Urinary incontinence

What is it?

Urinary incontinence consists of the involuntary loss of urine, objectively noticeable and constituting a hygienic and social problem. Potential risk factors are as follows: age, pregnancy, vaginal delivery, menopause, hysterectomy, obesity.
It is classified into 3 different types:
Stress incontinence: loss of urine under stress (coughing, laughing, walking). Accounts for 50% of female incontinence, a percentage that decreases with increasing age. It is due to an anatomic defect in the pelvic floor leading to reduced support and impaired function of the continence structures.
Urge incontinence: loss of urine associated with a strong urge to urinate that cannot be controlled. Predominantly occurring in old age, it is caused by bladder hyperactivity or disorganized contraction of the bladder muscle.
Mixed incontinence: combination of stress incontinence and urge incontinence. It is due to the concomitance of anatomical defect, hypersensitivity and hyperactivity of the muscular wall of the bladder.

Which are the symptoms?

The incontinence symptom is a sign of a failure of the pelvic floor that does not limit its effect to the bladder and urethra but affects the entire perineum and its support, creating disorders related to the descent of the rectum and, in women, the uterus. As mentioned above, the main symptom of urinary incontinence is the involuntary loss of urine with repercussions on the quality of life of the patient. Depending on the severity of the condition, this may be accompanied by the onset of infections or irritation of the genital and urinary tracts.

How is it diagnosed?

Gathering the patient's medical history is important to differentiate the type of incontinence and its severity. The severity of this condition can be measured through the compilation of a urinary diary in which the patient marks daily episodes of incontinence and the sensations associated with them. For this purpose it is also useful to carry out the diaper test that allows you to assess the amount of urine lost in a period of time. Objective examination accompanied by stress testing allows the clinician to objectify urine leaks during a cough or exertion and is also useful in assessing their severity. During the examination it is also possible to assess, through the insertion of a swab in the urethra, the hypermobility of the latter, which is often one of the causes of stress incontinence. There are also instrumental tests that can be performed to study and characterize the type of incontinence such as neuro-urological examination and urodynamic examination. The urodynamic examination is a three-stage examination allowing to study the activity of the bladder muscle during its filling and emptying and characterize the type and severity of incontinence in order to treat it in the most appropriate way. 

Suggested exams

How is it treated?

Conservative treatment: applies in both sexes. It consists of rehabilitation of the pelvic floor that includes sessions of electrostimulation and gymnastics. With the help of the therapist, you learn exercises that can be repeated at home. The percentage of benefit varies from 30 to 70%. If after 3-6 months of therapy there is no improvement it is necessary to follow other methods.
Pharmacological therapy: it is mainly used for the treatment of urinary urgency and incontinence associated with it. The drug of choice is the anticholinergic one, now available in slow absorption form which is more tolerable for the lower number of side effects (dry mouth), present in 25% of patients receiving treatment against 46% of those using anticholinergic rapid absorption drug. The role of drugs in stress incontinence is secondary and in women is limited to the use of topical or, more rarely, systemic estrogens.
Surgical treatment: This treatment is used mainly at stress urinary incontinence and urethral sphincter deficiency. The techniques are numerous and must be adapted to the anatomical situation of the patient.
In addition to traditional surgeries, the following techniques exist:

  • Minimally invasive laparoscopic methods, such as placement of prolene benderelles under the urethra or Tension Free Vaginal Tape (TVT);
  • Periurethral injections of substances such as collagen and silicone in both male and female sphincter deficits;
  • Artificial sphincter implant in severe cases;
  • Neuromodulation: suitable for the treatment of urgency-frequency syndrome and urge incontinence. After preliminary test, it involves placement of a definitive sacral nerve neurostimulator that modulates detrusor activity in such a way as to reduce detrusor contractions and reduce symptomatology
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