Urinary incontinence is the inability to control urination, which involuntarily occurs, leading to social and/or hygienic problems. With the studies carried out to investigate the incidence of urinary incontinence in our country, it has been found out that 40-69% of menopausal women and 20-46% of women of reproductive age have urinary incontinence to varying extents. Four out of five of these women consider urinary incontinence as a natural consequence of aging and delivery. Although roughly 3.5-4 million women in our country suffer from this problem, only one-fifth of them consult doctor for the treatment.
Ten percent of the patients use pads, limit their activation and, accordingly, their quality of lives is negatively affected. In one of our studies carried out to investigate the incidence, it has been revealed that three fourths of women with severe urinary incontinence and requiring treatment are not asked about urinary incontinence by the physician they visit. (Demirci et al., Istanbul Journal of Gynecology Obstetrics, 1999)
What is urinary incontinence, urinary incontinence treatment, urinary incontinence surgery
Urinary Incontinence Treatment
How does it affect women?
A woman constantly uses pads or diapers, cannot have social relationships due to incontinence and odor, and restricts herself to her house. This condition sometimes causes serious psychological problems.
What are the causes of urinary incontinence?
Urinary incontinence surgery, the most important reason is the urinary leakage caused by weakened pelvic floor and supportive tissue of the bladder.
In this type of urinary incontinence, the patient suffers from involuntary incontinence when coughing and forcing.
This is often associated with multiple deliveries, giving birth to big babies, giving birth at home on her own, difficult delivery, giving birth with intervention or delivery by untrained people.
Why does urinary incontinence occur?
It may also arise due to heavy work, advanced age, menopause, prolonged constipation, obesity, and pulmonary diseases such as asthma, bronchitis. Because of the high number of deliveries in our country, stress incontinence accounts for the majority of involuntary urinary incontinence and is commonly seen in young women of reproductive age.
The second most common cause of involuntary urinary incontinence is the contraction of bladder with an unknown origin when the bladder is filled with urine, called urge incontinence. This is also called overactive bladder syndrome.
This type of urinary incontinence is in the form of sudden urge to urinate and inability to get to the toilet in time experienced by those who have water-related jobs. In some patients, the first and second causes are seen together. This type of urinary incontinence is called mixed incontinence.
The patient should be evaluated by a physician who received special training in urogynecology or female urology. The pelvic floor and vagina support are investigated during the examination.
Simple clinical tests that can be carried out in outpatient clinic are also used. These are 3-day bladder (voiding) diary in which the patient notes daily bladder habits, and the pad test that determines the total amount of urine leak.
Urinary incontinence surgery, if the patient’s urinary incontinence is complicated and there is severe pelvic organ prolapse or the patient underwent surgery, tests in which bladder functions are investigated, called urodynamic testing or urodynamics, should be carried out in these patients.
What Is Urinary Incontinence Treatment And How Is It Selected?
Urinary incontinence surgery
The treatment selection of a patient with urinary incontinence is made based on the severity of complaints and the evaluation of examination findings. If the patient’s complaints are mild or in the form of urgency, it is treated with non-surgical methods and the progression of the disease can be stopped.
Urinary incontinence surgery, non-surgical methods include medication, behavior therapy, physiotherapy, pessaries, Kegel exercises, botox and magnetic chair.
In recent years, magnetic chair has come to the forefront among these treatments. The advantage is that the patient is seated in a chair which creates a magnetic field with the clothes on. This magnetic field takes effect by activating the bladder, the last portion of the large intestine and the pelvic floor.
Urinary incontinence surgery
This method is effective not only in urinary incontinence but also in enlarged vagina, gas, fecal incontinence, orgasmic dysfunction. It is also used for nighttime incontinence and incontinence after prostate surgery.
If the patient’s complaints are severe and adversely affect the quality of life or the patient has stress or mixed incontinence, the treatment option is surgery. The patient planned to undergo surgery should be evaluated in detail. Let’s keep in mind that the most effective urinary incontinence surgery is the first surgery and the success rate decreases as the number of surgeries increases.
Unfortunately, some of our patients are patients who previously underwent failed surgery. In the last 20 years, urinary incontinence surgeries have evolved and new types of surgery with a long-term success rate of over 90% have been developed.
These surgeries are performed under local anesthesia with very small incisions of 1-2 centimeters within 15-20 minutes, and the patient is not hospitalized.
Urinary incontinence surgery, in these surgeries, an artificial tape, 1 centimeter in width, meshed with surgical sutures is placed under the tubular organ, called urethra, which allows the urine to flow out of the bladder (Figure 1). During rest, the urethra does not overlap the loosened tape.
Therefore, the urethral functions are not affected. In positions such as straining and coughing, the urethra overlaps the tape and the urethra is folded (Figure 2). By placing this tape, the loose uretropelvic ligament is artificially reconstructed.
The surgeries we performed in the past required general anesthesia, large incisions were made in the abdomen or vagina and the patient was hospitalized for a few days. Urinary incontinence, moreover, the problem of postoperative inability to urinate was common. And the success rates were low.
What can be done to prevent urinary incontinence?
For prevention, a very good follow-up should be carried out during pregnancy and the patient should be delivered by cesarean section, if there is a problem making normal delivery difficult. If diseases adversely affecting the pelvic floor such as constipation, asthma and bronchitis are present, they should be treated, and smoking and excess weight should be avoided.
Patients should make Kegel exercises, in which the pelvic floor muscles are worked on their own, a part of the life in their daily routines and during pregnancy.