WHAT IS URINARY INCONTINENCE?

Urinary incontinence is an involuntary loss of urine,  which generates a profound discomfort and a worsening of the person's quality of life with effects also on the economic and psychosocial sphere. It is, in fact, the cause of psychological, occupational, relational, physical, and sexual problems.

SEE THE CAUSES 

L ' urinary incontinence female can be caused by several factors, because of the many anatomical and physiological mechanisms that contribute to the maintenance of continence in women and the multiple physiological conditions (pregnancy, childbirth, menopause) that can act on these mechanisms. The causes can, therefore, be borne by various districts: the bladder, the pelvic floor, or the structural stability of the ligament system of the urethra and bladder.

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WHAT ARE THE RISK FACTORS?

The main risk factors are age, the number of pregnancies and vaginal parts, a high baby weight, the presence of vaginal prolapse, obesity,  chronic cough in patients with chronic bronchitis, cigarette smoking, cystic fibrosis, the intensive practice of sports that require jumps or strong abdominal thrusts (some form of dance, jumps in athletics, trampoline), heavy work activities, menopause.

- Advancing age is associated with an increase in the prevalence of urinary incontinence

- The limitations of mobility, as patients with movement difficulties, will inevitably have difficulty reaching the bathroom in time

- The female sex, relating to cases of stress incontinence in women who have had a vaginal delivery

- Acute hospitalization

- Hygienic deficiencies accompanied by urine retention and urinary tract infections

- Neurological and especially dementia diseases

WHAT DO YOU THINK ARE THE SYMPTOMS OF URINARY INCONTINENCE?

Symptoms are directly related to the type of incontinence: 

• Stress incontinence: occurs when there is an increase in abdominal pressure (coughing, sneezing, weight lifting, jumping, physical exercises) and urinary loss varies from very slight to severe. This type of incontinence is particularly related to pregnancy, obstetric trauma, and pelvic changes associated with menopause and senile age. 

• Urge incontinence:  consists of one loss of urine following a strong and uncontrollable urination urgency as a consequence of involuntary contractions. The loss of urine occurs due to an imperious urination need that does not allow to get to the bathroom before the urine leak. The causes of contractions can be neurological (multiple sclerosis, stroke outcomes, spinal cord injuries), or they can derive from infectious pathologies, stones, or bladder tumors, foreign bodies. In many cases, this hyperactivity does not have a precisely identifiable cause.

• Mixed incontinence: the symptoms of stress incontinence and urge incontinence are associated.

DIAGNOSIS 

The diagnostic process is based on a very accurate, structured, and finalized anamnesis, highlighting all possible risk factors and obtaining a detailed description of the symptoms (urination frequency, circumstances in which loss occurs, impact on the quality of life).

A useful diagnostic tool is the urination diary, that is, the recording of the patient's urination habits over 24 hours, repeated for 4-5 days.

The urogynaecological physical examination assesses the tropism of the genital mucous membranes, the results of obstetric traumatism and/or previous surgery, the possible presence of genital prolapse, the state of the internal genitalia, the degree of urethral mobility and other parameters.

The diagnostic imaging makes use of ultrasound examinations, useful information both anatomical and functional, and urodynamic examination, which aims to provide a pathophysiological diagnosis of the condition of the patient.

Often the first level diagnostic approach, based on the clinical framework, may already be sufficient for diagnosis and therefore for a first therapeutic approach.

The use of second-level investigations should be reserved for more complex cases, relapses, and cases that deserve surgical treatment.

HOW DIFFUSED IS IT?

It is a predominantly female condition that affects:

• 20-30% of young women
• 30-40% of adult women
• 30-50% of older women
• 23-67% of pregnant and postpartum women.

HOW IS INCONTINENCE TREATED?

The first therapeutic approach consists in correcting or eliminating the risk factors identified with the anamnesis (for example, reduction of body weight, chronic cough, etc.) or of the factors that can worsen incontinence (genital atrophy, infections of the urinary tract).

The therapy must be personalized to the individual patient as much as possible and can count on pharmacological resources (for forms of urge incontinence) such as antimuscarinic drugs, or on perineal (for all forms) and surgical (for forms) rehabilitation therapies stress incontinence).

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