Urinary incontinence: what is it and how to solve it?

What is urinary incontinence?

Urinary incontinence, which affects both women and men, is the loss of control over the bladder, leading to the involuntary expulsion of urine. The condition can vary in severity, from the occasional loss of a few drops of urine when coughing or sneezing, to an urge so strong and sudden that you can't get to the toilet in time.

Urinary incontinence is not only a physical problem, but can also have a significant impact on emotional and mental health, affecting the sufferer's self-esteem and social life. Treatment may include lifestyle changes, pelvic floor exercises, medication and, in some cases, surgery. It is important to consult a doctor for proper diagnosis and treatment.

What types of urinary incontinence are there?

The types The most common causes of urinary incontinence are:

• Stress urinary incontinenceThe losses are associated with strains that cause an increase in intra-abdominal pressure.
• Urge urinary incontinenceinvoluntary loss of urine associated with a strong urge to urinate “voiding urgency”.
• Mixed urinary incontinence: combination of the two previous types.

These are the most common, although there are less common ones such as overflow urinary incontinence, urinary incontinence during sexual intercourse.

How is it diagnosed?

Diagnosis of urinary incontinence focuses on identifying the underlying causes and determining the best way to treat the condition. The process begins with a comprehensive assessment that involves understanding the patient's symptoms, medical history and any lifestyle factors that may be contributing to the incontinence.

This initial assessment is crucial in guiding treatment decisions. It looks for specific patterns in symptoms, investigates possible triggers and assesses how incontinence is affecting the patient's daily life. Based on this assessment, a personalised treatment plan can be formulated, selecting the most effective tools and strategies to address both the physical symptoms and the psychological and social impacts that incontinence can have.

The aim is to provide a holistic approach that not only treats the symptoms, but also improves the patient's quality of life. Diagnosis is therefore not only about identifying incontinence, but also about understanding it in the context of the individual's life, allowing for more effective and personalised treatment.

Treatment for urinary incontinence

It will depend on each person, and will be drawn up on the basis of the data we have collected in the assessment:

Step 1: Release tissue tension

We will start by normalising the tissue. It is not advisable to have contractures in the pelvic floor musculature, as a shortened musculature is a weak musculature. All the more so in cases where there is a scar, where we have to start by restoring mobility, flexibility and quality to the pelvic floor tissue, as well as working on any tensions in the diaphragm or abdominal wall that are going to interfere directly with intra-abdominal pressure.

How? We will combine the application of manual therapy together with the Radiofrequency (INDIBA) that will speed up recovery time.

Step 2: Re-educate urination

In a simple way we are going to learn how the physiology of urination works and how we can work towards healthy voiding habits.

The pelvic floor muscles can be controlled voluntarily, so we are going to work with the Biofeedback, This technology allows us to obtain graphic data about the contraction and relaxation of the musculature and allows us to train it to act correctly.

During the bladder filling phase, when we are interested in maintaining continence, we can contract the pelvic floor when straining to prevent leakage or to reduce urinary urgency. And during the emptying phase, we need to know how to relax the muscles and sphincters so that the bladder can empty correctly.

Step 3: Work on muscle strength

In this last step, we will finish correcting the weaknesses, increasing strength, the time in which the contraction is held and power.

In most cases, it will be necessary to strengthen the deep abdominal girdle so that when intra-abdominal pressure occurs, this musculature works together with the pelvic floor. This reduces mobility in the urethra and prevents urine leakage.

The best way to strengthen this abdominal girdle without putting pressure on it is by practising the Méall Pilates. In the case of urinary urgencies, we will also work with Neuromodulationóthe posterior tibial nerve to reduce the urge to urinate when the bladder is not yet full.

This treatment will put an end to urine leakage, but it must be remembered that just as the muscles are strengthened, they can be weakened again. It is therefore vitally important to continue with the strengthening work once the therapy has been completed. To this end, continuing with Pilates sessions is always the best option, in addition to carrying out a “reminder” session of pelvic floor physiotherapy, if necessary, after some time has passed.