Urinary incontinence: what are the most effective treatments?

Urinary incontinence: what are the most effective treatments?

Publication date: 28-03-2023

Updated on: 03-04-2023

Topic: Urology

Estimated reading time: 1 min

Approximately 4 million women in Italy suffer from urinary incontinence. A disabling condition that forces sufferers to modify their lifestyles to manage or conceal bothersome urine leakage. 

We discuss it with Dr. Umberto Favetta, a proctology specialist who recently joined the team as Head of Proctology and Pelvic Floor Surgery at the Istituto Clinico Città di Pavia.

What is urinary incontinence?

Women today are dynamic and busy on many fronts: from work to family, from 1,000 interests and hobbies to sports. Therefore, they do not intend to restrict their freedom because of bothersome urinary leakage that creates quite a few problems in daily life and also negatively affects social and family relationships.  

"Contrary to what you might think," Dr. Favetta explains, "urinary incontinence is not a condition necessarily related to advancing age and is not only female. In fact, although a smaller percentage, men can also suffer from it, albeit for different causes than women.

Urinary incontinence can manifest itself in varying degrees of severity depending on frequency and pattern. Leakage can be: 

  • meager, occurring sporadically on the occasion of a simple laugh or sneeze;
  • frequent and copious, so much so that they become part of the one's daily routine. In these cases habitually the patient tries to contain them with the use of sanitary pads.

The most severe stage is that which is also accompanied by lack of control by the anal sphincter, that is, fecal incontinence."

Causes of urinary incontinence

Urinary incontinence is characterized by the inability to control both the urethral sphincters and the bladder, which is often prolapsed.

"This condition may depend on many often associated factors, such as: 

  • connective or metabolic diseases, such as diabetes;
  • hormonal factors as in the case of menopause;
  • traumatic postpartum or surgical outcomes such as in hysterectomy. 

But not only that. Recurrent bladder inflammation or major cystitis can also induce structural alterations in the bladder wall and urethral sphincters, altering their perception of stimulus and thus causing an increase in both urinary frequency and urinary urgency.

In men, however, it may occur as a result of: 

  • prostatic pathologies;
  • traumatic surgical outcomes. 

Finally, those with neurological diseases such as Parkinson's and Alzheimer's or spinal cord injuries, which impair nerve function to varying degrees, including urinary tract function, are also subject to this type of disabling condition."

Remedies for urinary incontinence

The latest generation of tampons are a valuable aid, but if used daily and for many hours, they can cause side problems, triggering a vicious cycle of infections that worsen the patient's overall health picture. In addition, some forms of incontinence are so significant that they cannot be managed effectively with these aids alone. 

However, there are effective and definitive solutions to this condition. Let's look at them below.

From pelvic floor rehabilitation to surgery

If the incontinence is due to a pelvic and/or perineal disorder, either anatomical or functional (e.g., single-multi-organ pelvic prolapse, defecatory obstruction, and pelvic abdominal dyssynergia), before proceeding with surgery, the first step is to attempt to rehabilitate the pelvic floor by supporting the pelvic organs and allow proper performance of urinary and defecatory functions. 

"To do this we use Electrostimulated Abdominal Pelvic Rehabilitation or biofeedback, which, through endocavitary probes, allows the patient to regain physiological control of sphincter muscle activity and thus improve both urinary and fecal continence. It generally takes only 5 to 10 sessions of about 1 hour to see the first results," Dr. Favetta explains.

If the pelvic structural and functional situation and the organs in it are significantly compromised or if pelvic floor rehabilitation fails, surgery remains the most suitable choice. Safe and with a fast recovery time, it guarantees significant results. 

"It involves inserting a prosthetic mesh under simple laparoscopy or robotic surgery that, by reinforcing the pelvic floor and stabilizing the correct positioning of the endopelvic organs, allows the bladder and urethra proper modulation of downward movement following straining. This will then allow normal urinary continence to be regained," Dr. Favetta explains.

Fillers for urinary incontinence

Fillers are especially indicated in more severe cases of urinary incontinence, when the leakage occurs at rest and not as a result of exertion. 

"Instillations of collagen are used around the urethral duct, which, by increasing the thickness narrows its diameter so that major urine leakage can be limited. These are filler materials, which are reabsorbed by the body, and for this reason the person may have to undergo this type of procedure repeatedly, every 2 years or so." It is a method that is performed in the day hospital, following local anesthesia. 

In cases where urinary urgency is the main disabling symptom, botulinum infiltration into the bladder wall during cystoscopy is indicated. "In fact, botox is not merely a matter of cosmetic medicine, but can be useful in controlling bladder muscle activity, obviously only in specific and well-selected cases," the specialist concludes.

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