Dr. José Ignacio González Martín, specialist in Gynecology explains what urinary incontinence is, its different types, its causes and possible treatments.
What is urinary incontinence?
Urinary insufficiency or incontinence is the involuntary loss of urine that causes a social or hygienic problem and has an impact on quality of life.
The prevalence is 30%, and up to 50% in the elderly, with the most severe forms being around 15%. Most patients use absorbent pads, a fact promoted by the media, with a high economic and ecological cost, due to cellulose.
Are they all the same? What types of urinary incontinence are there?
There are different types of urinary incontinence:
- Stress urinary incontinence: loss linked to physical exertion.
- Urge urinary incontinence: when accompanied by “urinary urgency.
- Mixed urinary incontinence
- Other reasons.
What are the causes of urinary incontinence?
Among the various causes related to incontinence are: increased urethral mobility, overactivity of the detrusor muscle, whose function is to eliminate urine when it contracts; neurological problems or damage, alteration of the external sphincter and pelvic floor muscles, failure of the internal sphincter due to inappropriate relaxation or organic injury.
What are the risk factors?
The situations that may involve this type of pathology are vaginal childbirth, menopause and having undergone a hysterectomy, surgery for total or partial removal of the uterus.
There are other agents such as advanced age, obesity, constipation, reduced mobility, diabetes, Alzheimer’s disease or the intake of diuretic drugs.
How is it diagnosed?
The first step to be taken by the gynecological specialist is to certify the loss of urine, objectify it and quantify it.
This requires a thorough physical examination, an examination of perianal sensitivity and analytical, radiological and urodynamic studies, in addition to the assessment of personal history and concomitant diseases, i.e. that manifest themselves at the same time, neurological diseases, previous interventions that have affected the urinary tract, abdomen, pelvis and spine.
How is it prevented?
To prevent it, it is necessary to follow a Mediterranean diet, combat overweight and obesity, reduce the consumption of beverages such as coffee, soft drinks, alcohol and citrus fruits, avoid spicy foods, increase the consumption of fiber, reduce the consumption of diuretics and practice pelvic floor exercises.
What treatments are available?
The specialist will evaluate the woman’s personal situation, her current and future circumstances, the special vulnerability of women of a certain age, the impact on her quality of life, life expectancy and the risk of possible surgery. From that moment on, it will determine which methods or possible treatments to apply:
- Hygienic-dietary rules which are treatments for overweight, smoking abstinence or caffeine avoidance.
- Bladder re-education or pharmacological treatments due to urinary urgency.
- Pelvic floor muscle rehabilitation: first step in the treatment of stress urinary incontinence.
- Surgical treatment: suburethral bands are the first-line surgical treatment for stress urinary incontinence after failure of perineal reeducation, with 90% efficacy. In case of failure of the suburethral band or sling, other techniques, periurethral injections, less invasive but much less effective, periurethral balloons and artificial sphincter will be considered.