Urinary incontinence is a frequent problem in women, especially those who have had children and with more incidence after menopause.
Although it is a common pathology, we should not normalize it, because it can be treated and reject the idea conveyed by advertisements for feminine urine pads that it is something normal.
It is basically a female problem due to the different anatomy between men and women. The much shorter length of the female urethra compared to the male urethra, and the fact that women have a hiatus in the pelvic floor, through which the vagina passes, and men do not, make this pathology practically a problem of the female gender.
In short, there are two types of urinary incontinence: stress urinary incontinence and urge urinary incontinence.
Stress urinary incontinence is manifested when a force acts on the pelvic floor, which is weakened so that an effort such as a cough, sneeze, jumping, running, climbing stairs or lifting a weight causes a leakage of urine, a few drops or a jet, depending on the severity of the defect. It translates a weakness of the pelvic floor that apart from having a genetic component, is usually related to the trauma to the tissues involved in pregnancy and vaginal delivery. Under normal conditions, when a woman’s tissues are in good condition, when facing an effort, the urethra is supported by a firm pelvic floor that prevents the flow of urine through it when it is pushed down by this force. We will make a simile to make it easier to understand: If the urethra is a kind of hose through which water passes, and we exert a force on it (we step on it) we will have a different result if we do it on a firm ground (cement) or not firm (soft soil). In the first case we will be able to impede the flow of water, and in the second case the hose will sink and continue passing water.
The treatment for this type of incontinence is to strengthen the pelvic floor. In the case of mild defects, it can be corrected with physiotherapy of the muscles involved, restoring strength and tone to the pelvic floor. In the case of more serious defects, it is sometimes necessary to resort to surgery, placing a kind of “tape” of synthetic material under the urethra, anchoring it to the ligaments of the pelvis so that it acts as a firm floor when there is an effort.
Urge urinary incontinence has nothing to do with it. It can be associated with stress incontinence, in which case we call it mixed incontinence, but it can occur in women with complete anatomical integrity, with a firm pelvic floor. So what is wrong? Under normal conditions, for voluntary urination to take place, a complex mechanism is set in motion that on the one hand unblocks the forces that act as “sphincter” and have the task of preventing urine leakage if it is not the right time, and on the other hand the bladder walls contract, pushing the urine to the outside with more or less pressure depending on the force exerted, and these mechanisms are set in motion voluntarily when it is consciously time to urinate. For women with urge urinary incontinence what happens to them is that involuntarily the bladder contracts intensely and urine leaks. We have probably all felt the urge to urinate when we hear the sound of running water, or when we touch cold water, or when we get home we need to run to the bathroom when seconds before we were not even aware that the bladder was full. In these patients the need is so compelling that urine escapes before reaching the toilet before these stimuli, or even without them.
This type of incontinence can be treated with medication to prevent involuntary bladder contractions and physiotherapy can also be of help because the more toned the muscles are, the more effective they will be in counteracting the force of the uninhibited bladder contractions.
It is very important to know what type it is, through a directed and deep interrogation and the appropriate complementary tests, because the treatment is very different, and if a good diagnosis has not been made, the chances of treatment failure are high. And face surgical treatment if necessary, as it is not very aggressive and gives very good results. If you have this problem, do not resign yourself to live with incontinence and limit your activities because of it.
Dra. Natàlia Garcia Montaner