This pathology generally has a negative impact on the quality of life of the person and affects the family, social and professional sphere of the patients. But the emotional repercussions and the associated economic costs make this pathology a taboo subject and often lived in secret. Most patients do not seek medical evaluation for fear of social stigma, and much of the population views urinary incontinence as normal with age or as a consequence of physiological processes.
There are several causes that can lead to UI and in the vast majority of cases there is more than one cause, but speaking of the most common ones:
- age (more common at advanced ages);
- sex (more common in women due to the circumstances of pregnancy, childbirth and menopause);
- pelvic surgeries;
- associated drugs (diuretics, muscle relaxants, etc.).
Causes can be transient or permanent. Transient causes are associated with urinary tract infections, ingestion of alcohol, caffeine, carbonated drinks, or foods that irritate the bladder, excessive fluid intake, or temporary use of certain medications. Permanents can go through neurological diseases (Parkinson’s disease, stroke, multiple sclerosis), pelvic surgeries, urinary obstructions, menopause, or decreased pelvic floor muscle strength. Pregnancy, vaginal deliveries and menopause, as well as pelvic surgeries, are the main risk factors for weakening the perineal muscles.
Therefore, understanding what type of incontinence we are talking about is also important to define the therapeutic approach. This explains the identification of the different types of urinary incontinence:
Stress Urinary Incontinence (SUI):
It is the most common form of incontinence. Occurs as a result of physical activity or exertion, such as jumping, sneezing, coughing, laughing, or lifting heavy objects. In the most severe cases, the loss can occur during light activities such as, for example, walking, getting out of bed or even sitting in a chair.
When it comes to SUI, weakness in the muscles of the pelvic floor, the muscles that support the bladder and the urethra – the channel that carries urine from the bladder outwards – are the main causes. Therefore, sudden movements or movements that increase pressure in the abdominal region and pelvic muscles (a piston-like movement) cannot withstand the excessive load, resulting in urine leakage (which may be drops or jets).
Urge Urinary Incontinence (UII):
In this case, urine leakage is associated with episodes of urgency, that is, a sudden and intense urge to urinate, for example, when we come home or hear water running . In these situations, the bladder muscle contracts too soon and it is not possible to control the outflow of urine through the urethra. Other complaints associated with IUU fishing are:
- pain in the pelvic area or burning sensation when urinating;
- need to urinate more than eight times a day;
- wake up at night to urinate.
Mixed urinary incontinence (MUI):
This type of urinary incontinence combines symptoms of stress urinary incontinence and urge urinary incontinence. In this type of incontinence, the patient may feel an urgent need to urinate, such as leaking urine while playing sports.
Incontinence due to extravasation:
It arises from the inability of the bladder to withstand large volumes of urine and because its pressure exceeds the resistance capacity of the urethra.
This is a reality in patients with pathologies such as dementia, Alzheimer’s disease or Parkinson’s disease, which prevent patients from reaching the toilet in time.
Very common in children but also in adults, characterized by the loss of urine during sleep.
These are problems that more or less affect the quality of life of the people concerned. It is therefore important to have an early diagnosis and the adoption of an appropriate treatment, favoring prevention as much as possible. Thinking about pelvic care the way we think about our daily health care should be the norm.
The explanations are from the physiotherapist Soraia Coelho, specialized in the rehabilitation of the pelvic floor.