Small everyday gestures, such as socializing with family and friends, physical exercise and even sexual activity are strongly inhibited by the impact of urinary incontinence.
The prevalence of UI is largely unknown, motivated by the great difficulty that patients have in admitting the problem to their doctor. It is estimated that in Portugal, approximately 600 thousand patients of different age groups suffer from UI. Between 45-65 years of age, the proportion of cases of UI is 3 women for every man and 50% of people in old age homes suffer from some type of incontinence.
The list of diseases that cause UI is long and the first big message is to realize that the most important step is the correct diagnosis. The best treatment in the world is useless if the disease is misdiagnosed. Despite the multiple possibilities, in women, there are two major etiological groups: Stress UI and Urgent UI.
Stress UI is a consequence of weakened perineal muscles that support the bladder and urethra. This weakness means that in situations of increased abdominal pressure, such as coughing, sneezing, running or carrying heavy weights, the body cannot contain urine. Treatment consists primarily of lifestyle changes that can have an important positive impact, such as weight loss or pelvic muscle strengthening programs (Kegel exercises or biofeedback). Subsequently, the preferred treatment is surgery, with the aim of increasing pelvic support of the urethra and bladder, which consists in the placement of a mesh. This treatment has a high success rate, around 90%, when patients are carefully evaluated by Urologist in an out-patients consultation.
Urge UI, as the name implies, results from a sudden and uncontrollable urge to urinate and has a completely different origin; it occurs when the brain’s control of the bladder is altered, leading to involuntary bladder contractions. Several neurological diseases, Diabetes Mellitus, and even normal aging can contribute to the sudden urge to urinate, later associated with urinary losses.
Urgent UI’s treatment of choice is medication to inhibit involuntary bladder contractions. There are multiple therapeutic possibilities and if they do not work, it is always possible to opt for more invasive methods (either intravesical injection of Botox® or neuromodulation). It is estimated that only 10% of patients with this pathology are medicated, which highlights the need to improve diagnostic capacity and access to treatment.
Nowadays, there is a long list of risk factors for UI, and the best strategy to avoid it is to adopt behaviour to minimize or avoid these risk factors. Long periods without urinating, very common when the patient is away from home, obesity, sedentary lifestyle, smoking, among others, contribute negatively to the onset of this disease. In addition, the correct control of chronic diseases, such as Diabetes Mellitus, Chronic Bronchitis and degenerative pathologies, is very important.
The final message is undoubtedly to seek help and report the case to your doctor will significantly improve your quality of life.
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