Urinary incontinence

What is the prevalence of the women urinary incontinence?

Urinary incontinence (UI), the involuntary loss of urine, has a prevalence of approximately 25% in young women (aged 14 to 21 years), 44% to 57% in middle-aged and postmenopausal women (aged 40 to 60 years), and 75% in elderly women (aged 75 years).(1) Urinary incontinence can have many different causes, can develop in varying degrees of severity. There are three common types of urinary incontinence, among them we can also find the stress urinary incontinence. Millions of women around the world suffer from stress urinary incontinence.(2)

Stress urinary incontinence (SUI) is defined as the inadvertent loss of urine occurring as a result of an increase in intra-abdominal pressure (due to physical effort, sneezing, laughing or coughing).(1,3,4)

Principal causes:(5,6)

  1. Current heavy smoking.
  2. Chronic constipation.
  3. Giving birth to a heavy child (more than 4 kg) and the number of vaginal deliveries a woman has had may also adversely affect the functional resilience of the pelvic floor.
  4. Postmenopausal age.
  5. The use of catheters also increases the risk of damaging the urethral sphincter.

Urge urinary incontinence (UUI) is the involuntary leakage arising for no apparent reason and associated with urgency. This condition is caused by imbalance between inhibitory; and excitatory mechanisms’ detrusor activity which results in a disorder of micturition.(6)

Mixed urinary incontinence (UUI) is the combination of both SUI and UUI.(6)

The most prevalent is isolated SUI, followed by MUI and lastly UUI(3)

The presence of urinary incontinence is associated to stigma, fear, embarrassment, and shame related to clinical condition, with repercussion on self-esteem and disturbance of personal, social and sexual life.(3,7)

How to deal with stress urinary incontinence?

Treatment decisions for SUI should be closely linked to the ability of any intervention to improve the bother caused to the patient by her symptoms. If the patient expresses minimal subjective bother due to the SUI, then strong consideration should be given to conservative, non-surgical therapy. 

Current solutions for stress urinary incontinence

Conservative management (non-surgical intervention):

Pelvic floor muscle training

Pelvic floor muscle training, alone or associated to biofeedback or with electrical stimulation can be done by a physiotherapist or a midwife. Pelvic floor muscle training provides both subjective and objective improvement and also enhances the general health-related quality of life without any complications. It’s recommended to offer a trial of supervised pelvic floor muscle training of at least three months' duration as first-line treatment to women with stress or mixed urinary incontinence.(8)

Diapers and other protections

The range of products includes mobility aids, accessible commodes and containment products, such as absorbent pads. Advices for the appropriate use of incontinence aids and pads are important for enhancing quality of life and reducing the stigma of incontinence.(9) It is advised that toileting aids and absorbent containment products should be used only as an interim coping strategy while more definitive treatment is awaited, or as an adjunct to ongoing therapy.(10)

Intravaginal supportive devices and pessaries

Intravaginal devices were shown to be effective for stress urinary incontinence management when compared with behavioral therapy and represent a promising alternative or complementary nonsurgical approach. These devices are believed to act as a support for the urethra and bladder neck during peaks of intra-abdominal pressure.(11) A pessary is an intra-vaginal device to support vaginal wall prolapse or to treat urinary incontinence by elevating and compressing the urethra.(12)

Diveen®

Diveen® belongs to this category of intravaginal supportive devices or (continence) pessaries which has been designed for providing mechanical support to the anterior vaginal wall of women who are suffering from stress urinary incontinence (SUI) or mixed urinary incontinence and thus, by means of this support, for reducing the incidence of urinary leakage episodes.(7)
All initial incontinence therapy should start with non-invasive measures, because the benefits are associated with low risks for the women.(13)


Invasive treatment:

Surgical treatment

A surgery should only be considered as a therapy for female SUI after failure of conservative treatment as an ultima ratio principle.(7) The surgical treatment of SUI may involve either native-tissue or mesh-based repairs in the abdominal, laparoscopic, or vaginal approach.(12)

References:
1) Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429–40. doi:10.7326/M13-2410.
2) Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2003;93(3):324–30. doi:10.1111/j.1464-410x.2003.04609.x.
3) Mota R. Female urinary incontinence and sexuality. Int Braz J Urol. 2017;43(1):20–8. doi:10.1590/S1677-5538.IBJU.2016.0102.
4) Capobianco G et al. Management of female stress urinary incontinence: A care pathway and update. Maturitas. 2018;109:32–8. doi:10.1016/j.maturitas.2017.12.008.
5) Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG. 2003 Mar;110(3):247-54.
6) Kołodyńska G et al. Urinary incontinence in postmenopausal women - causes, symptoms, treatment. Menopause review. 2019;18(1):46–50. doi:10.5114/pm.2019.84157.
7) Cornu J.N et al. 75NC007 device for noninvasive stress urinary incontinence management in women: a randomized control trial. Int Urogynecol J. 2012 Dec;23(12):1727-34. doi: 10.1007/s00192-012-1814-z.
8) Robert M and Ross S. No. 186-Conservative Management of Urinary Incontinence. J Obstet Gynaecol Can. 2018;40(2):e119-e125. doi:10.1016/j.jogc.2017.11.027
9) Aoki Y et al. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. doi:10.1038/nrdp.2017.42.
10) National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management 2019
11) Lipp A et al. Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2014(12):CD001756. doi:10.1002/14651858.CD001756.pub6.
12) Wu YM and Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol. 2019;11:179–88. doi:10.2147/RRU.S191555.
13) De Vries AM and Heesakkers JPFA. Contemporary diagnostics and treatment options for female stress urinary incontinence. Asian J Urol. 2018;5(3):141–8. doi:10.1016/j.ajur.2017.09.001.