Syndrome of urogenital disorders in menopausal women

In adult representatives of the fair sex, the urge to urinate occurs from 4 to 8 times per day. This is the average figure for a volume of liquid drunk up to 1600 ml. These indicators are influenced by the temperature in the room, as well as the amount of coffee, green tea and herbal infusions consumed. An adult should urinate no more than once at night. If these indicators become higher, then we can talk about a deviation from the norm. Frequent urination in women without pain occurs for a number of reasons that are important to understand.

Symptoms

The main symptom of the problem, of course, is the frequent urge to urinate. However, other discomforts also arise. Not only an experienced doctor, but also a special program on the Internet can make a diagnosis based on them. It takes into account all the symptoms and causes and then analyzes the user's responses. As a result, the patient receives a presumptive diagnosis. This is convenient if it is not possible to see a doctor in the near future. However, the result is not 100% reliable and requires confirmation by a specialist.

In general, symptoms of frequent urination in women without pain include:

• chills and increased body temperature;
• uterine bleeding;
• discomfort in the pelvic area.

However, pain is often the main accompaniment of this problem. Women feel it in the pelvic area, as well as during urination. There can be many reasons for this problem. They are associated both with the patient’s lifestyle and with changes in her body. Doctors classify the physiological causes of frequent urination in women as a separate category. These factors include:

• the use of drugs with a pronounced diuretic effect;
• age-related changes, for example, the climatic period of women;
• unbalanced diet, including salty and smoked foods in large quantities;
• constant stress and depression;
• period of bearing a child;
• abuse of tea and coffee, as well as alcohol;
• hypothermia of the body;
• the period of menstruation when the body gets rid of large amounts of fluid.

Treating Frequent Urination

If you have an infection and want to pee because of acute cystitis, antibiotics will usually clear it up quickly and effectively.
There are also other medications that relax the bladder, which may be helpful in relieving overactive bladder symptoms and reducing episodes of urinary incontinence. In some cases, you can use injections - injections of gel into the urethra when urine leaks from a weak bladder. Nerve stimulation or surgery may also be recommended for some conditions. In any case, abnormalities in urination can be treated only after a comprehensive examination and clarification of the diagnosis. assignment_ind

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Transposition of the urethra for the treatment of cystitis after sex

Syndrome of urogenital disorders in menopausal women

UROLOGIST'S VIEW Tyuzikov Igor Adamovich, urologist, candidate of medical sciences, professor of RAE, honored worker of science and education, Tandem-Plus MC (Yaroslavl)

Until recently, it was indeed not customary to speak out loud about the problems of the genitourinary (urogenital) sphere of representatives of both sexes, which did not mean the absence of such problems in reality...

Some statistics or why we need to talk about this today?

Indeed, until recently it was not customary to speak out loud about the delicate problems of the genitourinary (urogenital) area in women, which did not at all mean the absence of such problems in reality. However, in recent years, these problems have become more actively discussed and resolved. One of the reasons for this is official statistics, according to which in the Russian Federation over the past 10 years, the level of urological morbidity among the population has increased by a total of 32%. And in the list of “traditional” female urogenital problems, the leading place is occupied by lower urinary tract infections (cystitis) and various types of urinary incontinence. The number of women with genitourinary disorders such as chronic pelvic pain syndrome, as well as with urolithiasis, which until recently was more often diagnosed in men, is increasing.

At the same time, against the background of a fairly high frequency of urogenital disorders in modern women, a paradoxical fact is observed: only 4–10% of women with such disorders seek help from specialists (primarily urologists and gynecologists). The remaining 90% of women unreasonably mistakenly believe that their problems are a “manifestation of old age” or cannot be treated at all. Women experience inexplicable fear and shame about even hinting to the doctor about such problems, considering them “indecent”, and therefore they endure, adapt with the means available to them to the existing problem, which gradually progresses and gets worse. This “expectation” leads to the fact that when a woman is already “ripe enough” to turn to specialists, both doctors and the patients themselves have to spend much more effort and money to get rid of existing genitourinary (urogenital) disorders. But it is known that it is better to treat any disease at the earliest stage, and the best treatment is prevention.

Therefore, if we want to help a woman maintain her health for many years, the problems of urogenital disorders need to be given no less attention than other problems of women's health. Moreover, in the arsenal of modern medicine there are various highly effective medicinal, instrumental and surgical methods for treating urogenital disorders, which make it possible to choose the most optimal way to get rid of the problem individually for each woman, depending on the stage and characteristics of the clinical manifestations of genitourinary disorders.

What do you need to know about the main features of the normal functioning of the urinary system?

In order to promptly recognize symptoms suspicious of genitourinary (urogenital) disorders and seek medical help as early as possible, it is extremely important for every woman to have a basic understanding of the basic parameters of the normal functioning of the urinary system in a healthy person, which are as follows: :

1. Normally, a healthy person urinates on average no more than 6 times during daylight hours (approximately every 2-3 hours) provided he gets at least 6 hours of sleep at night, during which he should not feel the need to get up to empty the bladder and interrupt your night's sleep. This is called the normal rhythm of daily spontaneous urination of a healthy person.

2. Normally, the urge to urinate and the physiological desire to empty the bladder occurs when at least 150–250 ml of urine accumulates in the bladder. This is called the average physiological urinary volume.

3. Normally, when a commanding (or, as it is called in the scientific literature, imperative) urge to urinate appears, a healthy person is able to suppress it by willpower for the time it takes him to get to the toilet and prevent premature urination (healthy cortical control micturition reflex).

4. Normally, with any increase in pressure in the bladder (coughing, sneezing, lifting heavy objects, jumping, straining, laughing, etc.), the muscles at the exit of the urethra (bladder sphincters) completely close, and urine is retained completely within the lumen of the bladder.

5. Normally, there is no pain and/or discomfort in the area of ​​the bladder and genital organs, whether related or not related to urination.

6. Normally, urination occurs freely, without straining, painlessly, the stream of urine is not interrupted from the moment urination begins until it is completed, the bladder is emptied completely in one urination.

7. Normally, urine is straw-yellow in color and transparent, it does not contain any pathological impurities visible to the eye (blood, pus, salts, stones, mucus, etc.).

The main clinical symptoms indicating the presence of genitourinary (urogenital) disorders in women.

Every woman who knows the basic parameters of the normal functioning of her urinary system can conduct self-diagnosis. It is thanks to this that it becomes possible to detect such disorders as early as possible, which means that with timely contact with a specialist, both timely diagnosis and effective early treatment. So, a woman should always consult a doctor immediately if she has the following problems:

1. Change in the rhythm of daily spontaneous urination towards its increase (more than 6 times during the daytime and/or the appearance of night urination (nocturia)).

2. Simultaneous decrease in the average physiological volume of urination to less than 150 ml, i.e. urination occurs frequently and in small portions (pollakiuria).

3. Weakening of volitional control over the imperative urge to urinate to varying degrees. It can lead to a sudden imperative urge to urinate (for example, even with the sound of water running from a faucet while washing dishes), requiring immediate emptying of the bladder, otherwise urinary incontinence may occur even before going to the toilet (imperative (or urgent) urinary incontinence).

4. The appearance of urine leakage (incontinence) with any increase in pressure in the bladder in any of the situations described above (stress urinary incontinence).

5. The presence of chronic or acute pain and/or discomfort in the bladder and/or genital area, either in connection or not with urination.

6. Discharge of a stream of urine with straining, pain, its interruption, a feeling of incomplete emptying of the bladder, which may require repeated visits to the toilet (two-stage urination, which is not typical for a healthy person).

7. Turbidity of urine and the appearance in it of pathological impurities visible to the eye (blood, pus, salts, stones, mucus, etc.). The most important condition for the successful treatment of female urogenital disorders is the need to timely seek advice from a specialist if their possible clinical symptoms described above are identified by a woman in the process of self-diagnosis. This is extremely important, since an increase in the frequency and aggravation of the severity of clinical manifestations of urogenital disorders occurs with increasing age of women. In most cases, the risk group is women aged 40+.

Why are women 40+ at risk for urogenital disorders?

In both sexes, almost all structures of the urinary system (especially its lower parts: the bladder, urethra, ligaments, sphincters and pelvic floor muscles) are hormone-dependent, therefore the endocrine system plays a key role in ensuring its anatomical and functional state. The most important hormones that regulate the structure and function of the genitourinary system are sex hormones (progesterone, testosterone, estrogens), as well as growth hormone (somatotropin) and vitamin D.

With aging, with increasing age, there is a decrease in the synthesis and secretion of these important hormones in the body, so age can be considered to a certain extent as a universal factor in the development and progression of genitourinary (urogenital) disorders, independent of gender.

Clinical manifestations of a woman’s hormonal decline (age-related deficiency of sex hormones) begin to appear in most cases after 40 years. The period of 40–50 years in women is called the menopausal transition (premenopause), which at 50–52 years ends in menopause (the last menstruation in life) for most of them. Afterwards, the postmenopausal period begins, in which the woman lives until the last days of life against the backdrop of further progression of age-related deficiency of sex hormones. Thus, age-related deficiency of sex hormones in women develops over a relatively short period of time (8–12 years), which adversely affects most of the functions of her body, including the genitourinary system. Therefore, women over 40 constitute the main risk group for the development of age-related urogenital disorders that arise for a number of reasons, but, above all, due to the age-related loss of sex hormones. They need to be identified and corrected very early - the sooner the better, because with the further transition of a woman from premenopause (40+) to postmenopause (50+), these problems will inevitably worsen along with the progression of age-related hormonal deficiencies, and they will be more difficult to treat .

In this regard, putting off a visit to a specialist for help for a woman 40+ with any symptoms of genitourinary illness in the hope that “everything will go away and resolve itself” is in no case possible!

What clinical variants of genitourinary (urogenital) disorders are most common in women?

Chronic recurrent cystitis.

This is one of the most common female infectious and inflammatory diseases of the bladder, which affects about 15–20% of women of various ages. It is characterized by a long, persistent course and leads to loss of ability to work, social adaptation and a decrease in the quality of life of a woman due to exacerbations. Exacerbations are manifested by frequent and painful urination during the day and at night against the background of inflammatory changes in urine tests. The frequency of exacerbations can vary from 1 to 5–10 episodes during the year. With cystitis, the infection causes inflammation of the mucous membrane of the bladder, the protective properties of which depend on the level of sex hormones. Therefore, in women 40+, a significant negative contribution to the mechanisms of bladder infection and relapses of chronic cystitis is made by the age-related deficiency of sex hormones that begins at this age and then steadily progresses (the so-called menopausal chronic cystitis).

Stress urinary incontinence.

One of the most common urogenital disorders in women, the frequency and severity of which steadily progresses with age (from 30% in women aged 30–60 years to 50% in women after 60 years). At the same time, in Russia, the number of women seeking treatment for stress urinary incontinence does not exceed 4–6%! The anatomical features of the female urethra (short length) in combination with weaker muscles and sphincters of the bladder and pelvic floor determine the predominance of this pathology in women. The disease is based on weakness of the sphincter apparatus of the bladder and/or increased mobility of the urethra (urethra), caused by various reasons. Manifestations: visible and sometimes significant loss of urine during any physical (stressful) activity (coughing, sneezing, jumping, constipation, and in severe cases - simply when changing body position, for example, when getting out of bed).

The problem of stress urinary incontinence in women is relevant all over the world, and today it is successfully solved on the basis of a complex of treatment measures, including both drug therapy and various low-traumatic, but very effective surgical interventions, which have been performed for a long time and successfully in our country. In this regard, the patience of women who try in every possible way to get rid of incontinence and urine smell, using pads or diapers, and do not turn to specialists in a timely manner, is incomprehensible.

Imperative (urgent, or imperative) urinary incontinence and overactive bladder (OAB).

OAB occurs in both sexes with approximately the same frequency and is manifested by a characteristic triad of symptoms:

— increased frequency of urination > 8 times/day,

- night urination (nocturia) > 1 time/night

- imperative (urgent) urge to urinate, which requires immediate emptying of the bladder.

If the imperative urge is not realized immediately, the patient may begin to urinate before reaching the toilet (this is urge (imperative) urinary incontinence, or the “wet” version of OAB). In other cases, the patient manages to run to the toilet without losing urine (“dry” version of OAB). Studies show that the quality of life of such patients is significantly worse than that of patients with asthma, coronary heart disease) or diabetes. At the same time, today there is a good arsenal of modern medicines that can be used to significantly reduce the manifestations of these urogenital disorders and improve the quality of life, but for this, again, you need to consult a specialist, and not endure or self-medicate.

Chronic pelvic pain syndrome (CPPS) in women.

Chronic pain is currently becoming a new global pandemic of the 21st century. According to a large-scale PaininEurope study (46,000 people from 16 countries), one in five European adults suffers from chronic pain. The average duration of chronic pain is 7 years, and every fifth patient experiences chronic pain for 20 years or more. According to the Russian Association for the Study of Pain, the prevalence of chronic pain syndromes in Russia varies from 13.8% to 56.7%, averaging 34.3 cases per 100 people. More than 40% of people suffering from chronic pain indicate that pain seriously reduces their quality of life, contributing to the formation of depression. It is no coincidence that today painkillers and antidepressants “flow like a river” in medical prescriptions and are the most advertised and sold medications.

Isolated chronic pain in the pelvic organs (chronic pelvic pain syndrome, CPPS) today is a pressing problem in both urology and gynecology. It is especially difficult to understand the mechanisms of pelvic pain and select appropriate treatment in cases where their obvious cause “does not lie on the surface”, and the examination must take a long time. Today, any chronic pain, including CPPS, according to international recommendations of scientific communities on chronic pain, almost always requires the participation of several specialists in an in-depth treatment and diagnostic process (urologist, gynecologist, endocrinologist, neurologist, vascular surgeon, clinical pharmacologist, etc.) .

Female sexual dysfunction (FSD).

An equally important “other side” of the coin of urogenital disorders in women is female sexual dysfunction (FSD), which, perhaps, is talked about even less and quietly than about themselves. However, modern epidemiological studies show a high prevalence of FSD in the female population as a whole, reaching 46%! At the same time, 34% of women report a decrease in sexual desire (libido), 23% report impaired arousal, 11% report impaired orgasm, and 44% of women experience constant or periodic pain during sexual intercourse. Against this background, the same high frequency of urogenital disorders is revealed. Thus, 47% of women who reported a decrease in libido have stress urinary incontinence. Approximately 60% of women with arousal disorders and 61% of women with chronic pelvic or genital pain suffer from chronic recurrent cystitis. 45% of women with orgasmic disorders report symptoms of urge incontinence. According to scientific data, women suffering from urogenital disorders have a 1.5–2.5 times higher risk of developing FSD compared to healthy women. Therefore, it is quite obvious that early diagnosis and proper comprehensive treatment of female urogenital disorders contribute to the preservation of the sexual health of not only the woman, but also the married (partner) couple as a whole.

Thus, urogenital disorders in women after 40 occur in various clinical variants, which require mandatory referral to specialists for examination and adequate treatment, since it is not possible to independently understand the problems.

Genitourinary (urogenital) disorders in women: who is to blame and what to do?

We have previously mentioned that almost all structures of the urinary system (especially its lower parts: the bladder, urethra, ligaments, sphincters and pelvic floor muscles) in men and women are hormone-dependent, therefore the endocrine system plays a key role in ensuring it anatomical and functional state in both sexes. The key hormones that regulate the structure and function of the genitourinary system are sex hormones (progesterone, testosterone, estrogens), as well as growth hormone (somatotropin) and vitamin D. Sex hormones (progesterone, testosterone, estrogens) play the most important role in the female genitourinary system, therefore, age-related deficiency of sex hormones seems to be the most important mechanism for their formation and further progression with age. The close interweaving of 40+ hormonal and non-hormonal factors in the mechanisms of urogenital disorders in women today dictates the need for comprehensive diagnosis and treatment by several specialists simultaneously (urologist, gynecologist, endocrinologist). Therefore, when contacting one of them, you should not be surprised that, for example, a urologist or gynecologist asked you to take a blood test to check your hormonal status or referred you for a consultation with an endocrinologist. This means that you have found a knowledgeable specialist who deeply understands the problem of female urogenital disorders.

It is important to understand that delicate female urogenital problems, once they arise, most likely will not be eliminated on their own, but will only progress, so you should consult with specialists as early as possible and undergo an appropriate comprehensive examination, the results of which will allow doctors to prescribe treatment that is suitable specifically for you, because, as the great Russian doctors said, “it is necessary to treat the patient, but not the disease”! It is also extremely important to understand that treating any disease at an early stage is always easier than its advanced forms. Today, the vast majority of urogenital disorders in women over 40 can be treated very effectively! And only in close and trusting doctor-patient contact can we defeat them together!

Health to you all!

Cited https://womendoctor.online/

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Frequent urination in pregnant women

During gestation, amniotic fluid is constantly renewed, and this is reflected in a woman’s urination.

Pregnancy causes the uterus to grow. Increasing in size, this organ puts pressure on the bladder, stimulating urination. Therefore, pregnant women most often feel the desire to urinate in the last stages, when the fetus, and with it the uterus, has reached its largest size.

If frequent urination during pregnancy is accompanied by pain or discharge with blood and pus, this is an alarming signal that requires urgent attention to a specialist.

Nature of treatment

How to overcome this disease is decided by the doctor in accordance with the examination results.

The nature of the treatment of the pathology is determined by its main cause. For a disease such as diabetes, the goal of treatment will be to control the acceptable level of blood sugar. Antibacterial therapy is used to treat inflammation of the urinary organs.

Bladder disorders are treated with special physiotherapeutic procedures (therapeutic gymnastics).

Cystitis and urethritis are treated on an outpatient basis - the patient undergoes rehabilitation at home, under the supervision of a specialist.

Pathologies in the form of acute pyelonephritis or newly diagnosed diabetes mellitus often require hospital treatment.

Frequent urination is successfully treated in the women's and men's health clinic. Our doctors have earned the trust of patients and gained experience in solving this problem.

Problems with the urinary system

Among the problems that result in frequent urge to go to the toilet are several groups of diseases:

• the presence of inflammatory processes - cystitis (characterized by frequent urination with pain in the lower abdomen, the patient feels a cutting pain, a burning sensation), urethritis (accompanied by itching, pain and burning in the urethra);
• kidney pathologies in the form of urolithiasis (with painful frequent urination with blood), pyelonephritis (with lower back pain and urine containing bloody-purulent inclusions);
• urethral stricture;
• bladder disorders in the form of atony (decreased tone, frequent urge and small movements), hyperactivity (increased activity of nerve endings in the walls of the organ) or cystocele (prolapse);
• cancerous tumors in the pelvic organs;
• infectious processes of the urinary ducts - they can arise due to non-compliance with the rules of personal and intimate hygiene.

When should urination be considered frequent?

The norm is the excretion of 1.5-2 liters of urine per day, while the frequency of visiting the toilet ranges from 3 to 7 times a day. In children, the urge to empty the bladder appears more often. Normal indicators per day are:

newborns: 12-16 times;

children aged 1-3 years: 10 times;

girls and boys aged 3-9 years: 6-8 times.

There are a number of factors that can affect how often you urinate. The urge will increase if a person drinks a lot of liquid or consumes diuretic products (for example, watermelon, melon, cucumber).

The concept of frequent urination varies between women and men. Some people visit the toilet 7 times a day, while for others 3 times is enough. If a person has not made adjustments to his diet, consumed fluids evenly, and the urge has increased, then we can assume that urination is frequent, especially if it brings discomfort, pain, or burning. Typically, it is considered a violation if a person visits the restroom more than 10 times a day. Often in this case the amount of urine excreted is insignificant. Normally, 200-300 ml of urine should be released at a time.

In medicine, frequent trips to the toilet are called:

1. Pollakiuria. This is a daytime urinary disorder.
2. Nocturia. This is the name given to impaired urinary excretion at night. A healthy person should visit the toilet no more than once at night.

Before contacting a specialist, answer the following questions

1. Do you experience frequent urination (>8 times during the day, >1 time at night)? 2. Do you have urgent (sudden) urges that are difficult to control? 3. Do you experience involuntary urinary discharge? 4. Do you use urological pads? 5. Do you have neurological or other diseases that can affect bladder function (consequences of stroke, neuropathy due to diabetes mellitus, osteochondrosis, herniated discs)? 6. Have you had brain/spinal cord or pelvic surgery? 7. Do you have inflammatory diseases of the genitourinary area that are difficult to treat with antibiotics? 8. Are there any discomfort or pain in the bladder, genitals, or perineum?

If you answered yes to 2 or more questions, you should contact a specialist.

Tests for diagnosing cystitis

If a urogynecologist diagnoses “postcoital cystitis” (or cystitis after sex), to confirm it, not only anamnesis and examination of the patient is required, but also additional examination.

First of all, analyzes are carried out:

• general blood test (the basis for diagnosing most diseases),
• general urinalysis (study of the chemical and physical properties of urine, which may indicate pathological processes in the body),
• urine culture - bacteriological examination (detects infection in the urinary tract and its sensitivity to antibiotics),
• vaginal smear (allows you to identify pathogenic bacteria and identify the inflammatory process).

Treatment

How to treat frequent urination? Before starting treatment, you will need to find out the cause of this symptom. If it was provoked by physiological factors, then there is no need to worry. The trouble will go away on its own. Pregnant women need to be careful. It is recommended to visit a doctor if a burning sensation is present.

If you suspect the development of pathology, you need to visit a doctor. Initially, you should go to a general practitioner, who will most likely refer you to a urologist. To understand how to treat frequent urination in men and women, you will need to make an accurate diagnosis. To do this, the patient undergoes a series of studies.

To get rid of an unpleasant symptom, the underlying pathology is treated. Doctors also often prescribe antispasmodics, antibacterial drugs, especially if there is an infection, and drugs to eliminate inflammation. You should not self-medicate; medications should be prescribed by a doctor.

Non-pathological disorders

An increase in the frequency of urine excretion may also have a non-pathological nature.

The most common non-pathological causes of frequent trips to the toilet:

• excessive fluid intake, in particular drinks with a high caffeine content, leading to bladder irritation (coffee, tea);
• overweight (obesity) – extra pounds put additional pressure on the bladder, causing a problem;
• weak muscular corset of the pelvic floor - in the presence of weakened muscles, the need for emptying occurs more often;
• pregnancy – the fetus, as it grows, puts pressure on the bladder;
• psychological stress, emotional experiences, feelings of anxiety, fear;
• the use of diuretic therapy - medications lead to an increase in the frequency of urination and an increase in the single volume of urine.

It is important to promptly determine why frequent urination occurs and what disease it is a symptom of. To do this, you must undergo the necessary diagnostics.

Causes of cystitis after sex

The main cause of inflammation of the bladder after sexual intercourse is a bacterial infection - the entry of pathogenic microorganisms into the female bladder.

Inflammation of the urinary tract after sexual intercourse can occur for several reasons, mainly anomalies of physiological development. In some women, the external opening of the urethra is located close to the opening of the vagina and bacteria easily enter the bladder.

Another cause of cystitis may be poor personal hygiene, both by women and men. Dirt and bacteria from the hands or genitals can enter the urinary system and cause inflammation.

In addition, the cause of the disease may be a combination of anal and vaginal sex in one sexual act. Among the bacteria that cause cystitis is E. coli, which, when it enters the urinary system, causes extremely unpleasant consequences. Up to 90% of cystitis is caused by the bacterium Escherichia coli, and movement during sex helps move this bacterium into the urethra and bladder.

Cystitis after sex can also develop due to sexually transmitted diseases, microflora disturbances in the vagina, and as a result, with inflammatory phenomena in the pelvic organs.

Any damage to the mucous membrane of the urethra during sexual activity gives rise to excessive proliferation of pathogenic microflora and the development of inflammatory processes. This is especially true if a woman has not had sex for a long time, sexual intercourse was prolonged and/or the woman’s vagina is poorly moisturized (dry, due to the lack of a sufficient amount of “natural” mucus).

Some women also find that certain sexual positions cause irritation and cystitis. Sex from behind, for example, is especially harmful for women who are prone to cystitis.

Diagnostics: what tests need to be done?

If you have a problem with frequent urination, tests and other types of examination should be performed in combination.

Diagnosis of the disorder may include the following procedures:

• conducting a clinical blood test (for the presence of inflammation in organs and systems);
• blood biochemistry (information about the amount of uric acid and kidney condition);
• clinical analysis of urine (detection of salts, protein, foreign bloody and mucous formations and other anomalies);
• Ultrasound of the genitourinary organs (kidneys, bladder);
• smear from the urethra (bacterial culture);
• X-ray diagnostics (thanks to computed tomography, the parameters of kidney stones are clarified);
• neurological and urodynamic testing.

When referring for diagnostics, a specialist doctor takes into account the data from the initial physical examination of the patient and individual signs of frequent urination.