Urinary incontinence (urinary incontinence) is a very sensitive and important problem that can be seen in women of almost all ages, not only because of its effects on women's individual lives but also on their social lives. Due to the feeling of "shame," it can push individuals into loneliness, such as "withdrawing" from social life or not leaving the house.
If urinary incontinence is of a frequency and amount that negatively affects the quality of life, it is necessary to "consult a physician." Because there may be an important underlying cause.
In this article, I will try to explain this "sensitive" issue and discuss risk factors and treatment options.
What is urinary incontinence?
Involuntary urine output is the inability of the bladder and the urethra (the outer tube of urine) to hold urine.
How common is urinary incontinence? Is there a relationship between age and incidence?
Urinary incontinence is a problem that can be seen at almost any age and in both sexes. Especially in women, it is much more common than in men of the same age group; according to research, while the incidence in women in the 30-60 age group is around 30%, it was found to be around 1.5-5% in men of the same age group. The incidence increases with age, appearing as a problem seen in around 50-84% of the advanced age group, that is, in 5-8 out of 10 women.
Are there different types of urinary incontinence?
Yes. There are 5 different basic types gathered under the general heading of "urinary incontinence=incontinence." It is possible to summarize these different types as follows;
- Stress incontinence: The most common type of urinary incontinence. Urinary incontinence that occurs with increased intra-abdominal pressure, such as coughing, sneezing, laughing, lifting weights, exercise, etc.
- Urge incontinence (overactive bladder): Urinary incontinence that comes with an urgent feeling of urination. It is the second most common type. In this case, the bladder contracts suddenly for some reason and expels urine. It is a sudden onset of incontinence. The sound of water, sudden changes in body position, or sexual intercourse (especially with orgasm) can trigger this type of incontinence.
- Mixed incontinence: Urinary incontinence where both of the above types occur together.
- Overflow incontinence: In this case, the bladder cannot hold all the incoming urine or "dribbles" because it cannot empty completely. This type of incontinence is more common in men and is usually seen in cases of prostate enlargement.
- Functional incontinence: Urinary incontinence associated with physical or nervous system diseases that lead to the inability to hold urine. For example, dementia, inability to go to the toilet, arthritis (inability to undo buttons), etc.
What are the risk factors for urinary incontinence?
The most important and modifiable risk factors for urinary incontinence are OBESITY and SMOKING. In general, risk factors can be summarized as follows;
- Obesity
- Smoking
- Age
- Lung diseases involving chronic (long-term) cough (e.g., Chronic Obstructive Pulmonary Disease-COPD)
- Decreased estrogen after menopause
- Diabetes (DIABETES)
- Heart Disease
- Tumors related to reproductive organs
- Certain other diseases (spinal cord diseases, kidney diseases, connective tissue diseases, nervous system diseases)
- Certain medications (diuretics, some blood pressure medications, psychological relaxants, some medications affecting the nerves, muscle relaxants, some over-the-counter allergy medications, etc.)
What tests should I have when I have a urinary incontinence problem?
The physician's interview, the information received from you, and the examination are extremely important. Apart from this, keeping a special "urinary diary" to determine the frequency and timing, investigating whether there are germs in the urine (urine culture antibiogram), investigating whether there is a sugar problem, the Q-tip test during examination, examination with coughing, measuring the post-void residual volume (PVR), observing the inside of the bladder if necessary (cystoscopy), and tests determining the urine flow, leakage amount, and timing (urodynamic tests) are performed. These tests are requested in line with the information provided by the patients and the physician's examination. A good preliminary investigation is the key to solving the urinary incontinence problem.
How should the treatment be for urinary incontinence?
First of all, it should be determined which of the above-mentioned types the urinary incontinence problem fits. Accordingly, in stress-type incontinence, strengthening the muscles in this area with exercise is primarily recommended. However, often this is not sufficient and "sling surgeries" need to be applied. In urge-type incontinence, bladder gymnastics (bladder training) and medications are suitable for treatment. In mixed type incontinence, the treatment is planned according to which type is predominant. In the last two types of incontinence, treatment of the underlying cause is required.
Is medication possible for urinary incontinence or is surgery a must?
Determining the type of urinary incontinence is extremely important in treatment planning. Surgery is not performed for every urinary incontinence; in fact, in some types (e.g., urge incontinence), surgery can lead to larger urinary problems.
What are the surgeries performed for stress incontinence?
The main goal of these surgeries is to provide the "angle" that should exist between the bladder and the urethra but has been disrupted. For this, surgeries performed through the abdomen or vaginal area, primarily called "sling" surgeries, are performed. Which surgery should be performed is determined after individual examinations.
What are the points to be considered after surgery?
As physicians, our desire is for patients to come for check-ups according to the characteristics of the surgery performed, not to lift heavy weights, and to remove risk factors such as weight and smoking. The successful surgery of patients who have had surgery due to this complaint also makes us happy as physicians.
The first condition for overcoming an important problem in a person's life, such as urinary incontinence, is to voice this problem. As the İrenbe team, we are ready to perform all kinds of investigations and treatments to help our patients.
Wishing you all healthy and pleasant days...
Prof. Dr. Ümit İNCEBOZ / Obstetrician and Gynecologist / İRENBE