Urinary Incontinence

Stress urinary incontinence (SUI) occurs when the patient makes some physical type of effort (coughing, sneezing, laughing) or exercise (jumping, dancing, jogging …) which leads to an increase of abdominal or bladder pressure.

This is the most frequent type which especially affects women. Predisposing factors are the number of pregnancies and deliveries , whether intervention was instrumental (forceps) or prolonged,  during menopause or previous gynaecological surgery.

SUI has a great impact on the quality of life for the people who suffer from it, since it prevents daily activities which generate a feeling of frustration.

Treatment varies according to type, seriousness and the patient:

• Conservative treatment for mild or temporary processes.
• Surgical treatment with biocompatible mesh implantation, being minimally invasive, requires only a few hours of hospitalization.

Urgency urinary incontinence presents itself, with a feeling of urgency. UI features are urinary urgency, high urinary frequency (increased frequency of urination) both day and night, and  small voided volume. It is produced by the involuntary contraction of the muscles of the bladder. The frequency increases with age, being higher in women. There are several causes, the most common are: urinary tract infection, urethral or bladder stones, bladder tumours, neurological or over active bladder .

UI is often associated with SUI (25%) named mixed UI. Treatment of UI is organized on two levels:

• Behavioural Treatment (change of fluid intake habits, distribution of voids), pelvic floor rehabilitation (specific exercise), Biofeedback. Electro stimulation.
• Pharmacotherapy.

a) Overflow incontinence: which occurs when the bladder is completely full and for some reason, such as the existence of obstruction or lack of strength in the bladder, urination is not achieved naturally, overflowing with urine when it exceeds the maximum bladder capacity.

b) Neurological disease associated with Incontinence: Many neurological diseases affecting the bladder and / or sphincter causing incontinence (Parkinson’s disease, multiple sclerosis, myelitis, spinal cord injuries, birth defects, and neurological tumours…) even in Diabetes Mellitus in some form of neurological voiding can be found.

c) Postsurgical incontinence: As a result of a surgery, there may be temporary or permanent incontinence. This is usually caused by damage to the urinary sphincter or injury to the nerves involved in continence. The most common interventions are:

• radical prostatectomy for prostate cancer.

• colorectal surgery for colon or rectal cancer.

• prostatic adenomectomy or resection of prostate.

• post-radiotherapy.

d) Enuresis or child bedwetting: is urine leakage during sleep in children over 5 years of age.

e) Urinary fistulas: are pathological communications between the bladder or urethra and the outside (vagina, perineum, rectum …) as complications arising from previous surgery.