What is the reason for holding urine? Beware of urinary incontinence

If you have trouble holding your urine, you should be alert to the possibility of urinary incontinence. There are many causes of urinary incontinence, and there are many types of urinary incontinence, including resistance incontinence, overflow incontinence, etc. If you have symptoms of urinary incontinence, you must get checked and treated.

1. The proximal urethral sphincter includes the bladder neck and the prostatic urethra above the spermatophore.

2. The distal urethral sphincter can be divided into two parts: ① The posterior urethra below the spermatophore. ②External urethral sphincter.

Whether male or female, the bladder neck (urethral smooth muscle controlled by the sympathetic nerves) is the main force to stop urine outflow. In men, if the proximal urethral sphincter function is completely lost (such as after prostate hyperplasia surgery) but the distal urethral sphincter is intact, urination can still be controlled as usual. If the function of the distal urethral sphincter is also damaged, varying degrees of urinary incontinence may occur depending on the severity of the damage. In women, stress urinary incontinence occurs when the bladder neck loses function completely. When the external urethral sphincter controlled by the somatic nerve (pudendal nerve) loses its function completely, it will not cause urinary incontinence in men if the urethral smooth muscle function is normal, but it may cause stress urinary incontinence in women.

3. Detrusor areflexia

The detrusor contraction force and urethral closure pressure (i.e. urethral resistance) of this type of patients are reduced to varying degrees. The detrusor muscle cannot completely and actively expel urine, and urination must rely on increasing abdominal pressure. When the residual urine volume is large and the urethral resistance is low, stress urinary incontinence may occur; overflow urinary incontinence may occur when urine is retained.

4. Detrusor hyperreflexia

Detrusor hyperreflexia can sometimes cause three different types of urinary incontinence: ① Complete upper motor neuron lesions can cause reflex urinary incontinence; ② Some patients with incomplete upper motor neuron lesions may experience urge urinary incontinence, and these patients are often accompanied by severe symptoms of frequent urination and urgency. ③For some patients, coughing may stimulate the uninhibited contraction of the detrusor muscle and cause urine outflow, and the symptoms are similar to stress urinary incontinence. The patient did not have urinary frequency, urgency, or urge incontinence, and surgical treatment for stress urinary incontinence was ineffective. Criminal punishment examination methods cannot be used to distinguish it from true stress urinary incontinence, but simultaneous examination of bladder pressure and urinary flow rate can obtain an accurate diagnosis. Bates et al. called it cough-urge incontinence.

incontinence).

5. Detrusor sphincter dyssynergia

There are two different types of urinary incontinence that sometimes occur. One type is that during the contraction of the detrusor muscle, there is a persistent spasm of the external sphincter, which leads to urine retention and subsequent overflow incontinence. The other is urinary incontinence caused by a sudden uninhibited relaxation of the external urethral sphincter (with or without detrusor contraction) caused by upper motor neuron lesions. Patients with this type of incontinence often do not have residual urine.