Urinary incontinence: a common but silenced condition that affects quality of life and has effective treatments

Urinary incontinence is a condition that affects millions of people, both women and men, impacting their quality of life. Despite its frequency, it remains a silenced problem, often due to embarrassment or misinformation.

‘The most common forms we treat in women are stress incontinence, urge incontinence and, frequently, a combination of both, known as mixed incontinence,’ explains Dr Almudena Coloma, a specialist in female and functional urology at the Urology Department of Ruber Internacional Hospital.

Stress incontinence occurs when coughing, laughing or exercising, while urge incontinence involves a sudden and uncontrollable urge to urinate.

The diagnosis is based on a detailed medical history, validated questionnaires, a voiding diary and the so-called ‘diaper test’. According to the doctor, ‘physical examination is crucial, especially to assess the condition of the pelvic floor, the presence of prolapse and urethral mobility’. Additional tests include urine analysis, ultrasound, flowmetry and, in complex cases, a urodynamic study that allows the behaviour of the bladder to be accurately characterised.

First line of treatment: conservative options

Dr Almudena Coloma Initial treatments are usually conservative. ‘Lifestyle changes, control of bladder irritants and pelvic floor exercises guided by specialised physiotherapists are very effective, especially in mild or moderate cases,’ says Dr Carlos Balmori, a specialist in the same department headed by Dr Antonio Allona and Dr Juan Ignacio Martínez-Salamanca.

Specific medication is also used for urge incontinence.

When these measures are not sufficient, there are advanced options. "In women with refractory urge incontinence, we use local therapies to reduce bladder hyperactivity or neuromodulation. For stress incontinence, TOT or TVT suburethral slings offer excellent results with rapid recovery," adds Dr Almudena Coloma.

Urinary incontinence in men

In men, urinary incontinence is a common occurrence after prostate surgery, especially after radical prostatectomy for prostate cancer. Urge incontinence is also observed, often associated with an overactive bladder secondary to chronic prostatic obstruction.

‘We apply the same diagnostic rigour as in women, including medical history, physical examination and urodynamic study when necessary,’ explains Dr Carlos Balmori.

Initial treatment also includes pelvic floor physiotherapy—essential after surgery—and medication in cases of urgency. In more severe situations, surgical solutions are considered: ‘The artificial urinary sphincter remains the gold standard treatment for severe post-prostatectomy incontinence. In moderate cases, we opt to implant male slings,’ he explains.

Technology and multidisciplinary team

Dr Carlos BalmoriBoth specialists highlight advances in minimally invasive surgical techniques and new-generation implantable devices, such as artificial sphincters, which are increasingly ergonomic and effective.

‘In addition, technologies such as sacral or tibial neuromodulation are establishing themselves as effective alternatives in certain profiles,’ says Dr Balmori.

A comprehensive approach is a fundamental pillar: ‘We work closely with physiotherapists, gynaecologists, geriatricians, psychologists and nutritionists to offer personalised care. This multi-professional coordination significantly improves results,’ emphasises Dr Coloma.

The doctors remind us that it is important to maintain healthy habits, perform pelvic floor exercises and not hesitate to seek help. Today, there are many effective and safe solutions for those living with incontinence. ‘You are not alone, and you should not normalise it,’ they conclude.