2017 03 27
Today urinary incontinence is no longer a problem
Gynaecological Diseases, Women’s Health
„I was jumping on the trampoline with my child when I realized that there had been an accident,” Irena Kirilova, an obstetric gynaecologist at the Medical Diagnostic and Treatment Centre shares her patient’s story with us. This is not exceptional at all that urinary incontinence has affected a young woman.
Doctors become more and more outspoken about the problem of urinary incontinence. Is this yet another epidemic caused by the modern lifestyle?
The involuntary leakage of urine has always affected women as well as men. This fact has probably contributed to our subconscious belief that we will inevitably experience a certain degree of urine incontinence as we grow older, and that incontinence is an unavoidable consequence of natural childbirth. We, gynaecologists, want to emphasise that this condition can be efficiently treated and people do get their normal life back. It makes no difference if you are thirty or eighty-five, if you experience urinary incontinence, you have to see your doctor and start treatment,” says obstetric gynaecologist Irena Kirilova.
Does a drop of leaked urine when a person sneeze qualifies as urinary incontinence? When is the time to start worrying?
Any involuntary leakage of urine, notwithstanding the amount, is a signal that “the system” is not airtight. The condition can be triggered by a number of different reasons, dictating the choice of treatment method. Treatment can be pharmacological or surgical, but sometimes it can be enough to make a lifestyle change, break certain eating habits or strengthen the pelvic floor muscles, especially when it comes to young women. Minor leaks are not life or health-threatening, and sufferers often try to solve the problem themselves.
Nowadays there is a wide range of sanitary products to choose from. However, the condition gradually progresses, and patients isolate themselves in fear of suffering “an accident”; they refrain from travelling, meeting other people, going to the theatre, doing active sports etc. This can lead to an inferiority complex and even depression. You should see the doctor if you leak urine involuntarily when coughing, sneezing, vomiting, or need to urinate often and go to the toilet at night if urination causes you pain or you experience a burning sensation if the urine becomes cloudy or contains traces of blood. Apart from pointing out the urinary incontinence problem, this could be indicative of other renal or bladder diseases.
What causes urinary incontinence?
Urinary incontinence mainly affects older people, and due to their anatomy women are more prone to it than men. The condition may be triggered by dementia, multiple sclerosis, Parkinson’s disease, stroke, endocrine disorders and use of certain medications.
Young and middle-aged women may experience urinary incontinence after childbirth if the baby was big or the delivery was complicated, and the perineal and pelvic floor muscles were overstretched. All mothers are advised to do Kegel exercises for strengthening their pelvic floor muscles daily, both before and after delivery. Simple exercises are very effective in that they work on vaginal and pubococcygeus muscles that help to anchor the pelvic organs in their proper anatomical locations, securing them from descent – the so-called uterine prolapse. Kegel exercises can add a whole new dimension to your intimate life.
There are three main types of urinary incontinence: stress incontinence, overactive bladder syndrome and mixed. Stress incontinence occurs due to a change in the position of the bladder neck or urethra, or decreased urethral closure pressure. In this case urine leakage is caused by physical exertion; involuntary leaks occur during lifting, running, coughing, sneezing, vomiting or laughing. Stress incontinence also includes emotional stress.
Women suffering from the overactive bladder syndrome constantly feel a sudden and strong urge to urinate even when their bladder is not full. Patients share that they feel a strong need to go to the toilet when they have nearly reached their home or are unlocking the door, but it then appears that the bladder wasn’t full. A similar effect may be caused by running tap water. In this case, involuntary leaks are caused by increased bladder receptor sensitivity.
What is urinary incontinence treatment? Is surgery unavoidable?
At first, the doctor has to establish the cause of the condition and therefore checks for pelvic organ prolapse, performs diagnostic tests and confirms the type of urinary prolapse. At times the causes of the condition are not that obvious, and then longer tests, consultations with the urologist or other doctors are required. During the consultation with the gynaecologist, the patient’s bladder needs to be full, i.e. they should not go to the toilet just before. If the diagnosis is overactive bladder syndrome, patients are normally prescribed medicines to reduce the sensitivity of the bladder receptors. Patients should also observe a certain diet, try to lose weight and strengthen their pelvic floor muscles.
Surgery is the most efficient treatment for stress incontinence and is performed as a minimally invasive surgery by the vaginal route. A narrow strip of synthetic mesh is placed under the urethra. This method works for 95% of patients, and in 70-80% of cases, the results are still retained 5-10 years later. The surgery takes just 10 min, and it is performed under general anaesthesia; 24 hours later the patient is discharged.
Drinking water is important
“Urinary incontinence sufferers often try to limit their fluid intake. This is a very bad decision, especially for those affected by the overactive bladder syndrome,” observes Dr. I. Kirilova. “Concentrated urine irritates the bladder, even more, causing the opposite effect. Everyone has to get enough water, but it is a good idea to avoid coffee, carbonated drinks, concentrated juice, alcohol and spicy food. Notwithstanding the type of their condition, patients are advised to lose excess weight, do Kegel exercises to strengthen their pelvic floor muscles, take good care of themselves and avoid lifting heavy loads or putting themselves under too much strain. These measures will help to stop the progression of urinary incontinence and prevent pelvic organ prolapse.”
Regular check-ups and open discussions with the gynaecologist will help to detect the bodily changes in good time, avoid diseases and control the consequences of natural ageing processes.