Diagnosis and Treatment of Urinary Incontinence

Urinary incontinence is the involuntary loss of urine that occurs at an inappropriate time and in an inappropriate situation. It can be of three types: stress incontinence, when it is consequent to an effort such as sneezing or coughing; urge incontinence, when it has no relation with intra-abdominal pressure changes, as in the previous case; or mixed incontinence, when the two previous causes are united.

It is a social problem, because it interferes with the woman’s habits, an economic problem, because it involves an expense with protection systems (pads, diapers) and it is also a health problem because of the added discomfort, irritation and infections it causes.

It should not be accepted because it is considered a problem linked to age, a history of childbirth or surgery; it should always be treated as a disease that can be solved. In the gynecologist’s office, the patient who suffers from it does not always ask for treatment, either because of embarrassment, because he/she considers that there is no solution or because the doctor does not ask.

Diagnosis of Urinary Incontinence

The gynecologist in a routine checkup has the obligation to ask about possible involuntary leakage of urine and gas or feces, to gauge the importance and offer solutions.

Once the problem is detected, the interrogation should be extended in the consultation to obtain the maximum information and thus be able to agree with the patient if the analysis should be extended and, in any case, if solutions can be offered.

If the seriousness of the situation warrants it, the type of incontinence that the patient seems to have should be explained to her, and the examination should be directed in search of evidence of the problem and its intensity, in order to determine the possible causes of the problem, such as anatomical faults like descent of the bladder (cystocele), descent of the uterus (hysterocele), prolapse of the posterior wall (rectocele), weakness of the pelvic support muscles, etc.

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The diagnosis can be complemented with a urodynamic analysis, which is performed on an outpatient basis and is absolutely painless. In little more than half an hour it gives us an exact idea of the functionalism of the urinary containment systems, indicates the most effective type of solution that can be offered and the prognosis of the problem and possible solutions.

In a survey carried out in our Center in 1997, we observed that out of 500 women chosen at random, 37% had some type of incontinence and 13% suffered from permanent discomfort, although only 2% of them consulted for the problem.

We also found that 35% of the respondents were over 50 years of age, but 12% were women between 20 and 30 years of age. With this we want to make it clear that it is a very common problem and that not always enough attention is paid to it.

Treatment for Urinary Incontinence

Once the type of incontinence is known, the best therapeutic option can be offered. Many cases can be improved or even cured with specialized physiotherapy sessions (pelvic floor rehabilitation techniques). In other cases, they may respond to pharmacological solutions that improve tonicity or help relax the bladder.

Occasionally, surgery must be resorted to which, in most cases, can be performed vaginally, under superficial sedation and practically on an outpatient or short-stay basis. If the diagnosis and treatment prescription are correct, the results are spectacular.

The most stubborn cases are those that affect very old women, since they are associated with limited mobility, medications that slow reflexes or deterioration of the nervous system.