Urinary incontinence, the great unknown

Urinary incontinence is a common condition characterized by the involuntary loss of urine. It can vary in severity , ranging from mild to moderate to severe.

Types of urinary incontinence

It is produced by multiple mechanisms and is mainly differentiated into 3 types:

de effort (the most frequent),
de urgencia
y mixed. The latter with a variable component of the first 2 types.

Incontinence and its incidence

It is a problem with a high incidence in the population, as the WHO estimates that some 200 million women may suffer from some degree of incontinence.

In developed countries, it affects around 25% of the young and middle-aged population, and up to 50% of older women (over 65). Studies show it is severe in 5-15% of cases.

It is therefore not a problem that only affects older women, nor an inevitable consequence of childbirth or aging as is commonly thought.

Furthermore, in the vast majority of cases, regardless of age, type of incontinence or cause, it can be prevented and treated successfully.

Why it is important to seek medical advice

Given these statistics, it's surprising how little people seek professional advice when this unpleasant condition arises. While it's true that it's not an illness and doesn't usually have serious health consequences, it can significantly diminish women's self-esteem, independence, and quality of life .

It is probably cultural reasons that reserve this situation for intimacy, seeing incontinence as inevitable in women's lives.

This situation is fueled by the media and advertising, which promote absorbent methods as the only viable alternative. This is an unrealistic solution that carries a high economic and environmental cost (due to the increased demand for cellulose).

What causes urinary incontinence?

Urinary incontinence is caused by multiple factors , which usually increase in incidence with age and add to one another.

Main causes are:

the pelvic floor injuries produced during childbirth,
el prolapse of pelvic organs,
algunas surgeries gynecological (such as hysterectomy),
infections urine,
neurological problems
and the taking of some medicines.
Also obesity,
la menopause,
el smoking,
la chronic cough,
el constipation,
the abuse of caffeine
or intense physical exercise.

The solution will therefore depend on the type of urinary incontinence, its severity, and the correction of certain lifestyle habits.

Treatment depending on the type of urinary incontinence

We differentiate between two types of incontinence:

First, the of effort. The involuntary loss of urine associated with physical exertion that increases abdominal pressure, such as running, coughing, laughing, or lifting heavy objects.
Second, incontinence urgently. That which produces involuntary loss of urine preceded by a sudden and intense desire that produces fear of escaping, generally urgent.
La mixed incontinence It will be one that associates urinary urgency and efforts to a different extent.

A correct diagnosis and identification of the cause of incontinence are essential for successful treatment. Therefore, it is crucial to consult a specialist, who typically has enough information to determine the appropriate treatment based on a medical history and a gynecological examination.

Sometimes, especially in cases of mixed or urge incontinence , a special technique, such as urodynamic testing , is required to more accurately determine the origin of the problem.

Treatment of stress incontinence

Stress incontinence occurs due to increased intra-abdominal pressure, which leads to increased intravesical pressure. The urethral sphincter (damaged by childbirth, surgery, coughing, constipation, etc.) is unable to withstand this pressure, resulting in incontinence.

The treatment for stress incontinence will vary depending on the degree of incontinence the patient presents:

Mild degrees

In milder cases, we will recommend conservative treatments first:

Like the singles kegel exercises, which, when performed regularly, strengthen the pelvic muscles,
physiotherapy treatments with techniques such as electrostimulation,
and correction of certain lifestyle habits such as smoking, weight loss, constipation, or decreasing caffeine consumption.
Likewise, treatment with the fractional CO2 laser It is giving excellent results.

It may be enough to correct, or prevent, the progression of the problem, strengthening, or not worsening, the urethral sphincter and the muscles that support it.

Moderate or severe degrees

In moderate or severe cases , or in those where conservative techniques have not been satisfactory, surgery will be the indicated solution to this problem.

In recent times, with the incorporation of laser into the field of Gynecology and its combination with Physiotherapy , the treatment of moderate incontinence can also be conservative.

However, fortunately, in the last 20 years, surgical techniques for incontinence have improved significantly. Currently, with the vaginal placement of so-called 'incontinence slings ,' which repair damage to the pelvic floor muscles and urethral sphincter, we can correct a problem that may have plagued us for years in a simple 10-minute procedure.

The success rates of these innovative techniques are around 90%. Using biological materials, they reduce risks and hospitalization time to less than a day, allowing for an immediate solution and a quick return to daily activities.

Treatment of urge urinary incontinence

Urge incontinence , less common than stress incontinence, is caused by an abnormal or involuntary contraction of the bladder muscles, specifically the detrusor muscle.

This 'hyperactivity' of the detrusor muscle is what is commonly known as 'overactive bladder'. It not only causes urge incontinence, but also increased urinary frequency.

The main cause of urge urinary incontinence is neurological, but other secondary causes also occur, such as:

pelvic organ prolapse,
repeated urinary tract infections,
medications (such as diuretics or caffeine…),
kidney stones,
bladder radiation,
bladder tumors,
even inflammatory bowel disease…

Some are difficult to diagnose.

The treatment will therefore depend on the origin of the problem and it will be the specialist's job to detect it during the consultation.

In the Women's Unit of the Ruber Hospitals Group, we offer multiple diagnostic techniques. These include the aforementioned urodynamic studies to assess bladder muscle function, renal ultrasounds, urine cultures, and more.

The treatment for overactive bladder and the urgency it causes, once secondary causes have been ruled out, is pharmacological. Anticholinergics , which have also undergone significant development in recent years, are used. Examples include fesoterodine and solifenacin, which can reduce incontinence episodes within a matter of weeks (4-8) with few side effects (e.g., dry mouth).

Stimulation of sacral nerve roots or the use of botulinum toxin are becoming increasingly accepted and effective in cases where pharmacological treatment has not been effective.

Urinary incontinence, the great unknown