urinary incontinence in medicine incontinence It is said. Basically, this problem is a disease of women. Involuntary urinary incontinence, especially during the day and while awake, is evaluated under this heading.
There is no specific amount measured to indicate urinary incontinence; Because, while there are women who do not complain despite having to use sanitary pads, there are also women who see even dripping and infrequent urinary incontinence as a big problem. Thus, the disease dimension of urinary incontinence is strictly dependent on the socio-cultural status of the woman. While in rural areas the problem is seen as a natural problem related to aging and people do not consult a doctor, in cities and especially in working women, urinary incontinence causes depression and restrictions in social relations (due to the smell of urine and the feeling of wetness), causing them to consult a doctor for treatment at an earlier stage.
Ultimately, any urinary incontinence that will affect a person's social life is a disease and must be treated. Contrary to popular belief, this problem is not a condition that only occurs with aging. Especially post menopause This condition, which is seen in women who are in their term and who have had multiple and difficult births, can sometimes occur at an earlier age. One in every five women over the age of 35 faces the problem of urinary incontinence, more or less occasionally. After the age of 65, almost one in every three women has this problem.
Studies have estimated that 25% of women experience urinary incontinence at some point in their lives. However, the number of women consulting a doctor is far below these figures. The complaint of urinary incontinence appears as a problem that is hidden by the woman and is often ashamed. In a study, it was observed that 70% of women with urinary incontinence were diagnosed with urinary incontinence as a result of examination and history taking when they consulted a doctor for other reasons. Another study found that women spend an average of 9 years with this complaint before consulting a doctor. This problem grows even more as human life increases.
In Which Situations Does Urinary Incontinence Occur?
urinary incontinence; It may occur in situations where intra-abdominal pressure increases, such as coughing, sneezing or laughing, or it may occur with less effort (such as walking, getting out of bed). This type of urinary incontinence strain It is called type urinary incontinence.
In some patients, incontinence is accompanied by a sudden urge to urinate and a feeling of urgency. For this type of urinary incontinence jam It is called type incontinence. The reason for this is usually not clear. These patients are afraid to go shopping, they are hesitant to visit guests; because they think that this situation will arise suddenly and they will not be able to reach the toilet. In some people, urinary incontinence occurs together with the two types of incontinence described above. This type of urinary incontinence is also called mixed type incontinence.
Urinary incontinence with straining is usually seen in women who have given birth vaginally. As a result of damage to the groin muscles or nerves during birth, the bladder neck shifts or cannot close during coughing, sneezing, laughing, climbing stairs, carrying loads, or sexual intercourse, causing the patient to leak urine due to increased pressure in the abdomen.
The treatment is usually surgery.
Physical therapy methods (strengthening the groin muscles, electrical stimulation) and hormone therapy can also be applied in menopausal women.
Urge urinary incontinence Although it is usually seen in older ages, it can also occur in cases where the bladder is irritated (inflammation, stone, tumor, etc.). In these patients, urination in bed at night, waking up from sleep to urinate at night (normally 2 times), and urinating a lot during the day (normally 6 times) are more common when they are young. There may be a feeling or urgency to urinate with the sound of water. The patient, who runs to the toilet with a sudden feeling of urination, which can usually be triggered by physical activity (such as laughing, talking, sneezing, coughing, lifting a load, sexual activity), becomes incontinent and leaks urine at the toilet door. Generally, the cause of this situation cannot be found. Treatments such as bladder training, correction of urination habits, electrical stimulation and medication are applied.
Mixed Type Urinary Incontinence:
mentioned above both situations occur together in the same patient. Therefore, both treatment options can be applied. First surgery, then physical therapy, medication or electrical stimulation, or if physical therapy or medication is not successful and is not successful, then surgery can be tried. In addition, urinary incontinence problems may occur as a result of more serious diseases such as Alzheimer's disease, Multiple Sclerosis (MS), stroke patients, and diabetes, and their treatment is a separate issue.
Diagnosis in Patients with Urinary Incontinence:
First of all, the type of urinary incontinence of the patient is determined. Then, a gynecological examination is performed to investigate whether there is sagging in the bladder, bladder neck, vagina and uterus, and whether there are persistent leaks, especially those caused by canals formed from the urinary tract to the chamber due to previous surgeries. Another known fact is that strain-type urinary incontinence is usually uterine and bladder prolapse It is in association with. After these procedures, the patient's urinalysis and urine cultures for inflammation are performed. If abnormal findings are detected in these examinations, appropriate treatment is given. Then, in order to observe the patient's urinary incontinence, urinary incontinence is tried to be visually observed by giving some liquid to the bladder or by straining, waiting for it to compress. A test called pad test can be performed to detect the presence or amount of urinary incontinence. A more detailed examination is required, especially in patients who continue to have urinary incontinence despite previous urinary incontinence surgery and in patients who will undergo surgery. Urodynamic Examinationis done.
During this procedure, water is administered through a catheter placed in the patient's bladder, and filling, leakage and urination pressures are recorded with the help of a computer and printed numerically and graphically. Since urodynamics is a very complex and expensive test, it is not appropriate to apply it to every patient. In addition, if the patient has problems that constantly increase intra-abdominal pressure, such as chronic lung disease that causes coughing, chronic constipation, and excessive obesity, these also need to be treated.
What are the Treatment Methods for Urinary Incontinence?
Treatment includes physical therapy applications, surgical methods and drug treatments, especially for women with accompanying uterine prolapse. There are many methods of treatment, from the simplest to the most invasive, considering the degree of urinary incontinence and its impact on the patient's social life.
First step in treatment is bladder training. This is especially important in impingement type incontinence. One should not run to the toilet to delay the urge. Must stand or sit. Pressure is applied to the perineum (perineum), breathing exercises are performed to relax the abdominal muscles. If it cannot be prevented, urination can be done to prevent incontinence. In addition to regular and regular urination, training on holding (stopping) urine while urinating normally should be done. Contrary to popular belief, a person with urinary incontinence should drink plenty of fluids except at night. This will prevent constipation. Fiber foods should be taken. Daily urine amount should be at least 1.5 liters on average.A normal person urinates 4-6 times during the day and once or twice at night. In order to empty the bladder, it is necessary to urinate 300 ml (about one to one and a half glasses) with each urination. If the patient goes to the toilet more frequently and in smaller amounts, ejaculation may not occur. Cola, coffee, tea, chocolate and alcohol can increase the need to urinate and cause urgency, so it would be appropriate to reduce it as much as possible. In cases with advanced urinary incontinence and where physical exercises are not beneficial to the operation is needed. The physician decides which type of operation to perform after the necessary examinations. Nowadays, with the application of new techniques, strain-type urinary incontinence can be treated. Nearly 90% successful is being done.
In these operations, which can be performed from the abdomen or the chamber, uterine and urinary bladder prolapses, if any, are corrected all together. They are not difficult surgeries. Nowadays, it can even be performed under local anesthesia in women. Through a small incision made in the vagina, the urinary tract is suspended to the abdominal folds by means of a tension-free band. There will be no scars other than two small incisions (0.5 cm) on the abdomen.
As a final word;
Many people remain unnecessarily silent on this issue. He is ashamed to consult a doctor and get the necessary help. Some people think that this condition is the inevitable result of aging and that they should just endure it rather than find possible causes and treatment options. However, simple treatments may be available, such as using antibiotics to control the infection or learning exercises to strengthen the muscles that control urine flow. If necessary, surgery is performed.
The important thing is to consult a doctor.