Urinary incontinence in women

Urinary incontinence treatment in women

Urine


During Normal daily work, it is called "urinary incontinence" from the urinary tract exit of the urine, except for the sudden and the person's request. " Urinary incontinence can also be defined as "involuntary urinary evasion", "urinary failure", "loss of bladder control". It is a very common health problem especially in women in society.

If urinary incontinence affects your social life and quality of life, it is necessary to treat it. Because this is a situation that needs to be ashamed and is not part of normal life. Many patients have serious results with simple lifestyle changes and simple medical treatments.

URINARY INCONTINENCE TYPES

There are 4 types of urinary incontinence when it comes to the reasons of urinary abduction.

Stress-type Urinary incontinence: 
It is the most common cause of urinary abduction in women. Urinary incontinence is seen in cases of increased intra-abdominal pressure such as coughing, sneezing, rubbing, laughing. Bladder (urine sac) and urethra (urinary tract from the bladder) are caused by the inability or weakness of the valves and pelvic floor muscles. The most important reasons are; Pregnancy, childbirth and menopause.

Urge incontinence (type of jamming):
It is defined as the abduction of urine with a sudden feeling of urination. There's a urinary incontinence before the person catches the toilet. The stress type differs from urinary incontinence, not from the pelvic floor weakness. caused by excessive active bladder muscles.

Mixed type urinary incontinence:
Stress is observed in cases where incontinence and urge incontinency are combined.

Overflow type urinary incontinence:
Although the bladder is full, there is no feeling of urination due to loss of sensation and urinary incontinence occurs when urine is stored in excess of bladder capacity. This type of incontinence is seen in diseases of the nervous system such as bladder injuries, urethra obstruction, advanced stage diabetes (nerve damage), spinal cord injury or multiple sclerosis.

CAUSES OF URINARY INCONTINENCE

• Advancing age
• Menopause (due to the reduction of estrogen hormone)
• Birth (difficult birth, giving birth to a large number of babies, making many births...)
• Diabetes
• Obesity
• Genetics (loose connective tissue in some women)
• Systemic diseases (such as chronic kidney diseases, asthma, bronchitis, multiple sclerosis, Parkinson's)

Conditions that may cause transient incontinen
ce: alcohol, excessive fluid intake, bladder stimulants, some medications (heart medications, hypertension medications), urinary tract infections, constipation may increase complaints of urinary evasion or temporary May cause urinary incontinence.

How to diagnose urine abduction?
In the evaluation of urinary incontinence, a good medical history (Anamnesis) is very important, from which the patient is a type of insulin and to understand its severity. After detailed anemic (story), the person's physical examination is passed. Physical examination is extremely important in determining the problem of a person's urinary incontinence.

Examination: A detailed pelvic examination and urine abduction should be observed. In addition, uterine prolapse (desensus), urine bag sags (cystocele), bowel sags (rectocele) should be observed, the degree to which they should be considered. In physical examination, a number of tests are applied to the patient. The frequent application of these tests is the "Marshall test" with the help of a cotton-tipped rod and the "Q type Test", in which the bladder neck is measured by vaginal lifting.

24-hour urine diary: A form containing daily fluids and frequency and amount of urination. This daily helps to diagnose and treat the doctor.

Urine Analysis: Urinary tract infections, blood or stone findings can be detected in the urine.

Postvoiding Residence Measurement (PVR): urine left in the bladder after urination is easily measured by ultrasonography. The presence of excess urine in the bladder after the urination indicates that there may be a problem with the urinary tract obstruction or the nerve and muscle layer of the bladder.

Urodynamic examinations: Tests based on the measurement of the pressure of the bladder during resting and uring. Although it is not always necessary for the diagnosis of incontinence, it can help in determining the type of incontinency.

TREATMENT OF URINARY INCONTINENCE

The treatment of incontinence is planned according to the type and severity. Conservative therapies, various medical or surgical treatments should be individualized according to the patient.

CONSERVATIVE THERAPIES (NON-SURGICAL TREATMENTS)
The purpose of this is to strengthen the pelvic floor muscles and bladder muscles carrying the bladder.

Bladder exercises: It is aimed to train and strengthen the bladder by holding a certain amount of time when it comes to the delay of urination and urine sensation.

Training of pelvic floor muscles: Exercises of pelvic floor muscles "KEGEL EXERCISES" strengthen the support of the vesicourethral compound (i.e. the angle of the urinary tract at the exit of the bladder and bladder), especially in patients with stress-type urinary incontinence Levator is the first step in the treatment, as it enhances the sudden and pelvic floor diaphragation.

Electrical stimulation: The use of the internal and the vaginal electrodes. It is a form of treatment based on the contractuation of the pelvic floor muscles with electrical stimulation by stimulating the pelvic nerves. It is aimed to increase the urethral closure pressure by reflex contraction in the muscles around the urethra. Many sessions are required and treatment should last for months. Nowadays it is not the most preferred form of treatment.

DRUG TREATMENT

Estrogen hormone: Increased blood circulation by stimulating the bladder mucosa and the six tissues of the mucosa; This can be used to increase the pressure of smooth muscle response and the closure of the urethra. Local estrogen application is administered intravaginal 1-2 G lying at night for 6 weeks; The maintenance dose is 2-3 times per week.

Especially urge (compression) and overflow type incontinence can be treated using anticcholinergic and/or tricyclical antidepressants. It increases the urine bag expansion and urine capacity and suppresses involuntary contractions of the bladder.

SURGICAL TREATMENT

Surgical treatment is usually preferred in stress type incontinin. Surgical abdominal (with open incision from the abdomen) can be administered laparoscopic or vaginal. Nowadays, it is the most commonly used "SLING" operations, depending on the progression of surgical techniques and the very progression of synthetic mesh technology.
Types of Surgery
• Surgery performed by the abdomen: MMK-Burch-Marchall Marchetti Cranz or Burch operation. They can be made open or laparoscopic.
• SLING (HANGER) OPERATIONS: TVT, TOT and mini-siling techniques.
• Artifitial urethral sphincter
• Periurethral injections: (Teflon, collagen, autologous fat...)

SLING OPERATIONS: 

Sling i.e. suspension surgeries are most commonly applied in cases of stress incontinence and mixed type urinary incontinence. The common point of suspension surgeries is to pass through the entire neck of the urethra or bladder and to create pelvic hangers, and to support the bladder neck and urethra. (TVT, TOT and Mini siling) The patient can be discharged one day after the operation and return to his daily life immediately. It is usually TOT (TRANSOBTURATOR TAPE) from the sling operations I prefer clinically. The vaginal urethra is made with an incision of about 1-2 cm in six. It's a simple operation that lasts about half an hour. The chances of success are above 90%. Long time results are quite good and the possibility of recurrence is minimal.

Recommendations to reduce the risk of urinary incontinence;

• Weight loss of fat patients
• Avoiding constipation and consumption of fibrous food
• Avoiding activity that causes urinary incontinence
• Cigarettes (smoking reduces the risk of incontinence.)
• Avoiding bladder stimers (reducing the consumption of caffeinated beverages such as tea, coffee, cola)
• Treating diseases leading to chronic cough
KEGEL EXERCISES (especially in pregnancy and pre-pregnancy period, reduces the risk of incontinence of KEGEL exercises in daily life)
• Regular sports or exercise.