Urinary Incontinence
What are the solutions for urine loss? Everything about the causes and treatments for urinary incontinence.
Symptoms and Causes
Urinary incontinence is the loss of bladder control, leading to an increased need and urgency to urinate, and it can even result in urine leakage in certain circumstances.
This condition is more complex than it may appear, as there are different types of urinary incontinence, each with its own causes and symptoms. The most notable ones are:
- Stress urinary incontinence: occurs when pressure is exerted on the bladder, such as when coughing, sneezing, laughing, or lifting heavy weights.
- Urgency urinary incontinence: common in older adults, causing both an urgent need to go to the bathroom and urine leakage.
- Mixed urinary incontinence: a combination of several different types, usually urgency and stress incontinence.
- Functional urinary incontinence: the inability to retain urine in the bladder due to causes not related to a urinary system disorder.
- Overflow urinary incontinence: occurs when the bladder cannot empty completely, causing it to fill quickly.
In many cases, changes in habits and rehabilitation exercises resolve the issue without needing less conservative approaches. However, there are cases where medications or surgery are necessary.
Symptoms
Common symptoms across all types of urinary incontinence include:
- Urine loss
- Increased urination frequency
- Urgency to urinate
Causes
Urinary incontinence can be triggered by various causes. Some of the most common include:
- Urinary tract infections
- Pregnancy
- Pelvic floor prolapse
- Aging bladder muscles
Additionally, each type has its own specific origins:
- Stress incontinence: weakness of the pelvic floor muscles or abnormal bladder positioning.
- Urgency incontinence: may be caused by an overactive bladder, urinary tract infections, neurological disorders, hormonal changes during menopause, or prostate enlargement.
- Functional incontinence: results from other conditions such as Alzheimer's or physical and mental disabilities.
- Overflow incontinence: can be caused by certain medications or the presence of tumors or stones in the urinary system.
Risk Factors
The most significant risk factors for developing urinary incontinence include:
- Being female: both the bodily changes during pregnancy and childbirth and the effects of menopause make women more prone to this condition.
- Aging: bladder muscles lose strength, and this loss increases with age.
- Parity: urinary incontinence increases with the number of childbirths, especially vaginal deliveries.
- Family history
- Diabetes
- Neurological diseases
- Physical or mental disabilities
- Obesity
Complications
Urine loss negatively impacts individuals' quality of life, including their social relationships. Furthermore, incontinence can lead to urinary infections or skin problems in areas that remain wet for longer than usual.
Prevention
There is no way to completely prevent urinary incontinence. However, maintaining a healthy weight, avoiding diuretic foods and drinks, and doing exercises that strengthen the pelvic floor significantly reduce the likelihood of experiencing it.
Which doctor treats urinary incontinence?
A urologist or, in the case of women, a gynecologist can treat urinary incontinence.
Diagnosis
Specialists use different methods to diagnose urinary incontinence. The most common are:
- Physical examination and evaluation of symptoms
- Micturition diary: tracks the frequency of urination and any urine loss over three or four days, also considering foods and drinks consumed.
- Urinary incontinence questionnaire (ICIQ-SF): assesses each patient's perception of their incontinence and how it affects their daily life.
- Flowmetry: measures the amount of urine expelled per second.
- Pad test: evaluates the severity of incontinence by recording the volume of urine lost over 24 hours.
- Post-micturition residual measurement: shows the amount of urine left in the bladder after urination.
- Urine analysis: detects infections.
Treatment
There are different treatments for urinary incontinence, chosen based on each patient’s needs and the characteristics of the condition. The most common approaches include:
- Behavioral modification: involves training the bladder to delay the urge to urinate. This is done by holding urine for a period each time the urge arises, starting with ten minutes and gradually extending to several hours.
- To treat overflow incontinence, it is recommended to urinate twice: go to the bathroom when the urge is felt, then return after a few minutes.
- Exercises for urine loss or Kegel exercises: these exercises strengthen the pelvic floor muscles. They are very simple to do; you just need to contract the muscle, like when holding urine, for three to five seconds, relax for the same period, and repeat ten times. Ideally, do this series three times a day.
- Medications: typically used for stress or urgency incontinence. Medications help relax the bladder muscles or use estrogen, particularly for women in menopause.
- Surgery: operations are performed when previous therapies have not worked as expected. Usually, a transobturator mesh (TOT) is placed under the urethra with a minimally invasive approach, inserted through an incision in the vagina. In some cases, neuromodulator injections may be applied to the bladder wall to reduce nerve activity.
