Urinary incontinence is the involuntary loss of urine and up to 50% of adult women may experience incontinence. Despite its high prevalence, incontinence remains underdiagnosed and undertreated.
Only 25% of affected women seek care and, of these, less than half receive treatment. Untreated incontinence is associated with falls and fractures, sleep disturbances, depression, and urinary tract infections.
Many women do not report incontinence symptoms to their doctor due to embarrassment or lack of knowledge. In all women, the doctor must identify and treat reversible causes, such as urinary tract infection, excessive fluid intake (less than 2 liters per day), the use of some medications and some conditions such as obesity, constipation, sleep apnea. sleep, smoking, dementia and depression.
Evaluation of patients should focus on the onset, duration, severity, frequency, and effect on quality of life, and be able to differentiate between types of urinary incontinence.
Stress incontinence is characterized by the involuntary loss of urine with increases in abdominal pressure such as exertion or coughing. The primary etiology is a malfunctioning urethral closure and is associated with vaginal delivery trauma, obesity, chronic constipation, heavy lifting, and high-impact exercise.
Urge incontinence is characterized by a sudden, compelling desire to urinate that is difficult to put off. Many women with incontinence experience coexisting symptoms of stress and urge, often called mixed urinary incontinence.
Treatment selection is based on the type of predominant symptom (stress incontinence versus urge incontinence), the woman’s goals and expectations for improvement or cure, her level of commitment to therapy, her tolerance for risk or adverse effects. .
Almost all initial therapy for incontinence should begin with noninvasive measures such as lifestyle modifications; smoking cessation, management of constipation and avoidance of excess fluids, weight loss, reduction in consumption of caffeine, carbonated beverages, diet drinks, and alcohol, timed voiding measures, or interval voiding.
Another measure is pelvic floor muscle exercises. Although there are no significant risks or expenses to unsupervised exercises, they do require personal commitment and time commitment.
Supervised therapy may also be offered by a pelvic floor rehabilitation specialist who offers a variety of exercises using specialized equipment. There are no approved medications for stress incontinence.
In contrast, there are some medications for urge incontinence, which are associated with modest improvements in urgency, frequency and episodes of urge incontinence.
Women whose predominant symptoms of stress incontinence persist despite conservative measures may be candidates for surgery. Surgery is highly effective, with a median cure rate of 84.4%.
Surgical management for urge incontinence is based on changes in nervous regulation, such as stimulation of the tibial nerve, application of botulinum toxin in the bladder, or sacral neuromodulation.
Urinary incontinence is common in women, yet few seek care despite many effective treatment options. Physicians should prioritize screening for urinary incontinence, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate medical and conservative therapy, and refer to specialists when underlying pathology or appropriate measures are identified. Conservatives are ineffective.
Dr. Ana Silvia Vidal Brandt.
Urologist specialized in general and functional urology, endourology and oncology
IG: anauro udm
Training as a General Medical Surgeon at the Autonomous University of Yucatan.
Specialty in General Surgery Autonomous University of Yucatan.
Training as a Subspecialist in Urology at the Hospital Centro Médico Nacional 20 de Noviembre of the ISSSTE, endorsed by the National Autonomous University of Mexico.
He completed training in urology oncology, endourology, laparoscopy and robotic surgery.
He has a Master’s degree in Medical Sciences from the National Autonomous University of Mexico.
High specialty in Neurourology and Urodynamics at the XXI Century National Medical Center of the IMSS.
Active member and part of the board of directors of the Mexican Society of Urology.
Active member of the American Society of Urology and the European Society of Urology.
Related Notes: