Urinary incontinence (in the elderly, during pregnancy): treatment

When urinary incontinence is not related to serious illnesses or risk factors (such as infections or cancer ), in general, it does not damage the patient’s physical health. However, emotional and social aspects are the most affected.

This is because, even in cases where there is little leakage of urine or dripping (when the pee is dripping after you go to the bathroom), the patient usually feels embarrassed. In cases where there is a high degree of incontinence, social relationships are even more affected, directly affecting personal and professional activities.

The result is that the patient, who often does not have any other delimiting symptoms, is inhibited when leaving the house due to the possibility of involuntarily urinating on the street, for example.

Urinary incontinence has several causes that involve structural conditions of the organism, age, habits and routine (physical exercise and food), in addition to diseases or dysfunctions of the urinary tract.

Treatment includes conservative, drug or surgical measures. In general, less invasive measures have good results and the patient does not need to undergo surgery.

Even in cases where surgical or medication procedures are not effective, it is possible to adapt the routine to prevent incontinence from causing disorders and compromising activities.

The structure of the bladder

To understand bladder dysfunction, we can start with the path that water takes when it is ingested, nourishing the tissues, passing through the organs, until it is eliminated.

The water path

Water travels in a similar way to food. After being ingested, it passes through the mouth, pharynx, esophagus, stomach (where a small amount is already absorbed) and reaches the intestine. The intestinal wall then absorbs most of the liquid and sends it into the bloodstream.

The blood flow directs water to the organs, nourishing the cells. The liver, the heart, the lungs and again the heart receive the liquid, which finally reaches the kidneys, which have the function of filtering the blood and, therefore, assist in the formation of urine.

Each person has 2 kidneys, which look like a slightly larger bean . In fact, much bigger, because each one is about 12 cm long and 7 cm wide. Inside the kidneys are hundreds of small structures called nephrons, which look like filtering tubules.

They are the ones that will form the urine. After the blood passes through the nephrons and is filtered, it returns to the body. But the content that was separated from the fluid constitutes the first stage of the formation of urine, also called pre-urine.

This content is loaded with wastes from the body that are going to be eliminated, but it also has minerals, glucose and amino acids that are reabsorbed while the pre-urine travels through the nephrons.

In the final part of the nephrons, part of the water is reabsorbed and returned to the blood, another part is sent to the bladder.

The amount of liquid absorbed depends on the need to hydrate the body. Therefore, if you drink water frequently, less liquid will be absorbed, as the body is probably well hydrated.

The compound that reaches the bladder is finally called urine and is directed to the organ through the ureters (which are channels similar to a straw). The urine accumulates and, when we decide to go to the bathroom, it goes through the urethra (another tube that conducts the pee) until it is eliminated.

Until it is eliminated, the pee passes through 2 sphincters, which are plugs in the urethral canal. The first is involuntary (that is, you cannot command your contraction or opening), the second is voluntary, being responsible for holding your urine when you have not reached the bathroom yet.

Urine in the bladder

The bladder is a kind of bag that extends and empties, capable of storing urine and releasing it only when there are nerve stimuli.

The organ has muscular walls, which contract to eliminate the fluid, and is located in the pelvis, region below the navel.

The pelvic region is the hollow of the pelvis, close to the waist. The pelvic floor is a muscle group responsible for assisting in the support of organs such as the bladder, uterus and intestine.

In general, the first urge to go to the bathroom comes when the bladder is approximately 150mL of urine. The organ, despite being elastic, has a maximum capacity between 400mL and 500mL of liquid.

To signal that it needs to be emptied, signals are sent to the brain and trigger the feeling of wanting to go to the bathroom. In healthy people, this will is controllable, even for longer periods.

In the lower part of the bladder there is a kind of plug, called an internal sphincter, which is not controlled by our will. The brain sends commands for the internal sphincter to relax and open, allowing urine to pass.

The bladder wall is made up of muscles for one reason: they need to contract to help empty the organ.

Then the urine begins to flow into the urethra, but it can be voluntarily held by the external sphincter. This prevents emergencies from occurring on the way to the bathroom.

But if there is loosening of the sphincter muscles, dysfunctions or problems in the urinary tract, it may be that small or intense leaks of urine occur.

Types

There are 3 best-known types of incontinence: stress, emergency and mixed. These represent the majority of diagnoses. However, there are still other classifications. The categories most used by doctors are:

Stress urinary incontinence

In general, it is the type of incontinence that causes less leakage of urine. This is because it is associated with some activity or movement of the body that exerts or increases intra-abdominal pressure, for example coughing, sneezing, laughing, jumping or moving.

In other words, there must be physical and intra-abdominal efforts for the pee to escape.

Urgent urinary incontinence

The type of urge incontinence generally compromises the patient’s daily activities more severely, as the urge to go to the bathroom is sudden and uncontrollable.

The bladder has a hyperactive function, that is, there is a constant or increased contraction of the muscular wall of the organ without any need. As the person does not have the ability to hold the pee, any activity (even sitting) can be interfered by the urge to urinate.

Mixed incontinence

The mixed type of urinary incontinence shows leaks during activities that force the abdominal region, such as coughing, and also at any time of the day, regardless of the activity. That is, the signs of mixed incontinence associate the type of effort and urgency.

Overflow incontinence

When the bladder fills, signals are sent to the brain about the need to go to the bathroom. The brain returns commands to the bladder and sphincters (involuntary and voluntary).

However, if the patient has a decrease in sensitivity (does not feel a full bladder), a weakening of the bladder wall or a chronic urethral obstruction, overflow leaks may result as a result of high bladder filling. Therefore, this type of incontinence can also be called paradoxical incontinence.

Urethral obstruction is more common in men, but reduced sensitivity is more prevalent in patients with diabetes , problems that affect neuronal function or are dependent on alcohol.

Chronic urine retention

In chronic urine retention, it is difficult to start emptying the bladder, which is usually accompanied by the inability to eliminate all the urine.

After the patient goes to the bathroom, involuntary drips and small losses of urine may occur. In addition, the condition favors infections, which can result in urge incontinence.

Coital urinary incontinence

The type is characterized by the loss of any amount of urine during sex. Despite occurring more frequently at the time of penetration or orgasm, the pee can leak at any time.

Nocturnal Enuresis

The type is quite common in children and usually represents a transient condition. Nocturnal enuresis tends to be associated with psychological, emotional factors or the ability to control the body.

Especially in childhood, bed wetting is a recurring situation. This is because the neuronal and urinary systems are not coordinated at all. Even after a few periods, stress and fear (for example, nightmares) can cause a leak of urine.

Causes of urinary incontinence

The causes of incontinence are diverse and also depend on the type.

For example, in urgent urinary incontinence, there is an involuntary contraction of the bladder wall. While the organ is still being filled, the muscular wall moves and forces the urine to descend into the urethra.

The conditions that most cause this undue contraction are stroke, Parkinson’s disease, multiple sclerosis, diabetes and myelodysplasia.

Urgent incontinence may also occur without pathological conditions involved. In this case, the dysfunction is caused by elements such as a tumor or bladder stone.

The causes of stress incontinence are caused by a malfunction in the final urinary tract process, which may involve an increased movement (hypermobility) of the urethra or the inability of the sphincter to remain contracted.

In these cases, the urethra may be affected by neurological disorders, changes in the urethral structure, as well as atrophy of the sphincter muscle.

In general, the situations or conditions that cause the most leakage of urine are:

Bladder muscle hypoactivity

The weakness of the bladder wall, also called hypoactivity, can alter the functioning of the organ. In general, there is an inability to pee properly, which can involve difficulty starting to urinate or emptying the organ completely.

Even though, initially, hypoactivity retains urine, over time the bladder overfills and reaches its limit. The result is that there is overflow incontinence.

In addition, the condition favors infections to develop and affect the urinary tract, causing urge incontinence.

Blocking or obstructing the bladder outlet

Different conditions can affect the final part of the bladder and the urethra, preventing the urine from being properly controlled and eliminated. Among the most common causes may be prostate hyperplasia, prostate cancer , bladder stones and even medications that cause the region to contract.

Chronic cough in smokers

Nicotine acts as a stimulant of the bladder muscle and the components of tobacco can irritate the tissue of the organ and favor the increase of contractions, resulting in urinary hyperactivity and, consequently, in urgent incontinence.

In addition, smoking can irritate the respiratory mucous membranes and cause chronic coughing which, in itself, can increase intra-abdominal pressure and encourage leakage of urine.

Gynecological or pelvic surgeries

Patients who have undergone pelvic or gynecological surgery, such as removal of tumors, may have a weakening of the sphincter, which causes incontinence.

Radiotherapy

As with surgeries, the radiotherapy procedure after surgery in the pelvis region can affect sphincter muscle contractions and relaxation.

Urinary fistula

There is an improper connection or communication between an organ (usually the bladder, but it can also be the ureters) and the vagina. Some very rare cases can involve communication between the bladder and another organ, such as the urethra, uterus or intestine.

In general, the condition occurs after surgical procedures, inflammations or infections, injuries, trauma or radiological treatments.

Diabetes

People with diabetes can have bladder sensitivity altered, and the occurrence of urinary disorders in these patients is up to 2.5 times higher. The relationship between incontinence and diabetes can be established by several causes, that is, it is usually a multifactorial condition.

Normally, there may be changes in muscle, neuronal, urothelial responses and inflammatory processes in the tissues involved causing:

• Bladder hyperactivity;
• Dysfunction of the urethral sphincter control;
• Infections of the urinary tract;
• Urinary retention (causing overflow incontinence).

In addition, patients with uncontrolled diabetes or hyperglycemia tend to drink more water. With excessively high intake, visits to the bathroom are more constant. If there is a factor predisposing the difficulty of holding urine, there is a greater chance of leaks.

Diabetic neurogenic bladder

Urinary incontinence in diabetic patients can only be a temporary and treatable condition. Many patients develop difficulty in containing urine for associated causes, for example diabetes and a bladder infection.

However, diabetes can cause a problem called diabetic neurogenic bladder, which causes a drastic or complete reduction in sensitivity or difficulty in contracting the internal sphincter.

The condition is a complication resulting from the severe and prolonged lack of control of glycemic rates.

Pregnancy and childbirth

Pregnancy causes several hormonal and physical changes that can lead to urinary incontinence. The causes mentioned involve elevation of the hormones, alteration of the structure of the muscular wall or pressure of the belly.

Generally, the biggest cause of incontinence is the baby’s growth. This is because the uterus begins to occupy more space in the belly and, for this, it compresses and pushes the other organs, among them, the bladder.

With less space to dilate and extend, the bladder has a reduced capacity to store urine, which can result in difficulty holding the pee.

After delivery, normal or cesarean, urinary incontinence may develop. But there are usually very specific factors that involve the situation, and childbirth, when well attended, tends not to cause incontinence. Probable causes include:

• Number of deliveries (as the musculature may become more flabby and contract less);
• Baby weight (the baby with very high weight needs a greater distension of the vaginal tissue to pass);
• Prolonged delivery period (when the process takes too long, it can cause muscle tissue to loosen).

Obesity

Excess weight causes high pressure on the bladder and urethra. As in pregnancy, the weight concentrated in the abdominal region causes a continuous tension of the organs, which can push the bladder or weaken the muscles and other structures of the pelvic region (responsible for the control and release of urine).

Hold urine

Although it is not always possible to go to the bathroom when you feel like it, the habit of holding the pee can compromise the proper functioning of the urinary tract.

Avoiding emptying the bladder, holding the urge to urinate for long periods favors the entry of bacteria through the urethra, especially in women. That is, the simple fact of not peeing favors the installation of a urinary infection .

In addition, over the years, the custom can damage the bladder walls, weaken the pelvis muscles and result in persistent urinary incontinence (not caused by treatable infections).

Conditions that increase the amount of urine

The use of diuretics, dietary changes and excessive consumption of caffeine (such as teas, soft drinks, coffee and energy drinks), in addition to alcohol consumption can result in high urine production and more difficulty in retaining fluid.

Menopause

It is not exactly menopause that favors urinary incontinence, but an association of factors that promote the weakening of the bladder or sphincter muscles, for example.

In general, the main causes of menopausal incontinence refer to hormonal changes, the propensity to infections, changes in mood (which can undermine immunity), in addition to reduced strength and muscle contraction.

Another helper is that women who have children have one more factor that can contribute to the difficulty in containing urine.

This is because the musculature of the vagina has already had to dilate and, not always, has managed to recover completely.

Aging

Aging, in itself, does not cause incontinence. It is wrong to think that the difficulty in holding urine is a normal condition of age.

In fact, there is a change in the body and in life: difficulty in walking, reduced sensitivity and loosening of tissues (including muscle). Changes in diet and decreased physical activity can also occur (with less sweating, the person produces more urine).

In this case, it may be that the elderly feel like going to the bathroom more often and are unable to hold the urine or that they do not realize the need to urinate.

Cognitive, psychological or physical impairment

These dysfunctions do not affect the functions of the bladder or sphincters. Therefore, in some cases, the urinary tract works properly in the continence of the pee. However, cognitive changes, such as delusions and dementia, can make the patient not have a full bladder perception.

In addition, emotional or cognitive conditions can alter environmental perception. That is, the patient is not able to recognize the bathroom or remember how to get there.

Physical situations, in which the person cannot move around the house, get out of bed or take off clothes, are also compromises that cause urinary incontinence.

Constipation

When the intestine does not function properly, the swelling is usually noticed. This is because feces accumulate in the organ and cause swelling.

The intestine begins to occupy other spaces and press on nearby organs. The bladder compresses and is unable to accommodate urine properly.

Urinary infections

Urinary infections are more frequent in women and the causes are attributed to the provision of the intimate region, since the vagina and anus are very close, which favors the entry of bacteria and the installation of infections.

In addition to the pain or burning sensation when peeing, the infection can cause incontinence. In general, the condition is reversed when the correct treatment is performed.

Medicines

There are some remedies that can cause changes in the ability to hold urine, causing pelvic or sphincter muscle weakness, blocking urine output (resulting in overflow incontinence) or causing bladder muscle overactivity. According to the causes, some of them are:

Weakening of the sphincter or bladder musculature

Alpha-adrenergic blockers are used mainly for high blood pressure , erectile dysfunction , neurogenic bladder and prostate hyperplasia. Among them , alfuzosin , doxazosin , prazosin , tamsulosin or terazosin .

The medication misoprostol , which is prescribed for stomach ulcers and as an abortion resource, can cause changes in pelvic muscle contraction.

Bladder obstruction

It is caused by drugs such as pseudoephedrine (alpha-adrenergic agonists).

Bladder muscle hypoactivity

Anticholinergic remedies, such as antihistamines, antipsychotics, benzatropine and some antidepressants can cause the functional reduction of the bladder. Calcium channel blockers, such as diltiazem, nifedipine or verapamil, in addition to some opioids can also result in hypoactivity.

Risk factors

Urinary incontinence can affect men and women at any age. However, some aspects may favor the appearance of the dysfunction.

Women are the most affected by several factors, such as the propensity to urinary infection and hormonal changes.

In addition, some women may have a tendency to develop urinary tract infection after sexual intercourse, as there is a favorable entry of bacteria through the urethra.

In general, risk factors involve:

• Advancing age: aging does not cause urinary incontinence, but the sum of decreased immunity, weakened muscles, limited mobility, and neurological and emotional disorders can favor leakage of urine;
• Obesity or pregnancy: the prevalence of urinary incontinence is high in obese and pregnant patients. It is suggested that the weight concentrated in the abdominal region is able to compress the bladder and decrease its capacity to store urine;
• Diabetes and neurological diseases: any condition that affects sensory communication can be a risk factor. This is because there is a decrease in sensitivity or an inefficient communication between relaxation and muscle contraction of the urinary tract. Among them, Parkinson’s disease, Alzheimer’s and multiple sclerosis;
• Smokers: tobacco and nicotine can trigger irritation in the bladder wall, favoring the organ’s hyperactivity;
• Low immunity: having a compromised immune system or having habits that favor urinary infections can often cause incontinence.

Risk factors for female urinary incontinence

In addition to these factors, there are others that specifically affect each sex. The main risk factors for female urinary incontinence are:

• Pregnancy and postpartum;
• Hormonal changes (which can cause atrophy of the pelvic muscles);
• Hormone replacement in menopause (the use of hormones also suggests risks for urinary incontinence);
• Cognitive and functional dysfunctions;
• Ischemic heart disease, stroke and heart failure;
• Hysterectomy (removal of the uterus);
• Ethnicity and race (there are studies that indicate that white women have more diagnoses of stress incontinence than non-Hispanic, black or Asian women).

Risk factors for male urinary incontinence

The main risk factors for male urinary incontinence are:

• Lower urinary tract diseases and infections;
• Cognitive and functional changes;
• Depression;
• Prostate surgery;
• Radical prostatectomy;
• Treatment of prostate carcinoma with radiation, brachytherapy or cryotherapy.

Symptoms and occurrences

Urinary incontinence makes the patient unable to contain urine, whether in small or large quantities. It can be at specific times, such as when pushing, or at rest. The signs reported by the patient will determine the types of the dysfunction.

The main symptomatic specifications refer to stress incontinence and urge incontinence. That’s because stress leaks occur when the patient coughs, laughs or sneezes.

In addition, activities such as lifting weight, jumping, or exercising can make the pee run. In general, the amount is small and tends to cease when the person stops pushing.

In the type of urgency, the urge to pee is uncontrollable and, normally, there is no time to get to the bathroom. Faced with the sudden need to go to the bathroom, the patient has a larger and more frequent leak.

In the mixed type, the signs appear together, that is, the patient has an urge to pee, accompanied by the inability to contain the urine. Small or moderate leaks occur during the day, but also when efforts are made (such as lifting weight or coughing).

Some types of urinary dysfunction may show more specific signs, such as coital urinary incontinence, in which the patient urinates during sex, or nocturnal enuresis, in which the leak occurs while the person sleeps.

It is also possible that, in cases where there is a small leak, only drips of urine occur. In general, the most associated cause is the difficulty in emptying the bladder completely, causing leakage of pee soon after the person left the bathroom.

The patient is not always able to perceive the urine flowing through the urethra, so the signs involve material observation (yes, you have to look at your underwear if you suspect urinary incontinence).

How is the diagnosis made?

The diagnosis essentially consists of the patient’s self-assessment and reporting to the doctor. The professional will make a survey of the clinical picture, habits and other complaints that he may have.

It is necessary to check specific conditions, such as the use of medication, urinary tract infection or other diseases that cause difficulty in controlling the pee, which require different referrals.

The patient is also asked to do an intensive follow-up of trips to the bathroom and incontinence episodes. For this, the voiding diary is used. The more accurate the patient’s note, the better the doctor’s assessment.

Therefore, schedules, approximate amount of urine (too much pee or just a drip), frequency of visits to the bathroom and even the amount of water ingested are important aspects to be recorded.

The most suitable professionals for the diagnosis and treatment of urinary incontinence are the general practitioner , urologist , gynecologist and geriatrician .

Exams

Some tests may be indicated to assess the patient’s condition. Tests usually check for conditions that affect the urinary tract and rule out other conditions, such as cancer.

Physical exams

The doctor will be able to physically assess the patient and check abdominal volume. To do this, he will probe the region to identify undue volumes in the pelvic region and bladder distention.

Neurological evaluation and muscle exams can also be done. In women, gynecological exams and in men, observation of Organs genitals also helps the professional.

Urine analysis

A urine sample is collected to detect or rule out infections or other changes, such as the presence of blood in the liquid.

Urofluxometry with post-voiding residual measurement

Despite the complex name, the test is quite simple. The patient is indicated to pee in a funnel that will measure the amount of liquid poured.

After that, an ultrasound examination in the bladder region assesses whether fluid residues remained. That is, if the patient has a disability or difficulty in emptying the entire bladder.

Specific exams

These tests are indicated when other diseases or disorders have been ruled out and it is necessary to measure urinary impairment.

Stress test

The test requires the patient to have a full bladder and then the person is asked to cough. The doctor will check if there is any leakage of urine.

Q-tip test

To check the mobility of the urethra, a small tubular instrument or a sterile cotton swab is inserted and moistened with lubricant in the channel. The patient is asked to cough and, during the effort, how much the urethra channel moves is measured. If there is a movement greater than 30º, the presence of hypermobility is suggested.

Uroanalysis

Laboratory tests may be ordered, such as urine culture to rule out other conditions, such as haematuria (abnormal presence of red blood cells in the urine).

Is there a cure?

-Yeah . The condition can be treated with several resources, which will be indicated according to the type and the compromise of the patient’s routine.

In cases not associated with disease (such as cancer or diabetes), most patients experience significant or complete improvements in a short period of time.

In young women, up to 70% recover completely from urinary incontinence through strengthening exercises or correction surgery.

Palliative and associated treatment

Urinary incontinence has different therapeutic interventions that are determined according to the type and condition of the patient. In general, the measures are associated and can include behavioral changes (routines and food, for example), medications, physical therapy and specific exercises or surgical treatments.

Treating diseases and triggering conditions

As urinary incontinence is a condition that, in some cases, is associated with primary causes, it is necessary to regulate, treat or eliminate the original problem or dysfunction.

According to the guidelines for urinary incontinence, the main diseases that can trigger or favor unwanted urine loss are:

• Cardiac insufficiency;
• Diabetes;
• Chronic obstructive pulmonary disease;
• Neurological disorders;
• Stroke;
• Insanity;
• Multiple sclerosis;
• Cognitive disorders;
• Sleep disorders, such as apnea.

Performing intensive monitoring of these conditions (through more rigorous treatment, changing medications or adopting new habits, for example), reducing impacts on the body, may be sufficient to eliminate or minimize urinary incontinence.

Palliative measures

The patient must be accompanied in his psychological and emotional condition, indicating him for therapy if necessary. This is because urinary incontinence is strongly linked to low self-esteem , difficulty in socializing and the tendency to isolation.

As the patient is often ashamed to seek help or share the problem, the doctor must explain the situation and the causes of the leakage of urine (preventing the person from blaming himself, for example).

The urinary incontinence intervention guidelines point out, as a fundamental role of treatment, the participation of the health professional in reassuring the patient. Therefore, it is necessary that the dialogue be enlightening, removing the guilt or shame of the person so that the treatment is properly continued.

In addition, emotional factors can aggravate leaks, causing, regardless of age, a cycle begins where incontinence generates stress and stress aggravates episodes.

Along with emotional support, it is necessary to present anti-incontinence options, such as pads or specialized underwear. It is necessary for the patient to know that he has options to mitigate leakages of pee, allowing urinary dysfunction not to prevent or change his daily activities.

In people with obesity , it is recommended that treatments and behavioral changes be made in order to reduce weight.

All patients should avoid excessive use of alcohol, caffeine and diuretic products, as they can also interfere with the functioning of the bladder. Therefore, the observation and reduction of these components can be requested by the doctor as part of the treatment.

Behavioral techniques

There are several tactics that can be combined with routine and reduce or treat urinary incontinence, such as:

Bladder training

Also called bladder reeducation, as it intends to change the patient’s urination habits, stipulating time intervals between each visit to the bathroom. The main objective is to assist in the continence of the pee, being indicated in cases where there is an urgent need to urinate associated or not with urinary incontinence.

The training consists of going to the bathroom at scheduled times (for example, every 1 hour) and gradually spacing that time. That is, after a week, the patient increases the time to 1h30 and then to 2 hours.

When there is a desire to go to the bathroom, distraction or relaxation tactics are used to delay urination.

Double urination

Double urination is especially indicated in cases of overflow incontinence and basically consists of trying to pee again after having already urinated.

It is necessary that the doctor or therapist explain that the emotional processes also interfere with the efficiency of the technique. That is, if the person is anxious or nervous, probably the sphincter will remain contracted, preventing the urine from being completely released.

For patients who experience a loss of urinary tract sensitivity, scheduling trips to the bathroom can prevent leaks. For example, going to the bathroom every 2 or 3 hours, even if you don’t feel like it or if you haven’t drunk a lot of liquid, helps to create a behavioral habit.

Treatment by auxiliary devices

Through devices or small elements inserted in the urethra or in the vaginal canal it is possible to reduce or stop incontinence.

Balloons or tampons

Small disposable devices are inserted to prevent loss of urine. They act by supporting the bladder or even taking the place of the sphincter.

The procedures are not permanent and the time for disposal or replacement of the device will depend on the procedure chosen.

Botulinum toxin injection

The method was approved in Brazil in 2009 and helps in the treatment of overactive bladder, reducing the urge to pee. Botulinum toxin injections are applied directly to the bladder and are mainly indicated for patients who do not respond well to drugs and exercise.

The treatment is not permanent and the injection can be reapplied between 3 and 12 months, depending on the case and the organism’s response.

Bulking agents

They are invasive procedures, but they are not classified as a surgery. In general, fills are made or devices inserted through the urethra to contain the leaks.

The procedure is more recommended for cases of stress incontinence (in which there is inefficiency of the sphincter) or as a complementary measure to conventional surgery in other types of incontinence.

Exercises for urinary incontinence

Exercises that strengthen or stimulate the pelvic floor muscles should be started right after the diagnosis, being maintained for at least 3 months in cases of stress or mixed incontinence, including in pregnant women. Gradually, the patient can start the practice of programmed urination.

It is important to remember that the exercises must be indicated by the doctor or physiotherapist, who will give the necessary recommendations for each patient. But one of the most popular techniques is the Kegel exercise.

The tactic is even recommended to all women and, especially, after the pregnant woman gives birth, as it helps in strengthening and recovering the muscles of the vagina.

Kegel exercises

For the exercise to be performed correctly, it is necessary to identify which muscle groups you need to exercise. A simple method to perceive the musculature is to try to stop the pee during urination.

The muscles that contract to stop urine are the ones that you must exercise. To facilitate the performance, women must contract the inner wall of the vagina, while men can contract the muscles of the buttocks. Both must reproduce suction with the internal muscles.

Over time, the exercise becomes easier to perform. In general, between 3 and 5 sets of 10 quick contractions can be done (you tighten the muscle and then relax.

Long-lasting sets can also be performed, in which you must contract the muscle and hold it for 10 seconds, then relax. Rest for 10 seconds and repeat the exercise, totaling between 3 and 5 accomplishments.

Electrical stimulation

The guidelines for the treatment of urinary incontinence indicate that the electrostimulation of the pelvic muscles can be performed in conjunction with physical exercises, since the isolated use of the technique may not present such effective results.

The alternative consists of inserting small electrodes into the patient’s vagina or rectum, which cause low-intensity electrical stimulation (that is, a very weak shock) into the muscle wall.

Stimulation alone does not cause muscle strengthening, but it makes the nervous system more sensitive to the perception of that muscle. It is very common that the patient is unable to perform Kegel exercises because he does not recognize and, consequently, is unable to contract the muscle.

The procedure also reduces bladder hyperactivity, helping in cases where there are involuntary contractions of the organ.

Medicines

Drug treatment for urinary incontinence aims to reduce bladder hyperactivity (acting by relaxing) or to strengthen the sphincter.

It is always advisable to jointly treat other diseases or conditions that may interfere with the patient’s health. Therefore, some methods may consist of hormone replacement, in the case of menopause, or use of psychiatric drugs, in neurological cases.

Among the options, for the treatment of stress incontinence caused by weakness of the urinary sphincter or reduction of the strength of the pelvic muscles, the drugs that help in strengthening the contractions of the urinary sphincter and can be prescribed are:

• Duloxetine ;
• Imipramine: also promotes bladder relaxation;
• Pseudoephedrine .

When the doctor recommends treatment with medication, it usually starts with the use of antimuscarinics for cases of urge incontinence. If there are no good responses to the drug, transdermal oxybutynin or antimuscarinics can be tried .

In patients with cognitive impairment, urinary incontinence guidelines advise preferring the use of trospium hydrochloride instead of oxybutynin, due to side effects.

For male patients with urge incontinence due to bladder obstruction, medications prescribed for urinary sphincter relaxation can be:

• Alfuzosin ;
• Doxazosin ;
• Prazosin ;
• Silodosin ;
• Tamsulosin ;
• Terazosin .

To decrease the enlarged prostate, remedies such as dutasteride and finasteride may be indicated.

In cases of urge or stress incontinence, aiming to increase the filling capacity of the bladder and reduce muscle contraction or movement of the organ, some of the medications that can be prescribed are:

• Darifenacin ;
• Fesoterodine;
• Hyoscyamine;
• Imipramine : also helps in strengthening the urinary sphincter;
• Dicyclomine: also promotes the relaxation of involuntary muscles;
• Mirabregone: also helps in bladder relaxation.
• Onabotunlinumtoxin: decreases involuntary bladder contraction;
• Oxybutynin ;
• Solifenacin ;
• Tolterodine ;
• Tróspio.

In overflow incontinence or to treat the weakened bladder wall, bethanechol can be prescribed, which helps in muscle contraction of the organ.

Medicines such as duloxetine can be recommended for temporary incontinence, helping to reduce symptoms in the short term.

Intravaginal estrogens still raise debates about the effectiveness of their use, but they can be recommended in women who are menopausal.

It is still possible to resort to the immediate use of desmopressin . The remedies should not be part of a continuous treatment, but it can show good results quickly.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Surgery

Surgical procedures for urinary incontinence include several procedures, ranging from dilation of the urethra to the need for tissue reconstruction of the bladder, for example.

The most used techniques are:

Sling

The sling is a procedure indicated for cases of stress incontinence, aiming to increase the resistance of the bladder and urethra, and is efficient in up to 90% of cases.

The technique is minimally invasive and, therefore, sedation and recovery tend to be fast. A catheter is inserted through the urethra and empties the entire bladder. The sling is introduced and accommodated internally.

Then, the procedure is checked. For this, the bladder is filled with saline and the patient is instructed to cough. If there are no leaks, the process has been completed properly, otherwise the sling is repositioned.

In general, after the anesthesia ceases and the patient spills spontaneously, complete recovery takes 3 days, and the use of medications to prevent infection in this period is recommended.

Bladder neck suspension

The procedure is more invasive than the sling and aims to support the urethra and bladder. An incision (cut) is made in the abdominal region close to the navel and sutures (ligaments) are made in the bladder tissue, so that the organ is firmer.

Recovery is slower than minimally invasive procedures and takes about 6 weeks, and it is usually necessary to use a catheter to urinate during this period.

Sacral neuromodulation

Sacral neuromodulation is indicated in cases of bladder hyperactivity and urinary retention in which there is no obstruction, for example. The procedure works by stimulating the bladder through light electrical frequency.

A small stimulator is implanted in the region close to the bladder (extremity of the sacrum) and a test period is carried out. For 14 days, the patient will check the functionality of the procedure. If the results are satisfactory, a new intervention is performed to make a permanent implant of the stimulator.

The equipment sends electrical signals that help the bladder to contract and relax properly.

Living together

Urinary incontinence is not a rare condition, whether temporary (for example, infections) or permanent (due to changes in bladder functioning).

Despite being a frequent complaint, there are several measures that can be adopted and that resolve or, at least, alleviate the situation.

Mental health

Initially, the patient needs to be made aware of the psychological aspects of the dysfunction. The shame and fear of going through situations in which someone will notice incontinence can have a high impact on daily life and activities.

For this reason, psychological counseling and mental health care can be quite significant, involving frank conversation with friends and family, relaxing activities and maintaining social interaction.

food

It may be beneficial to change some eating habits while treating incontinence. Although water intake is essential for the body, it is necessary to control consumption before physical activities or efforts (in the case of stress incontinence) or when you know that you do not have quick access to the bathroom.

Some foods promote urine production and should be avoided or consumed less frequently, including:

• Alcohol;
• Soft drinks, black teas, coffee and energy drinks (because of caffeine);
• Artificial sweeteners;
• Diuretic foods (melon, watermelon, cantaloupe, pineapple, spinach, cucumber, for example);
• Citrus foods (like orange and lemon);
• Sugar-rich foods;
• Aerated drinks;
• High dosages of vitamins B and C;
• Spicy or spicy foods.

In addition, reducing fluid intake is not ideal, as in addition to causing damage to the body (such as constipation and dehydration), they can cause the reverse effect, increasing urinary incontinence.

It is necessary to maintain a good intake of fluids throughout the day by making choices and adaptations, such as grape , apple, blackberry and cherry juices that avoid bladder irritation and minimize urine odors.

In overweight or obese people, care with food also favors weight reduction and can alleviate incontinence. Therefore, it is ideal to carry out a nutritional monitoring and follow a balanced diet.

Facilitating measures

There are products designed for people with urinary incontinence that are very effective so that no activity is abandoned. You can use urine pads to prevent leakage of pee. The product is developed to absorb up to large volumes of liquid and there are several discrete models and formats.

There are also underwear developed with special fabrics to absorb urine and prevent odor. They are very effective in cases of stress incontinence or when there is small leakage of urine.

For men, there are accessories called uropen, which are urine collection bags. They are attached to the leg and have a capacity, generally, between 1 liter and 1.5 liter.

There are waterproof sheets that can be used to prevent nighttime spills. It is also possible to use bedpans (containers to urinate) during the night, when there is not always time to go to the bathroom.

In addition, care must be taken as to the organization and arrangement of things at home. For example, carpets can slip and cause the patient to fall. Small changes facilitate mobility, as keeping doors open or removing items can make it difficult to go to the bathroom.

Warning signs for people nearby

The patient is not always aware of urinary incontinence and how harmful to the routine it can be. For example, if the causes are due to psychological or neuronal problems, such as dementia, the patient may not realize that he is losing pee during the day.

But it is not always necessary to have dysfunctions of lucidity or self-awareness. This is because urinary incontinence tends to be an embarrassing situation that is often hidden by the patient.

Out of shame or difficulty in sharing the problem, the patient may not seek help and starts to avoid places where the problem can be evidenced.

For those close to you, it is necessary to observe if there is an increase in trips to the bathroom, frequency of peeing or if the patient has reduced the fluid intake (in order to decrease the volume of pee).

Social isolation can also present itself, as the person avoids situations in public or environments that do not have a bathroom nearby.

Prognosis

Palliative and drug therapies offer good results to about 80% of patients. In general, the association of muscle exercises tends to be sufficient in mild cases not associated with infections or other diseases.

However, in cases of stress incontinence, conservative (non-invasive) therapies tend to be less efficient. Recently, invasive procedures alternative to surgery, such as the application of botulinum toxin, have shown very promising results, although they need to be continued or performed frequently.

In addition, conservative measures have less impact on the organism and faster recovery. In surgical cases, the tendency is for recovery to be good and without complications. The quality of life of patients after treatments and interventions is significantly improved.

Complications

The complications most associated with incontinence refer to skin problems due to the humidity of the intimate region. Infections, rashes and tenderness may occur. Therefore, it is necessary to maintain care with hygiene and ensure that the skin is dry.

When incontinence is not treated, the risks of developing a urinary tract infection are greater.

Loss of urine can result in falls and injuries indirectly. This occurs when the patient pees and the liquid accumulates on the floor, favoring him to slip. Falls are also constant when there is an urgent need to go to the bathroom, causing stairs and furniture to pose risks.

However, dysfunction tends to present greater damage to mental health, in which incontinence causes social isolation, a feeling of shame and abandonment of activities, such as work, courses or trips to the market, for example.

How to prevent urinary incontinence?

There are steps you can take to reduce the chances of having difficulty holding your urine.

Do strengthening exercises

Exercises to strengthen the muscles are not just for those who already have urinary incontinence. Increasing the intimate muscle tone can also have great results in the sexual way, as the sensitivity is improved.

In men, muscle strengthening can help treat premature ejaculation and erectile dysfunction as well.

Train your bladder

Make it a habit to go to the bathroom often (do not pee for more than 4 hours). Sometimes, activities and routine end up making you lose track of time and this can be quite bad for your bladder.

Set times to go to the bathroom or, at least, remember not to spend many hours without peeing.

Take care of the weight

Maintaining the proper weight helps to reduce abdominal pressure and prevent bladder compression. In addition, to avoid the accumulation of fats, it is necessary to invest in a more balanced diet, which results in more health for the whole organism.

With the body functioning properly, your immunity is more resistant and prevents urinary infections, which can cause incontinence.

Urinary incontinence in the elderly

Studies carried out point out the high prevalence of the condition in the elderly population, which can bring several emotional and functional damages to the patient.

Although advancing age is not the cause of incontinence, about 30% of the elderly have urinary dysfunction and approximately half of those who are hospitalized are unable to control the pee.

Due to old age, treatments tend to be more limited, especially if there are associated diseases. The use of medications is restricted, as the side effects may not compensate.

Surgical procedures can severely compromise the health condition, being generally advised against due to the risk of infections or slow recovery.

However, palliative and conservative measures can show good responses if there is a multidisciplinary treatment, associating behavioral and nutritional changes with the medications.

Common questions

Does incontinence happen only in women?

Despite being quite common in women, incontinence can affect both sexes. The higher frequency in women is explained by the fact that they have conditions that favor the difficulty in holding the pee, such as pregnancy and hormonal changes.

Is incontinence the same as low bladder?

Urinary incontinence can also be called a low bladder, because when the pelvic floor muscles (which hold the bladder) weaken, the organ may become lower than normal.

However, the lower bladder should not be confused with uterine prolapse. Although both cause difficulties in containing the pee, uterine prolapse occurs when the uterus is too close or even outside the vagina.

Does holding the pee cause incontinence?

Holding urine sometimes poses no risk to the bladder. But the frequent habit can be quite bad. This is because there are greater risks of causing urinary infections or resulting in overflow incontinence (when the bladder is already completely full).

The ideal is to empty your bladder every 4 hours.

Who has incontinence should avoid taking fluids?

No . Although it seems a logical condition (less liquid = less pee), reducing fluid intake can aggravate incontinence, in addition to bringing risks to the body.

The ideal is to avoid drinks that can irritate the bladder or stimulate urination, such as soft drinks and diuretics. During the day, it is recommended to fractionate the liquid intake so that there is no dehydration.

By maintaining regular water intake, you avoid consuming too much at once and result in greater difficulty in containing the pee.

Who has incontinence will have to do the exercises forever?

-Yeah . Except for the transient cases of incontinence (such as infections that, when treated, tend to eliminate the symptoms), it is necessary that the patient performs the exercises continuously, at least once a week or according to medical recommendations.

Does stress make incontinence worse?

Stress and anxiety , for example, can worsen incontinence. This is due to the emotional pressure suffered by the patient, who finds it more difficult to control the sphincters or perceive the manifestations of the body.

Does incontinence always happen in pregnancy?

No, not all pregnant women will have difficulty in controlling the pee, although it is quite common, especially in the final stretch of pregnancy.

Can a man with incontinence urinate during sex?

-Yeah . Although coital incontinence is more common in women, men can also suffer from the condition. Therefore, it is recommended to pee before sexual intercourse and always use a condom.

Child has urinary incontinence?

Most, if not all, children have already peed in bed or had difficulty controlling their bladder during childhood. This is not necessarily an incontinence caused by dysfunction.

The most recurrent causes in children are emotional ones, such as anxiety or euphoria. As there is still not much self-control over bodily functions, leaks can occur.

But if the episode is frequent, you need to pay attention, as it may be urinary incontinence. In that case, you need to see a pediatrician.

Imagine that such a simple action, like peeing (something you’ve been doing since you were born) is causing a lot of problems.

The causes are diverse and incontinence can be quickly treated. However, it is always a situation aggravated by shame or fear of the judgment of others.

Medical treatment is essential, but self-understanding and support from those close to you is essential so that incontinence is not aggravated by emotional and psychological factors.