Involuntary URINARY INCONTINENCE (URINARY INCONTINENCE)
The International Continence Association defines urinary incontinence as any type of urinary incontinence complaint. It is seen 3-4 times more frequently in women than in men, and this rate increases in both sexes with age. ) complains about problems in the muscles and organs. In addition, it is a condition that must be treated because it negatively affects the quality of life of the person and causes a decrease in self-confidence.
Types of Urinary Incontinence:
Stress Urinary Incontinence: It occurs in women with a high number of births, those who have had a difficult delivery, and in cases where intra-abdominal pressure is high such as chronic constipation. Women who leak urine while coughing or laughing are in this group.
Urge Incontinence – Squeezing Type Urinary Incontinence: There are also women who have complaints of sudden urination, sudden urgency, and inability to catch up when they suddenly feel the need to urinate.
Mixed urinary incontinence: Urinary incontinence occurs when intra-abdominal pressure increases, such as both squeezing-inability to reach and cough-sneezing-laughing.
What are the Risk Factors for Urinary Incontinence?
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Age: As the pelvic floor support and tissues weaken as age progresses, urinary incontinence may be observed more frequently.
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Birth: High number of births, large baby births, difficult births, giving birth at home increase the possibility of urinary incontinence.
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Menopause: Support tissue weakens due to estrogen deficiency.
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Obesity
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Diseases that cause weakness of the muscles of the pelvic floor (inguinal region in the pelvis)
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urinary tract infections
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Genetic predisposition
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Obesity
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Cigarette
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Alcohol
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Past surgeries: History of uterus removal surgery (hysterectomy)
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Various diseases: Stroke, diabetes (diabetes), neurological diseases, Medications
Urinary Incontinence Diagnosis
1) Detailed anamnesis should be questioned:
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Do you smoke or use alcohol?
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How much fluid do you consume per day?
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Are there any medications you use? (Some drugs may cause coughing; some may cause difficulty in urination by excessive contraction of the muscles; some may indirectly cause urinary incontinence through various mechanisms.)
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Have you ever been pregnant? What is your birth type?
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Have you entered menopause?
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Have you had any previous surgery?
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Do you leak urine when coughing while laughing?
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Do you happen to be unable to reach the toilet?
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Do you feel that your bladder is not empty after you use the toilet?
2)Physical examination
Patients are asked to come to the examination with a full bladder. It is tested whether the patient leaks urine by coughing and straining. Afterwards, the bladder is emptied and the amount of urine left behind is measured, and the patient is checked for sagging in the bladder, vagina and adjacent organs by performing a gynecological examination.
After the examination, we ask our patients to keep a voiding diary to record when and how often they go to the toilet, how much liquid they consume per day, and how much urine they urinate in the toilet until the next examination.
3) Urinalysis and culture
Urinary Incontinence Treatment:
The goal of treatment is to completely prevent urinary incontinence. Before starting medication or deciding on surgery, patients need to make changes in their lifestyles. We want them to lose excess weight, limit their nightly fluid intake, especially tea and coffee, and avoid foods that cause them to be constipated. Our patients who lose weight and have a regular bowel habit can observe an improvement in their complaints. Regular sports should be done and Kegel exercises should be done to strengthen the bladder and pelvic floor muscles.
Surgical and non-surgical treatment methods are available.
Non-Surgical Treatments:
1) Pelvic Floor Training: Exercises of the pelvic floor muscles (Kegel exercises); is the first step in the treatment. To find the pelvic floor muscles, squeeze and hold the muscles below the belly button while urinating while sitting on the toilet. The muscle you feel when you stop urinating is the pelvic floor muscle.
You can start doing Kegel exercises at any time of the day and in any position (while cooking, watching TV). Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Repeat at least 3 times a day. For best results, pay attention to tightening only your pelvic floor muscles. Be careful not to stretch the muscles in your abdomen, legs, or hips. Avoid holding your breath. Instead, breathe freely during the exercises. You should not do Kegel just to contract the muscles while urinating, which you need to pay attention to.
An improvement of 50-75% has been reported in appropriate cases.
2) Biofeedback Therapy: With the electrical stimulation applied into the vagina, it can tighten the vagina muscles and tissue.
3) Hormonal Therapy: Estrogen-containing drugs can be beneficial, especially in women in the menopausal period, by providing the missing local estrogen.
4) Oral Incontinence Drugs: Patients with urge urinary incontinence may benefit from some drug groups such as Anticholinergic group and Beta-3 Agonists, depending on the severity and cause of incontinence.
5) Supporting vaginal tissue, muscles and bladder neck using laser devices
Surgical treatment:
-Colposuspension (retropubic urethropexy) (BURCH, paravaginal repair)
-Pubovaginal sling (uretropexy)
-Minimally invasive sling: (TOT, TVT)
-Periurethral and transurethral injections
– Laparoscopic (closed way) suspension methods
Supporting the base of the bladder with a synthetic tape, such as transvaginal tape (TVT) and transobturator tape (TOT), is one of the most effective surgical techniques in the treatment of urinary incontinence. These operations can be performed vaginally (from the chamber) without excessive bleeding, with very small incisions. After these surgeries, patients regain their normal lives in a short time.
With laparoscopic (closed way) suspension methods, the neck of the urinary bladder is hung up with various methods. It has important advantages such as less pain after surgery, shorter hospital stay, smaller incisions and a shorter return to daily life.
Urinary incontinence can be a situation that can negatively affect your quality of life and social life, cause depression, loss of self-confidence, and create problems in your sexual life and relationship with your partner. Remember that you have a medical condition that can be treated. The important thing is that you feel good and special.
