Urinary Incontinence is a problem that affects about 20% of the Portuguese female population over 40 years old, but only 10% of these people seek specialized medical help.
Talking about this problem in the World Continence Week is essential to remember the importance of early diagnosis of this situation, the different treatment options available according to the diagnosis established, as well as the high possibility of cure rate.
What is Urinary Incontinence?
Urinary Incontinence is defined as the involuntary loss of urine through the urethra, which may range from slight and occasional to more severe and regular losses. It may occur in both sexes and at different ages, although the prevalence is higher in women and at older ages.
It is a serious problem that usually has a profound impact on patients’ personal, social, family, and professional quality of life, often with significant emotional repercussions.
Prevention, early diagnosis and treatment are fundamental for a better prognosis in the evolution of the disease.
What are the causes?
It has multifactorial causes, and there may be predisposing risk factors for its appearance, such as age, gender (more frequent in women), menopause, number of vaginal deliveries, obesity, chronic constipation, gynecological or pelvic surgeries, neurological diseases, eating habits, excessive fluid intake, alcohol intake, caffeine/teophylline and urination habits, among others.
How is it treated and prevented?
Pelvic floor rehabilitation plays an important role in preventing the onset of urinary incontinence, for example, in postpartum situations, promoting the identification of pelvic floor muscle contraction in order to restore their function through exercises and other techniques that restore contraction strength and tissue tone, reducing urinary complaints.
Kegell’s exercises are directed to the pelvic floor muscles, performing their voluntary contraction, which will promote urethral closure, favoring continence by strengthening the perineal muscles.
These exercises aim to improve urethral resistance and the tone of the tissues that support the pelvic organs, ensuring their correct positioning.
They are simple, non-invasive exercises that should be repeated several times a day, independently by patients anywhere after they are properly learned.
Their effectiveness depends on adherence to the exercises and motivation to maintain them in the long term.
Kegell exercises can be complemented with other techniques:
Electrostimulation aims to stimulate the development and tone of the pelvic floor muscles, improving their ability to contract.
It is recommended for patients who cannot easily identify the contraction of the pelvic floor muscles or who have a great decrease in the strength of this group of muscles, thus improving the mechanism of their contraction.
Biofeedback is also an important therapeutic support in all forms of UI. It uses electrodes capable of capturing the muscle contraction of the pelvic floor muscles and transforms them into visual or auditory stimuli, allowing patients who have difficulty understanding how to contract their muscles to learn how to do it correctly, avoiding the recruitment of accessory muscles.
Different types of incontinence, different treatments
There are several types of Urinary Incontinence according to the reason or the way the losses are triggered, and a correct diagnosis is fundamental to define the best type of treatment for each one. Generically, there are three main types:
– Effort – Involuntary loss of urine after performing an effort (coughing, sneezing, laughing, weight, exercise).
– Urgency – The loss of urine is preceded by a sudden and intense urge to urinate, not associated with any effort, not always allowing the patient to reach the toilet in time.
– Mixed – Association of the symptoms of stress and urge urinary incontinence.
There are also other different types of Urinary Incontinence:
– by overflow – It happens when the bladder contains large volumes of urine and the pressure of the liquid is so high that it overcomes the resistance of the urethra.
– Functional – When the patient cannot reach the toilet in time (more frequent in elderly patients, neurological patients, etc)
– Enuresis – Involuntary loss of urine during sleep.
The treatment selected will depend on the type of incontinence.
In mild/moderate Stress Urinary Incontinence, pelvic floor re-education is usually the first choice of treatment, while in Urgent and Mixed Urinary Incontinence, pelvic floor re-education is usually associated with pharmacological treatment.
In more severe situations that do not respond to conservative treatment, surgery is often indicated.
We cannot forget that along with these treatment options, changes in various behavioral and lifestyle measures (weight loss, dietary changes, urination habits) are also essential.
Why is it so important to seek differentiated help?
An evaluation by specialized specialists, sensitized and focused on a multidisciplinary approach, allows a more correct guidance of the patient, from diagnosis to treatment with the aim of restoring quality of life.
It is equally important to deconstruct myths! For fear or shame, urinary incontinence is still a subject that people tend to live with without seeking professional help. The idea that it is a normal consequence of aging without the possibility of treatment is wrong. Your doctor can help you improve your symptoms and find the right treatment.
An article by Teresa Soares da Costa, MD, Physical Medicine and Rehabilitation Coordinator at Instituto CUF Porto and Hospital CUF Porto.