Urinary incontinance And Treatment

Urinary incontinence is a very common complaint in women. Almost one in four women experience urinary incontinence at some point in their lives. Urinary incontinence, urinary incontinence or urinary incontinence is the involuntary loss of urine.

Unfortunately, many women cannot bring up the complaint of urinary incontinence and do not know that it can be treated, and cannot express this complaint even when they come for a gynecological check-up. Although the complaint of urinary incontinence increases with age, it should not be considered as a normal condition and should be treated.

How Does the Urinary System Work?

In the urinary system; the harmony and working order between the brain, spinal cord and bladder is important. Urination is a reflex originating from the spinal cord and is under the control of the brain. Your kidneys act as filters, filtering the waste in your blood and sending the fluid, urine, to the bladder through channels called ureters. The bladder consists of flexible muscles and urine accumulates here, then urine is excreted through a channel (urethra). Thanks to the pelvic floor muscles that surround the hammock-shaped pelvic internal organs under the urethra and bladder, you can hold urine and stool whenever you want and make it whenever you want.

Types of Urinary Incontinence

We can classify urinary incontinence according to the complaint of urinary incontinence, examination findings and urodynamics (urination test). There are 4 types of urinary incontinence in women.

Stress Type Urinary Incontinence

It increases with age. It increases to 20% after menopause. In this type of urinary incontinence, urine leakage is observed as a result of factors that increase the pressure in the abdominal muscles. In cases such as coughing, sneezing, straining, lifting heavy objects, the intra-abdominal pressure increases and urine leakage may occur. This type of urinary incontinence occurs as a result of the weakening of the pelvic floor muscles that help hold urine.

Urge Incontinence

We mostly think of urge incontinence in patients who come with complaints of urine leakage before reaching the toilet. Urine leakage can be observed as the muscles in the bladder contract occasionally (overactive bladder). Many conditions can trigger this.

Overflow Incontinence

This type of urinary incontinence can be seen due to reasons such as neurological diseases, diabetes, alcohol, weakening of the bladder muscle or blockage of the bladder outlet.

Other Type Incontinence

Urinary discharge problems, frequent and urgent urination can be seen in some women (constant urination, urinating more than 6-7 times a day, nighttime incontinence in women or urinating more than once).

What are the Symptoms of Urinary Incontinence?

Urinary incontinence symptoms may start as mild and uncontrollable at first. Urinary incontinence symptoms can be listed as follows.

• Frequent urination,
• Pain, burning complaint while urinating,
• Feeling of not being able to urinate completely,
• Urinary tract infection may be seen.

What are the Causes of Urinary Incontinence?

While examining the causes of urinary incontinence, it has been observed that women may experience urinary incontinence as a side effect of some medications used. Being overweight or chronic and forceful coughing can increase incontinence by applying more pressure to the pelvic floor muscles.

Weakening of the pelvic floor muscles, coughing, sneezing, laughing, and lifting weights can cause women to be unable to hold their urine. Pregnancy, giving birth, being overweight, and estrogen withdrawal from the body during menopause can also cause this. Urinary tract infections increase bladder sensitivity and constantly feel like there is urine, constantly taking the woman to the toilet.

Due to neurological reasons, nerve pathways are damaged due to damage to the brain, and urinary incontinence can occur. Pregnancy and childbirth put pressure on the pelvic floor muscles, bladder, and connective tissue, and these muscles relax and stretch due to pregnancy hormones. Due to the decreased function of these muscles, urinary incontinence may develop during and after pregnancy. Urinary incontinence during pregnancy and postpartum urinary incontinence complaints may decrease over time, but they generally increase. During menopause, estrogen hormone levels decrease and pelvic floor muscles weaken. This can reduce bladder control.

Who Can Get Urinary Incontinence?

Urinary incontinence is most common in older people. However, it can also be seen in younger people. Urinary incontinence can be more common depending on the following factors:

• Genetic factors,
• Diet,
• Pregnancy,
• Menopause,
• Birth,
• Smoking and alcohol use,
• Previous surgery on the urinary system are factors that increase the risk of urinary incontinence.

How is Urinary Incontinence Diagnosed?

First of all, the patient's history is very important for diagnosing urinary incontinence. Questions we need to ask;

• Do you have complaints of incontinence while coughing, incontinence while sneezing, or incontinence while sneezing?
• Do you leak urine while lifting heavy objects?
• Do you leak urine when you can't make it to the toilet and leak urine?
• How much urine do you urinate during the day?
• How many times do you go to the toilet at night?
• Have you leaked urine into bed?
• Do you feel the need to use a pad during the day?
• Do you suddenly leak urine without realizing it?
• How many times do you go to the toilet while sleeping?
• Did you have complaints of incontinence during pregnancy?
• In the second stage, chronic diseases that may cause urinary incontinence should be questioned and investigated. (Parkinson's disease, chronic lung disease, etc.)

In the third stage, the patient should be examined and a stress test should be performed to see if there is incontinence. A stress test is to see if there is incontinence by making the patient cough with a full bladder, sitting down and getting up.

In the fourth stage, tests should be requested. Urine analysis should be performed. Blood tests should be requested to investigate the presence of infection and kidney diseases. Afterwards, a urodynamic test can be performed to examine the function of the urinary tract. Urodynamics, or the urination test, examines the function of the bladder, or bladder, and the channel at the bladder exit (urethra).

Treatment of Urinary Incontinence

There are two methods applied for the treatment of urinary incontinence in women: surgical and non-surgical. The treatment method to be applied is completely personalized and will be shaped by your doctor's examination and the tests and examinations to be performed.

Many methods can be applied for the treatment of urinary incontinence. First of all, non-surgical methods are applied to eliminate the discomfort. A solution is sought in individuals who experience this discomfort due to excessive weight by adopting a healthy diet. The amount of fluid taken may need to be re-determined.

Treatment can also be done with some medications that will affect the bladder muscle. If it occurs due to hormonal reasons in women, a treatment method can be applied through hormones. Training the bladder and strengthening the pelvic floor muscles, i.e. Kegel exercises, can be applied. In cases where these methods do not work, help can be obtained from surgical treatment.