|Urinary incontinence in women|
Urinary incontinence: what can you do? If you happen to lose urine unintentionally, also called “urinary incontinence”, you should know that this is a very common disorder in women, especially after childbirth. or after menopause. However, this is not inevitable: with appropriate management, most women achieve marked improvement in this problem.
Urinary incontinence is a largely underestimated problem in clinical practice. Its prevalence in women rises to almost 50% in adulthood, according to cross-sectional studies. The majority of the patients concerned do not spontaneously talk to their doctor about it, either out of modesty or because they think that there is no treatment. The pathophysiology of urinary incontinence is complex and not fully understood. The aetiologies can be multiple and often intertwined.
Asymptomatic classification of urinary incontinence
Urge-type incontinence (bladder instability): Urgencies (sudden and urgent need to urinate, difficult to postpone) accompanied by loss of a greater or lesser amount of urine often related to the need to urinate frequently or at night.
The possible causes are multiple, most often idiopathic
Stress incontinence: Loss of small amounts of urine with increased intra-abdominal pressure due to exertion, sneezing, laughing, coughing, or simply standing. Possible causes: often secondary to laxity of the ligaments of the gynecological sphere, the urethra and the anterior wall of the vagina (pregnancies, childbirth), and/or an intrinsic deficit of the urethral sphincter (more common in elderly postmenopausal women) Mixed type incontinence: Association of urgency type and stress type incontinence (in variable proportion)
Overflow incontinence: More or less continuous drip discharge, daily, linked to urinary retention (bladder), which may be secondary to a history of pelvic surgery/radiotherapy, or to suprasacral neurological damage. Also to be suspected in case of repeated urinary tract infections, or worsening under antimuscarinic treatment. A clinical diagnosis based on symptomatic classification is sufficient to initiate conservative treatment. Conservative management is based on changes in lifestyle, specialized physiotherapy, and in some cases drug treatment.
In studies of various physiotherapy protocols, there is a reduction in the frequency of incontinence episodes of around 60%. At least three out of four women find satisfactory improvement in their incontinence. According to clinical studies and medical guidelines, physiotherapy should be offered systematically as a first-line treatment. It allows the strengthening of the pelvic floor by Kegel exercises (repetitive directed contractions of the pelvic muscles), supplemented if necessary by biofeedback or electrical stimulation in the event of difficulty in identifying the musculature concerned. Physiotherapy should also include bladder training, which involves teaching a gradual spacing of the intermittent interval