Female Urinary Incontinence
What is Female Urinary Incontinence?
Female urinary incontinence is characterised by involuntary urine leakage. Its frequency increases with age and is usually seen in women aged 40 and upwards, becoming very common in women of an advanced age.
Though benign, this condition can significantly reduce quality of life and self-esteem, and substantially limit everyday activities, affecting general well-being and often leading to depression.
The patient is constantly afraid that any urine loss will be noticed by others; they fear that the people around them can smell the urine and often avoid leaving home or even doing the most basic and simple everyday activities, knowing they can trigger urine loss.
Risk Factors for Urinary Incontinence
Number of pregnancies and vaginal births
Obesity, which enhances and perpetuates incontinence
Besides these, this condition can affect women who are deficient in oestrogen, suffer a structural change in the pelvic floor or urogenital mucous (changes which worsen after menopause), have diabetes or dementia, or suffer a loss of cognitive capacity
Symptoms of Female Urinary Incontinence
The symptom of incontinence is... loss of urine. It is very common for patients to mention "I lose urine from time to time, but I don’t have incontinence!"
There are various types of incontinence.
It can occur due to exertion that increases abdominal pressure (such as coughing, sneezing, lifting heavy objects, running, dancing, physical exercise), in which case it is known as stress incontinence.
It can be associated with a sudden urge to urinate. The patient feels an urgent need to urinate, that they cannot retain urine and eventually loses urine. This is called incontinence associated with a hyperactive bladder.
Many women suffer from both types of incontinence. This is known as mixed incontinence.
Pelvic organ prolapses (POPs) are often associated with this problem. Around 48% of women have some degree of urogenital prolapse.
Other Origins of Urinary Incontinence Symptoms
Another problem associated with urinary incontinence is urogenital prolapse. Around 48% of women have some degree of urogenital prolapse.
When concomitant, pelvic floor diseases must be studied in conjunction and the treatment must, whenever possible and indicated, be simultaneous.
For example, isolated surgical correction of a urogenital prolapse may reveal an incontinence that should, whenever possible, be corrected in the same operation.
Diagnosing Female Urinary Incontinence
The diagnosis is clinical and immediate and provided to patients quickly and simply. As a rule, incontinence is very easy to assess and diagnose.
The key aspect for a good diagnosis, however, is a correct characterisation of incontinence and an assessment of the type of incontinence in question.
After analysing the patient’s clinical history and undertaking a careful objective examination (including a gynecological exam), which help to clarify important urological, obstetric and gynecological details, several other tests are performed such as uroflowmetry, ultrasounds, blood and urine tests, full urodynamic testing and cystoscopy.
These help to clarify if there are any discrepancies between the symptoms and clinical observation, and to confirm the patient’s specific type of incontinence.
Dr. Daniela Moutinho explains what urinary incontinence is.
Do you Have any Symptoms of Urinary Incontinence?
Treatment of Female Urinary Incontinence
The treatment chosen depends on the type of incontinence diagnosed and the needs of each specific patient. Different therapeutic solutions exist.
In most cases, the treatments are relatively simple and have excellent immediate results that continue in the medium and long term.
Currently, the best-known and most common treatments are minimally invasive surgeries (such as transobturator suburethral sling surgeries) and pelvic rehabilitation/physiotherapy. The latter includes Kegel exercises and also electrostimulation and biofeedback to strengthen the pelvic muscles.
However, lifestyle and behavioural changes and oral or intravesical medication can play an important or even crucial role in complementing the effectiveness of the aforementioned techniques, particularly in incontinence associated with urge and a hyperactive bladder.
Prognosis of Female Urinary Incontinence
The prognosis is positive, as the treatments for this condition are mostly very efficient. In addition, this urinary problem has a low rate of symptoms recurrence.
Patients usually recover their quality of life and can return to “normality” and their daily routines without any restrictions.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Female Urinary Incontinence
Does urinary incontinence occur more in women than in men?
Does childbirth raise the likelihood of urinary incontinence?
What are the main symptoms?
How is urinary incontinence diagnosed?
References
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- Urinary Incontinence - https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808
- What is Urinary Incontinence? - https://patients.uroweb.org/other-diseases/urinary-incontinence/