Urinary Incontinence

What it is

Urinary incontinence is the involuntary leakage of urine, a very common complaint that is still underreported out of embarrassment. It can occur with exertion — coughing, laughing, sneezing, physical activity —, from urgency, with a sudden and hard-to-control urge, or as a mixed type. Pregnancies, childbirth, menopause, excess weight, constipation and weakening of the pelvic floor are among the most frequent factors. The urogynecological assessment includes a detailed history, physical examination, a voiding diary and, when necessary, additional tests. Treatment is stepped up according to the type and severity of the leakage: lifestyle changes, pelvic floor physical therapy, medication for an overactive bladder, intimate laser in selected cases and, when indicated, sling surgery. The plan is defined together with the patient, based on her routine and goals.

Most common symptoms

• Urine leakage when coughing, sneezing, laughing or exercising
• Sudden urge to urinate, with leakage before reaching the bathroom
• Very frequent trips to the bathroom during the day
• Waking up several times at night to urinate
• Needing to use a pad or panty liner because of the leakage
• A feeling of incomplete bladder emptying
• Limiting social and physical activities for fear of leaks

Causes and risk factors

• Pregnancies and vaginal deliveries, especially with large babies or forceps
• Menopause and the drop in estrogen, which weaken the tissues
• Weakening of the pelvic floor muscles
• Excess weight, chronic constipation and persistent cough
• Overactive bladder, urinary tract infections and certain medications
• Previous pelvic surgeries and aging

How it is diagnosed

The urogynecological assessment begins with a detailed history: in which situations urine leaks, how often, how much fluid the patient drinks, and which medications she uses. A voiding diary kept for a few days helps characterize the type of incontinence. During the physical exam, your gynecologist assesses the pelvic floor, the presence of prolapse, and leakage with exertion. Urinalysis, ultrasound and, in selected cases, urodynamic testing complement the investigation when necessary.

How we treat it at Femi Saúde

Treatment is stepped up according to the type and severity of the leakage. The gynecology team at Femi Saúde starts with lifestyle changes, such as adjusting fluid intake, managing weight and constipation, and bladder training, along with pelvic floor physical therapy, the foundation of treatment. For urgency incontinence, bladder medication may be indicated; during menopause, vaginal estrogen helps the tissues. Intimate CO₂ laser is an option in selected cases of mild stress leakage. When leakage persists despite these measures, sling surgery may be indicated. The plan is defined together with the patient, according to her goals.

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