Urinary incontinence is an entity that mainly affects the female population and has a negative effect on their psyche due to social self-limitation. Also, it is a taboo and the majority of women do not resort to the Urologist out of shame, considering it normal with age. However, incontinence also affects the male population with a different etiology and origin.

Symptomatology is investigated to categorize incontinence and screening is performed to rule out organic causes such as UTI, lithiasis, and pelvic visceral prolapse. Then, according to indications and depending on the category of incontinence, medication is administered, an incontinence tape is placed and Botox injections are made intravesically.

Urinary incontinence is divided into the following categories:

• Stress incontinence: Stress incontinence is the involuntary loss of urine usually after an increase in intra-abdominal pressure (coughing, sneezing, lifting weights). It is usually due to relaxation of the pelvic floor (increasing age, normal childbirth, pelvic surgeries, radical prostatectomy) and disturbance of the anatomical position of the urethra.
• Urge incontinence: Urge incontinence is characterized by a voluntary loss of urine that cannot be delayed. It is due to diseases that cause overactivity of the bladder extensor muscle (neurological diseases, idiopathic causes, spinal injuries, subcystic obstruction - prostatic hyperplasia).
• Mixed incontinence: Mixed incontinence includes both stress and urge symptoms.
• Overflow incontinence: Overflow incontinence is found in patients with a large residual urine who have urine loss due to non-residual free bladder capacity (fountain overflow phenomenon).

Treatment for incontinence is as follows:

• General measures: Exercising, avoiding caffeine intake, limiting fluid intake according to thirst and pelvic floor strengthening exercises are recommended (https://www.youtube.com/watch?v=HQDyximQHUg).
• Effort Incontinence: Upon failure of the above, there is an indication for surgical repair with placement of a transthyroid suburethral incontinence band (http://www.bostonscientific.com/en-US/products/mid-urethral-slings/obtryx-II.html).

• Urge incontinence: Antimuscarinic drugs and recently B3-agonists are the main treatment. Main side effects of antimuscarinics are constipation and dry mouth. On failure, intravesical injection of Bottox is indicated.
• Mixed incontinence: There is evidence that surgically correcting stress incontinence also improves urgency.
• Overflow incontinence: Surgical management of subcystic obstruction.

 

References:

https://huanet.gr/wp-content/uploads/2017/08/02_A%CE%9A%CE%A1%CE%91%CE%A4%CE%95%CE%99%CE%91-%CE%9F%CE%A5%CE%A1%CE%A9%CE%9D.pdf
http://uroweb.org/guideline/urinary-incontinence/#4