Urinary Incontinence
Urinary Incontinence is a frequent symptom that regards women of all ages, with a wide range of severity and of types. Although it is rarely life-threatening, urinary incontinence can seriously affect the natural, psychological and social status of the affected persons.
The burden to the families and to the people that take care of these women with Urinary Incontinence may be unbearable and the economic consequences for the health care system may be quite significant.
Urinary continence is based on the natural function of the urinary bladder and of the urethra (there is a relaxation of the first and contraction of the second).
There must be a complete harmonious cooperation, so that the urethra is closed when the urine is gathered in the urinary bladder and open when the bladder contracts, and, therefore, pushing its content to the exit.
In order for the Urogynaecologist to assess that it is a case of incontinence and to find out its type, apart from the patient’s history and the clinical assessment, a Urodynamic test is also required.
There are various types of incontinence. Depending on the type that will be identified by the Urodynamic test, we will provide the proper treatment, which many times may be surgical.
Stress incontinence
The accidental involuntary loss of urine from the urethra in the event of an abrupt increase of the intra-abdominal pressure, for example in case of laughter, cough, intense physical effort, running, brisk walking.
It occurs due to the failure of the supporting structures of the pelvic floor (fascias, levatorani muscle and pubic-urethral ligaments). The urethra lapses out of the abdominal area, towards the vagina, every time the intra-abdominal pressure is increased, such as in the case of vaginal birth, menopause, surgeries that took place in the past, and radiation in the area.
The treatment of stress incontinence is based on the reinforcement of the urethral resistance with the transvaginal placement and application of the tension-free tapes (TVT, TOT, TVTO). Recently, a pharmaceutical product with relatively good results has been approved and licensed and can be found in the market.
Urgencyincontience
The loss of urine occurs after an intense desire to urinate (urination urgency). Here, there is an instability of the detrusor muscle of the urinary bladder which contracts in lower amounts of urine in the bladder. This results to urinary incontinence as well as to increased urination frequency (overactive bladder).
It can occur after urinary tract infections, bladder calculi, foreign bodies, radiation in the area, etc. Its treatment is based on the relaxation of the detrusor muscle with the use of anticholinergics, such as oxybutynin (ditropan), tolterodine (detrusitol) και and solifenacin (vericare) that are inhibitors of the cholinergic receptors of the detrusor muscle of the urinary bladder.
Mixedincontinence
It is the incontinence that combines the characteristics of the two previous types, that is, of stress incontinence and urgency incontinence.
Its treatment is based on the two causes that are responsible for its manifestation, that is on the use of anticholinergics and the application of free-tension tapes (ΤVT).
Overflowincontinence
It accompanies the hyperdilatation, the overfilling of the urinary bladder when it cannot contract due to neurogenic damage – atonic neurogenic bladder – or when the bladder is fatigued due to sub-bladder impediment – a phase of complete atony of the bladder.
There are various causes, such as the use of medicines (antidepressants), diabetes mellitus, multiple sclerosis and pelvic surgeries. The treatment is causal, that is, it takes place through the surgical correction of its cause.
Totalincontinence
It is the incontinence that occurs all the time and incessantly, under any kind of condition. It is due to the presence of vesico-vaginal, ureterovaginal or vesico-uterine fistulas (usually after gynaecological surgeries), to congenital abnormalities (bladder exstrophy, ureteral ectopia).
The treatment is surgical and aims at the correction of the existing congenital or acquired anatomical abnormality.
