Avoiding a sedentary lifestyle, losing weight, drinking enough water and exercising to strengthen the pelvic floor are some of the recommendations to prevent urinary incontinence, a disease that affects six million Spaniards.
How many types are there?
There is stress urinary incontinence when the patient performs activity that produces an increase in abdominal pressure, which leads to urine loss (coughing, sneezing, lifting weight, walking, etc.); urge incontinence: associated with an irrepressible desire to urinate, but before being able to reach the bathroom, urine loss occurs; mixed: when two types of incontinence coexist; that of overflow, which appears, paradoxically, in patients who cannot empty their bladder properly, and insensible incontinence, which occurs without the patient knowing that they are losing urine.
Which is the most frequent?
In women up to 50-60 years of age, the predominant type is exertion. From the age of 60, the urgency is predominant. In men, the most frequent is the emergency one, whose incidence increases with age, and the stress one is associated with prostate interventions. The most severe and complex presentation occurs in those patients in whom both types coexist.
What is this pathology due to? Can it be prevented?
The stress has two fundamental causes. Urethral hypermobility due to a weakness of the urethral clamping mechanisms, which prevents proper closure of the urethra during abdominal efforts. And the intrinsic sphincter deficit due to insufficient function of the external urinary sphincter. In the first case, the causes that lead to urethral hypermobility are increased pressure and trauma to the pelvic floor (pregnancy, childbirth, exercise, obesity, chronic cough, etc.), and in the second, other factors (age, previous surgeries, neurological, vascular diseases, radiotherapy…). Urgency has different causes and can appear secondary to other pathologies, such as obstruction of the urine outlet due to benign prostatic hyperplasia, pelvic organ prolapse, urinary infections or tumors. In many patients there is no cause, considering it an idiopathic disease, often due to the changes that occur in the bladder over time. Of course, prevention is key: such as doing daily physical exercise, preventing overweight or avoiding tobacco and alcohol consumption.
Early diagnosis is essential. Why?
To reduce the impact it may have on the patient’s quality of life and social sphere.
The Rey Juan Carlos University Hospital offers the patient individualized treatment.
Yes, we focus our efforts on making a correct diagnosis of each patient so that we can then offer the most individualized treatment possible. In stress incontinence, when the conservative approach fails, we offer surgical treatments with a high success rate.
In less severe cases, do they start with pelvic floor rehabilitation?
In general, we always recommend starting with pelvic floor rehabilitation and changes in lifestyle. For stress urinary incontinence, we recommend at least six months of pelvic floor rehabilitation exercises performed constantly and always supervised by a health professional. In addition, we also try to modify lifestyle habits that help control incontinence (stop smoking, drink less coffee or tea, lose weight, etc.).
What pelvic exercises can pregnant women do to avoid urinary incontinence?
Pregnancy and childbirth are fundamental moments to prevent subsequent pelvic floor problems, including urinary incontinence. During pregnancy, the pelvic floor must be strengthened for childbirth. For this, it is recommended to perform pelvic floor exercises, consisting of sustained contractions of the pelvic muscles for about five seconds with subsequent relaxation for 10 seconds, 20 repetitions. Perineal massage is also recommended to improve relaxation and distensibility of the pelvic muscles in the face of childbirth.
When do you have to operate?
In the case of stress incontinence, we propose surgery when the rehabilitation treatment fails. Despite the efficacy of this treatment, a high percentage of patients will require surgical intervention to achieve complete continence. The case of urge incontinence is different, in which conservative and pharmacological management achieves symptom control in a higher percentage of cases. However, in those cases in which we cannot control the symptoms, we have effective techniques such as the administration of Botox, posterior tibial or sacral root neuromodulation, and bladder enlargement.
What percentage of success do they achieve after the operation?
If we talk about stress incontinence, with a correct diagnosis, we can obtain success rates of between 80 and 90%. In the case of urge urinary incontinence, with the more invasive options discussed, we can expect an 80-85% improvement in symptoms.
If this disease is not properly treated, what can be the consequences?
The patient ends up ordering his life around his incontinence (he avoids public transport where he cannot control when to stop, acts where there is no bathroom available, social activities due to fear of incontinence, etc.) and this ends up having a high impact on your quality of life. But not only the emotional sphere is affected, older patients are more at risk of medical problems such as an increased risk of falls and fractures or a higher risk of urinary tract infections or skin problems derived from their incontinence.