Understanding and Managing Urinary Incontinence: Types, Causes, and Treatments
1. What is Urinary Incontinence (UI)?
Urinary Incontinence (UI) affects 27% of the global population, impacting women twice as frequently as men. Prevalence rates in women aged 15 to 64 range from 10% to 55%, with up to 77% of women in nursing homes experiencing UI. It is defined as any involuntary loss of urine, excluding children, significantly impacting quality of life.
2. What is the Most Common Type of UI?
Stress Urinary Incontinence (SUI) is the most common type, characterized by involuntary urine leakage during physical activities like coughing, sneezing, or exercise. Affecting an estimated 4-35% of adult women and 86% of incontinent women, SUI is believed to stem from a complex interplay of factors, including weakened pelvic muscles and collagen-dependent tissues crucial for pelvic support.
Other types of UI include:
- Urgent or Urge Incontinence: Urine leakage accompanied by a sudden, strong urge to urinate.
- Mixed Incontinence: A combination of SUI and urge incontinence.
- Unconscious Incontinence: Urine leakage without any prior urge or awareness of bladder overflow.
3. What are the Risk Factors for UI?
Risk factors for UI can be categorized as:
Non-obstetric:
- Age
- Race (higher prevalence in non-Hispanic individuals)
- Collagen-related genetic predisposition
- Smoking (particularly for urge UI)
- Obesity
- Low socioeconomic status
- Occupations involving strenuous physical activity
- Previous gynecological surgeries
Obstetric:
- Vaginal delivery, especially operative deliveries (forceps use)
- Routine episiotomy
- Newborn weight exceeding 3,000 grams
- Prolonged second stage of labor
- Non-cephalic fetal presentation
4. How is the Pelvic Floor Functionally Assessed?
The contractile strength of the pelvic floor muscles is evaluated through visual inspection and physical palpation of the levator ani muscle.
5. What is the Pad Test for UI?
The Pad Test, also known as the Tampon Test, objectively measures urine leakage to assess and compare UI treatment outcomes. Patients wear absorbent pads for a specific duration (1 hour, 24 hours, or 48 hours) while maintaining their regular activities. The test results are interpreted as follows:
1-Hour Pad Test:
- 1-10g increase: Mild incontinence
- 11-50g increase: Moderate incontinence
- >50g increase: Severe incontinence (according to the International Continence Society – ICS)
24-Hour Pad Test:
- 4-20g: Mild incontinence
- 21-74g: Moderate incontinence
- >75g: Severe incontinence
6. What is the Purpose of Pessaries?
Pessaries are removable devices inserted into the vagina to provide support and are used to manage pelvic organ prolapse and certain cases of UI.
7. How is Biofeedback Used in UI Assessment and Treatment?
Biofeedback complements Pelvic Floor Muscle Training (PFMT) by enhancing patients’ awareness of their pelvic floor muscles and facilitating muscle retraining. It helps isolate accessory muscle groups and provides feedback on muscle activation during exercises. Biofeedback equipment can be manometric or electromyographic.
8. What Electrical Stimulation (ES) Parameters are Used for UI Treatment?
Transcutaneous Electrical Nerve Stimulation (TENS) is commonly used for UI treatment. The standard parameters include a frequency of 10 Hz, a pulse duration of 200 microseconds, and a treatment duration of 30 minutes. The tibial nerve, originating from the sciatic nerve and the lower lumbosacral plexus (predominantly L5-S3 nerve roots), is often targeted.
9. How are Vaginal Cones Used in UI Treatment?
Vaginal cones are inserted into the vagina to induce involuntary pelvic floor muscle contractions, improving muscle strength and sensory feedback. Prolonged contractions engage type I muscle fibers (slow-twitch fibers), enhancing endurance. Physiotherapists guide patients in using vaginal cones for both passive and active training, as described by Haddad et al.
10. What is Benign Prostatic Hyperplasia (BPH)?
Benign Prostatic Hyperplasia (BPH) is a common age-related condition characterized by prostate gland enlargement. Symptoms vary but often include:
- Changes in urination (hesitancy, weak stream, interruptions)
- Urgency and dribbling
- Increased urinary frequency, especially at night
- Urge incontinence
11. What is Behavioral Treatment for UI?
Behavioral treatments for UI focus on modifying bladder habits and strengthening pelvic floor muscles. These may include:
- Fluid Management: Limiting fluid intake at specific times or strategically planning bathroom breaks.
- Bladder Training: Gradually increasing the intervals between bathroom visits to improve bladder control. This often involves Kegel exercises.
- Kegel Exercises: Strengthening the pelvic floor muscles to improve bladder control. An example is the”Lying Kege”: Lie on your back, contract your pelvic floor muscles for 5 seconds, relax for 5 seconds, and repeat 10 times.