Urinary incontinence in women

By Kitti Lepp BSc. (Hons.) MSc. (Rehab)

Urinary Incontinence is defined by the International Continence Society (ICS) as “any involuntary loss of urine” (Haylen et al., 2010). It is a widespread disorder affecting 44–57% of the middle-aged female population at least one in every four young adult women during their life. These losses contribute to underestimating significant problems in personal and social wellbeing (Pizzol et al., 2021; Paiva et al., 2016; Rajavuori et al., 2022).

There are different types of urinary incontinence. The most common are:

• Stress incontinence – is linked to the increase in intra-abdominal pressure (that, therefore, affects the bladder) when making movements and physical efforts. Even sneezing, coughing, or lifting small weights may be enough to trigger this mechanism (Paiva et al., 2016).
• Urge incontinence – characterized by a significant increase in urination urgency. (Paiva et al., 2016)
• Mixed incontinence – presents the symptoms of both stresses (effort) and urgency (Paiva et al., 2016).

Causes and risk factors

Due to anatomical and constitutive reasons, women tend to be more affected than men by this condition (Pizzol et al., 2021). With the hormonal transformations occurring during menopause, for instance, some unfavorable changes occur in the bladder, urethra, and all the structures involved in the elimination of urine. Aging, high BMI, possible traumas, high-impact sports, and alterations of pelvic support related to pregnancy and childbirth are among the causes (Rajavuori et al., 2022).

Consequences

Key consequences include loss of quality of life, self-confidence, and social isolation in addition to other negative outcomes such as anxiety, depression, deterioration in sexual life, and a decrease in physical activity (Paiva et al., 2016; Pizzol et al., 2021).

Pelvic floor rehabilitation

Pelvic floor rehabilitation programs should be carried out by experienced physiotherapists. When we talk about rehabilitation,  we refer to an essentially “conservative” approach to the problem. Pelvic floor muscle training (PFMT) is recommended as the first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and some with symptoms of urge urinary incontinence (UUI) (Paiva et al., 2016). 

Urinary incontinence is a non-life-threatening disease but can significantly reduce the quality of life. Many women tend to “ignore” the problem due to lack of information, shame, or embarrassment, or because they believe it to be an inevitable side-effect of aging. Contrary to common beliefs, however, incontinence can and must be prevented, counteracted, and treated (Paiva et al., 2016).

References

Haylen B, Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.

Paiva, L., Ferla, L., Darski, C., Catarino, B. and Ramos, J., 2016. Pelvic floor muscle training in groups versus the individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. International Urogynecology Journal, 28(3), pp.351-359.

Pizzol, D., Demurtas, J., Celotto, S., Maggi, S., Smith, L., Angiolelli, G., Trott, M., Yang, L. and Veronese, N., 2021. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clinical and Experimental Research, 33(1), pp.25-35. 

Rajavuori, A., Repo, J., Häkkinen, A., Palonen, P., Multanen, J. and Aukee, P., 2022. Maternal risk factors of urinary incontinence during pregnancy and postpartum: A prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 13, p.100138.