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Urinary incontinence, the silent condition that affects millions of people worldwide

Although it affects men and women, urinary incontinence is more common in women and people often associate it with pregnancy and the menopause.
Although it affects men and women, urinary incontinence is more common in women and people often associate it with pregnancy and the menopause. / JCOMP FOR FREEPIK
  • The problem affects the quality of life of those who suffer from it, restricting their autonomy and reducing their self-esteem as well as often causing urinary infections and ulcers

Urinary incontinence is a condition that occurs when a person can't stop urine escaping from their urethra, the tube which transports it outside the body from the bladder. Age, surgery, weight increase, neurological disorders, pregnancy and the menopause are some of the most common causes of this condition.

According to the International Continence Society, more than 400 million people all over the world are affected by urinary incontinence, and approximately 6.6 million of them (about 15 per cent of the population) are in Spain. However, it is difficult to give exact figures because an estimated four million people hide the fact because of the social stigma associated with it. It is also perceived as a health problem which is not particularly serious, or even as a normal consequence of ageing, despite the difficulties it places on the quality of life for those who suffer from it, making them less autonomous and affecting their self-esteem. It can often also cause urinary infections and ulcers.

With regard to age, although it is true that incontinence becomes more common as the years pass, it can occur at any time of life and is not always associated with getting older.

Equally, although it is more common in women and people often associate it with pregnancy and the menopause, it can actually affect both sexes at any stage of life.

In fact, experts estimate that one in every four men will suffer incontinence after the age of 40. Ageing, the size of the prostate, cancer and neurological disorders such as Parkinson's or Alzheimer's are some of the most common causes.

Treatments

Depending on the type of incontinence, there are different lines of treatment and alternatives. What is important is that the diagnosis is correct in each case, so the patient receives the treatment which is most suitable for their condition.

Treatments range from medication to physiotherapy of the pelvic floor, different types of electrostimulation, the injection of botulinum toxin (botox) in the bladder, or surgery.

One of the most traditional and effective treatments is physiotherapy, which solves the problem in a high percentage of cases, but other very effective therapies include the application of suburethral mesh, which presents a low morbidity and suitable clinical security.

This surgical treatment is used for women who suffer incontinence when doing physical activity. It should be remembered that the synthetic meshes used for stress incontinence are different to those used in the case of prolapse of pelvic organs and therefore, when considering the risks, it is important to distinguish between the minor ones associated with the surgery using mesh for stress incontinence and those associated with surgery using mesh to treat a prolapse.

Another treatment which is being used for hyperactive bladder and urinary incontinence is botox, which is giving very good results.

This toxin is administered in small doses directly into the tissue of the bladder, producing a relaxation of the overactive muscles to increase capacity and stop involuntary contractions.

This reduces the frequency of urinating and episodes of urinary incontinence.

With regard to surgery for women, a recent study carried out by researchers at the Mayo Clinic in the USA has shown that retropubic suspension surgery is more effective than transobturator surgery for stress incontinence.

The report, based on the experience of 1800 patients, says the two most common types of operation are the retropubic sling, which consists of placing a mesh sling below the uretha and behind the public bone, and the transobturator sling, where the sling is placed at a less acute angle through the space.

With regard to recovery rates within eight years of surgery, experts found it was 11.2 per cent for patients in the transobturator group and 5.2 per cent in the retropubic group.