Experts Concerned As Urinary Incontinence Among Women Becomes More Common
Introduction
Urinary incontinence in women is a significant social, economic, psychological and medical problem. According to literature data, approximately two out of three women experience urinary disorders. In France, around 3 million women are affected, while in Belgium the number reaches about 470,000. The prevalence of urinary incontinence in Lithuania is also being actively studied.
Approximately 15,000 women visit the Women’s Consultation Clinic at the Obstetrics and Gynecology Clinic of the Lithuanian University of Health Sciences in Kaunas each year, and around 15% of them complain of urinary incontinence. In Kaunas, urinary incontinence among women aged 50–70 reaches approximately 42%.
Urinary incontinence causes many difficulties for women. It reduces physical activity and work productivity, changes daily behavior, disrupts sexual relationships and often leads to social isolation. In order to reduce the burden of urinary incontinence, it is important to thoroughly study the functions of the bladder and urethra, focus on the prevention of childbirth-related injuries, improve medical treatment, develop physiotherapy methods and ensure appropriate hygiene measures.
Urinary System
The urinary system consists of the kidneys, ureters, bladder, sphincters and urethra. Its primary functions are the production, storage and excretion of urine. Working together with other body systems, the urinary system helps remove metabolic waste products from the body and maintains water and electrolyte balance.
Approximately one and a half liters of urine are excreted daily. The urinary system removes urea from the blood, which is produced during the breakdown of proteins from food. Urea is transported through the bloodstream to the kidneys, where it is filtered through the renal nephrons. Combined with water and other waste products, it forms urine.
Table 1. Risk Factors for Female Urinary Incontinence
| Risk Factor | Description |
|---|---|
| Age | The risk of urinary incontinence increases with age. |
| Number of childbirths | Stress urinary incontinence occurs in approximately 3% of women after the first childbirth. The risk increases after each delivery. |
| Postmenopause | Urinary incontinence affects 30–50% of women during the postmenopausal period. Overactive bladder syndrome becomes more common with age. |
| Obesity | Directly associated with overactive bladder syndrome and stress urinary incontinence. |
| Urinary tract infection | |
| Other diseases and functional disorders | Women who have had a stroke, suffer from severe arthritis, or have reduced mobility are more likely to experience stress urinary incontinence or overactive bladder syndrome. |
| Heavy physical work | |
| Medication use | Diuretics, antihypertensive drugs, sedatives, etc. |
| Other factors (diabetes mellitus, use of oral estrogens, hysterectomy, excessive consumption of sweeteners and coffee) |
Urine Formation And Bladder Function
Urine produced in the kidneys travels through the ureters to the bladder by rhythmic contractions and relaxation of the ureteral muscles. Approximately every 10–15 seconds, a small amount of urine enters the bladder from the ureters.
The bladder stores urine until a person feels the urge to urinate. A healthy bladder can usually hold about two cups of urine for approximately 2–5 hours, allowing voluntary control over urination. The sphincters regulate urine storage and release.
When the bladder becomes full, nerves send signals to the brain indicating bladder distension. The urge to urinate then appears, and the brain signals the bladder muscles to contract while simultaneously instructing the sphincters to relax. Once the sphincters relax, urine passes through the urethra and is expelled from the body.
Causes Of Urinary Incontinence In Women
The main factors associated with urinary incontinence include advanced age, pregnancy and childbirth, menopause, obesity, urinary tract infections, cognitive impairment, hysterectomy and occupational factors (Table 1).
It has been observed that women diagnosed with cystocele or uterine retroversion may sometimes retain urine normally, while urinary incontinence is more commonly observed in women with anatomically normal reproductive organs. Urinary incontinence most frequently occurs during physical exertion due to increased intra-abdominal pressure, excessive mobility of the cervicourethral angle and insufficient bladder support.
Table 2. Tests Used to Diagnose Urinary Incontinence
| Tests Used to Diagnose Urinary Incontinence |
|---|
| Assessment of symptoms and medical history |
| Urinalysis and, if necessary, urine culture |
| For women – gynecological examination assessing vaginal mucosal atrophy, uterine prolapse or descent, and perineal damage |
| Neurological examination |
| Cough stress test |
| Assessment of post-void residual urine volume |
| Assessment of willingness for treatment and quality of life |
| Assessment of mobility function |
| Assessment of mental status, consciousness, and mood |
| Urodynamic studies |
Diagnosis Of Urinary Incontinence
The most common contributing factors to urinary incontinence include inflammatory conditions, infections, bacterial contamination and sexually transmitted diseases. Due to anatomical differences, women are approximately ten times more likely than men to experience bladder inflammation.
Occasional bladder inflammation once per year usually does not pose significant risk. However, recurrent infections may increase the likelihood of developing urinary incontinence over time.
Diagnosis is established through detailed medical history collection and general as well as specific examinations (Table 2). During history taking, it is important to determine how often and under what circumstances urine leakage occurs, such as while standing, sitting or during physical activity. Additional questions include whether urination is painful, the amount of urine lost, medications used and access to toilet facilities.
Obstetric history, sexual activity, menstrual cycle characteristics, bowel function, previous pelvic surgeries, congenital urogenital abnormalities, neurological conditions and other disorders potentially affecting continence should also be assessed. Information regarding previous urinary incontinence episodes, prior treatments and the use of pads, tampons, intrauterine devices or vaginal rings is equally important. Body mass index should always be evaluated.
General laboratory tests include complete blood count, biochemical blood tests, urinalysis, blood type and Rh factor determination, coagulation profile, urine culture, vaginal swab culture, electrocardiogram and chest X-ray.
External and internal gynecological examinations are performed to detect genital prolapse, inflammatory conditions, mucosal atrophy, urethral polyps, ectopies, diverticula and ureterovaginal or vesicovaginal fistulas.
Neurological assessment includes evaluation of sphincter tone, voluntary sphincter contraction and perineal sensitivity. Pelvic floor muscle strength is also assessed using specific examination methods.
Additional diagnostic procedures may be performed when necessary to determine the type and severity of urinary incontinence and to select the most appropriate treatment strategy. These include kidney, bladder and pelvic ultrasound, urethrocystoscopy, Bonney test, urinary leakage test, colpocystography and urodynamic studies such as cystometry and uroflowmetry.
Patients may also be referred for consultation with specialists including gynecologists, neurologists and surgeons.
Treatment
Currently, three main treatment strategies are used for urinary incontinence.
Non-Pharmacological Treatment
Patient education plays a crucial role. Women are advised to modify dietary habits by limiting fluid intake to approximately 1.5 liters per day, reducing coffee and tea consumption, avoiding constipation and decreasing excess body weight.
Pelvic floor strengthening exercises, particularly Kegel exercises, are commonly recommended and can be performed at home. Patients should also ensure easy access to toilet facilities and wear easily removable clothing. During exercise or daily activities, specially designed absorbent pads for urinary leakage may be beneficial.
Behavioral therapy and bladder training are also important. Patients should be encouraged to empty the bladder regularly once the urge to urinate appears and to maintain a voiding diary.
Physiotherapy procedures, including electrical and magnetic stimulation, help strengthen the pelvic floor, urethral sphincter system and muscle tone. The best results are often achieved through kinesitherapy, pelvic floor exercises, vaginal cones and specialized rehabilitation devices combined with electrostimulation.
These methods are particularly useful for postpartum urinary incontinence, stress urinary incontinence, overactive bladder syndrome and mild genital prolapse.
Psychotherapy techniques may also help restore cortical bladder control. Relaxation therapy, autogenic training, hypnosis and acupuncture are sometimes used as supportive methods.
Pharmacological Treatment
Anticholinergic medications are commonly prescribed for overactive bladder syndrome. These drugs reduce bladder irritation, decrease involuntary bladder contractions, improve bladder filling and increase bladder capacity.
A newer treatment option for overactive bladder is botulinum toxin injection therapy.
Various medications may be used depending on the type of urinary incontinence, including anticholinergics (tolterodine), mixed-action medications (flavoxate, oxybutynin), calcium channel blockers (diltiazem, verapamil), alpha-adrenergic antagonists (alfuzosin, doxazosin), beta-adrenergic agonists (terbutaline, salbutamol), antidepressants (amitriptyline, imipramine, duloxetine), prostaglandin synthesis inhibitors (indomethacin), vasopressor analogues (desmopressin) and other agents such as estrogens, baclofen and capsaicin.
Stress urinary incontinence may additionally be treated with alpha-adrenergic agonists, beta-adrenergic antagonists and hormone replacement therapy. Bladder instillation therapies are also used in some cases.
Medication is usually combined with pelvic floor exercises and physiotherapy for better treatment outcomes.
Surgical Treatment
Surgical treatment is considered when conservative treatment methods have failed to provide satisfactory results.
Hygiene Measures
Absorbent hygiene products play an important role in managing urinary incontinence. Women often worry that urine leakage may become noticeable to others, causing embarrassment and discomfort.
Although many women initially use menstrual pads, specially designed urinary absorbent products such as TENA Lady are more effective. These products absorb larger amounts of fluid, provide rapid moisture absorption and distribution and help control unpleasant odors.
Urinary absorbent pads are generally recommended to be changed approximately three times per day. If more frequent changes are required, products with higher absorbency should be considered.
Appropriate use of specialized hygiene products helps women manage not only hygiene-related issues but also psychological and social challenges associated with urinary incontinence. These products help preserve self-esteem, mobility, independence and quality of life.
Summary
Urinary incontinence is a common condition affecting women of different ages and significantly reducing quality of life. Despite its prevalence, many women hesitate to discuss urinary incontinence with healthcare professionals, and physicians may not always ask about it directly.
When urinary incontinence is suspected, it is important to identify temporary contributing factors and determine the predominant type of incontinence in order to select appropriate treatment and prevent further complications.
Compiled by Rūta Jasiukevičiūtė
Source: "Internistas" No.6, 2016
