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Dec 12 / 2021

Urinary incontinence

The urinary incontinence It is defined as the involuntary loss of urine through the urethra that is objectively demonstrable and of such magnitude that it constitutes a hygienic and social problem. Then we will differentiate the symptom referred to by the patient as the involuntary leakage of urine, the sign as the objectification of the leak and finally the pathology as the demonstration of the origin of the different types of incontinence. It is a frequent problem that increases with age, being especially relevant after 60 years.

How does urinary incontinence occur?

We can find different types of urinary incontinence according to the evolution time:

  • Transient or acute incontinence (less than 4 weeks of evolution): As possible causes we find urinary infection, states of mental confusion, drugs, atrophic vaginitis and mobility limitation
  • Established, chronic, or persistent incontinence: The main causes are detrusor overactivity, detrusor underactivity, infravesical obstruction, and sphincter incompetence.

Symptoms

Clinically we can differentiate incontinence in:

  • Stress incontinence: Involuntary loss through the urethra while abdominal pressure increases from coughing, sneezing, physical exercise. It is typical of women
  • Urge incontinence: Involuntary loss associated with sudden intense desire that cannot be voluntarily inhibited. The urgency can be motor (due to bladder instability) or sensory (early sensation of fullness).
  • Unconscious incontinence: Urine leakage without the presence of effort or urgency secondary to neurological disease
  • Overflow incontinence: There is a picture of urinary retention, and the urethra allows the passage of urine due to increased pressure in the bladder.
  • Postvoid incontinence in men: Post-void drip in men due to an alteration of the posterior urethra.

These different types of incontinence can be due to an overactivity of the detrusor (bladder muscle) due to a neurological cause or not, and also to a problem of the urinary sphincter.

Diagnosis

The evaluation of a patient with urinary incontinence should go not only to the demonstration and quantification of leakage, but rather to the search for the reason for it, since a correct diagnosis will lead us to be able to offer the appropriate treatment for each type of incontinence according to its cause. The main points of diagnostic support are a correct clinical history and physical examination and, as a princely test, the urodynamic study. In addition, imaging tests can be performed to morphologically assess the bladder and kidneys, basically with ultrasound.

6 Types of treatment for urinary incontinence

There are different types of treatment depending on the type of incontinence that exists.

  • In both stress and urge incontinence, conservative treatment is the first therapeutic step, especially indicated in patients who are unwilling or unable to undergo surgery. Rehabilitation techniques are aimed at strengthening and rehabilitate the pelvic muscles, with exercises of the pelvic floor and vaginal cones, making contractions of said muscles. They are useful in stress incontinence and urge incontinence.
  • The biofeedback It consists of the recognition of unconscious physiological processes through instruments that provide visual, auditory and tactile signals. With its use the patient learns to control the physiological process. Closely linked with this technique is behavior modification, with learning new skills and strategies to prevent leakage, learning how to contract the pelvic floor muscles and try to inhibit detrusor contractions.
  • The Pharmacotherapy It can be very useful to improve urinary incontinence depending on the cause that produces it. In urinary incontinence due to overactive bladder or detrusor, anticholinergic drugs (tolterodine, fesoterodine, solifenacin, oxybutin) have high efficacy, and can cause dry mouth, blurred vision and constipation. In stress incontinence, medical treatment is not as effective, being able to give alpha-adrenergic agents, estrogens and inhibitors of serotonin secretion, including tricyclic antidepressants.
  • The surgical treatment It is especially useful in stress incontinence, using different types of devices that increase urethral resistance by placing a sling below the urethra. It is a little aggressive surgery, transvaginally and with a very fast recovery.
  • There is a new surgical alternative in detrusor hyperactivity incontinence, which is the injection of Botulinum toxin in the bladder. It is a not very aggressive surgery and with good results the first 6 months, being necessary reinjections later.
  • In cases of pure sphincter deficit and severe incontinence, a artificial sphincter, which works like a tap that opens and closes the passage of urine through the urethra.


    • (Updated at Apr 14 / 2024)

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