Female incontinence

Urology Treatments

Female Incontinence

Urinary Incontinence (or UI) colloquially takes different names: "urine leakage, leakage of pee, uncontrollable urination ...".

Female Incontinence

Table of Contents

Definition

What is urinary incontinence?

Urinary Incontinence (UI) is commonly known as: “urine leakage, urine loss, uncontrollable urination …” It is a condition involving the serious discomfort of urination against the will or without the control of the patient. This problem is often aggravated by the unpleasant situation of no bath nearby.

The different types of incontinence are classified according to their origin. Some women may pass out some drops of urine when coughing or laughing while others feel a sudden urge to urinate that they can not control. Urine loss can also occur during sexual activity, and this can cause great emotional distress.

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FREQUENT CAUSES

What causes urine leakage?

Generally, urine leakage is related to the malfunctioning of muscles and nervous tissues that enable the retention or release of urine which is produced in the kidneys and then stored in the bladder before getting to leave the body through a small tube that connects the bladder to the outside: the urethra.

The role of the muscles that make up the structure of the bladder is mainly contraction (to eject or expel the fluid). This process also involves the sphincter muscles (surrounding the urethra) which relax to allow the fluid to be expelled from the body.

The prevalence of this condition is different for both sexes as it tends to affect women more than men. Pregnancy, childbirth, and menopause are risk factors that contribute in many cases to its appearance. To a lesser extent, it can also be caused by surgical interventions, diabetes, being overweight, neurological degeneration and other injuries.

Pelvic Organ Prolapse (POP) is a pathology that is often associated with urinary incontinence in women. We have performed a few surgeries to solve complex cases that present both pathologies. Thanks to the use of polypropylene meshes in urology, patients who once did not find a definitive solution to these problems can now return to their completely normal lives.

There are different types of incontinence depending on its origin. Some women may lose a few drops of urine when coughing or laughing, while others feel a sudden urge to urinate that they cannot control. Urine leakage can also occur during sexual activity, which can cause great emotional distress.

Medical evaluation

What are there different types of UI?

Various physiopathological factors cause the same problem and there are five main types classified according to their origin and nature:

1 Functional: Patients who cannot control their bowels because of a disease like Alzheimer’s, spinal damage or pathology of nervous origin that makes it impossible for them.

2 Urge: If you browse the Internet enough, you will surely see the concept of overactive bladder, which is associated with this type of incontinence. The emergency leak (also called imperious) happens when the muscles contract involuntarily before the bladder is filled, generating a sudden need to urinate. It is more common in older patients and is usually very disabling, causing very poor quality of life.

Types of urinary incontinence

3 Stress: The most common type of incontinence is called stress because voluntary or involuntary actions such as coughing, sneezing, exercise, laughter, carrying weight and other similar movements apply pressure on the bladder which is not capable of containing the fluid normally.

Types of urinary incontinence

4 Overflow: In this type of UI, the bladder appears oversized, so uncontrolled leakage occurs when urine accumulates. Generally, it is more common in men, although some neurological diseases in women cause this presentation.

Types of urinary incontinence

5 Mixed: When any of the above types occur at the same time.

There are many ways to manage, reduce and combat urine leaks, or even make them disappear totally as is the case with surgery. However, the specific type of incontinence must be noted so that the treatment is appropriate since the treatment for one type cannot be used for the others.

Urge incontinence has often been treated with pharmacological therapy (Oxybutynin, Fesoterodine, Solifenacin, and Mirabegron) combined with behavioral training and routines. The latest remedy for this type of UI is Botox treatment that “paralyzes” the muscles of an overactive bladder.

Female suburethral mesh surgery

For “overflow” incontinence, urethral dilatations are performed because treatment with medications usually don’t give good results. In cases in which the detrusor muscle of the bladder is not functional, the only possible treatment is bladder catheterization.

Consistent and well-executed routines of pelvic floor exercises improve the symptoms of stress UI, which turn into long-lasting results over time.

The safest and most effective solution for stress incontinence is surgery to place a sub-urethral mesh.

TECHNIQUES AND TREATMENTS

Which women are candidates for this surgery? When is it recommended?

When there are indications of “stress incontinence” which, as seen in this article is one of the three most common types (stress, urge, and overflow), the band (or mesh) placement surgery is usually the best treatment option. The material from which it is manufactured is polypropylene, which is a completely safe compound, with hundreds of thousands of women around the world operated upon successfully.

Keep in mind that this surgical option is useful only in the treatment of stress incontinence and that if it is inappropriately used as a solution for another type of incontinence, there are risks of causing serious health problems to the patient.

What is involved in the preparation for the surgery? What previous steps must be taken before it is performed?

The surgical intervention is minimally invasive, simple, fast and has very few postoperative requirements. You will follow the same steps as with any other surgical intervention (general and pre-anesthetic tests) you may have had.

How long is the intervention? What techniques are used? Do you have to be completely asleep?

A few years ago, a much more invasive technique was used, with inguinal access and general anesthesia.

After years of experience and improvement, we have achieved a very high level of optimization and the operation spans between 20 and 30 minutes. Today, we make use of single-incision suburethral bands, which greatly simplify the surgical process. It is conducted under local anesthesia with mild sedation (sleep or drug-induced hypnosis).

The control and safety measures are very high, guaranteeing total sterility in the operating room (in order to prevent the possibility of infections once the mesh is placed). The large team of professionals at the Andromedi Clinic is headed by Dr. Blanca Madurga Patuel, one of the most renowned specialists in our country. This is one of the greatest ways we guarantee success.

The most important advances we have already started implementing at our center in Seville mainly relate to the use of new meshes or adjustable bands, which will make it possible to carry out a completely personalized treatment that takes into account the anatomical or pathological characteristics of the patient.

Is it permanent? Or are there can be revisions or changes?

We can affirm that this solution is permanent. Once the success of the intervention has been verified after a reasonable period of time, no subsequent revisions or replacements are necessary.

What are the common problems or complications with this intervention?

The main complication is the so-called “mesh extrusion”, which is nothing more than the person’s body rejecting the placed band. Also, some women (very few cases, less than 1%) may experience urethral or vaginal pain as well as dyspareunia (pain during or after sex).

We are experts in secondary sub-urethral mesh surgeries. In other words, we are experts in solving problems that have been created in interventions carried out in other centers. It requires much experience and a lot of knowledge to be able to identify, diagnose and revert problems caused by the bad implementation of this technique.

How is the postoperative period?

There is practically no postoperative period in the hospital; typically, the patient can comfortably go home just a few hours after leaving the operating room. From then on, the resting process is very smooth although some medical recommendations must be followed specifically:

What results are obtained?

The results we have obtained in our center in Seville after many years of experience with this intervention are exceptional. Compared with the effectiveness that was recorded years ago, we can affirm that the surgical techniques against incontinence are much more effective today. Up to 95 out of 100 women operated upon have had their incontinence problems successfully eliminated. The technical advancements, the provision of the operating room, the simplification of the process and the possibility of financing the total cost of the process in simple terms are the main reasons why we encourage all women with stress incontinence to choose this solution.

OPINIOn

Real testimonies from our patients

Emilia Clarke

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Frequent questions

What else can UI cause?

UI also causes the obvious discomfort resulting from leaks, embarrassment, and withdrawal in patients. Many who suffer from it keep silent, and the lack of information sometimes only aggravates the problem. Nowadays, thanks to web portals such as ours, many people find answers to the most common questions they usually ask in our Seville office once they make the decision to obtain treatment.

Do “normal” pads work for urine loss?
They are hardly adequate; you need another type of material that has a different (faster) absorption capacity for the menstrual flow.
Does eating worsen or improve on the symptoms?

Eating does not help to eradicate the problem, but can mitigate its symptoms and prevent them from worsening. Avoid excess sugar, alcohol and spicy foods and eat a balanced and varied diet.

If I drink less water, will I have less leakage problems?

No, and be careful. Common sense can lead us to think that if we drink less, we will have less need to urinate, but urine that is unbalanced by drinking little water can be very irritating to the bladder and increase the symptoms instead.

Can incontinence caused by a Neurogenic Bladder be cured?

This type of incontinence occurs in patients who have some type of disease/nerve injury presenting many associated pathologies (urinary tract infections, renal deterioration, etc). They require special and individualized care, which depends on the type of neurogenic bladder they develop. The study, treatment and follow-up of these patients must be specialized and intensive, with a continuous and personal doctor-patient relationship. It is complex to cure or eliminate completely. However, through Urodynamic Studies, which involve teaching these patients certain routines such as self-catheterization, and specialized surgeries, it is possible to obtain a better quality of life, while reducing complications and hospital admissions.

What are those beneficial (routine) exercises?

There are very extended routines like the classic Kegel exercises or the newest and most recommended hypopressive gymnastics.

How do I know if urine leakage is not indicating a major health problem?

You should check everything to be reassured, of course. That is why it is ideal that you seek help from a professional (urologist).

How do I know the type of UI I’m suffering from?

You can compare your case with the different types we have described above. However, it’s always ideal for you to seek help from a professional to assess everything in depth as earlier mentioned.

 

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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