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Urinary incontinence in women

The pelvic floor is made up of muscles that have very important functions. These muscles support the organs of the abdominal cavity (uterus, bladder and intestines), work in bladder and bowel control and sexual function.

The bladder is responsible for storing the urine continuously produced by the kidneys and which reaches it through the ureters. When it reaches a certain volume and it's in a position to expel it, different nervous pathways are activated, allowing its voluntary elimination. When urine losses occur in an uncontrolled way, we stop having continence and start to have urinary incontinence.

Urinary incontinence is not a normal situation and is characterized by involuntary loss of urine. It is a problem that tends to develop with aging, particularly in women from the age of 40.

It may have several causes at its origin. The main ones are the number of pregnancies, the number of endovaginal deliveries and obesity. However, there are other risk factors that can potentiate this condition, such as: diabetes, dementia, loss of cognitive abilities, estrogen deficit, hormonal changes, aging, structural changes in the pelvic floor, changes in the urogenital mucosa and poor functioning of the pelvic muscle bladder (detrusor).

This condition limits the performance of the most diverse daily tasks, lowers self-esteem, conditions quality of life and general well-being and can lead, due to these consequences, to depressive states. The woman lives in fear that her urinary losses will be noticed by others, either because they see the marks or because they can smell it. Therefore, avoid leaving the house and carrying out everyday tasks for fear of triggering urine leakage.

When there is loss of urine, frequent or not, we are dealing with Urinary Incontinence. This can be of two types:

Stress Urinary Incontinence: arises when there are efforts that increase abdominal pressure, such as coughing, laughing, sneezing, carrying weights, jumping, running, exercising.

Urgency Urinary Incontinence: arises from a sudden urgent urge to urinate and that it is not possible to stop, even with a small urinary bladder volume.

Mixed Urinary Incontinence: appears in Women who have the two previous types, one of them being more predominant.

The diagnosis of this problem is simple to obtain. The Gynecologist or Physiotherapist obtains the clinical history of the patient and performs a physical examination: gynecological examination and evaluation of the tone of the pelvic floor muscles. Additionally, the Doctor may request tests to complement the evaluation and confirm the type of Urinary Incontinence: blood tests and urine analysis (renal evaluation and screening for urinary infection), uroflowmetry, pelvic ultrasound, urodynamic study, cystogram and cytoscopy.

Physiotherapy is recommended as a first-line treatment for many problems in the pelvic region. This assumes an important role in the treatment of urinary incontinence in women. Physiotherapists specializing in pelvic health have the ability to assess and treat this health problem. They are endowed with scientific knowledge and professional experience that allows them to use the most appropriate therapeutic techniques to restore function to the pelvic floor muscles, improve bladder control and alleviate the symptoms caused by incontinence, thus leading to continence. The techniques used are always adapted to each person, so it is important to make a good diagnosis and understand what type of urinary incontinence we have. The treatment of Female Stress Urinary Incontinence can involve changing lifestyle habits, surgery or giving function to the pelvic floor muscles (strengthening or relaxing them, thus giving balance to the pelvic floor) with Physiotherapy. In the case of Urgent Urinary Incontinence, the treatment can also include changes in lifestyle, bladder training and work on the pelvic floor to create a balance in the muscles.

To complement his work, the Physiotherapist also provides guidance aimed at changing lifestyle and behavior, such as not avoiding fluid intake, avoiding foods sensitive to the bladder, maintaining a healthy weight, using relaxation techniques, avoiding constipation that leads to a worsening of urinary incontinence and practicing physical exercise.

Treatment for urinary incontinence depends on its cause and severity. Monitoring by health professionals who are specialists in the field, such as doctors or physiotherapists, is essential to obtain a correct assessment and a personalized treatment plan.

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