Urinary incontinence is a common condition that can affect people of all ages. Learn more about symptoms, causes, and treatments available from experts in the field. Find out how to manage your condition and improve your quality of life with comprehensive information.
Urinary incontinence is the involuntary loss of urine. It affects women more than men and occurs more frequently after age 50. It is a disabling condition that is too often overlooked. However, incontinence is not an inescapable problem and solutions exist.
What is Urinary Incontinence?
Urinary incontinence is the involuntary loss of urine. It affects women more than men and occurs more frequently after age 50. It is a disabling condition, that is too often overlooked. However, incontinence is not an inescapable problem and solutions exist.
Urinary incontinence is the involuntary loss of urine. Stress incontinence , the most common, is due to a relaxation of the muscle that closes the bladder and the muscles of the perineum . The hormonal changes of menopause contribute to this relaxation, especially in women who have experienced repeated deliveries. Urge incontinence is the result of the bladder being too sensitive and constricting when it is not full. This contraction triggers the urge to urinate.
What are the symptoms of Urinary Incontinence?
Leakage of urine due to stress incontinence occurs when coughing, sneezing, laughing, playing sports, etc. Urge incontinence is characterized by pressing and uncontrollable urges and is seen more often in women over 65 years of age. It can be linked to another disease such as a urinary or vaginal infection, a urinary stone or a polyp in the bladder. In men, overflow incontinence is often the result of difficulty urinating, for example, when the prostate is too large.
What are the possible complications of urinary incontinence?
Because it can limit activities of daily living, incontinence leads to psychological complications. To avoid them, it is best to consult a doctor at the first symptoms .
Is urinary incontinence common?
The frequency of urinary leakage is difficult to estimate because a small percentage of patients consult for this symptom . It is estimated that 20 to 30% of women suffer from urinary incontinence in France and about 8% of men aged 65.
What causes urinary incontinence?
Stress incontinence is due to a relaxation of the muscle that closes the bladder and the muscles of the perineum . The hormonal changes of menopause contribute to this relaxation and explain the frequency of this form of incontinence in women over 50 years of age. Repeated deliveries contribute to the appearance of this inconvenience. To avoid this complication, about ten perineal rehabilitation sessions are systematically prescribed after each delivery.
Urge incontinence is the result of the bladder being too sensitive and constricting when it is not full . This contraction triggers the urge to urinate. It may be linked to another disease ( urinary or vaginal infection, urinary calculus or polyp in the bladder, etc.). Some women are, due to the morphology of their urinary tract, more prone to incontinence .
How to prevent urinary incontinence?
Strengthen your perineum . Working the muscles of the perineum helps to strengthen their tone and therefore better control the emission of urine. The so-called Kegel exercises are easy to perform (see box). They are very effective against stress incontinence .
Reduce your consumption of alcohol , tea, coffee and colas. These drinks stimulate the urge to urinate. Avoid drinking more than once or twice a day or cut them out.
Don’t drink too much at night. This prevents the bladder from being too tight during the night. Drinking enough is essential for health, it is better to quench your thirst in the morning and during the afternoon.
Avoid sports that strain the perineum , such as running, jumping, aerobics, volleyball, or heavy weight training.
What does the doctor do in case of urinary incontinence?
He searches for the cause of the incontinence and prescribes an appropriate treatment. In difficult cases, he advises consulting a urologist who may perform a urodynamic examination (which measures urine flow).
Treatments for urinary incontinence vary depending on the type of incontinence .
What are the treatments for urinary incontinence?
Treatments for urinary incontinence implement rehabilitation techniques for the perineum and the muscles of the bladder, but also behavioral techniques to better manage the urge to urinate. Sometimes the doctor prescribes medications applied locally, orally or in injections. In women, if the muscles of the perineum are too relaxed, a strip of polymer can be placed through the vagina and the skin of the abdomen during surgery under local or epidural anesthesia .
Treatments for stress incontinence associated with menopause
Perineosphincteric rehabilitation (of the muscles of the perineum and the bladder) is recommended in stress and mixed incontinence . It is sometimes useful in urge incontinence after the use of so-called “anticholinergic” drugs (see Treatments for urge incontinence ). The use of several techniques (manual, biofeedback, electrostimulation ) seems more effective than the practice of a single one. The benefit can only be appreciated after 15 to 20 sessions.
In case of stress urinary incontinence , self-rehabilitation work must be performed by the patient between rehabilitation sessions.
Local estrogen applications
In the case of stress incontinence linked to the menopause , it is possible to set up a treatment to correct the estrogen deficits . Applied topically , estrogens play a role in improving pressure in the urethra, muscle strength in the pelvis and relaxation of the bladder during the filling phase.
Compared to oral administration , the local route has the advantage of being as effective without causing adverse effects . Prescribed for two months, this treatment must be associated with rehabilitation therapy.
If the muscles of the perineum are too relaxed, a strip of polymer can be placed through the vagina and the skin of the abdomen during a half-hour surgery under local or epidural anesthesia (TVT method). This intervention, which must be carried out by a surgeon familiar with this technique, makes it possible to support the canal of the urethra and facilitate the retention of urine.
Dextramonomer/hyaluronic acid implant injections
These injections are performed under local anesthesia . Like the strips, these semi-absorbable implants help support the urethral canal and facilitate urine retention. The risk of transient urinary retention requires monitoring for a few hours after the injection.
Treatments for urge incontinence
Behavioral therapies aim to teach people who suffer from urge incontinence to better control their urges to urinate. They are based on programming urination (urinating) throughout the day and on learning how to react in the event of an urgent urge. These therapies promote awareness of the delays and frequencies of urination in order to combat certain anxious or phobic behaviors that aggravate the consequences of incontinence .
Medications called “anticholinergics”
These medicines contain a substance that reduces the sensitivity and hyperactivity of the bladder. They can be prescribed immediately or after the failure of behavioral treatment or rehabilitation. No anticholinergic drug appears to be superior to behavioral therapy, but the behavioral therapy/anticholinergic combination may be beneficial.
The effects of different anticholinergic drugs on symptoms are similar and modest. Maximum effectiveness is achieved after 5 to 8 weeks of treatment. It is therefore recommended not to interrupt the treatment earlier, if it is well tolerated.
Their side effects are more common in the elderly: dry mouth, constipation , flushing of the face, retention of urine, blurred vision, headaches, confusion , anxiety, etc.
In some cases of urge incontinence , a non-anticholinergic antispasmodic drug, flavoxate (URISPAS), may be prescribed.
list of medications
- Urinary antispasmodics
- OXYBUTYNIN AGREEMENT
- OXYBUTYNIN BIOGARAN
- OXYBUTYNIN EG
- OXYBUTYNIN MYLAN
- OXYBUTYNIN TEVA
- SOLIFENACIN AGREEMENT
- SOLIFENACIN BIOGARAN
- SOLIFENACIN BGR
- SOLIFENACINE CRISTERS
- SOLIFENACIN EG
- SOLIFENACIN EVOLUGEN
- SOLIFENACIN HCS
- SOLIFENACIN MYLAN
- SOLIFENACIN SANDOZ
- SOLIFENACIN TEVA
- Solifenacin tablets
- SOLIFENACIN ZYDUS
- Reference drug
- Generic drug
- Drug with presentations available without a prescription
Botulinum toxin injections
Sometimes the doctor prescribes injections of botulinum toxin directly into the bladder muscle responsible for the urgency. These injections are performed when behavioral treatments, perineosphincteric rehabilitation and anticholinergic drugs have had no effect. Their effectiveness lasts between 6 to 9 months, after which a new injection can be considered.
Sometimes these injections can cause urine retention and require self-catheterization (by the patient or a loved one) to empty the bladder.
Electromodulation (or electrostimulation)
Muscle training of the perineum by electrostimulation (similar to that offered to young mothers) is systematically prescribed in the event of refractory and disabling bladder hyperactivity. An electrode is implanted near the nerve that innervates the bladder, connected to a box placed under the skin. The cure rate of this method is 30 to 50% with several years of hindsight, with an overall improvement rate of 90%.
Treatments for overflow incontinence
Overflow incontinence , linked to urethral obstruction, observed mainly in men, is treated surgically if possible, otherwise by intermittent or permanent urinary catheterization, performed by the patient or a relative.
In all forms of urinary incontinence, when urinary leakage is not controlled and interferes with daily life, there are various substitute solutions in pharmacies and supermarkets such as panty liners or waterproof underwear (diapers for adults) that allow you to feel comfortable and dry.