Urinary Incontinence in Middle-Aged Women: When to Consider Surgery? - Obstetrics and Gynecology

Dr. Chen Fuhao reply Obstetrics and Gynecology

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Dear Miss Jiajia,
Urinary incontinence, broadly defined, is the involuntary loss of urine.
The International Continence Society defines it as the involuntary leakage of urine that causes social or hygienic problems.
Therefore, urinary incontinence can be attributed to the dysfunction of the physiological mechanisms that maintain urinary control.
Statistics indicate that approximately one-third of women experience this issue, with the incidence increasing with age.
However, many individuals may feel embarrassed to discuss it and do not seek treatment proactively.
The causes of urinary incontinence are generally due to pregnancy and difficult childbirth; complications during the postpartum recovery period; and chronic increases in abdominal pressure, such as long-term constipation, chronic cough, or prolonged activities that increase abdominal pressure.
Additionally, some postmenopausal women may experience it, as well as individuals with genetic factors, such as congenital muscle weakness.
Improper urination habits, such as straining to urinate or holding urine for extended periods, and the use of medications, such as antihypertensives and diuretics, can also lead to urinary incontinence.
Urinary incontinence can be classified functionally into stress incontinence and urge incontinence, which together account for 85% to 90% of cases in women.
The types of urinary leakage associated with the urethra include stress urinary incontinence and urge urinary incontinence, while overflow incontinence may be associated with conditions such as fistulas or congenital abnormalities.
Diagnosis of urinary incontinence includes a medical history, obstetric history, physical examination, and a simple neurological examination of the perineum, as well as pelvic examinations and rectal examinations.
Additional assessments may include routine urinalysis, endoscopy, ultrasound, and X-ray imaging, as well as pad tests and urodynamic studies.
Not every test is necessary; the physician will determine which are appropriate.
Patients can also keep a simple record of daily urination times, frequency, and instances of incontinence to assist in diagnosis.
The pad test can help determine the volume of leakage and the severity of the condition.
Some urodynamic tests require specialized medical expertise and will not be discussed here.
Treatment methods can be divided into:
1.
Behavioral therapy: including bladder training, scheduled voiding, and pelvic floor muscle exercises.
2.
Pharmacological treatment: Hormone replacement therapy for postmenopausal women can improve the urethral mucosal layer, aiding in the treatment of incontinence.
Medications that enhance or inhibit different receptors affecting the nerves in the bladder and urethra can also be used for therapeutic purposes.
3.
Surgical treatment: The type of surgery will be determined by the physician after discussing options with the patient.
4.
Other supportive treatments: such as intermittent self-catheterization, use of catheters, and pessaries.
Preventive measures for urinary incontinence include:
1.
Avoiding trauma to the birth canal during delivery.
2.
Allowing the pelvic area to rest during the postpartum period, maintaining balanced nutrition, and performing pelvic muscle exercises to help restore normal pelvic floor function.
3.
Developing good bowel and bladder habits, avoiding chronic constipation and holding urine.
4.
Avoiding abdominal pressure during urination.
5.
Engaging in appropriate exercise while avoiding activities that excessively increase abdominal pressure, such as heavy lifting.
6.
Maintaining a healthy weight.
7.
Not forcing frequent urination, as overly frequent voiding can reduce bladder capacity and may not improve incontinence.
8.
Using proper posture, such as avoiding downward straining positions for those with stress urinary incontinence.
9.
Avoiding diuretic or irritant beverages like coffee or tea.
I hope my written communication provides you with a conceptual understanding of urinary incontinence.
Remember, prevention is better than treatment, and paying attention to daily health practices is the best strategy.
However, if early symptoms occur, it is crucial to seek medical attention and treatment promptly.
Thank you.

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Reply Date: 2002/05/09