Oana Maria Popescu
Incontinenta urinara este incapacitatea de a retine urina in vezica urinara, ca urmare a afectiunilor neurologice sau modificarilor mecanice la nivelul sistemului de control al micitunii.
Cauzele incontinentei urinare sunt:
– instabilitatea detrusorului
– incontinenta de stres (care se refera la stresul datorat presiunii intraabdominale- stres organic): apare mai ales la femei dupa menopauza, datorita atrofiei uretrale prin deficit de estrogeni, care nu mai rezista presiunii intraabdominale crescute din timpul tusei, stranutului, urcatului pe scari, si altor activitati fizice. Suportul pelvin este afectat, iar uretra se scurteaza. La barbati incontinenta de stres apare mai ales ca urmare a interventiilor chirurgicale pe prostata secundare hipertrofiei sau carcinomului prostatic.
– incontinenta mecanica
– incontinenta paradoxala sau reziduala
– incontinenta psihogena si functionala: copiii si uneori adultii tineri atrag atentia asupra lor prin mimarea incontinentei, din care obtin satisfactii emotionale secundare. Este necesara o evaluare diagnostica completa pentru a ne asigura ca nu exista afectari organice , chiar si atunci cand se suspecteaza din start ca este vorba despre incontinenta psihogena. La batrani, in special cei care au o capacitate limitata de a se deplasa singuri sau care sunt confuzi ca urmare a unei boli sau medicatii, incontinenta poate fi functionala, respectiv este pur si simplu o incapacitate de a ajunge la toaleta in timp util.
O alta problema este aceea a vezicii hiperactive, definita ca necesitate de a mictiona, cu sau fara incontinenta, de obicei asociata cu nicturie, in absenta factorilor patologici locali sau hormonali.
Tratamentul vezicii hiperactive include terapie farmacologica, cistoplastia, administrare intravezicala de oxibutinina, toxina botulinica intra-detrusor si neuromodulatori, in timp ce tratamentul actual in incontinenta urinara se realizeaza in primul rand prin psihoterapie comportamentala, biofeedback, stimulare electrica, anticolinergice, terapie locala cu estrogeni la femei postmenopauza si interventii chirurgicale in cazurile severe.
Incontinenta urinara este o afectiune cu impact negativ semnificativ asupra calitatii vietii, justificand interventiile psihoterapeutice, atat la nivel suportiv cat mai ales pentru ameliorarea simptomatica. Nu este vorba doar despre un simptom, ci despre o boala clinica relevanta, cu consecinte fiziologice si psihologice. Cercetarile din ultimii 40 de ani au fost orientate de teoriile asupra schimbarii comportamentale, mai ales conditionarea operanta, si in ultima perioada teoriile cognitive.
Nu exista inca date concludente referitoare la mecanismul de actiune al terapiei comportamentale, dar se pare ca terapia comportamentala si medicamentoasa actioneaza sinergic, pe cai diferite.
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