Md. Süleyman ESERDAĞCosmetic Gynecologist, Fellow of European Committee of Sexual Medicine (FECSM),Sexual Therapist, Editor of the Book ‘Female Aesthetic and Functional Genital Surgery’
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Urinary Incontinence in Women

Urinary Incontinence in Women

Urinary incontinence in women can be treated with a variety of procedures. Urinary incontinence treatments include medical procedures, surgical procedures, and lifestyle changes.

Urinary Incontinence

Urinary incontinence is a condition that leads to significant psychological and sociological problems in women.

Urinary incontinence problem is more common in women than in men. The reason for this is the fact that the length of the urethra (urinary canal) in women is shorter than that in men. In addition, childbirth, menopause or hormonal problems play a role in this problem. In this section, you will be able to find detailed information about “the causes of urinary incontinence in women, how it occurs, what are the types of urinary incontinence, treatments of urinary incontinence in women".

What are the causes urinary incontinence in women?

Urinary incontinence is a nightmare for many women. Over time, social estrangement can lead to loss of self-esteem and chronic depression.

We can list the causes of urinary incontinence in women as follows:

  • Decreased amount of collagen and connective tissue weakness due to advancing age,
  • Estrogen deficiency in the menopausal period,
  • Vaginal deliveries, the story of a difficult childbirth and vaginal delivery of a large baby,
  • Conditions increasing the intra-abdominal pressure such as obesity-chronic lung diseases (asthma, bronchitis, COPD),
  • Constipation and intestinal problems,
  • Urinary tract infections and urolithiasis,
  • Previous urological and gynecological operations,
  • Certain systemic and neurological diseases (such as Parkinson, Alzheimer, diabetes).

A diagnosis of urinary incontinence is made after listening to a detailed medical history and performing physical examinations and analyses, by also considering that it may be caused by a variety of etiological factors.

Types of urinary incontinence

Involuntary urinary leakage is simply defined as “urinary incontinence”. An individual’s ability to control his/her gas, stool or urine is referred to as “continence” while his/her inability to control these is referred to as “incontinence” problem. Involuntary urinary leakage is called “Urinary incontinence” in medical terminology. Urinary incontinence in women is generally classified into 3 groups.

  1. Stress Urinary Incontinence (SUI),
  2. Urge Incontinence (UI),
  3. Mixed Urinary Incontinence.

1- Stress Urinary Incontinence (SUI)

Involuntary urinary leakage that occurs during any increase in the intra-abdominal pressure due to laughing, straining, coughing, sneezing etc. is defined as “Stress Urinary Incontinence” (SUI). It is usually seen in women from early ages. Initially a small amount of urinary leakage occurs but it increases to an extent that can negatively affect daily life over time.

Stress type urinary incontinence can be diagnosed during examinations. It is commonly found in women in cases of vaginal deliveries, obesity, and menopausal estrogen deficiency. Surgical procedures intended for the treatment of stress urinary incontinence as well as laser treatments developed especially in recent years give very satisfying results.

2- Urge Incontinence (UI)

The sudden feeling of need to urinate and the consequent involuntary urinary leakage before reaching the toilet is defined as “Urge incontinence”. . It is the problem of “inability to reach the toilet in time”. It does not include any physical problem in the urinary tract and bladder.

Urge type incontinence, which is a kind of neurological disease, includes a neural disorder. Urge type urinary incontinence can also be seen temporarily in cases of urinary tract infections and urinary tract stones. After the treatment of the current condition, the problem of urinary incontinence ends spontaneously. Urge type incontinence accompanying neurological diseases is treated with some drugs.

3- Mixed type urinary incontinence

It is a type of urinary incontinence that includes both stress incontinence and urge incontinence. The predominant type is determined based on the intensity of the patient's complaints and the results of the urodynamic tests. The treatment plan involves a surgical or non-surgical procedure.

Treatment of urinary incontinence in women

Urinary incontinence can be treated with a variety of procedures. Treatments of urinary incontinence in women vary depending on the type of incontinence, complaints, and intensity of urinary incontinence.

Urinary incontinence treatments include medical procedures, surgical procedures, and lifestyle changes.

Drug treatment of urinary incontinence

Drug treatments are also used in some cases of mixed type incontinence, but mostly in cases of urge type urinary incontinence. Therapeutic drugs act on neurological nerve pathways. The duration and dose of treatment with “urinary incontinence drugs” differ from patient to patient. Such drugs give very successful results but have serious “anticholinergic” side effects. Therefore, is recommended to use them under the supervision of a physician and with regular follow-up controls.

Surgical Treatment of Urinary incontinence

There are surgical procedures commonly performed today in the treatment of urinary incontinence. Combined surgical procedures are performed in cases accompanied by prolapsed uterus, bladder, and bowel.

Cystocele surgery

Prolapse of the urinary bladder in the anterior vaginal wall is defined as “Cystocele”. In case of cystocele, the anterior vaginal wall is repair with a surgical procedure called “Colpography anterior”. With this surgical procedure, an incision is made on the anterior vaginal wall, the weakened connective tissue is strengthened with sutures, the excess skin is removed, and then the tissues are brought closer to each other. These operations which strengthen the bladder floor usually eliminate the problem of urinary incontinence.

Bladder suspension surgery

In stress type incontinence, the pelvic floor muscles surrounding the bladder are mostly damaged due to vaginal deliveries in particular. There is a urethra with impaired posture, and a prolapsed urinary bladder. “Mid-Urethral Sling (MUS)” operations performed on the urethral neck can be performed alone or in conjunction with cystocele surgery. In TOT (Trans Obturator Tape) and TVT (Trans Vaginal Tape) surgeries performed to eliminate urethral mobilization, which are the most preferred suspension procedures, mesh placement is done by accessing the underneath of the urethra through the vagina.

Postoperative recovery of urinary incontinence surgery

Surgical procedures are commonly performed in the treatment of urinary incontinence and mostly successful results are achieved. Pain, bleeding and difficulty in urination are the most common conditions after urinary incontinence surgeries. These problems should be resolved within a few days.

In the long term, problems such as inability to empty the bladder completely and urinary incontinence can be encountered. Since urinary incontinence can be caused by a variety of factors, it will be useful to support the operation with medical and behavioral treatments, in cases where there is no complete postoperative recovery.

Lifestyle recommendations in case of urinary incontinence

In addition to medical and surgical treatments, lifestyle changes are recommended to women with urinary incontinence. These recommendations that can be followed easily in daily life are as follows.

  1. Avoiding excessive fluid consumption,
  2. Consuming at least 1.5 - 2 liters of liquid throughout the day,
  3. Avoiding fluid consumption in the last 4-5 hours before going to sleep,
  4. Avoiding the consumption of excessive alcohol as well as caffeinated and acidic beverages,
  5. Increasing physical activity and strengthening the pelvic floor muscles,
  6. Avoiding weight gain,
  7. Eliminating chronic problems that increase intra-abdominal pressure such as constipation and cough.

Urinary incontinence and sexuality in women

Urinary incontinence in women leads to many physiological, social and psychological problems. This situation that prevents daily life and disrupts human relations over time also reflects on sexual life. Mostly women who are ashamed of this situation have problems in their marriages.

Urinary incontinence during sexual intercourse is referred to as “coital incontinence”. This condition causes loss of self-confidence, sexual desire and lack of sexual drive in women. Women, who have avoided telling this problem even to their physicians for years, struggle with serious problems. When they visit the doctors at the last stage, improvement can be achieved in every aspect with special treatments, which are planned based on their conditions.

Procedures intended to treat urinary incontinence are developing day by day and are supported with new methods. Today, the efforts to find solutions for women’s urinary incontinence problems are in a better condition, and treatment opportunities can now be reached an early stage.

Laser treatment for urinary incontinence

Today, there are also non-surgical procedures performed for urinary incontinence problems in women. In certain patients, urinary incontinence problem can be completely eliminated with technologies such as fractional vaginal laser, vaginal radiofrequency, genital PRP and magnetic chair.

Laser treatment for urinary incontinence is suitable for menopausal women and aged women who cannot have surgical treatment due various health problems. Moreover, laser vaginal rejuvenation and urinary incontinence treatments have almost no risk. You can contact our clinic to get detailed information about risks.

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Dr. Süleyman EserdağMd. Süleyman ESERDAĞCosmetic Gynecologist, Fellow of European Committee of Sexual Medicine (FECSM),Sexual Therapist, Editor of the Book ‘Female Aesthetic and Functional Genital Surgery’
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