URINARY INCONTINENCE IN WOMEN
Various types of urinary incontinence may occur in women, especially in women over the age of 40 and mostly after menopause. It is possible to examine urinary incontinence in several different types:
- Stress (pressure) type
- Urge (urgency/jam) type
- Mixed type
- Overflow type
TYPES OF URINARY INCONTINENCE
Urinary incontinence, which we call stress type, is urinary incontinence that occurs when coughing, sneezing, in situations that increase intra-abdominal pressure, while carrying loads or lifting objects. Generally, after the pelvic floor muscles weaken, the pressure cannot be balanced and excessive pressure is applied to the urinary tract, resulting in sphincter insufficiency and urine leakage.
Stress urinary incontinence is treated surgically with mid-urethral sling surgery. These are surgeries such as transobturator tape (TOT), tension-free vaginal tape (TVT) and Sling. The surgeries last an average of 30 minutes and do not compromise comfort much, and a 1-day stay is sufficient.
Urge type urinary incontinence may occur due to reasons such as deterioration in the storage function of the bladder over time, overactive bladder, change in the collagen structure of the bladder wall, and chronic infections. Stones in the urinary tract can also sometimes cause a feeling of urgency. If a cause is found, treatment is given towards the cause. If it cannot be found, medical treatments are applied. These may be in the form of anticholinergic drugs and beta3 agonists. While there are medications that can be taken orally, there are also medications that can be taken in patch form to avoid side effects.
In mixed type urinary incontinence, both urgency and stress urinary incontinence may occur together. In these, the sphincter is weakened, pelvic floor support is reduced and bladder function is impaired.This type of incontinence is primarily treated with anticholinergics, and sometimes both conditions improve with this treatment. If it does not improve, middle urethra sling surgeries are performed.
Overflow urinary incontinence occurs when urine overflows in people who cannot empty their bladder. The bladder may be flabby due to nerve damage, or the sphincter tone may be high and the sphincter may not be able to relax to urinate. It usually develops in diabetic people or due to other neuropathies. Treatment here consists of correction of neuropathy or, if not possible, intermittent emptying of the bladder by clean intermittent catheterization.
Patients with urinary incontinence are evaluated with urinalysis, bladder ultrasonography, and cystoscopy if necessary. Rarely, a voiding diary and urodynamic studies are required. In cases where neuropathy is suspected, additional examinations such as cerebrospinal MRI examination and EMG may be required.
Constipation is also effective in urinary incontinence, especially the urge type. Stress urinary incontinence is more common in overweight, multiparous women.Relieving constipation and losing weight, avoiding foods that stimulate the bladder, such as chocolate, strawberries and spices, are the primary treatment methods to be tried. If these are not successful or cannot be applied, physical therapy methods such as pelvic floor strengthening kegel exercises can be used. If there is still no success, surgical methods are tried. Botulinum toxin bladder application is effective for 9-11 months in urge incontinence that cannot be treated with medication, but it must be repeated.
In resistant types of incontinence, peripheral nerve stimulation, TENS method and sacral nerve stimulation (sacral neuromodulation) are among the last options.
FREQUENTLY ASKED QUESTIONS ABOUT URINARY INCONTINENCE
Why is urinary incontinence more common in women?
The urinary tract is longer in men (18-20cm). Just below the bladder outlet, the urinary tract is surrounded by the prostate. In women, the urinary tract is much shorter (3-5cm). Urinary incontinence is more common in women as the tissues that support the urinary tract weaken after normal birth or menopause.
How many types of urinary incontinence are there and what are the differences?
The most common types of urinary incontinence are: Urinary type, stress type, mixed type. In the urge type, the feeling of urination comes suddenly as a result of the bladder muscle contracting too frequently and strongly, and the patient leaks urine before reaching the toilet.
- In the stress type, the patient leaks urine when coughing, sneezing, or lifting heavy loads.
- Mixed type is the co-occurrence of both stress and compression type incontinence.
Apart from this type of incontinence, there are two other rarer types of incontinence: persistent, overflow incontinence.
- Patients with persistent urinary incontinence, as the name suggests, leak constantly.
- Overflow type urinary incontinence is the least common type. In these patients, there is a problem that blocks the urinary tract. Since urination cannot be done, the bladder fills with urine and its pressure increases, and when this pressure exceeds the force blocking the tract, the patient begins to leak urine drop by drop.
At what age and how often does urinary incontinence occur?
It is a very common disorder, especially in women over the age of 50; However, many patients cannot be treated because they are embarrassed.
What is the cause of urge urinary incontinence and how is it treated?
The problem with urge incontinence is that the bladder muscle contracts even though the bladder is not yet full and the person does not want to urinate. This condition is medically called overactive bladder. Medicines that weaken bladder contractions are used in the treatment. Although very rare, inability to urinate may also occur due to these medications. While these medications reduce the function of the bladder muscle, unfortunately they can also reduce the function of the salivary glands and large intestine, causing dry mouth and constipation.
What is the cause of stress urinary incontinence?
Loosening of the tissues surrounding the urinary tract after many normal births or births of overweight children or with advancing age causes the sagging urinary tract (urethra) to become deprived of support. Intra-abdominal pressure increases during coughing, sneezing, lifting, and standing up from a sitting and lying position. This increase is also reflected in the bladder. In normal individuals, during this time, the urinary retention muscle (sphincter) contracts and squeezes the urine between the supporting tissues, preventing urine leakage. If the supporting tissues are not intact, the urinary tract cannot be closed and urine leakage occurs.
How is stress urinary incontinence treated without surgery?
Leakage can be prevented by increasing the strength of the urinary retention muscle. This can be done in two ways:
- The patient can strengthen the urinary retention muscle and the pelvic floor muscles, which provide support to the surrounding organs, with exercises, by contracting himself as she does when she wants to hold urine when she has an urge to urinate.
- Using drugs that strengthen the urinary retention muscle.
How is stress urinary incontinence treated with surgery?
Treatment is possible with many surgical methods (such as TOT, TVT, PVS, BURCH). The goal of all these surgeries is the same: to provide support for the urinary tract. Non-absorbable synthetic patches can be used as support, as well as the patient’s own tissue.