Post partum urinary incontinence
What is it?
Among the various possible sequelae of vaginal delivery, one of the most common is urinary inconitnence. It consists of the involuntary loss of urine, objectively demonstrable and of such magnitude as to constitute a hygienic and social problem. Postpartum urinary incontinence is typically defined as stress incontinence i.e. loss of urine under stress (coughing, laughing, walking). It is usually due to tissue laxity and an anatomical defect created by childbirth, especially in the presence of risk factors such as advanced maternal age, infant weight, and prolonged childbirth. Its incidence is imprecise due to the patient's difficulty in reporting this symptom, but it is around 15% in the first 6 months postpartum (it often self-resolves).
Which are the symptoms?
The symptom is precisely the involuntary loss of urine in an unsuitable social context. In most cases it is associated with an abdominal effort such as a cough, lifting a weight, or laughing.
- involuntary loss of urine
How is it diagnosed?
Urinary incontinence should be simply objectified on examination or by taking a careful history with the patient.
How is it treated?
Conservative treatment: It consists of rehabilitation of the pelvic floor that includes sessions of electrostimulation and the so-called pelvic gymnastics. With the help of specialized midwives, you learn exercises that can be repeated independently at home. The percentage of benefit varies from 30 to 70%. In case there is no improvement after 3-6 months of therapy, other methods should be tried.
Pharmacological therapy: used in case of urge incontinence (rarer, as mentioned before). The drug of choice is anticholinergic drug.
Surgical treatment: it is the best method to treat stress incontinence and urethral sphincter deficit. The techniques are numerous and must be adapted to the patient. The traditional surgical interventional procedure requires the application of a suburethral bandage capable of maintaining continence (sling); newer techniques are the periurethral injections of substances such as collagen and silicone.
Where do we treat it?
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