Incontinencia urinaria: pistas para un mejor enfoque

Urinary incontinence is a problem affecting all ages of life, with a great impact on quality of life and health care cost. Internationally, guidelines have been proposed that suggest the consensus of the Anglo-Saxon setting (International Society of Continence and International Consultation in incontinence). We present a summary of the logical concepts that may be integrated in the reasoning of the general physician to help in referrald and diagnostic criteria. The micturation cycle and continence are a simple system of pressures (with conceptual similarity to the cardiac hemodynamics): any alteration will produce incontinence or micturational disorders. The keys of the anamnesis and physical examination as well as the different clinical presentations (including enuresis) are summarized. We also review the utility and indications of the urodynamic studies, that should no longer be a myth and should become an accessible and undestandable aid. The interdisciplinary work and communication between general physicians and specialists may achieve greater attention in all incontinent patients.