Urinary incontinence is the involuntary leakage of urine, either in drops or in larger amounts, resulting from a loss of bladder control. Studies show that 25 percent of women over the age of 18 experience urine leakage. This condition occurs at a rate of 10-15 percent in young people, rising to 35-40 percent in those in their 70s. Some data suggest that this rate rises to 70 percent in older adults.
Despite its prevalence, urinary incontinence is often a hidden health issue, often hidden from even those closest to them because it's considered "shameful" or a natural consequence of aging. However, the problem grows over time, becoming a social problem that isolates women from society and causes them to live introverted lives. Women who initially managed the condition by using pads eventually stopped traveling long distances and then stopped making closer visits. She can't spend long periods away from her home and the toilet, and she gradually becomes isolated from society.
TYPES OF URINARY INCONTINENCE
Stress urinary incontinence: This is the most common type of urinary incontinence in women. Urine is leaked during various activities such as coughing and exercise.
Urge (Urgent) urinary incontinence: This is the leakage of urine before reaching the toilet when there is a strong and urgent need to go to the toilet.
Mixed Urinary Incontinence: When stress and urge incontinence occur together, this is called mixed urinary incontinence. For example, the patient may leak urine when coughing or sneezing, or sometimes after a sudden urge.
Overflow Urinary Incontinence: When urine is stored in excess of its capacity in the bladder, small amounts of urine are leaked without the urge to urinate. The patient feels as if they have never completely emptied their bladder.
Total Urinary Incontinence: The patient states that they are unaware of urine leakage and that their underwear is constantly wet.
Functional Incontinence: Despite urinary incontinence in some patients, tests are normal. This patient group may have conditions such as Alzheimer's, Parkinson's, or arthritis.
What Causes Urinary Incontinence?
Bladder outlet obstructions due to bladder infections, cystitis (inflammation of the bladder) in women, vaginal infections, bladder stones, tumors, and prostate enlargement, especially in men, can all cause overactive bladder. Other causes of persistent urinary incontinence in women include fistulas between the bladder and vagina, or between the kidneys and bladder, or between the ureters and vagina. Diabetes and alcoholism can be among the causes of nerve damage in overflow urinary incontinence.
In girls, sometimes, an ectopic ureter (the opening of the urethra from the kidney to a location other than the bladder) can cause persistent urinary incontinence. Such children, despite going to the toilet regularly, experience occasional urinary incontinence. Nighttime (nocturnal) or daytime (diurnal) incontinence in children is called enuresis. Spinal cord compression can lead to neurological incontinence and dysfunction in children; constipation can predispose to infection and urinary incontinence.
Various surgeries can cause urinary incontinence in both sexes. In men, prostate cancer surgery, other prostate and bladder neck surgeries, surgeries around the bladder and sphincter, and surgeries that may cause sphincter insufficiency in women, as well as fistula formation, can be considered among these causes.
Medications can also cause or exacerbate incontinence: These include muscle relaxants, blood pressure-lowering medications, diuretics, tranquilizers, antidepressants, and allergy medications.
Diagnosis of Urinary Incontinence
In treating urinary incontinence, determining the type of incontinence is crucial for treatment. In addition to the examination, your doctor may order certain tests to confirm the diagnosis of incontinence. These tests are crucial for administering the correct treatment. These tests include:
- Urine Culture
- Urine Flow Rate
- Cystogram
- Cystoscopy
- Urodynamics
HOW IS URINARY INCONTINENCE TREATED?
The most appropriate treatment will be determined by the type of urinary incontinence. Not every treatment approach may be effective for every type of urinary incontinence. Treatment alternatives include:
Kegel exercises
Exercises to strengthen the pelvic floor muscles are sometimes effective alone, but are generally an adjunct. This treatment strengthens the pelvic floor muscles by controlling the bladder and urination muscles. In addition to these exercises, a diary (urinary diary) is kept and bladder training is provided within the program. Biofeedback and electrical stimulation, applied alone or in conjunction with these exercises, are also effective in strengthening weakened pelvic floor muscles.
Medication
Medication for some types of urinary incontinence or hormones. Medication is the first choice, especially for urge urinary incontinence. The duration of medication varies from patient to patient.
Surgical Treatment
Surgery is performed when other treatment approaches fail. New methods are now available that are very simple, less invasive (require fewer incisions), quick to perform, highly effective, and have a much shorter discharge and recovery period, even under local anesthesia. In the TOT (Transobturator Tape) method, a tape is placed in the middle of the urethra that will remain closed under stress. The patient is discharged home the same day or the next day without a catheter.
Injections Around the Urethra (Urethra)
For patients who cannot undergo surgery or will not benefit from it, surgery is performed to open the urethra. Various substances are injected into the surrounding area under local anesthesia. These are different proteins or chemical structures called collagen, polytephthalate, or macroplasty.
Botox Injections
This very new method involves injecting botulinum toxin into the bladder muscle to temporarily relax the bladder contraction muscles, thus treating urgency or incontinence.
WHEN SHOULD YOU CONSULT A DOCTOR?
If you answered "yes" to any of the following questions, consult a Urologist.
- When you laugh or cough or when you sneeze; when you walk or exercise; when you lift heavy objects; or when you stand up from a sitting or lying position.
- If you have to go to the toilet frequently throughout the day.
- If you have to use a pad because of these problems.
- If you can't get to the toilet when you feel the urge to urinate.
- If you feel like you can never completely empty your urine when you're on the toilet.