What is Urinary Incontinence? What are the Symptoms, Diagnosis and Treatment?

Urinary incontinence (urinary incontinence) is a phenomenon of incontinence. Urinary incontinence symptoms occur more frequently in older ages.

The bladder capacity of an adult is approximately 400-500 grams.

For normal urination, the brain-nervous system, muscular system and passageways must be intact. Urine coming into the bladder from the kidney via ureter tubes begins to accumulate.

The bladder muscles relax and begin to store this urine. After reaching a certain volume, it sends a signal to the brain through the spinal cord through the nerve endings and a feeling of urine occurs.

If there is no suitable place to urinate, the brain sends a signal to the bladder and urine is kept with the urine-holding mechanism we call the sphincter.

The bladder continues to expand for a while. When going to the toilet, the brain decides that it is a suitable environment to urinate.

The bladder detrusor muscles start to contract, while the urinary retention mechanism, which we call the sphincter, relaxes and the bladder empties through the urethra.

Urinary incontinence (urinary incontinence) can be defined as the incontinence of an adult even though he / she does not expect it.

35-50% of adult women experience urinary incontinence at varying degrees throughout their life. Although it affects about half of the women in the society, most of them do not apply to a health institution for treatment.

In fact, this situation seriously affects the quality of life, freedom of movement and social communication.

Inability to control urine manifests itself in several ways.

1. Stress-type urinary incontinence: It is the incident of incontinence in situations that increase intra-abdominal pressure such as cough, sneezing, climbing stairs, climbing stairs, laughing, due to changes in the anatomy of the external urethra, which is seen especially in women who have given birth too much or have had a difficult birth. Sometimes this situation can be seen with bladder prolapse, which we call cystocele. However, it can also be seen in those who have never given birth. It is the most common type of urinary incontinence (approximately 40-50% of women may face this type of incontinence in varying degrees).
2. Urge type urinary incontinence: It is the event of urinary incontinence before reaching the toilet due to the sudden feeling of urine in an unexpected place and time. This type of leakage is mostly seen in situations that affect the nervous system. Urinary tract infections, old age, Parkinson’s disease, diabetes, stroke, genetic factors are among the causes. However, this type of incontinence can be seen without any reason (approximately 20% of women are faced with this type of incontinence).
3. Mixed (mixed) urinary incontinence: It is a phenomenon of incontinence due to both stress and sudden compression. Approximately 30% of urinary incontinence is like this.
4. Other types: we can describe the patient as incontinence at all. The patient cannot hold any urine coming to the bladder and is constantly diapered. There is no bladder capacity or the mechanisms that enable urinary retention are not working at all. Fistula may have developed from bladder or urinary tract to vagina due to diseases or previous surgeries. This type of urinary incontinence affects about 2% of women.

In a patient presenting with the complaint of urinary incontinence, we first take a good history such as when it started, whether it increased continuously, whether it was incontinence type, stress type, continuous or mixed type.

In addition, we thoroughly question whether he has a chronic disease such as diabetes, blood pressure, heart, the drugs he uses, and the surgeries he has undergone. Then, we make a detailed physical examination in a suitable environment when the patient is cramped.

We evaluate in detail whether there is an organ prolapse, whether there is a cystocele, and whether there is urinary incontinence with cough.

If we deem it necessary, we make a urodynamic test and determine the treatment principles as a result of all these evaluations.

First of all, after the type of abduction is determined, the treatment phase is started.

Stress type urinary incontinence treatment: This type of incontinence can be in varying degrees from mild to severe. With exercises such as weight loss, pelvic floor exercises, kigel exercises, holding and releasing the grandfather while urinating, the muscles that provide urinary retention can be strengthened.

In addition, anticholinergic drugs can be added as needed. Most mild patients may respond to this treatment.

However, when we do not respond to all these medical treatments or in severe cases, surgical treatment comes into play. Surgical treatment can be done vaginally or through the abdomen. In case of organ prolapse or cystocele, both organ prolapse and urinary incontinence are treated together.

In the vaginal approach, urinary tract hanging operations (TVT, TOT, Pubovaginal sling) are largely successful.

If the vaginal route is not successful, both organ prolapse and urinary incontinence can be treated with open, laparoscopic or robotic surgery. However, it is very important to evaluate the patient correctly in success.

Urgency type urinary incontinence treatment: The underlying cause should be investigated very well in such patients. If there is a urinary tract infection, this should be treated first.

Patient’s age, chronic diseases, surgeries and medications are very important. If there is no infection, voiding training can be given. In addition, it can be supported with bladder relaxant (anticholinergic) drugs.

Bladder capacity, sensitivity, the degree of leakage, and whether there are uncontrollable contractions should be evaluated by performing urodynamics. Botox injection can be applied to the bladder if there is insufficient response or no response to drug treatment.

If the bladder capacity is small and the age of the patient is appropriate, the treatment can be successfully performed with bladder dilator surgeries.

Treatment in mixed urinary incontinence: First of all, if there is an underlying cause, it should be eliminated. If the patient’s complaints are mild, voiding training, pelvic floor exercises, diet regulation, weight loss, and anticholinergic medication when necessary are the first things to be done. If we do not respond to the treatment, surgical treatment may be considered after urodynamic evaluation. If there is a urinary tract infection, it should be treated first.

In other types, especially fistulas, the cause should be eliminated. Otherwise, treatment is not possible.

As a result, urinary incontinence in women is a serious and common health problem that affects one in two women and negatively affects social life. First of all, the underlying cause should be found and treated. The type and severity of the abduction are important in determining the treatment principles. If the correct diagnosis is made, its treatment is very promising.