Urinary incontinence in women: consequences and treatments

The female pelvic area is the site where copulation, pregnancy and childbirth take place, but also other non-sexual and reproductive functions, such as urination and defecation.

In this area, three systems are located with their respective organs: the genital (uterus and vagina), the urinary (bladder and urethra) and the rectum, which are supported by what is known as the pelvic floor, a set of muscles and ligaments that close the abdominal cavity in its lower part.

“Because these three systems are together, several of their functions depend on each other. That is why it has long been stated that it is a medical error to have divided the pelvic area between gynecologists, urologists and gastroenterologists to treat the conditions that originate there.“says Margarita Martínez Gómez, researcher at the UNAM Biomedical Research Institute dedicated to the study of female reproductive physiology.

Pregnancy and childbirth can affect the pelvic floor and lead to conditions such as prolapse (displacement or fall) of the pelvic organs, overactive bladder syndrome, and urinary and fecal incontinence.

“One of the most common is urinary incontinence, that is, the involuntary leakage of urine. Although its prevalence increases over the years in both women and men, it is higher in the early“, indicates Martínez Gómez.

Three types

There are three types of urinary incontinence: stress incontinence, which appears when doing intense exercise, sneezing or coughing; urgency, which is accompanied or preceded by an urgent sensation to urinate; and the mixed one, which combines the previous two.

Urinary incontinence in women has several risk factors, such as the total number of pregnancies (including abortions), age, menopause, pelvic surgeries, high-impact exercise, obesity, constipation and chronic cough.

“Aging itself causes the weakening of the muscles and a decrease in the capacity of the bladder which, when added to the effects of other chronic diseases such as diabetes, hypertension and arthritis, contribute to the appearance of urinary incontinence.“adds the researcher.

Deterioration of quality of life

People with urinary incontinence are at increased risk of urinary infections, skin ulcers and falls, as well as loss of self-esteem, lack of acceptance, anxiety, depression, sexual dysfunctions, isolation and dependence on others, all of which make their quality of life worse. life deteriorates dramatically.

“As if that were not enough, in many cases, urinary incontinence also involves the purchase of diapers to cope with it, and these are not cheap at all.“.

According to Martínez Gómez, in Mexico, generally, when a woman goes for a gynecological check-up, the specialist does not ask her if she has urinary incontinence or perform any test to verify it, as happens in other countries.

“Thus, it would be most advisable for this practice to spread among all gynecologists, urologists and gastroenterologists, that is, among those doctors who treat conditions of any of the three systems of the pelvic area. The strength of the striated muscles of the pelvic floor should also be assessed and, of course, these muscles should be exercised.“.

To do?

To deal with urinary incontinence, conservative non-pharmacological treatments are currently used that include lifestyle changes, bladder re-education and muscle training in the area, among other things, or hormonal treatment, a surgical one (although it is true that its beneficial effects are not permanent in all cases) or a neuroelectrostimulation one.

“In particular, my group and I are working with pelvic floor electrostimulation in animal models and analyzing the results“reports the university researcher.

Regarding the Clinical Practice Guideline. Detection, diagnosis and initial treatment of urinary incontinence in women, which the Ministry of Health of the federal government released in 2009 and which is still in use, Martínez Gómez finally says: “It is very outdated, because, for example, one of the therapies it recommends is hormonal, but it was recently found to have very differential, complex and even negative effects.“.

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Kegel or pelvic floor rehabilitation exercises

To strengthen the pubococcygeus muscle, which is located precisely on the pelvic floor, and thus reduce the probability of suffering from urinary incontinence, young and mature women – regardless of whether they have had children or not – are recommended to put into practice the Kegel or pelvic floor rehabilitation exercises (can be found on the Internet).

“The pubococcygeus muscle is identical to other muscles in the sense that if you exercise it, it gets stronger. And since it contracts at will, any woman can recognize it by interrupting the flow of urine. Kegel exercises, which involve the repeated contraction and relaxation of this muscle, are great for decreasing the likelihood that women will struggle with urinary incontinence later in life. In Spain, for example, as part of health programs, the government offers women free courses to learn how to practice them.”points out Martínez Gómez.