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In daily life, unexpected and unwanted outflow of urine from the urinary tract is called “urinary incontinence”. Urinary incontinence is also called “involuntary urinary incontinence”, “involuntary incontinence”, “urinary incontinence” or “loss of bladder control”. It is a common health problem in the society, especially in women.
If urinary incontinence affects your social life and quality of life, treatment is absolutely necessary. Because it is not something to be ashamed of and is not considered part of normal life. Many patients can achieve significant results with simple lifestyle changes and basic medical treatments.
When we look at the causes of urinary incontinence, there are 4 types of urinary incontinence.
Stress urinary incontinence:
It is the most common cause of urinary incontinence in women. Urinary incontinence is seen when intra-abdominal pressure increases such as coughing, sneezing, straining, laughing. It is caused by inadequate or weak valves in the bladder (urinary bladder) and urethra (urinary canal leading out of the bladder) and pelvic floor muscles. The most important causes are pregnancy, childbirth and menopause.
Urge incontinence (urge type):
It is defined as urinary incontinence with a sudden urge to urinate. Incontinence occurs before the person reaches the toilet. Unlike stress urinary incontinence, it is not caused by weakness in the pelvic floor, but by overactive bladder muscles.
Mixed urinary incontinence:
It is observed in cases where stress incontinence and urge incontinence are together.
Overflow urinary incontinence:
Although the bladder is full, there is no sensation of urination due to loss of sensation, and urinary incontinence in the form of overflow is seen when urine is stored in excess of the bladder capacity. This type of incontinence is seen in diseases of the nervous system such as bladder injuries, urethral obstruction, advanced diabetes (damage to the nerves), spinal cord injury or multiple sclerosis.
Conditions that can cause temporary incontinence: Alcohol, excessive fluid intake, bladder stimulants, some medications (heart medications, hypertension medications), urinary tract infections, constipation can increase urinary incontinence complaints or cause temporary incontinence in normal individuals.
In the evaluation of urinary incontinence, a good medical history (anamnesis) is very important to understand the type of incontinence and its severity. After a detailed anamnesis, a physical examination is started. Physical examination is extremely important in determining the person’s urinary incontinence problem.
Examination: A detailed pelvic examination and observation of urinary incontinence is required. In addition, prolapse of the uterus (desensus), prolapse of the bladder (cystocele), prolapse of the intestines (rectocele) should be observed to get an idea of their degree. During the physical examination, the patient is subjected to a number of tests. The most common of these tests are the “Marshall Test”, in which the bladder neck is lifted vaginally and the “Q Tip Test”, in which the mobility of the bladder neck is measured with the help of a cotton-tipped swab.
24-hour urine diary: A form that includes daily fluids intake and frequency and amount of urination. This diary helps the doctor with diagnosis and treatment.
Urine analysis: Signs of urinary tract infections, blood in the urine or stones may be detected.
Postvoiding residual measurement (PVR): The urine remaining in the bladder after urination is easily measured by ultrasonography. The presence of excess urine in the bladder after voiding indicates that there may be obstruction in the urinary tract or problems with the nerve and muscle layer of the bladder.
Urodynamic tests: Tests based on the measurement of bladder pressures at rest and during voiding. Although not always necessary for the diagnosis of incontinence, it may be helpful in determining the type of incontinence.
Treatment of incontinence is planned according to its type and severity. Conservative treatments, various medical or surgical therapies should be individualized to the patient.
The aim is to strengthen the pelvic floor muscles and bladder muscles that carry the bladder.
Bladder Exercises: It is aimed to delay urination and to train and strengthen the bladder by holding it for a certain period of time when the urge to urinate comes.
Pelvic Floor Muscle Training: Exercises of the pelvic floor muscles “KEGEL EXERCISES” are the first step in treatment as they strengthen the support to the vesicourethral junction (i.e. the bladder and the urinary canal angle at the bladder outlet) and strengthen the levator ani and pelvic floor diaphragm, especially in patients with stress-type urinary incontinence.
Electrical Stimulation: Anal and vaginal electrodes are used. It is a form of treatment based on electrical stimulation of the pelvic floor muscles by stimulating the pelvic nerves. It is aimed to increase the urethral closure pressure by reflex contraction of the muscles around the urethra. Numerous sessions are required and treatment should last for months. Today, it is not the treatment of choice.
Estrogen Hormone: It can be used to stimulate the bladder mucosa and submucosal tissue to increase blood circulation, thereby increasing smooth muscle response and urethral closure pressure. Local estrogen administration is 1-2 g intravaginally at bedtime for 6 weeks; maintenance dose is 2-3 times a week.
Anticholinergics and/or Tricyclic Antidepressants can be used to treat urge and overflow incontinence. It increases the expansion and urinary capacity of the bladder and suppresses involuntary contractions of the bladder.
Surgical treatment is generally preferred in the treatment of stress-type incontinence. Surgery can be performed abdominally (through an open incision in the abdomen), laparoscopically or vaginally. Nowadays, due to the advancement of surgical techniques and the advancement of synthetic mesh technology, the most commonly used “SLING (sling)” operations.
– Operations on the abdomen: MMK-Burch-Marchall Marchetti Kranz or Burch operation. These can be performed open or laparoscopically.
– Sling (Suspension) Operations: TVT, TOT and mini-sling techniques.
– Artificial Urethral Sphincter
– Periurethral Injections: (Teflon, collagen, autologous fat…)
Sling surgery is most commonly used in cases of stress incontinence and mixed urinary incontinence. The common point of suspension surgeries is that they are operations based on passing completely under the urethra or bladder neck, creating a pelvic sling, and supporting the bladder neck and urethra. (TVT, TOT and Mini sling) The patient can be discharged one day after the operation and can return to his/her daily life immediately. Among the sling operations I prefer clinically, it is usually TOT (TRANSOBTURATOR TAPE). It is performed vaginally through a 1-2 cm incision under the urethra. It is a simple operation that takes about half an hour. The chance of success is over 90%. Long-term results are quite good and the possibility of recurrence is minimal.
Recommendations to reduce the risk of urinary incontinence:
– Weight loss in obese patients
– Avoiding constipation and fiber consumption
– Avoiding activities that cause urinary incontinence
– Smoking (smoking cessation reduces the risk of incontinence)
– Avoid bladder stimulants (reduce consumption of caffeinated beverages such as tea, coffee, cola)
– Treating diseases that cause chronic cough
– Kegel Exercises (Performing Kegel exercises in daily life, especially during pregnancy and pre-pregnancy, reduces the risk of incontinence).
– Regular sports or exercise.
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DISCLAIMER All of the articles, images and all content on this website are for informational purposes only. Op. Dr. Cem Özlük cannot be held responsible for any damages that may arise from any unconscious application without consulting a specialist.