Urinary incontinence
The definition of urinary incontinence is the unintentional loss of urine.
How frequent is it?
1 in 5 women over 40 suffer from urinary incontinence. This number is even greater, considering that many women do not even report their problem to their doctor because of fear or shame. Also, many women have the wrong impression that incontinence is normal in old age and that it is incurable, which is a mistake.
Which is the normal mechanism of urination?
Around the bladder and urethra there are the pelvic floor muscles. These muscles hold the urethra closed and prevent urination, except when the woman goes to the toilet to urinate.
When the bladder is full, the brain receives nerve impulses. The brain in turn sends stimuli to the pelvic floor muscles to relax while the bladder contracts and in this way the patient urinates.
How many kinds of urinary incontinence exist?
We observe it when any increase bladder pressure that occurs in various situations such as sneezing, coughing, physical activity (jumping or running). Sometimes body movements can cause urine loss.
Some patients have stress incontinence during sexual intercourse.
The pelvic muscles can relax for various reason such as
Urge incontinence occurs when you have a sudden urge to urinate. In urge incontinence, the bladder contracts when it shouldn’t, causing some urine to leak through the sphincter muscles holding the bladder closed.
In most cases we do not know why this happens. Muscle and bladder seem to send wrong stimuli to the brain about how full the bladder is.
Urge incontinence also occurs in diseases of the brain and nerves, such as stroke or Parkinson’s disease, multiple sclerosis or spinal cord injuries.
The symptoms are
A combination of stress incontinence and urge incontinence. Many women complain of both types of incontinence. Depending on the case, one of the two types may be the primary problem.
Overflow incontinence, which we also call chronic urinary retention, is when the bladder cannot completely empty when you pass urine. This causes the bladder to swell above its usual size.
If you have overflow incontinence, you may pass small trickles of urine very often. It may also feel as though your bladder is never fully empty and you cannot empty it even when you try.
We observe it in patients with severe diseases which inhibit the brain desire to urinate. It often happens in patients with Alzheimer disease.
Diagnosis
It is very important to see the appropriate doctor. The urogynecologist is a gynecologist specializing in urological problems in women In addition, the doctor has a perfect knowledge of the female anatomy of the vagina and pelvic floor.
The first step is a very detailed history, including the symptoms and their duration. The doctor will ask you about the liquids you drink, the amount and type (especially liquids containing caffeine, such as coffee, tea, wine and cola) and the frequency you urinate.
The doctor will ask you to fill in a diary with the exact hours, frequencies and amounts of fluid consumed and urine produced. He/she will also ask you about symptoms of cystocele or rectocele, surgery, medical and obstetric history and general health problems.
We always do urine analysis at the first visit to check for infections or hematuria. The first visit also provides a detailed clinical examination to check for anatomy, skin and tissue problems, urethral support, stress incontinence and pelvic floor muscle quality.
Then the urogynecologist performs the urodynamic control.
