Treatment

Female Urinary Incontinence

Conservative treatments

• Hygienic-dietary measures: include weight control, modification of fluid intake, restriction of certain foods such as coffee or alcohol, modification of physical activity and dietary guidelines to improve constipation.
• Pelvic floor muscle training: aims to optimize the musculature and improve urine leakage in patients. A previous assessment by the urologist, physiotherapist is essential to determine the muscle strength and thus obtain better results. It is advisable to perform the training program daily for a minimum of 3 months and then move on to the maintenance program a minimum of 3-4 times per week. Kegel exercises strengthen the pelvic floor and are especially indicated for pregnant women and people with stress urinary incontinence. It is recommended to do them with a physiotherapist and experts in pelvic floor management to ensure the correct performance of the exercises.
• Bladder training: consists of correcting inadequate frequent urination patterns, improving control over voiding urgency, prolonging intervals between micturitions, increasing bladder capacity, decreasing incontinence episodes and restoring the patient's confidence in bladder control.
• Biofeedback: is performed through electrodes placed in the vagina and/or anus, which record the activity of the pelvic floor muscles while the exercises are being performed. The electrodes provide visual and/or audible signals to check if it is being done correctly. The goal is to help women selectively contract and relax the pelvic floor muscles using signals from their own body. Pelvic floor assessment by a healthcare professional is also an example of biofeedback.
• Electrical stimulation is recommended when it is not possible to contract the pelvic floor muscles due to nerve damage, for example secondary to childbirth or after surgery. Electrostimulation will provide an artificial contraction of the pelvic floor muscles helping to strengthen them. This method is not appropriate for women who can contract their pelvic floor muscles even if these contractions are weak.
• Vaginal devices: help improve urinary incontinence by supporting the urethra and preventing urinary incontinence (vaginal tampons and pessaries), as well as strengthening the pelvic floor muscles (vaginal cones and spheres).
• Urinary incontinence pads: is a palliative treatment for urinary incontinence that is recommended when there is no other therapeutic solution. Many times, the compress makes the patient get comfortable and gives little feasibility for the patient to do physical therapy. Knowing that they are wearing a pad, they do not make the physical effort to prevent urine leakage.
• Incontinence chair: the incontinence chair ACTIVE HIFEM is an innovative technology used in the treatment of stress urinary incontinence in both women and men. This device uses high-intensity focused electromagnetic energy to stimulate the pelvic floor muscles, strengthening and improving their functionality without the need for invasive procedures. The ACTIVE HIFEM chair achieves thousands of contractions of the pelvic floor muscles, similar to those experienced during Kegel exercises, improving their tone and restoring neuromuscular control of the area.

Medication treatment

When conservative treatments have not worked, medication with pills, patches or vaginal treatments can be used depending on the patient's clinical condition. For this, an individualized study and a specialized approach is made to the patient, informing her adequately of the expected effects. Among the treatments administered in the bladder are botulinum toxin, hyaluronic acid or, in case of urinary tract infection and painful symptoms related to the bladder, chondroitin sulfate.

Vaginal laser

Vaginal laser treatment has a role in several female urological functional pathologies. It is a painless treatment that consists of applying CO2 laser in the vagina to stimulate the production of collagen at a muscular level, achieving the tightening of the pelvic floor.

This treatment does not require any special preparation before the treatment, nor any post-operative precautions. The patient returns immediately to her daily activities.

Surgery

In the case of stress incontinence surgery may be necessary, this operation for urinary incontinence is traditionally based on the use of mesh or slings. In case of abdominal prolapse, surgery can be performed vaginally or with a minimally invasive abdominal approach with laparoscopic or robotic. In case of incontinence, the surgery is usually performed in 25 minutes and the patient can go home the same day.

We perform a detailed study of the patients and to apply individually the different treatment maneuvers with suburethral bands, adjustable sling or artificial urinary sphincter.

For recovery from surgery, it is recommended to avoid exertion during the first weeks after surgery to ensure proper healing of the pelvic floor. The recovery time is about 6 weeks. Returning to work will depend on the profession performed, if it is an office job, perhaps the next day you can resume. However, if it is a job in which you have to take weight, it is necessary to wait the 6 weeks of recovery to get the mesh to integrate with the body and heal so that it does not give problems.