Urinary incontinence, medically known as urinary incontinence, is the inability to hold your urine inadvertently. When you are incontinent, you experience uncontrolled urinary incontinence. Simply put, urinary incontinence can also be defined as involuntary leakage of urine.
What we call continence is the state of being able to control large bladder, gas and urine. The inability to control is defined as incontinence. Urinary incontinence is also known as urinary incontinence.
Urinary incontinence, popularly known as urinary incontinence, is a condition where you involuntarily leak urine.
Urinary incontinence is more common in women than in men. The reason is that the urinary canals (urethra) after the bladder are shorter in women than in men and birth traumas are more common. With advancing age, it begins to be seen in almost a large proportion of women in society.
Women who have never given birth may encounter urinary incontinence. As for the causes, there may be underlying causes such as chronic constipation, being overweight, asthma and smoking. In overweight women, pelvic floor muscles have difficulty in carrying intra-abdominal weight, which may cause urinary incontinence after a while.
For many women, urinary incontinence can reduce their quality of life physically, sociologically and psychologically. Unfortunately, it can also negatively affect sexual life. Urinary incontinence can occur due to many reasons and treatment is planned according to these reasons.
Infections that can reach the bladder, vaginal infections, bladder stones, difficult and traumatic births, hormonal changes, bladder tumors, diseases affecting the nervous system, diseases that block the bladder outlet, old age, excessive tea and coffee consumption are among the main causes of urinary incontinence. In fact, urinary incontinence is not a disease, it is a symptom of the disease.
The presence of urinary incontinence can be a sign of a serious condition. It should not be considered as a disease that occurs with increasing age and is therefore important. Because most of the complaints of urinary incontinence are more common in women who have given birth.
Decreased sensitivity of the bladder nerves due to the long-term effects of diabetes can also cause urinary incontinence.
Multiple sclerosis, which causes loss of muscle control, causes urinary compression in conditions such as rheumatic diseases. In this case, it may prevent the bladder from fulfilling its function in a healthy way.
Drinking dark brewed tea and coffee containing caffeine during the day and especially consuming them intensively in the evening hours can trigger some health problems and increase urinary incontinence problems.
Urinary incontinence in daily life is a serious health problem that affects the quality of life of women. It is an important health problem that causes the person to feel ashamed, isolate herself from society and avoid private life.
The truth is that most women unfortunately normalize this situation. In other words, they accept it as normal with aging. They delay applying to a physician for treatment or do not even tell this to their relatives because they are ashamed and postpone applying to a health institution for treatment. However, there is a solution to this problem with developing technologies.
When my patients apply to me, they often express the following. They say that due to the possibility of urinary incontinence, they avoid long travels and trips, they cannot make plans with their friends, they feel older than they are and even like a child, they do not accept guests, they think "I wonder if I smell? Do those around me smell me?" and they do not participate in many activities.
Unfortunately, they can become increasingly lonely and experience mental conditions such as depression. And even some women often tell us that they often need to go to the toilet at night, and that they are in danger of falling with the fear of not being able to reach the toilet when they apply to our clinic.
Women who suffer from urinary incontinence face many problems in terms of physiological, social, psychological and quality of life. Over time, this condition, which affects their daily lives, disrupts their human relations and social life, is also reflected in their sexual life. Feeling ashamed and embarrassed towards their husbands, these women develop sexual reluctance and avoid sexual intercourse. This drum eventually causes marital and couple problems.
Stress urinary incontinence is a condition in which people with stress urinary incontinence leak urine during physical exertion, such as sneezing, laughing, coughing, heavy lifting, jumping rope and jumping on a trampoline, when they perform an action that creates pressure in the abdomen. Stress urinary incontinence is the most common cause of urinary incontinence in young women.
It is the second most common cause in older women. Difficult childbirth history, giving birth to large babies, being a mother at an advanced age, prolonged labor and giving birth to many babies are the most common causes of stress-type urinary incontinence. Even if there is no urinary incontinence problem after childbirth, urinary incontinence problem starts in most women with the stimulation of the aging process with menopause. In addition, chronic lung diseases such as asthma, emphysema and cystic fibrosis, which cause frequent coughing without aging, can also cause stress urinary incontinence.
Over time, the bladder muscles gradually weaken and the incontinence picture progresses. In this type of urinary incontinence, while there is a small amount of urinary incontinence in the beginning, as time progresses, urinary incontinence in amounts that will affect daily life causes consequences that will negatively affect daily life.
In overactive bladder urinary incontinence, it is called a condition in which urine escapes involuntarily without being able to reach the toilet with a sudden urinary sensation. Urge means excessive desire. In this type of urinary incontinence, there is no anatomical problem related to the bladder (bladder) or urinary canal (urethra). These women feel as if they are stuck in the toilet even though their bladder is not full. If the feeling of being squeezed is followed by the inability to reach the toilet, we think of urge incontinence.
Urge incontinence does not always cause urinary incontinence. However, in a place where you gather with your friends or on a long trip, in your social life, in a meeting for work reasons, it can cause the quality of your social life to deteriorate. Urinary tract infections caused by bacteria such as cystitis, especially in women, the presence of stones in the bladder, the presence of diseases affecting the muscular nervous system such as multiple sclerosis are among the most common causes of urge incontinence.
Unlike stress-type urinary incontinence, which develops because the muscles of the bladder work weakly in urge incontinence, it occurs because the muscles of the bladder work overactive. Urge urinary incontinence, which is a kind of neurological disease, has a neural conduction disorder.
Temporary urinary tract infections, stones in the urinary tract can also cause this type of incontinence. However, this is a temporary condition, the problem resolves after treatment of the existing disease. Drug treatments are used in urge incontinence accompanying neurological diseases.
Mixed urinary incontinence combines symptoms of both stress urinary incontinence and urge urinary incontinence. It is the most common type of urinary incontinence in women.
Whichever type of urinary incontinence is the predominant symptom, treatment is planned surgically or medically according to the intensity of that complaint and the results of urodynamic tests. Mixed urinary incontinence can be seen in men as well as women. Men may face this problem in older men or after prostate surgery.
Overflow urinary incontinence is a type of urinary incontinence usually seen in very old people. It is a condition in which the bladder muscles contract to urinate and the urine outlet valve cannot relax sufficiently. Since urine emptying is incomplete, some urine remains in the bladder and this urine creates constant pressure on the bladder. When the amount of urine exceeds a certain level, it is a disorder that causes the urinary valve to open with pressure and suddenly urine discharge. In women, overflow incontinence is most common in cases where the uterus is prolapsed, in advanced diabetes where muscle control cannot be achieved and there is nerve damage, or in diseases that cause spinal cord injuries, as the nerve cells of the bladder are damaged.
In reflex urinary incontinence, a person suddenly urinates without any feeling of urine coming out. This type of urinary incontinence can be seen commonly in diseases that damage the nervous system, spinal cord injuries, traffic accidents, medical interventions that have adverse effects on the nervous system such as radiotherapy.
In advanced ages, due to diseases such as Alzheimer's, stroke and dementia, in individuals who are unable to know the need to go to the toilet, which requires thinking and action, or in damage to the nervous system that manages the bladder, such as spinal cord injuries, incontinence of the large bladder can be seen in addition to urinary incontinence.
It is defined as urinary incontinence with the first penetration of the penis during sexual intercourse, during the movements of the penis and during orgasm. In women who experience this condition, sexual dysfunctions such as loss of self-confidence, decreased sexual desire and inability to orgasm develop one after another over time. Women with this problem also have difficulty in admitting this issue to themselves for years and are ashamed to talk to their doctors. When they consult a physician at the last stage, recovery is achieved with the planned treatment.
If you have a problem such as burning and pain while urinating, this suggests an infection. With urine culture, it is determined what kind of bacteria is present and accordingly, the person's urinary incontinence problem is eliminated with an antibiotic treatment. Sometimes, urinary incontinence can also occur in cases of asymptomatic bacteriuria without any symptoms.
Therefore, every patient who presents with urinary incontinence should first have a urine test. During the gynecological examination, your physician will perform some tests to determine the type of urinary incontinence with tests called stress test and Q-type test. The stress test can be performed standing, sitting and during a gynecological examination. During this test, your doctor will ask you to cough violently and observe whether you are incontinent. If you have urinary incontinence, it can be said that you have a stress type of urinary incontinence.
There is an easy method for measuring the amount of urinary incontinence. If a person has leaked a teaspoon to a tablespoon of liquid into his underwear, it can be said that he has a mild urinary incontinence problem. If more than two tablespoons of urine has leaked out, enough to fill a teacup, we can call this moderate incontinence. If more than a tea cup of urine has flowed, we say that this is a severe urinary incontinence problem.
Urinary incontinence occurs more frequently in women than in men. This is because the length of the urinary canal, the urethra, is anatomically shorter in women than in men. Apart from this, menopause, hormonal problems, birth traumas and pregnancy itself also increase urinary incontinence problems in women.
Many of these types of urinary incontinence I mentioned above can be treated and urinary incontinence problems are a serious problem that affects the quality of life, social life, mental and psychological dimensions of the person and most of them are treatable. First of all, if you have such a problem, you should consult an experienced gynecologist and obstetrician with urogynecology training or a urologist working in this field.
We first perform a vaginal and pelvic examination for our patients with urinary incontinence who apply to our clinic. With a detailed preliminary interview, we take a gynecological history to identify underlying medical problems. Urinary incontinence is an important health problem that affects the quality of life and causes mental problems that cause isolation from social life in both young and old people.
Some of them may be associated with life-threatening and serious diseases. Problems such as neurological conditions, bladder cancers and even sleep apnea may be underlying. Therefore, a detailed anamnesis is very important. If you have such a question, it is very important to consult your physician for treatment.
If you, dear reader, have read the texts I have written above, the problem of urinary incontinence, which negatively affects your quality of life, condemns you to social isolation, negatively affects your sexual life and gradually increases, becomes a health problem that you will have difficulty in finding solutions in your old age. Do not ignore it, do not be ashamed, there is a way out, of course, and there is a treatment. First of all, you should consult an obstetrician or urologist working in this field (urogynecology).
After taking your detailed anamnesis and history, your urogynecologist will evaluate you with a gynecological examination. He/she checks your pelvic muscles and bladder muscles with a vaginal examination. After determining the type of urinary incontinence, he/she will organize your treatment. In women who have had many normal births, there may be sagging of the uterus and vaginal walls.
After the gynecological examination, some tests such as complete urinalysis, urine culture, ultrasonographic imaging to investigate the presence of stones and masses in the renal tract are used. Urodynamic tests can be performed to determine the type of urinary incontinence.
Urinary incontinence is a health problem that causes serious problems in both young and old age. When this problem is ignored, it can sometimes be a symptom of a life-threatening disease such as cancer. So do not ignore this problem, do not be ashamed, do not worry. Be sure to consult with an obstetrician who is trained in urogynecology working in this field.
Treatment methods for urinary incontinence are very diverse. Treatments for urinary incontinence in women vary according to the type of incontinence, complaints, severity of symptoms and the amount of urine missed. Basically, urinary incontinence treatments are divided into medical methods (laser, medication, etc.),surgical methods and lifestyle changes.
In recent years of developing technology, applications such as carbon dioxide laser applications and platelet-rich plasma (P*RP) prepared from the person's own blood, which are widely used in aesthetic and cosmetic gynecology, have started to be widely used in the treatment of urinary incontinence problems. Therefore, the first step in treatment is to use non-surgical methods.
In addition, exercises of the pelvic floor muscles, local estrogen applications in case of stenosis of the urine outlet hole, local estrogen creams during menopause, local hyaluronic acid applications are useful in treatment.
In addition to all these, oral drug therapies that act on the receptors of the bladder muscle can also be added to the treatment. Vaginal laser vaginal rejuvenation and urinary incontinence treatments for all patients who do not have advanced uterine prolapse and bladder prolapse and for whom surgery is not considered have enabled us to achieve very satisfactory results in recent years.
The success of the first surgical operation is quite high in patients in whom we plan surgery after detailed gynecological anamnesis, questioning to determine other health problems and to determine the type of urinary incontinence, and finally gynecological examination. The success of the surgery is also directly affected by the patient's age, whether the patient is in menopause or not, the presence of obesity, the type of urinary incontinence, and whether there is uterine prolapse or not.
Many surgical methods are used in surgery. The decision on which surgical method to be applied is made by considering the patient's gynecological examination, ultrasound, the presence of conditions such as uterine prolapse, urodynamic test parameters, surgical experience and complications that may develop after surgery and their management. The physician decides which surgical method to apply together with the patient after the patient examination.
Today, non-surgical methods are also frequently used in women with urinary incontinence. In some patients, depending on the type of incontinence, technologies such as vaginal laser applications with carbon dioxide laser, vaginal radiofrequency, magnetic chair treatments are combined individually or together to achieve satisfactory results in treatment success.
Laser urinary incontinence treatment is an alternative treatment to surgery, especially in menopause, in patients who cannot undergo surgery due to different health problems at advanced ages. The pain is almost non-existent. For detailed information on this subject, you can contact our clinic and have a detailed discussion with us.
In recent years, with the development of cosmetic gynecology, carbon dioxide laser technologies have been widely used in gynecology. It is especially effective in stress-type urinary incontinence and mixed-type urinary incontinence and is applied painlessly and painlessly in 10-15 minutes and on the gynecological examination table. Special vaginal probes have been produced for this purpose, and 360-degree laser shots are made on the entire vaginal wall.
By creating a controlled thermal damage in the dermal area, it helps to increase collagen and elastic connective tissue and reorganize collagen fibrils in the area of collagen and elastic connective tissue under the skin. The procedure is short, painless, without the need for any surgical intervention and without the need for anesthesia, and has proven itself successfully in the treatment of mild and moderate urinary incontinence.
After the application, the person can walk out of the clinic and continue their daily life. Vaginal dryness, vaginal tightening and vaginal rejuvenation are also applied in the same session.
In recent years, with the introduction of P*RP into our lives, the combination of P*RP and laser applied to the anterior bladder wall has been shown to be very successful in urinary incontinence treatments. I see this frequently in clinical observation. Apart from this, in some types of urinary incontinence, b*otox is applied into the bladder and it has been observed to have a positive effect on the urinary incontinence of the person for 6-8 periods.
Drug treatments are also used for urge urinary incontinence and mixed urinary incontinence. These drugs act on the nervous system. The duration and dose of drug treatment varies according to the symptom and the type of urinary incontinence. Although these drugs are very successful, they have some side effects and should be used under the supervision of a physician and with regular follow-up.
Alpha-adrenergic agonists, anticholinergics and locally acting estrogen therapies are among the drugs we frequently use. In recent years, duloxetine, one of the antidepressants, has also been found to be effective on stress urinary incontinence. However, these drugs also have many side effects. If unwanted side effects such as fatigue, dry mouth, constipation, nausea and increased intraocular pressure are experienced intensively, drug treatments should be reconsidered.
Anatomically, there is a urinary bladder, the bladder, in the anterior wall neighborhood of the vagina. The herniation and prolapse of the bladder outward from the vagina is called cystocele. When women with cystocele look at their vagina from between their legs, especially during the toilet, they can feel that the anterior wall of the vagina comes to their hand, bulges, herniates and the tissues sag downwards with their own physical examination and they frequently apply to us with this problem. Surgery for these problems is performed in the operating room, under anesthesia, with a surgical operation called Colporrhaphy Anterior, which is the repair of the anterior wall of the vagina and the repair of the broken muscle, fascia and connective tissue plans. With this operation, an incision is made in the anterior wall of the vagina. The weakened connective tissue is strengthened with non-absorbable surgical sutures. Excess sagging skin is removed and the tissues are brought closer to each other again with sutures. Mild urinary incontinence problems are eliminated with this surgical method that strengthens the bladder base, strengthens the bladder neck and urinary canals.
Urinary incontinence is a common problem in women after their 40s. When a woman complaining of urinary incontinence applies, a treatment plan is made after the underlying medical cause is determined. Suspension surgeries give very successful results, especially in young women who have urinary incontinence when they cough and sneeze, that is, stress-type urinary incontinence problems.
This type of surgery is especially preferred in patients with stress-type urinary incontinence (urinary incontinence when coughing, laughing or sneezing). Due to herniation and damage to the connective tissues between the vagina and the bladder (pubo cervico vaginal fascia),the urinary duct (urethra) and the urinary bladder (bladder) are herniated downwards. The angle between the urinary duct and the bladder is distorted.
Midurethral suspension surgeries are performed with a mesh placed in the middle of the urethra. Cystocele surgery can sometimes be added to this method. TOT (transobturator tabe) surgery and TVT (transvaginal tabe) surgeries are the most common suspension surgeries performed to correct urethral mobilization because the angle between the bladder neck and urethra is distorted. These surgeries are performed in the operating room, vaginally, using a mesh.
These surgeries are the most preferred surgeries for young women with stress-type urinary incontinence. It is called TOT (Transobturator Tabe) and TVT (Transvaginal Tabe) surgery. These are surgical methods in which the bladder neck is lifted vaginally in the operating room, under spinal anesthesia or general anesthesia, using mesh, the bone in the genital area is suspended and fixed in the vagina.
TOT and TVT surgeries are middle urethra suspension surgeries. In these surgeries, a tissue-compatible mesh made of a special material is placed under the urinary canal (urethra). This sling supports the bottom of the urethra. During the operation, the surgeon makes small incisions in the lower abdomen and vagina. These incisions through the vagina are only big enough for a needle to pass through. The special tape is passed around the bladder and the urethra and bladder are lifted in this way.
During the operation, your surgeon adjusts the tension of the tape to provide the right amount of support. After the operation, this band is not removed, it becomes part of your body. It is not visible from the outside and does not sag. The incisions are then closed with special stitches. In the following days, these stitches are absorbed spontaneously without the need for removal. At the same time, if there is an abundance in the vagina, vaginal tightening surgeries can be added to the sling surgeries.
After this surgery, you will be hospitalized overnight. The next day, your urinary catheter is removed and you can be discharged home after you are seen to urinate comfortably. After resting at home for the first week after surgery, you can easily return to your daily life. Avoid activities such as sexual activity, pools and baths for one month after the operation. When going to the toilet for a month, it is recommended to wash with boiled and cooled water and special antiseptic solutions.
These two operations work on the same principle. The main difference is where this band that passes through the middle of the urinary canal, which we call the midurethra, exits the body. In Tot surgery, it exits from the groin area where the legs meet the vulva, and in TVT surgery, it exits from your abdomen where the cesarean section line is. The way the special synthetic mesh to be used as a band reaches the hanging and urethra is the same. The patient does not have the knowledge to decide which operation to choose. This is a position to be determined by the surgeon after a detailed examination and anamnesis. Both operations are completed in a similar period of time and success rates are very close to each other.
The medications used by the patient should be listed before the surgery. Before the surgery, especially aspirin, coumadin and warfarin and drugs that make blood clotting difficult should be stopped. Different medications can be used instead. If the patient smoked before the operation, he/she should quit smoking one week before the operation.
The patient is asked not to eat or drink anything for 12 hours before the operation. If the patient is taking medication, they may be allowed to take their medication with a small sip of water. Before the operation, the patient should discuss possible complications and risks with his/her physician. When it is time for surgery, the patient should be at the hospital at the specified time.
After the operation, the patient is taken to his/her own room after he/she regains consciousness and his/her vital signs stabilize. If the patient is under general anesthesia, he/she is asked to take deep breaths to open the lungs. There should be a catheter in the bladder. This catheter is not removed until the patient can empty the bladder on his/her own. Sometimes a gauze or tampon is placed in the vagina to stop the bleeding. Depending on the bleeding, the tampon can be removed a few hours after the operation or the next day or even a few days later. After going home, the patient is given information about medication, dressing care, nutrition, bathing and activities. If he/she smokes, he/she is advised to quit until the wound healing is complete. She is invited for a follow-up visit one week later.
Urinary incontinence surgeries are among the surgeries I commonly perform. As a result of the surgeries I have been performing for many years, I can observe that the treatment is successful both in the light of scientific literature and in the patients I have operated on. The medical problems we expect after urinary incontinence surgeries are as follows. Pain, bleeding and urination difficulties occur in the first few days. Most of these conditions resolve by the end of a week. Since the healing process may take 3-4 months due to the edema caused by the stitches placed on the bladder base, symptoms such as frequent urination, sometimes urinating drop by drop, and not feeling relieved after urination may be seen at first. But these symptoms are temporary. In mixed-type urinary incontinence problems, after suspension surgery, conditions that increase intra-abdominal pressure, that is, urinary incontinence that occurs when coughing, sneezing and laughing, improve. Due to the presence of other diseases that cause mixed type incontinence, the inability to empty urine and other types of urinary incontinence problems persist in the long term. Therefore, it will be beneficial to continue medical and behavioral treatments after surgical recovery.
In fact, the treatment of urinary incontinence is organized depending on the underlying causes. The type of treatment to be applied is planned after these causes are determined, and if surgical method is preferred, the type of surgery to be applied is planned depending on the age of the patient and other factors. In sudden urinary incontinence, drug treatments, pelvic floor physiotherapy, laser and similar treatments can be used, while surgical methods should be applied in stress-type urinary incontinence, i.e. urinary incontinence caused by coughing and sneezing, and if there is sagging of the vaginal walls during gynecological examination. If the uterus is protruding out of the vagina, it may be necessary to remove the uterus vaginally in older women. In younger women, the uterus can be preserved and stapled to the pelvic bones or back bones. A special mesh is used for these operations. The operations can be performed as vaginal laparoscopic or open surgery. Surgical operations such as TOT and TVT are most commonly performed on young women. However, a detailed and complete evaluation before these surgeries is very important for the success of the surgery.
In addition to medical and surgical treatments for urinary incontinence problems, we also recommend lifestyle changes. We can list some of these changes that women can easily apply in their daily lives as follows.
Normally, a person should urinate 4-6 times during the day and 1-2 times at night. It is not considered normal to urinate more than 8 times during the day. Going more than 2 times at night is also not considered normal. In the treatment, the person is first asked to keep a urination diary. The urination diary is determined according to the measurements of the number of times the person urinates for 24 hours, the amount of fluid taken daily and the amount of fluid excreted. The type of fluid taken, how many times urine was missed, and the times between two urinations are noted. When a problem is detected after the urination diary, it is aimed to increase the strength of the bladder muscle endurance with pelvic floor muscle strengthening exercises, i.e. kegel exercises, in order to train the bladder muscles. A reduction in urinary incontinence problems is achieved at the end of this treatment.
Pelvic floor muscle exercises are aimed at increasing the bladder muscle and pelvic muscle strength with pelvic floor muscle strengthening exercises, i.e. kegel exercises, for the purpose of training the bladder muscles. It can sometimes be applied inside the vagina using cones of different weights.
Pelvic floor exercises should be performed daily and should be done for 20 to 40 minutes standing, sitting or lying down. Exercises should be practiced for a minimum of 10 days. Continuation for at least 3 months should be ensured for success. In older individuals, treatments such as magnetic chair, electrical stimulation with the help of electrodes, rectal stimulant low dose electrical currents can be used for pelvic floor muscle strengthening. It is possible to achieve satisfactory results with biofeedback therapy, which is a frequently used method in pelvic floor muscle strengthening exercises.
In this method, the contractions and relaxations of the pelvic floor muscles are projected on the screen and the measurements of muscle contraction are recorded during the exercises performed by the patient. Intravaginal cones can be added to the biofeedback method.
In addition to all these, patients are advised to change their daily lifestyle, to lose weight if overweight, to reduce excessive coffee and tea consumption, to control excessive fluid intake, to develop the habit of consuming more fibrous, pulpy foods in their daily diet, to quit smoking, to plan the treatment of lung diseases such as asthma and emphysema, to avoid exercises that strain the pelvic floor muscles such as heavy lifting, jumping rope, horseback riding, and to urinate at certain intervals without waiting for urinary urgency.