La Urinary incontinence It affects many women. It is known that up to 50% of women experience urine leakage at some point in their lives, and between 10-20% may experience leakage that bothers their normal lives.
It is important to understand that the urine leakage it is not a normal aging process. We must also know that there are treatments available to reduce or eliminate the problem.
The causes of urinary incontinence can be several. Involuntary contractions of the bladder muscle, called detrusor, is one of the main ones. Existing changes in the anatomy of the genitals, such as a prolapsed bladder, is also a common reason.
at the Institute of Gynecology from Barcelona Dra. Gómez Roig we care for women with urine leakage. Our specialist doctors offer this care within our medical services.
What is urinary incontinence?
Urinary incontinence, also known as accidental loss of urine, occurs when a woman cannot control urination and urinates unintentionally.
This affectation always implies an important psychological and social impact.
This problem is more common in older women, but it can also appear in younger women.
Importantly, not a normal aging process Or something you have to live with.
What are the symptoms of urinary incontinence
Symptoms of urine incontinence will depend on the type of incontinence.
There are two different types and the symptoms are different.
- Stress urinary incontinence. These urine leaks occur when the woman makes efforts that imply an increase in abdominal pressure. It is also very common to appear with coughing spells in colds or irritative coughs. Once the effort yields, the loss also disappears.
- micturition urgency. This type implies an urgent need to urinate without being able to hold it in and without giving time to get to the bathroom. It is due to involuntary contractions of the bladder muscles. It is not related to exertion, and when the need to urinate appears, it is difficult to contain yourself and not do it.
Both types of incontinence cause the discomfort of wetting panties and therefore the need to wear protectors that reduce moisture and the smell of urine. Both can be very annoying and reduce the quality of life with psychological affectation of the woman. It is therefore very important to consult the gynecologist or gynecologist and remedy the problem.
What causes urinary incontinence in women
La cause of urinary incontinence it can be multifactorial.
Stress-related incontinence is due to weakness and decreased muscle tone of the pelvic floor muscles or perineum. This weakness is associated with risk factors such as obesity, previous vaginal deliveries, smoking, and toxic habits.
Menopause, due to the disappearance or decrease of estrogen, is also the cause of loss of muscle tone and atrophy. The Kegel exercises They help to recover part of the tone and strength of the perineum musculature.
La decreased estrogen with age, they also cause changes in the characteristics of the bladder musculature, making it more sensitive and irritable. This fact can cause urinary urgency, the other type of incontinence.
What types of urine leakage are there?
The two most common types of urine losses in women are:
- Stress or stress incontinence.
- Urgently.
- Mixed.
- For overflow.
Stress incontinence
La stress incontinence or stress occurs when the muscles and tissues that surround the urethra they do not close properly when abdominal pressure increases. This muscle weakness causes a leak of urine when efforts are made. Coughing, sneezing, laughing, or running can cause it. This type is more common in obese women or women who have given birth to several children vaginally.
urgent
This type of urine leakage is also called an overactive bladder. In these cases there is a sudden and uncontrollable urge to urinate due to involuntary contraction of the detrusor. Leakage often occurs when a woman wants to go to the bathroom and doesn't make it in time. There are triggers that cause it, such as opening the door when you get home, the cold, or turning on the tap to wash your hands.
Women with this type of urine incontinence They tend to go to the bathroom more frequently both during the day and at night.
We consider a normal frequency of urination of about 8 times a day and once a night.
This may be influenced by the amount of fluids you drink.
Mixed
When the two previous ones are combined: effort and urgency.
by overflow
This occurs when the bladder it is not completely emptied, causing urine to leak as the bladder becomes too full.
How is it diagnosed?
This pathology is diagnosed by performing the timely questions how they would be done normally. The doctor should include in the visit important questions such as:
- How often does urine leak?
- How is it triggered?
- Has it gotten worse or better over time?
- Do you take any medication?
Another way to study this topic is by using a voiding diary. This diary is a 24-hour record of how you urinate. The amount of liquid a woman drinks should be noted on it and the times you urinate. It is important to write down any leaks and the activities you were doing when you had the leaks.
Apart from the diary, other tests can also be performed. The specialist during the gynecological examination You can make the lady cough and watch for urine leakage.
Generally, you always ask for a urine analysis and sometimes a culture to check for infection.
Through one ultrasound it can also be checked if the bladder empties completely when urinating.
La urodynamics It is a more complex test, but it measures very accurately the amount of urine that the bladder contains. In addition to the contraction of the detrusor, and the cause of the escape. It also guides on the correct treatment.
How is urinary incontinence treated?
The leaking or leaking urine They can be treated with or without drugs.
Before starting treatment, it is important to take a good medical history to detect triggers that can worsen leaks.
Initial treatments include:
- lifestyle modification: Some changes in your lifestyle can help improve urinary incontinence.
- Weight loss: If you are overweight, urine loss is more frequent due to increased abdominal pressure.
- Control fluid intake: If you drink large amounts of fluids, drinking less may improve the problem.
- We also suggest reduce the amount of alcoholic, caffeinated and carbonated beverages.
- If you get up frequently during the night, stop drinking liquids 3 to 4 hours before going to sleep.
- The constipation it can make leaks worse. Increasing the amount of fiber in your diet can help.
- schedule urination at regular intervals, rather than waiting until the bladder is very full, can decrease incontinence episodes. Try to urinate every 3 to 4 hours regularly.
- Pelvic floor exercises called kegel exercises.
- train the bladder learning to go to the bathroom less often. The bladder must be taught to be able to hold more urine.
If we differentiate the different types of urinary incontinence, we can better specify the types of recommended treatment:
Treatment of stress urinary incontinence
In this type of leak, it is recommended to start with the least invasive techniques, and if it does not improve, progress in the treatment.
- Physiotherapy: If you are not doing Kegels effectively, you can see a specialist to teach you how to do them.
- Vulvar and vaginal cream with a female hormone called estrogen: may be helpful for women already in menopause.
- Vaginal pessaries: They are flexible devices that are placed in the vagina and prevent urine leakage.
- Surgery: This is the technique that offers the best results in this type of incontinence. There are several surgical procedures for the treatment of stress incontinence.
Treatment of urge urinary incontinence
Once the recommended changes in habits have been made, and the problem continues to persist, we can start other treatments.
Drug treatments help prevent involuntary detrusor contractions in urge incontinence.
- Acupuncture: this technique sometimes improves urinary incontinence in some women.
- Pharmaceutical products: There are a wide variety of drugs that relax the bladder muscle and prevent its involuntary contractions. Sometimes the treatment is temporary, and at other times indefinite. These medications can cause discomfort such as a drier mouth, some constipation, and heartburn. There are remedies for it.
- Botox: Botulinum toxin A, also known as Botox, temporarily paralyzes muscles. As an inconvenience, it can cause urine retention due to difficulty emptying.
You should always inform and be the woman who decides the choice of the solution.
On Institute of Gynecology of Barcelona Dra. Gómez Roig We will visit you, we will diagnose the type of urinary incontinence and we will offer you the best treatment.
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- About the Author
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Head of the Obstetrics and Gynecology Service at the Sant Joan de Déu Hospital in Barcelona. Associate Professor of Obstetrics and Gynecology and Coordinator of the Sixth Course of Medicine at the University of Barcelona, UB. Director of the Dra. Gómez Roig Institute and Coordinator of Obstetric and Gynecological Processes at the Corachan Clinic in Barcelona.