Urinary Incontinence (UI) is defined as the involuntary loss of urine through the urethra, objectively demonstrable and which constitutes a hygiene and social problem.
It is not a disease, but rather a symptom that can be caused by a wide variety of diseases. Incontinence can be caused by diabetes, stroke, multiple sclerosis, Parkinson’s disease, surgery or even during the maternity leave. Although it is more common in women over the age of 60 years, it can occur at any age.
Most health-care professionals classify incontinence by symptoms or circumstances in which it occurs. In the normal population, the incidence of incontinence in women over the age of 65 years is over 25%compared to 15% for men.
The problem may also join the existence of prolapse or celes because of inadequate muscle support. This includes bladder prolapse (cystocele), uterine prolapse, rectal prolapse (rectocele) which can aggravate or mask the UI. It may cause abdominal discomfort, urinary tract infections, make sex difficult, i.e. alter the quality of life.
We offer the following therapeutic options in this area:
- Physical examination and diagnostic methods (Urodynamic Studies, Cystography, daily voiding, etc).
- Pelvic Floor Rehabilitation:
- Pelvic Floor physiotherapy (pre and postpartum).
- Bladder retraining and modification of voiding habits.
- Pharmacological treatment (New Drugs).
- Surgical treatment:
- Suburetral tapes free from tension, or retropubic or transobturators, fixed and indexed
- Vaginal surgery of pelvic prolapse with biocompatible meshes
- Robotic surgery via full prolapse (laparoscopic colposacropexy)
- Urethral injectable substances
What are the different types of urinary incontinence?
Urinary incontinence is the most common cause of urine loss. It occurs when urine is lost during activities such as walking, aerobics or even sneezing and coughing. The increased abdominal pressure associated with these events causes urine to escape. The pelvic floor muscles which support the bladder and urethra can be weakened and prevent the sphincter muscles to work properly.
This can also occur if the sphincter muscles themselves are weakened or damaged as a result of surgical trauma or previous deliveries. Postmenopausal women can also suffer from loss of urine as a result of lower oestrogen levels. Among men, the most common cause of incontinence are surgical procedures in the prostate.
Also known as “overactive bladder”, urge incontinence is another form of urine loss. It can occur when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and as a result, suffers urine loss.
Overactive bladder is also associated with strokes, multiple sclerosis and spinal cord injury.
This type of incontinence occurs when the bladder is full and cannot be drained, resulting in the loss of urine. The symptoms are small, frequent urination and constant dripping. This type of incontinence is not common among women, and is more common in men who have undergone surgery or have prostate problems.
Mixed incontinence refers to the combination of more than one type of incontinence, commonly stress incontinence and urge incontinence.
How do you make the diagnosis?
As with any other clinical problem, it is very important to elaborate a good medical history and physical examination. The urologist will ask you questions about individual habits and fluid intake, as well as the clinical, surgical, and family background. There will be a thorough pelvic examination to look for correctable reasons for the loss of urine. Normally, in the first evaluation, an analysis of urine and a cough-inducing stress test will be performed. If any of the results suggests that a more detailed assessment may be necessary, further studies may be recommended such as cystoscopy or even an urodynamic study. These studies are performed on an ambulatory basis are usually made by inserting a small probe into the bladder through the urethra and sometimes with a small rectal probe.
What are some of the treatment options for each type of incontinence?
Most cases of incontinence require a minimally invasive treatment (handling of liquids, bladder training, exercises of the pelvic floor muscles and medications). However, if this fails, it may be necessary to Perform a surgical treatment.
Minimally invasive treatment of urinary incontinence
Some of the causes of incontinence are temporary and can be easily reversed.
Reversible causes include urinary tract infection, vaginal infection or irritation, the use of certain medications, constipation and restricted mobility.
In some cases, however, further medical intervention is needed. Minimally invasive treatment options are those that do not resort to surgery and should be the first line of treatment for patients. However, they can also be used in combination with the surgical treatment.
- Control of liquids: this option is to help the patient increase or reduce the intake of fluids. Patients with incontinence may need to reduce the amount of caffeine or other irritants in their diet.
- Bladder training: Bladder training begins with daily voiding. Patients are instructed to record fluid intake, the hours of urination and urinary accidents if they occur. The objective of the training is to increase the amount of urine the patient may retain in the bladder.
- Pelvic floor exercises: also known as Kegel exercises. This type of minimally invasive treatment focuses on strengthening the external sphincter muscle and the pelvic muscles. Patients who can contract and relax the pelvic floor muscles can improve the strength of the same by performing exercises on regular basis. Other patients need help from a professional to learn how to contract those muscles. It is possible to use biofeedback and electrical stimulation to help these patients perform pelvic floor exercises.
- Treatment with antimuscarinic drugs.
Surgical treatment of Urinary Incontinence
When the symptoms are more severe and conservative measures do not help, the treatment involves surgery.
In abdominal surgery (Burch suspension), the vaginal tissues are attached to the pubic bone. The long-term results are good, but the surgery requires a long recovery time. The most common surgery and the most popular for stress incontinence is the sling procedure. In this operation, a tape of tissue is applied under the urethra to provide compression and improve the closing of the urethra. The operation is minimally invasive and patients recover very quickly.
The goal of any treatment for incontinence is to improve the patient’s quality of life. In most cases, it is possible to achieve great improvements and even cure the symptoms. Medical treatment is usually effective. Similarly, large increases in weight and activities that promote abdominal effort put any repair under stress and any repair will probably not resist the passage of time.
The medical treatment of overactive bladder (urgency and urge incontinence) can be very successful, but some factors can adversely affect the effectiveness of treatment, for example a previous surgery, the lack of hormones, neurological diseases and age. There are mild complications from treatment with medications, which include constipation and dry mouth, which some patients cannot tolerate.
Surgery for urinary incontinence (stress incontinence) in women is generally very successful, but it is important to choose the proper procedure. Many patients with stress incontinence also have other diseases such as bladder prolapse, rectocele or uterine prolapse that must be treated at the same time.
The procedure of choice will depend on several factors, such as the need for abdominal surgery for other diseases, the degree of incontinence, the degree of mobility of the
Urethra and bladder and the surgeon’s personal experience. In simple cases of stress incontinence with mild to moderate urethral mobility, the procedure of choice is the sling procedure.