Urinary Incontinence in Women

Edited by Doctor Eugenio Ciuccetti

Generality

Urinary incontinence is a condition that today affects about 30% of women and is characterized by the involuntary loss of urine in socially inappropriate moments and places. These losses obviously constitute a significant problem, both from a hygienic, psychological and relational point of view.

Types of Incontinence

There are different forms of urinary incontinence: stress incontinence, for example, is linked to the increase in intra-abdominal pressure (and therefore on the bladder) when making movements and physical efforts. Even a sneeze or raising the expense may be enough to trigger this mechanism.

Urge incontinence, on the other hand, is characterized by a significant increase in urge and frequency of urination. We speak of an "overactive bladder." A bladder that can no longer be completely controlled.

Finally, there are forms of mixed incontinence, in which the symptoms of both types just described appear.

Causes and risk factors

In general, women tend to be more affected than men for intrinsic anatomical and constitutive reasons. With the hormonal transformations typical of menopause, for example, some unfavorable changes occur in the bladder, the urethra and all the structures involved in the elimination of urine.

It should be noted, however, that the problem of urinary incontinence also frequently affects many young women. Consider, for example, the possible trauma and alterations of the pelvic support related to pregnancy and childbirth.

Hence, then, the importance of knowing the risk factors: such as obesity, excessive weight gain during gestation, smoking, constipation or heredity.

Prevention in pregnancy

Equally the need for future mothers to adequately prepare (with simple exercises and treatments) their perineum during pregnancy, relying on the experience of qualified professionals such as the midwife.

In this way it will be possible to increase the proprioceptivity of the perineum, correct the imbalances of the lumbo-pelvic statics, tone the activity of the levator anus muscles and prevent possible alterations of urogenital continence.

Different techniques will be used for this, also based on the specific time of pregnancy. From the traditional cat exercise to perineal contractions in a squatting or supine position to some effective relaxation and breathing strategies.

Even after giving birth, it will be necessary to be cautious. Many women want to recover their physical and aesthetic shape as soon as possible. But overloading the abdominals before having recovered the integrity and tone of the perineal muscles could cause unpleasant surprises later on.

Pelvic floor rehabilitation

Equally important are any pelvic floor rehabilitation programs now available in various centers in our country. The pelvic floor - to be precise - is that musculo-fascial structure that closes the abdominal-pelvic cavity at the bottom, surrounding and supporting the urethra, the bladder, the vagina up to the anorectal system.

When we talk about rehabilitation we refer to an essentially "conservative" approach to the problem. An approach that often avoids or integrates any surgical or pharmacological interventions.

Rehabilitation can be based on different techniques.For example, kinesitherapy, based on specific exercises capable of restoring the awareness of her perineal area (often little known and "felt") to the woman and the ability to control and strengthen it.

The so-called Kegel exercises, among other things - by increasing the flow of blood to the muscles of this region - have also proved effective in increasing the woman's feelings of pleasure at the genital level.

Further possibilities are then offered by Biofeedback (which, using a "special vaginal probe, helps the subject to correct himself and to work correctly with his perineum) and functional electrical stimulation (a passive technique, based on the use of special electrodes and related impulses electric - absolutely painless - which in turn stimulate the pelvic floor muscles).

Urinary incontinence does not die but certainly the quality of life is deeply conditioned. Many women tend to "remove" the problem, for little information, for reasons of modesty and embarrassment or considering it an inevitable side effect of aging. Incontinence, on the other hand, can and must be prevented, counteracted and treated.