Urinary Incontinence in Women
Incontinence is the individual's inability to control urination. In this case, incontinence occurs when the force that excretes the urine in the bladder exceds the holding force from the external urinary tract. It is a common condition. The condition reaches a level that causes problems and adversely affects the quality of life for 35 out of every 100 women.
What are the Types?There are three types of urinary incontinence in women. The first is compression-induced incontinence. In this case, the bladder cannot store urine adequately, and discharge occurs before the desired amount is reached. 22 out of every 100 urinary incontinence is of this type. The other is stress-type incontinence. It occurs in physical activties such as coughing, sneezing and laughing. This type of disorder occurs in 50 out of every 100 incontinence patients. Finally, the type in which both types coexist, and this accounts for 30 out of every 100 incontinence cases. While physical activity-related incontinence is more common in young and middle-aged women, compression-induced incontinence and coexisting types are more frequent in later ages.
What are the Causes
- Familial predisposition If the mother/sisters have it, the risk increases 3 times.
- Advanced age.
- Pregnancy, childbirth - difficult or with intervention
- Previous gynecology operations
- Radiation therapy due to cancer
- Frequent urinary tract infection, cystitis
- Excessive alcohol consumption.
- Lumbar hernia, dementia, multiple sclerosis affecting bladder nerves
- Chronic Constipation
- Diabetes, high blood pressure, heart disease, chronic lung disease
- Being overweight or obese.
- Inactivity, sedentary lifestyle
What is the Treatment?Conservative treatments: Weight loss in overweight patients, regular physical activity or exercise in those with a sedentary life, encouraging smoking cessation in smokers, changing some drugs that cause urinary incontinence, regulation of fluid intake, limiting coffee-tea-coke consumption, eliminating constipation, teaching some positions that may help holding urine, urination training and similar practices may completely eliminate or mitigate the problem in some patients.
Drug treatments: Depending on the type of urinary incontinence, patients may benefit from drug therapies. In particular, drug therapies are one of the effective options in compression-induced urinary incontinence. Such drugs may have some side effects and may interfere with other medications used for other purposes, their use has to be recommended by a urologist.
Surgical treatment: Surgical treatments may be considered in patients whose life style cannot be changed, whose complaints are more serious and who don't respond to drug treatments. Sometimes, patients may prefer surgical treatment because their social conditions may be adversely affected due to severe deterioration in their quality of life.
Strap OperationsThis is usually referred using closed methods through the vagine in suitable patients. The objective is to provide the support to prevent urinary incontinence. For patients without significant sagging in the bladder, 15-20 minutes operation usually permanently solves the problem. In appropriate patients, these surgeries can be performed under local anesthesia and daily hospitalization. The patient is usually discharged on the same day and the effect of the operation can be felt on the next day. This completely eliminates the problem of patients with mild-medium complaints with a success rate of 90% and without side effects.
Correction of Sagging BladderFor patients with significant sagging of the bladder and pelvic organs, closed methods applied through the vagina can eliminate the incontinence problem. Sagging surgeries lift the organs and provide support through sutures or specially designed materials to prevent sagging again. Since the sagging is corrected during surgery, the operation duration can reach an hour. Patients are anesthetized either epidurally or with general anesthesia, and usually a 1-day hospitalization is planned.
Treatment of Urinary Incontinence with RoboticsIn patients with significant pelvic organ sagging with urinary incontinence, severe sagging of the bladder can be corrected by robotic surgery. In this method, the sagging organ can be put in place by entering through several 1 cm holes in the abdomen. Generally, this procedure can be performed with a 1-day hospitalization. The results are quite good.
Recurrence After SurgeryPostoperative incontinence recurrence rate is 10-20%. It is possible to repeat the operation in these patients with closed, vaginal methods.
Sometimes these patients can become pregnant after surgery. In these cases, it is generally recommended to give birth by caesarean section. However, there are also patients who give normal birth. This can eliminate benefits of surgery. In this case, it is possible to repeat the surgery.