Diagnosis and Treatment of Urinary Incontinence
Written by:Urinary incontinence is the involuntary loss of urine that occurs at an inappropriate time and situation. It can be of three types: stress incontinence , when it is consistent with an effort such as sneezing or coughing; urgency incontinence , when it has no relation to intra-abdominal pressure changes, as in the previous case; or mixed incontinence , when the two previous causes are combined.
It is a problem of a social nature, because it interferes with the habits of women, of an economic nature, since it involves an expense with the protection systems (compresses, diapers) and it is also a health problem due to the discomfort, irritations and added infections that provokes
It should not be accepted as a problem linked to age, history of births or surgeries, it should always be treated as a disease that can be solved. In the gynecologist's office, the patient who suffers does not always ask for treatment, either because of embarrassment, because he thinks it has no solution or because the doctor does not ask.
Diagnosis of Urinary Incontinence
The gynecologist in a routine review has the obligation to ask about possible involuntary leaks of urine and gas or feces, to gauge the importance and offer solutions.
Once the problem is detected, the interrogation should be expanded in the consultation to obtain the maximum amount of information and thus be able to agree with the patient if the analysis should be expanded and, in any case, if solutions can be offered.
If the seriousness of the situation deserves it, it will be necessary to explain to the patient the type of incontinence that it seems to have and, the exploration should be directed in search of evidencing the problem and its intensity, in order to arrive at the possible causes of the problem, as anatomical failures such as bladder descent (cystocele), descent of the uterus (hysterocele) , prolapse of the posterior wall (rectocele), weakness of the supporting muscles of the pelvis, etc.
The diagnosis can be complemented with a urodynamic analysis , which is performed on an outpatient basis and is absolutely painless. In little more than half an hour it gives us an exact idea of the functionalism of the systems of urinary containment, it indicates the type of most effective solution that can be offered and the prognosis of the problem and of the possible solutions.
In a survey carried out in our Center, already in 1997, we observed that out of 500 women chosen at random, 37% had some type of incontinence and 13% suffered a permanent discomfort, although only 2% of them consulted because of the problem
We also detected that 35% of the respondents were over 50 years old, but that 12% were women between 20 and 30 years old.. With this we want to make clear that it is a very frequent problem and that not enough attention is always paid to it.
Treatment for Urinary Incontinence
Once the type of incontinence is known, the best therapeutic option can be offered. Many cases can be improved or even cured with specialized physiotherapy sessions ( pelvic floor rehabilitation techniques ). In other cases, they may respond to pharmacological solutions that improve tonicity or help to relax the bladder.
Sometimes you must resort to surgery that, in most cases, can be done vaginally, under superficial sedation and practically in outpatient or short stay. If the diagnosis and the prescription of the treatment have been correct, the results are spectacular.
The most rebellious cases are those that affect very old women, since they are associated with limiting factors of mobility, medications that slow down reflexes or deterioration of the nervous system.
