Urinary Incontinence
Women suffering from urinary incontinence while coughing, laughing, sneezing, or exercising...
URINARY INCONTINENCE
The urinary incontinence might actually be seen even in healthy women from time to time. Since its recurrence affects the person's life quality negatively and reduces their self-confidence, it is a condition that must be treated absolutely. One out of every four women complains about problems in their urinary bladder or inguinal region, i.e. pelvic floor, muscles and organs. If you say 'I can't hold my urine', 'I'm afraid of going outside', 'my underwear gets wet whenever I cough or lift something heavy', you should know this is not destiny but instead curable. Maybe because they think there is no solution, many women prefer to put up with it instead of receiving help. Today, thanks to the availability of permanent and effective treatment methods, the urinary incontinence problem is no more an accepted and hidden taboo.
WHAT ARE THE REASONS OF URINARY INCONTINENCE?
• Age: Although it can be seen in any age, the risk for older women is higher, depending on the accompanying factors.
• Menopause: Depending on estrogen deficiency, the risk is higher in the menopause period.
• Pregnancy: Although it is seen in the women who have had vaginal delivery more frequently, it can also be seen in the women who have had c-section delivery.
• Delivery at young age
• Delivery for many times
• Difficult and interventional deliveries
• Diseases weakening the pelvic floor muscles (the inguinal region in the pelvis)
• Urinary tract infections
• Genetic predisposition
• Obesity
• Smoking
• Alcohol
• Past operations: Hysterectomy story
• Various diseases: Stroke, diabetes, neurological diseases
• Medicines
IN WHO IS URINARY INCONTINENCE SEEN?
Contrary to popular belief, this condition that affects the life quality negatively because of being unable to go out without using pad, shame caused by bad odor, refraining from sexual intercourse due to the fear of leaking urine during sexual intercourse is not only the older women's problem. Although it is generally seen in the persons who have had too many and difficult deliveries, it may also be seen in the persons who have not had normal vaginal delivery, or who have had c-section delivery.
Deliveries, past operations, age-related weakening of the pelvic floor muscles and connective tissue, frequent infections, obesity, chronic diseases like diabetes, certain medicines used may cause urinary incontinence.
HOW IS IT DIAGNOSED?
1. The anamnesis (the questions asked to the patient by the doctor to make a diagnosis) must be investigated in detail.
• Do you smoke?
• Do you drink alcohol?
• How much fluid do you take a day?
• How much fluid do you take in the evenings?
• Are you on any medication? (Certain medicines may cause difficulty in urination by causing coughs or excessive contraction of the muscles, while others may lead indirectly to urine leakage through various mechanisms.)
• Have you ever become pregnant? What was your type of delivery?
• Are you in menopause?
• Have you ever had surgery?
• Do you leak urine while laughing or coughing?
• Are there times you have failed to get to the toilet on time?
• Do you have the feeling that your bladder is not completely empty after urination?
2. Physical Examination
3. Ultrasonography
4. Urination log: We request our patients to record until the next examination when and how frequently they go to urination, how much fluid they consume a day, and how much urine they discharge.
5. Urine analysis and urine culture: A possible infection in the urinary tract may mislead us by mimicking the urinary incontinence symptoms.
6. Measurement of the residual urine volume after urination: Incomplete bladder emptying may also cause urinary incontinence. The residual urine volume can be measured with the help of a catheter or ultrasonography.
7. Urodynamic tests
WHAT ARE THE TYPES OF URINARY INCONTINENCE?
There are several types of urinary incontinence. When and how the patient leaks urine is important.
• Stress Urinary Incontinence (SUI): Coughing, sneezing, exercises, lifting heavy objects increase the pressure in the urinary bladder in the abdomen, and the bladder muscles cannot resist this increase, as a result of which some urinary is leaked. This is generally a result of weak urinary bladder support or damage to the muscles helping to hold urine.
• Urge Urinary Incontinence (UUI): The condition in which the person feels urge to urinate upon unexpected contraction (overactive) of the bladder muscles that must be active normally when we want to urinate and usually leaks urine without getting to the toilet on time.
• Overflow Urinary Incontinence: The condition in which the bladder is congested in a manner that blocks normal flow of the urine from the bladder due to its weakness or any other reason.
The patients are put on the gynecologic table when their bladders are full and asked to cough or strain during examination, thus finding out the type of their urinary incontinence. The degree of the prolapse is determined through vaginal examination and pelvic floor ultrasonography. The post-urination residual urine volume is measured with the help of a catheter or ultrasonography, thus checking whether the patient can empty their bladder completely. After all these examinations, the type of the patient's urinary incontinence is diagnosed, and the treatment to be applied is determined.
HOW IS IT TREATED?
Before starting the medication or deciding on surgery, the patients are required to change their life styles. We want them lose excess weight, limit the night time fluid intake, tea and coffee consumption in particular, and avoid the foods that may cause them to be constipated. Our patients who lose weight and get a regular intestinal habit may observe a reduction in their complaints. It is necessary to play sports and do Kegel exercises regularly to strengthen the urinary bladder and pelvic floor muscles.
HOW TO DO THE KEGEL EXERCISES?
Before starting the Kegel exercises, it is necessary to know what the pelvic floor and muscles are. In order to find the pelvic floor muscles, contract your muscles below your navel and try to keep them contracted while urinating in sitting position. The muscle you feel when you stop your urine is the pelvic floor muscle, and you can start to control them.
You can start to do the Kegel exercises in any position. Contract your pelvic floor muscles and keep them contracted for five seconds, then relax for five seconds. Do this for four or five times consecutively. Try to keep the muscles contracted for 10 seconds at a time, and relax for 10 seconds between the contractions. For the best results, concentrate on contracting your pelvic floor muscles only. Pay attention not to flex your stomach, hip or leg muscles. Refrain from holding your breath. Instead, breathe freely during the exercises. Repeat for 3 times.
You can do the Kegel exercises any time of the day, while cooking, watching TV, etc. The only thing you should care is not to do Kegel exercises to contract the muscles while urinating. Since doing the Kegel exercises while urinating causes that the bladder is not emptied completely, some urine may remain in it, increasing the urinary tract infection risk.
The treatment options are determined on the basis of the type and severity of the urinary incontinence. Mostly, medication or surgical treatments may be applied in addition to life style change and Kegel exercises.
Medication: The patients who suffer from urge urinary incontinence may benefit from some groups of anticholinergic drugs, depending on the severity and cause of the incontinence. These drugs can be taken as pills or through adhesive patches.
Alternative treatments of urge urinary incontinence: Sometimes, the life style changes and medication may fail to give positive results. There are also alternative treatment methods for such cases.
These methods are as follows:
• Botox to bladder
• Neuromodulation
Surgical treatment:
- Colposuspension (retropubic urethropexy) (BURCH, paravaginal repair)
- Pubovaginal sling (urethropexy)
- Minimally invasive sling: (TOT, TVT)
- Periurethral and transurethral injections
- Artificial sphincter
Transvaginal tape (TVT) and transobturator tape (TOT), which are supporting of the base of the bladder with synthetic tapes, are effective operational techniques in treatment of urinary incontinence. This operation can be done vaginally with very small incisions without much bleeding. The loose connections are strengthened, and the prolapsing tissues are suspended to their normal positions with lattice materials if necessary. After these operations, the patients go back to their normal lives quickly.
Advantages of the surgical treatments applied vaginally:
* High success rate
* Less pain
* Small scar
* Brief hospitalization (generally 1 night)
* Quick return to daily life
* Natural and vaginal intervention without any abdominal incision
Suspension methods applied through laparoscopy:
They are the laparoscopic surgery done to see inside the abdomen with laparoscope inserted through 0.5-1 cm small incisions in the abdominal region. The bladder neck is suspended upward through various methods. Its important advantages compared to open surgery are less postoperative pain, shorter hospitalization, smaller incisions, and faster return to daily life.
HOW CAN I COPE WITH URINARY INCONTINENCE?
Urinary incontinence may become a condition that affects your life quality and social life, causes depression and loss of self-confidence, loss of performance in sexual life, and affects your relationship with your partner. Remember that your disease is curable. We, your doctors, are always beside you. What is important is that you feel good and special.
All our women are very special to us…
