Female urinary incontinence: beyond the stigma

Urinary incontinence is defined as the involuntary loss of urine: it is estimated that approximately 40% of women may experience episodes of incontinence during their lifetime. Although it is discussed too little, it is a problem with a significant social and economic impact on women and society. Often, it is the social stigma that represents an obstacle to seeking help, which is why awareness and education on this topic are essential weapons in the fight against this condition.

There are several types of urinary incontinence, each with its specific characteristics:

– Stress incontinence: This is undoubtedly the most common form of incontinence. It occurs when we experience urine loss during activities that increase abdominal pressure, such as exercising or, more simply, laughing, sneezing, or coughing. It is often caused by weakness in the pelvic muscles and is very common in multiparous women.

– Urgency incontinence: This is characterized by a sudden need to urinate, followed by involuntary urine loss. It can be caused by involuntary contractions of the bladder and may be associated with conditions such as interstitial cystitis.

– Mixed incontinence: This is the second most common form of incontinence. It is a combination of the previous two.

– Overflow incontinence: This occurs when the bladder becomes excessively full, resulting in a loss of its ability to hold urine. It is therefore related to problems with bladder emptying.

WHAT ARE THE CAUSES?

Urinary incontinence can be secondary to numerous factors. The main ones include:

– Anatomical factors: Weakness of the pelvic floor muscles.

– Hormonal changes: The decrease in estrogen during menopause can negatively affect bladder function.

– Medical conditions: Diabetes, obesity, and neurological diseases.

HOW IS INCONTINENCE DIAGNOSED?

All women experiencing episodes of incontinence should consult a specialist for diagnosis and to discuss various treatment options. A correct diagnosis requires a comprehensive and detailed evaluation. The first step is certainly a thorough medical history aimed at identifying the severity and frequency of symptoms, pregnancy history, surgeries, or other pelvic interventions, and medications taken.

Patients are often asked to keep a voiding diary for several days. This allows them to record the volume of urine, frequency of urination, and episodes of incontinence.

A careful physical examination should focus on examining the abdomen, external genitalia, and perineum. During the examination, it may be helpful to reproduce the urine loss using a cough test. Although this has been shown to have greater sensitivity in an upright position, the same test has now been standardized in the lithotomy position with the bladder containing approximately 300ml of urine.

A chemical and physical examination of the urine with a corresponding urine culture should always be performed.

In some cases, the specialist may request specific investigations such as urodynamic tests, or even MRI and CT scans to exclude other conditions that may contribute to incontinence.

TREATMENT

Treatments for incontinence are varied and should be personalized based on the patient’s characteristics, considering the severity of symptoms, any underlying causes, and, of course, the patient’s preferences. In this regard, clear and open communication with the specialist is fundamental.

The main treatment strategies include:

– Lifestyle modifications: Obesity is one of the risk factors for urinary incontinence in women; many studies show that weight loss is associated with an improvement in symptoms.

– Pelvic floor training: Muscle training of the pelvic floor allows for greater urethral stability and lifting of the bladder neck. For this reason, intensive training lasting at least three months should always be recommended for all women with stress or mixed incontinence. Such exercises are used not only in the treatment of existing urinary incontinence but often also in pregnant women before childbirth to prevent incontinence.

– Pharmacological therapy: Estrogen medications for urinary incontinence have been tested using oral, transdermal, and vaginal administration. To date, it has been shown that treatment with vaginal estrogen improves short-term symptoms of incontinence without being associated with an increased risk of thromboembolism or breast cancer. However, the ideal duration of treatment and long-term effects are uncertain.

– Surgical management: Surgery should be recommended for patients in whom conservative treatment has not led to improvements. Currently, the main recognized procedures are colposuspension, suspension with autologous tissues, and urethral bulking agents. This surgery is not without complications; for this reason, the therapeutic option should always be agreed upon with the full participation of the patient, to whom the risks and benefits of each approach should be explained.

The follow-up of these patients obviously depends on the type of treatment chosen; for physical and behavioral therapies, a longer observation period is required for benefits to manifest, whereas for pharmacological and surgical therapies, early follow-up is recommended.

The success rate of these therapies is evaluated considering the degree of continence, the quality of life of the patients, and any complications.

What should always be considered is the significant impact that incontinence can have not only on the physical health of the patient but also on their psychological and social well-being. Women suffering from incontinence often bear feelings of frustration and helplessness. Anxiety about potential accidental episodes can lead to a reduction in social life. For this reason, it is vital to help the patient understand that she is not alone by providing the right emotional and professional support.

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