What is urinary incontinence?
Urinary incontinence or enuresis
is the involuntary loss of urine at a time and inadequate, that can be
objectified and demonstrate and creates a hygienic and social problem
for the person who has it. So far it has not been recognized as a disease in itself, but as a sign or symptom common to many other disorders or diseases.
Of interest
Who is affected?
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It is estimated that between half and one million women suffer from it in Spain. We know that only a small proportion of these women seek medical help.
Women do not usually consult directly by this problem, try to keep the
disorder hidden as long as possible and tend to endure stoically, either
by shame, because they consider it unavoidable or because they assume
that is an inherent consequence of aging and, therefore, no solution. Due to this concealment, often it becomes a problem taboo or a long concealed symptom.
Although from a medical point of view is not a serious problem and is
not a cause or threat of death, it has significant social implications
and can affect the self-esteem of the person, causing devastating
effects on the health and welfare of the woman who has it ( depression , social isolation, damage to one's identity, etc.).
It has been found that the quality of life of these women is also lower.
Aspects of daily life that are most affected sleep and rest, mobility,
emotional behavior, social interaction and leisure activities. Health professionals have an important role in detecting these patients incontinence.
Age is the main factor associated with incontinence, detecting a peak of maximum frequency between 50 and 60 years.
Have identified a number of additional risk factors:
obstetrical-gynecological (pregnancy, childbirth, pelvic organ prolapse,
hysterectomy), general diseases ( obesity , heart disease , arterial hypertension
treated with diuretics, nervous system diseases) and factors
environmental and occupational, that may predispose to this disorder.
Types of incontinence
Basically there are the following types of urinary incontinence:
- Stress: is the involuntary loss or leakage of urine to a daily effort as coughing, sneezing, laughing, running, walking, jumping, lifting a weight, incorporated a low seat, etc. It is the most common type of urinary incontinence in women.
- Urgent: the involuntary loss of urine associated with a strong urge to urinate. The woman disclaimer will urinate and can not help it. Usually it accompanied by an increase in the number of day or night urination.
- Mixed: when the same woman match involuntary urine loss associated with urgency and effort.
- Continuous: constant and continuous loss of urine.
- Overflow: involuntary loss of urine that occurs in the form of drip associated with urine retention. Women can refer incontinence symptoms associated with symptoms of difficulty emptying the bladder of urine.
- Overactive bladder include those patients with symptoms of increased urinary frequency and urgency, with or without urge incontinence, presumably produced by the same mechanism as urge incontinence.
Evaluation and study of a patient with urinary incontinence starts with
a correct and comprehensive history or directed and aimed at obtaining
abundant information provided by the woman questions, followed by a
complete physical examination and complementary studies that estimate
the specialist who studies (analysis, imaging, specialized urological
studies, etc.).
The procedures basic diagnostics we include the history, risk factors and predisposing, basic analyzes of blood and urine
, called questionnaires of symptoms and quality of life and voiding
diary (record of all episodes associated with urination and urinary
symptoms for a period of 2-7 days).
The physical examination will be comprehensive and include the general
part but also a neurological examination, urology, pelvic and gynecological .
Among the specialized urological procedures usually a urodynamic examination, ie the measurement of pressure, flow and volume of urine from the patient will be included. This consists of various tests such as peak flow graph or urination; cystometry or measurement of the volume / pressure ratio urinary bladder;
study pressure / flow, which studies the emptying phase of the
micturition cycle and other more sophisticated electrophysiological
studies as urethral sphincter electromyography, the viedocistografía and
videoecocisto
The techniques are the most common image ultrasound , the radiography Simple abdomen, x-ray contrast cystography or bladder urine, urography and intravenous contrast radiography of the entire urinary tract and nuclear magnetic resonance . Finally, you can also perform a urinary endoscopy or urethrocystoscopy.
Medical treatment
Basically it includes:
- Most basic lifestyle modifications, such as restricting drink liquids and distributing them throughout the day.
- Techniques of behavior modification, as called timed voiding, bladder training, voiding adaptation, pelvic floor exercises and relaxation techniques to reduce the level of anxiety often associated. In short, a series of techniques or treatments that apply the concepts of learning theories to behavioral disorders.
- Drugs, usually the drug group called anticholinergics (oxybutynin, trospium chloride, tolterodine, etc.). These drugs improve and may even solve the urgency, but do not produce benefit in urinary incontinence.
It is the preferred treatment of urinary incontinence. There are several surgical techniques.
Currently the most commonly used are performed through the vagina by
placing different materials or ribbons around the urethra, or urine tube
trying to put it to its correct anatomical site.
Functional treatment
Fundamentally pelvic floor rehabilitation, where the muscles that open and close the sphincter of the bladder.
The purpose of pelvic floor exercises is to improve, in general, the
tone of the muscles in this area and, more specifically, a major called
detrusor muscle of the bladder.
These exercises exercise emphasizes the call Kejel consisting of "cutting the flow of urine during urination voluntarily". This exercise will help women to know which muscles should contract. They should be practiced outside urination sessions 25 times in succession three times daily. As with any exercise, consistency is needed in its implementation and its effects can be observed in the long term. All these exercises are performed to improve urinary incontinence.
New alternatives - Injectable agents: is the creation of a compression around the urethra to increase the resistance to the closing mechanism. Have been used, with varying results, different substances such as collagen, saline filled microballoons or collagen microspheres coal, oil, etc.
- Sacral root neuromodulation: indicated in patients with urge incontinence who have not responded to conservative treatment, and before surgery. It involves electrical stimulation of the sacral nerve plexus in order to modulate abnormal involuntary reflex root lower urinary tract. The stimulation system is fully implantable and consists of 3 components: an electrode, a generator similar to a pacemaker electrical impulses, and a cable that connects them.
- Palliative: When none of the above treatment has been effective. It produces a significant improvement in the quality of life of patients and although not directly address the causes of the problem, it does improve their social consequences. In this type of palliative care medical devices for incontinence which highlight absorbent, popularly known as diapers are used. As the name suggests, are products intended to absorb and retain urine and be worn by incontinent people about their body keeping the patient dry and preventing wet clothes or bed. Exist in the market absorbent various shapes, sizes and absorption capabilities that facilitate use depending on the type of urinary incontinence, the patient characteristics and physical activity. They are placed on the body by a suitable fastening device.
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What treatments are used?
Each type of incontinence requires specific treatment, so it is very
important to the proper assessment and individualized study of the
patient by the medical specialist, as we noted before. It is interesting to know the preferences of the patient, the kind of life you do and your personal circumstances.
Various treatments have been proposed, which we review
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