Do you know that the World Health Organization (WHO) and the International Continence Society (ICS) defines urinary incontinence (UIC) as involuntary leakage of urine from the urinary bladder, constituting a hygienic and social problem?
The UIC problem varies between women, men, and children. This results both from anatomical differences in the structure of the lower urinary tract in both sexes, as well as from different causes of UIC in men, women, and children.
URINARY INCONTINENCE TYPES ACCORDING TO ICS
According to the definition by ICS, the following types of urinary incontinence are distinguished:
- stress urinary incontinence – urine leakage during physical effort, sneezing, coughing;
- urge urinary incontinence – urine leakage preceded by a feeling of urgency (an urgent, uncontrollable need to urinate);
- mixed urinary incontinence – urine leakage connected with urgency and effort, sneezing, coughing.
Treatment of each type of urinary incontinence should start with conservative treatment.
The conservative treatment of UIC consists in modulation of the lower urinary tract functions through performance of appropriate pelvic floor muscle exercises by the patients, and/or mastering appropriate miction habits, as well as – if necessary – use of medicine enabling modification of the contractive function of a detrusor muscle and/or the urethral sphincter mechanism muscles.
In the clinical practice, urinary incontinence, especially in older patients, often coexists with other conditions (such as: diabetes, cardiovascular diseases, chronic kidney disease, COPD, neurological diseases, stroke, generalized atherosclerosis, metabolic syndrome, depression). Therefore, it is understandable that proper treatment of the coexisting conditions is not indifferent to urinary incontinence.
9 METHODS OF TREATMENT OF STRESS URINARY INCONTINENCE
However, the most important method of conservative treatment of stress urinary incontinence, the effectiveness of which has been proven by numerous studies, is physiotherapy. The physiotherapy methods recommended for stress UIC patients include:
- pelvic floor muscle training (PFMT), commonly known as Kegel exercises;
- so-called biofeedback (biological feedback), or the training in voluntary contraction and relaxation of pelvic floor muscles;
- temporary/local electrostimulation, when electrical stimuli are used to stimulate specific muscles or muscle groups, responsible for the urinary continence process, into working;
- use of vaginal inserts of different shapes, including vaginal balls and cones with replaceable weights of different mass;
- 5. estrogen therapy, administered vaginally;
- magnetic stimulation directed to nerve roots and pelvic floor muscles;
- vibrotherapy conducted with a special vibrating platform simulating human walk;
- a supplementary form of physiotherapy is the use of cones, balls, pessaries, and the new product on the market, discussed by doctors: urinary incontinence tampons (vaginal), enjoying increasing popularity due to their extreme efficiency; in a discrete and invisible manner, they support the urethra. They are particularly intended for women who wish to remain physically, socially and professionally active and do not intend to let UIC make them give up on any aspects of their lives;
- In case of failure of conservative procedures, surgery is the preferred treatment. During qualification for surgical treatment, each patient should undergo a urodynamic test confirming the stress nature of their urinary incontinence and demonstrating lack of counterindications for the surgery. There are more than a dozen kinds of surgery performed to treat stress urinary incontinence. The selection of the appropriate technique is always case-specific, dictated by both patient-related factors (intensity of the disease, anatomical conditions, the history of previous procedures) and the operator’s experience, and frequently also the availability of equipment.
A significant factor in UIC treatment is modification of your lifestyle, including:
- reduction of caffeine intake may affect the reduction of urgency;
- moderate physical effort may have a positive effect on reduction of urinary incontinence; one should keep in mind that UIC symptoms intensify during intense effort;
- seeking to optimize the quantity of consumed liquids; both extremely high and low intake of liquids has an adverse effect on the UIC intensification;
- body mass reduction – overweight is a risk factor in UIC incidence;
- surgical or non-surgical reduction mitigates the UIC symptoms and enables proper blood sugar control, reducing the risk of incidence of UIC in diabetic patients;
- cessation of smoking; although no correlation between smoking and UIC has been proven, it is compliant with the good medicinal practice to suggest quitting it.
QUALITY OF LIFE AND THE FUNCTIONING WITH UIC
Permanently or periodically occurring UIC contributes to considerable deterioration of the quality of life of the patients; it may cause serious psychophysical disorders in the affected people and restrict the efficiency of their functioning in the society, or even isolate them from their environment.
The costs of treatment and supplying of UIC patients are gradually growing, due to the increasing health awareness of the society on the one hand and the aging of the society and increase in the number of elderly people, characterized by high incidence of UIC, on the other hand. In our country, increased interest of the media and society in the problem of UIC can be noticed, yet improvement is still insufficient in this regard.
URINARY INCONTINENCE TAMPONS
– Przegląd Urologiczny 2006/2 (36): “Leczenie nietrzymania moczu. Stan aktualny i kierunki rozwoju” [Treatment of Urinary Incontinence. The Current State and Directions of Development].
– Przegląd Urologiczny 2016/4 (98): “Aktualne metody leczenia nietrzymania moczu u kobiet” [The Current Methods of Treatment of Urinary Incontinence in Women].
– “Raport: Pacjent z NTM w systemie opieki zdrowotnej 2020”. [Report: A UIC Patient in the Health Care System 2020]