore\u015fte tratat \u015fi rezolvat sau m\u0103car ameliorat. Al doilea aspect important de l\u0103murit este c\u00e2t se poate ameliora acest simptom cu diverse metode de tratament, \u015fi dac\u0103 exist\u0103 vindecare complet\u0103 \u015fi definitiv\u0103. Al treilea aspect ce nu trebuie omis este discutarea reac\u0163iilor adverse \u015fi a urm\u0103rilor diverselor metode de tratament. Prima linie de tratament este recomandat s\u0103 fie o metod\u0103, sau o combina\u0163ie de metode, care s\u0103 nu produc\u0103 modific\u0103ri ireversibile, adic\u0103 metode care conserv\u0103 situa\u0163ia prezent\u0103 \u015fi au \u015fanse s\u0103 \u00eembun\u0103t\u0103\u0163easc\u0103 situa\u0163ia dar la care se poate renun\u0163a sau poate fi \u00eenlocuit\u0103 cu o alta f\u0103r\u0103 \u00eens\u0103 a l\u0103sa urm\u0103ri asupra pacientei, a\u015fa cum ar l\u0103sa o opera\u0163ie chirurgical\u0103. Pentru pacientele cu urinare deas\u0103 \u015fi vezic\u0103 hiperactiv\u0103 aceast\u0103 prim\u0103 linie de tratament este reprezentat\u0103 de medicamente calmante vezicale \u015fi de stimul\u0103ri electrice ale nervului tibial, \u00een \u015fedin\u0163e de c\u00e2te 20 min de 2-3 ori pe s\u0103pt\u0103m\u00e2n\u0103, cca 20 de \u015fedin\u0163e. Prin acest procedeu curentul emis de aparat ajunge pe calea nervului tibial la centrii care relaxeaz\u0103 vezica urinar\u0103 situa\u0163i \u00een regiunea sacrat\u0103. Pentru pacientele cu pierderi de urin\u0103 la efort, prima linie de tratament este reprezentata\u0306 de \u00eenv\u0103\u0163area unei contrac\u0163ii corecte a mu\u015fchilor perineali \u015fi exersarea zilnic\u0103 a acestei contrac\u0163ii, cu control periodic, astfel \u00eenc\u00e2t pacienta s\u0103 recapete controlul acestor mu\u015fchi \u015fi prin exerci\u0163tii regulate s\u0103 le cresc\u0103 tonusul \u015fi eficien\u0163a. Pentru cele care nu pot contracta eficient perineul mu\u015fchii pot fi stimula\u0163i electric, \u015fi tonifia\u0163i prin \u015fedin\u0163e de stimulare de 2 ori pe s\u0103pt\u0103m\u00e2n\u0103, cu ajutorul unui electrod vaginal\/perineal de unic\u0103 folosin\u0163\u0103. Aceste metode ajut\u0103 cam 2 din 3 paciente s\u0103 simt\u0103 o \u00eembun\u0103t\u0103\u0163ire suficient\u0103, astfel \u00eenc\u00e2t s\u0103 fie mul\u0163umite de tratamentul prescris, pe care \u00eens\u0103 \u00eel vor urma prin exerci\u0163ii sau medicamente, la domiciliu, permanent. Dac\u0103 aceste metode nu dau rezultate satisf\u0103c\u0103toare \u00een 3-6 luni de tratament, se trece la metode mai invazive. Astfel, pentru pacientele cu vezic\u0103 hiperactiv\u0103 se poate injecta \u00een vezic\u0103, prin cistoscopie, toxin\u0103 botulinic\u0103, care calmeaz\u0103 vezica \u015fi face ca pacienta s\u0103 mearg\u0103 mai rar la toalet\u0103, f\u0103r\u0103 grab\u0103 \u015fi s\u0103 nu mai piard\u0103 urin\u0103. Pentru pacientele cu pierderi de urin\u0103 la efort se poate monta chirurgical o bandelet\u0103 sub uretr\u0103, pe care uretra s\u0103 fac\u0103 o curbur\u0103 c\u00e2nd pacienta face efort \u015fi astfel pierderea de urin\u0103 s\u0103 se reduc\u0103 sau s\u0103 dispar\u0103. Este important de men\u0163ionat o confuzie frecvent\u0103. \u201eRuptura de perineu\u201d este un termen care nu este legat de tulbur\u0103rile urinare sau de pierderea de urin\u0103. \u201eRuptura de perineu\u201d este un termen care exprim\u0103a o modificare de pozi\u0163ie a vezicii urinare. Opera\u0163ia de \u201eruptur\u0103 de perineu\u201d nu este o opera\u0163ie f\u0103cut\u0103 s\u0103 corecteze tulbur\u0103rile de urinare ci s\u0103 restabileasc\u0103 pozi\u0163ia vezicii. \u201eRuptura de perineu\u201d nu se corecteaz\u0103 cu bandelet\u0103 care se pune sub uretr\u0103<\/p>\n","protected":false},"excerpt":{"rendered":"

Cauze. Cauzele pierderii de urin\u0103 la femei includ afec\u0163iuni ale vezicii urinare, sau afec\u0163iuni ale mecanismului sfincterian (pierderea de urin\u0103 la efort). Cele dou\u0103 situa\u0163ii men\u0163ionate mai sus pot fi […]<\/p>\n","protected":false},"author":9,"featured_media":5733,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[67,467],"tags":[],"class_list":["post-5732","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-urologie"],"yoast_head":"\nIncontinen\u021ba urinar\u0103 la femei \u2013 cauze, diagnostic, tratament<\/title>\n<meta name=\"description\" content=\"Incontinen\u021ba urinar\u0103 la femei \u2013 cauze, diagnostic, tratament\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/pacienti\/incontinenta-urinara-la-femei-cauze-diagnostic-tratament\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Incontinen\u021ba urinar\u0103 la femei \u2013 cauze, diagnostic, tratament\" \/>\n<meta property=\"og:description\" content=\"Incontinen\u021ba urinar\u0103 la femei \u2013 cauze, diagnostic, tratament\" \/>\n<meta property=\"og:url\" content=\"https:\/\/jurmed.ro\/pacienti\/incontinenta-urinara-la-femei-cauze-diagnostic-tratament\/\" \/>\n<meta property=\"og:site_name\" content=\"Jurmed - 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