Urinary Incontinence



Urinary incontinence is inability to control urination, which is out of control of women and poses social and hygienic problems .

Studies investigating the frequency of urinary incontinence in Turkey reveals that half of women in menopausal period and one-third of women in reproductive age have urinary incontinence in different levels. Atasehir Florence Nightingale Hospital, Department of Women’s Health and Diseases Prof. Dr. Fuat Demirci, MD points out that four out of five women who have had urinary incontinence thinks urinary incontinence as a natural consequence of aging and birth!

Urinary incontinence is a serious disease that disrupts the quality of life and should be treated!

The woman with urinary incontinence constantly uses pads or diapers, avoids social relations due to incontinence and odor and restricts herself to her home. This sometimes causes serious psychological problems and depression.

What are the causes of urinary incontinence?

The most important cause of urinary incontinence is weakening of the pelvic floor and the support tissue of the bladder. In this type of urinary incontinence called stress incontinence, the patient experience urinary incontinence when s/he coughs and sneezes, and forces. This is often associated with a high number of births, giving birth to large babies, giving birth at home, giving birth hardly, giving birth with intervention or giving birth by untrained people. In addition, it can be caused by heavy work, advanced age, menopause, prolonged constipation, obesity, or lung diseases such as asthma, bronchitis. Due to the high number of deliveries in our country, most of the involuntary incontinence cases are seen as stress incontinence mostly seen in young women of reproductive age.

Urge incontinence  is the second most common cause of urinary incontinence that occurs due to the contraction of the bladder muscle due to an unknown manner. This is also called overactive bladder syndrome . This type of urinary incontinence is often in the manner of sudden urination in water-related work and inability to reach the toilet. In some patients, the first and second coexist. This type of urinary incontinence is called mixed urinary incontinence.

Urinary incontinence should be evaluated by a physician with special training in urogynecology or female urology. During the examination, pelvic floor and vagina support should be examined and common genital organ prolapse should be investigated (uterus, bladder, end of large intestine). If the patient’s urinary incontinence is complicated, if there are severe genital organ prolapse, or if the patient has undergone surgery, tests should be performed to investigate the functions of the urine bag called urodynamics.

If the patient’s complaints are mild or if there is urge incontinence, it is treated by non-surgical methods.

Non-surgical methods include drug, behavior therapy, physical therapy, pessaries, Kegel exercises, botox and electromagnetic stimulation (magnetic chair). These treatments provide a 60-70% improvement in the patient. The magnetic chair has some advantages from these treatments. The most important advantage is that the patient is seated in a chair which creates a magnetic field with their clothes on during treatment. This magnetic field is effective by activating the bladder, the last part of the large intestine, the pelvic floor. This method is effective not only in urinary incontinence but also in enlarged vagina, bowel and fecal incontinence, orgasm disorders. It is also used for night incontinence and incontinence after prostate surgery.

If the patient’s complaints are serious and affect the quality of life negatively, definitive treatment is operation if there is stress incontinence or mixed urinary incontinence.

Solution in 20 minutes…

The patient should be evaluated very well for operation. Remember that the most effective surgery is the first operation and the success rate decreases as the number of operations increases. Unfortunately, a significant number of our patients had undergone failed surgeries. Urinary incontinence surgeries have been a revolution in the last 20 years and new types of surgery have been developed with a long-term (17-year) success rate above 90%.

The patient is discharged on the same day and can return to work and normal life.

In these surgeries, an artificial band, which is 1 centimeter wide, is placed under the tubular organ which we call the urethra which allows the urine to flow out of the bladder. These operations are performed under local anesthesia with very small incisions of 1-2 centimeters in 15-20 minutes. Bleeding and pain are minimal.

The operations we used in the past required general anesthesia, large incisions were made in the abdomen or vagina and the patient was hospitalized for a few days. In addition, postoperative urinary problems were frequently encountered. Success rates were low.

What are the postoperative measures for the success of the surgery?

After surgery, the patient may return to normal routine life within 2-3 days but some limitations should be made for the success of the operation. First of all, the patient should avoid heavy work that increases intra-abdominal pressure. In addition, the patient should not gain weight or get constipated. Pulpy foods should be predominant in nutrition. Sexual life can be started after 2 months.

What should be done to prevent urinary incontinence?

In order to protect against urinary incontinence, the patient should be followed up well during pregnancy and if there is a reason that makes the normal delivery difficult, the patient should be delivered by cesarean. If there are diseases affecting the pelvic floor such as constipation, asthma and bronchitis, they should be treated, and smoking and excess weight should be avoided. Women should self-study their Kegel exercises, which have their pelvic floor muscles, as part of life in their normal lives and during pregnancy.