Urinary incontinence in women is a common problem that constitutes a real problem for many, what is enuresis, what are its types, causes of enuresis in women, methods of prevention and the latest treatments in Turkey.
What is urinary incontinence?
Urinary incontinence is urination without intending to pass urine. It affects both men and women but is more common in women, especially with age. It's hard to say exactly how many women have incontinence, because many women are too embarrassed to talk about it. For those who suffer from incontinence, it can be embarrassing and upsetting for them and can affect every area of a woman's life.
Some women stop going out or being physically active because of this. Incontinence can affect their sexual and social lives, your relationships, and sometimes lead to depression. Many women do not seek help and tolerate it, but there is a lot of help available and it can often be treated.
Types of urinary incontinence
There are two main types of urinary incontinence:
With this type, women feel the sudden need to urinate without warning, which is difficult to postpone - you need to go to the toilet immediately.
Stress incontinence occurs when you pass urine when you sneeze, cough, or strain yourself.
It can also be "mixed incontinence" which means that some women may have both stress incontinence and urge incontinence.
An overactive bladder occurs when you feel a strong urge to urinate often, including at night. Sometimes, but not always, this leads to urge incontinence.
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Urinary incontinence symptoms
The main symptom of urinary incontinence is urine leakage. But this can vary quite a bit, from leaking a few drops to partially or completely emptying the bladder.
If you have urge incontinence, you'll feel a sudden urge to go to the toilet that you can't put off.
You may not be able to get to the toilet in time. Some women also need to go to the toilet at night and sometimes leaks occur at night as well.
If you have stress incontinence, the main symptom is leaking urine when you do things like cough, sneeze, laugh, lift something heavy, or exercise.
You may have other symptoms such as:
- The need to urinate often
- Feeling of pressure in the vagina
- dripping urine after you go to the toilet
- burning when urinating
Urinary incontinence causes
The cause of urinary incontinence depends on the type of incontinence.
Urge incontinence occurs when the bladder wall muscle contracts when you don't want it to. This makes you feel the need to urinate urgently. This can develop as you get older or be caused by other medical conditions such as neurological diseases such as stroke or multiple sclerosis.
Some things that increase the likelihood of developing incontinence:
- Pregnancy and childbirth: This causes the pelvic floor muscles to tighten and weaken, which can cause urinary incontinence. Vaginal delivery, or cutting the perineum (the area between the vagina and anus) during childbirth or pregnancy, are all associated with stress incontinence.
- Aging - the older you get, the more likely you are to develop any type of incontinence.
- Other close family members have stress incontinence.
- Genital prolapse - this occurs when one or more pelvic organs slip from their normal position and bulge into the vagina.
Other causes of incontinence include:
- Urinary tract infections
- Drink a lot of caffeine
- pathological disorders asParkinson's disease
- Long-term severe cough
- Strenuous physical activity such as lifting weights.
Urinary incontinence diagnosis
If urine is leaking involuntarily and is bothering you or affecting your daily life, you should see a specialist. Your doctor will ask you about your symptoms and medical history. Knowing this helps your doctor know what type of incontinence you have and rule out any underlying causes. Your doctor will also ask you about any medications you may be taking.
The doctor does a physical exam, too. He will feel your abdomen and possibly perform an internal examination. This means placing a finger in the vagina and asking you to apply pressure to the pelvic floor muscles. This can help show how well they are working.
Your doctor may ask you to write down how much urine you pass when you go to the toilet for a few days, and whether or not you have incontinence. It is better to record this on working days and non-working days to give a complete picture.
Depending on your symptoms, your doctor may order a urine analysis to see if you have an infection.
They may also refer you to a specialist for further tests, such as:
- an ultrasound of your bladder after urination – this can help show if your bladder is emptying properly
- Urodynamic tests.
There are many things you can do to help manage symptoms. Your doctor may suggest some of the following:
- Cut back on caffeine
- Weight loss If you are obese
- Change the amount of fluid you drink every day
- Treat any constipation - this means eating more fruits and vegetables and drinking plenty of fluids
- Doing less strenuous exercises
- Doing pelvic floor exercises - these exercises may help you with stress incontinence
- Bladder training – this may help if you have urge incontinence
You may also find it helpful to use incontinence products. for example:
- Wear bandages in your underwear to absorb any leaks
- Use a portable urinal
- Use devices that you insert into your urethra or vagina to prevent leaks - they can't be used all the time, but may help temporarily in some situations (for example, during exercise).
- Teaching self-catheterization - this involves inserting a thin, flexible tube into the urethra to drain urine when needed. If this is the right option for you, your incontinence specialist will teach you how to do it.
Urinary incontinence treatment
Treatment for incontinence usually begins with less invasive treatments first. This means trying lifestyle changes, such as those listed above, as well as other treatments before considering surgery. The treatment you need depends on the type of incontinence you have.
There are three main treatments for stress incontinence:
- Pelvic floor muscle training (Kegel exercises)
The pelvic floor muscles help control the bladder and bowels. Strengthening these muscles with these exercises can sometimes help relieve incontinence.
You will be told how to do these exercises and you will need to do them three times daily for three months to see if they help. If you have problems tightening your pelvic floor muscles, biofeedback and electrical stimulation may help.
Biofeedback is when sensors placed on your skin or in your vagina send signals to a monitor when you squeeze your pelvic floor muscles.
This can help you show how well you are doing the exercises. Electrical stimulation uses an electrical current to stimulate the pelvic floor muscles from a small electrical probe placed in the vagina.
There are some medications that may help treat incontinence, but they often cause side effects and aren't usually given as an initial treatment. If you don't want to have surgery, your doctor may suggest medication. They will tell you the best medication for your specific conditions and review it after four weeks to see if it works well in your case.
There are many surgical procedures to treat stress incontinence, depending on the cause. Your doctor will often suggest surgery for incontinence if you've tried nonsurgical treatments first and they haven't worked.
Urinary incontinence surgery in Turkey
If less invasive treatments don't help, your doctor will refer you to a specialist to discuss surgery. The main types of urinary incontinence surgery include:
Vaginal suspension is an operation to treat stress incontinence in women. Stress incontinence occurs when you accidentally urinate because you're doing something that puts extra pressure on your abdomen and bladder. Additional stress can be caused by activities such as laughing, coughing, sneezing, exercising or jumping.
Your doctor may suggest a vaginal suspension if other options haven't worked.
About Vagina Comment
Stress incontinence can be caused by changes in the muscles and ligaments that hold the bladder and prevent urine leakage. The pelvic floor muscles are the sphincter, the ring of muscle that closes the bladder.
In a vaginal suspension, the surgeon raises the bladder neck to the correct position and secures it in place with stitches. This helps prevent urine leakage.
Consider the suspension of the vagina
There are a few things to consider before deciding whether or not a vaginal suspension is the right treatment for you.
A vaginal suspension works well as a long-term treatment for stress incontinence in most women. In the first year after the operation, studies show that the operation was successful in eight and nine out of 10 women. After five years, about seven out of 10 women will continue to have pathological findings. If the operation works well, it can improve your quality of life.
However, the vaginal suspension does not always work and incontinence may not heal after the procedure. Full recovery from the procedure may take up to six weeks or sometimes longer. There is also a risk of some problems occurring during or after the operation.
Ask your surgeon to explain the benefits and risks of the procedure and how they might affect you in your particular circumstances.
What are the alternatives to vaginal suspension?
Before suggesting a vaginal suspension, your doctor will likely suggest trying other options such as the following.
- Incontinence dressings can be helpful if the patient's symptoms are not too bothersome.
- Lifestyle changes, such as losing weight for women who are overweight, and reducing fluid intake, including caffeinated beverages, can help.
- Pelvic floor exercises or exercises can be helpful. You may be offered help from a physiotherapist.
- Biofeedback in which your doctor uses an electronic device to tell you how well you're doing pelvic floor exercises, by giving you feedback as you do them.
- If you can't tighten your pelvic floor muscles because they're weak, electrostimulation, a device that uses a small electric current to stimulate and help strengthen them, may help.
- If you cannot have an operation or if you do not want to have an operation you may be offered a medicine called duloxetine.
There are also other procedures (operations) for stress incontinence.
- A sling procedure where the surgeon uses a piece of your tissue as a hanger to support your urethra.
- A tape procedure in which a tape-like plastic mesh is placed under the urethra as a support.
- A substance such as silicone may be injected to thicken and enable the area around the urethra to help it remain closed.
- Using an artificial sphincter is an option that's only used if other treatments haven't worked.
Your doctor or surgeon will discuss treatment options that may be right for you. They can also tell you more about the pros and cons of these different options.
Preparation for vaginal suspension
The patient will be asked to go to the hospital for a medical examination a few weeks before the procedure, and you will be given information on how to prepare. For example, if you smoke, you will be asked to stop. This is because smoking increases your risk of chest and wound infections, which may slow your recovery.
If you are taking any medicines on a regular basis, you should be told if you need to continue taking these medicines or stop before the operation. If you are not sure, ask. Before you go to the hospital, a urinalysis may be done to check for an infection.
Prepare to stay in the hospital for three or four nights.
The operation is performed under general anesthesia. This means that you will be asleep during the procedure. Vaginal suspension can also be performed under local anesthesia using lumbar anaesthesia. This means that you will be awake, but will feel numb from the waist down. It is very important to follow any instructions the hospital gives you about not eating or drinking before the anaesthesia.
You may be asked to wear compression stockings to help prevent blood clots from forming in the veins of your legs.
The nurse or surgeon will discuss with you what will happen before, during and after the procedure, including any pain you may feel. If you are unsure of anything, ask.
Being fully informed will help you feel more comfortable and will allow you to give your consent to proceed with the procedure. You may be asked to do this by signing a consent form.
What happens during a vaginal suspension?
You can have a vaginal suspension as open surgery or keyhole (laparoscopic) surgery. Most women undergo open surgery because laparoscopic surgery is not available in all hospitals.
If you have open surgery, the surgeon will make a cut in the lower abdomen to allow it to reach the bladder. The cut is usually very low and is sometimes called a bikini line cut because of its location.
The surgeon will raise the neck of the bladder by sewing the top of the vagina with the tissue in the back of the pubic bone. The surgeon may then place a small camera inside your bladder to check that the stitches are in the correct place and that there are no infections in your bladder.
What to expect after vaginal suspension process
You will need to rest until the effects of the anesthesia wear off. There are medications available to relieve any pain or discomfort you may have.
If you've had open surgery, you may have a tube (catheter) inside your bladder when you wake up. It is responsible for draining urine from the bladder into an external pouch.
You may have an ultrasound to check that your bladder is emptying properly. If you have problems urinating after the catheter is removed, another catheter may be inserted.
Or the nurses may teach you how to perform self-catheterization. This happens when a disposable catheter is inserted and then removed each time you need to empty your bladder. If you need to do this, it's usually only for a few days.
After the procedure, you may have a detonator, which is tubes that flow from the wound into a bag or bottle for the first day. Draw any blood or fluids.
Your nurse will encourage you to get out of bed and get moving as soon as possible. This helps prevent other problems later, such as blood clots in your legs or lungs.
You will likely have some bleeding from the vagina. You can use sanitary pads until the bleeding stops.
It is important that you do not become constipated, because the pressure after the operation can put pressure on the wound and cause pain.
Before you go home, your nurse will tell you how to care for your wound. You may also be scheduled for a follow-up appointment. You will need to arrange for someone to drive you home.
You may need some help at home for a few weeks to fully recover.
Healing from the suspension of the vagina
You'll likely begin to return to your usual activities after about four weeks, and for some women it may take longer than that. You may recover more quickly if you have laparoscopic (keyhole) surgery rather than open surgery.
It is best not to have sex, exercise or lift anything heavy for six to eight weeks after the procedure. Ask your surgeon when you can return to your usual activities and return to work.
You should not drive until the pain in the wound or from the operation is completely gone. Ask your surgeon for advice about when it should be safe for you to drive.
Your wound may be uncomfortable for up to six weeks after the procedure. If you need pain relief, you can take painkillers such as ibuprofen or paracetamol.
Always read the patient information that comes with your medication, and if you have any questions, ask your pharmacist for advice.
Call the hospital or your GP if you have any of the following symptoms when you are at home:
- Urination problems, such as not being able to go to the toilet, feeling a burning sensation when urinating, or needing to go to the toilet quickly.
- Signs of wound infection such as redness, pain, and leakage of fluid or pus (pus) from the wound.
- high temperature;
- Increased pain or pain that cannot be controlled with analgesics.
Side effects of vaginal suspension
Side effects are unwanted, but mostly temporary, effects that you may experience after undergoing the procedure. All medical procedures involve some risks. Side effects of the vaginal suspension include:
- Pain and discomfort
- some vaginal bleeding
- Urination problems so you may need to use a self-catheterization.
Complications of vaginal suspension
Complications occur when problems occur during or after the operation.
Most women recover well after a vaginal suspension procedure. However, it does not necessarily work for every woman and some women may continue to experience incontinence after the procedure.
Other potential complications include:
- Infection, which can be in the wound, inside the pelvis, or a urinary tract infection
- Trouble urinating - if this happens, you may need a catheter.
- Overactive bladder - the patient may need to urinate often and urgently
- Damage to the urethra or bladder - you may need another operation to fix this
- Genital prolapse in which part of the uterus moves downward to create a bulge in the vaginal wall
- Pain during intercourse
Your surgeon will be able to talk to you about the risks of complications in your particular circumstances.
Prevention of urinary incontinence
Being overweight, being constipated, lifting heavy weights and drinking a lot of caffeine all make incontinence more likely. So, if you're concerned about incontinence, try to maintain a healthy weight, eat and drink healthily, and reduce strenuous exercise.
You may be able to prevent urinary incontinence during pregnancy and for the first few months after that by doing pelvic floor exercises during pregnancy.
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Frequently asked questions and answers about urinary incontinence in women and its treatment in Turkey
Can pelvic floor exercises help treat or prevent stress incontinence?
Pelvic floor exercises, known as Kegel exercises, help strengthen the pelvic floor muscles. These muscles in the lower abdomen support the bladder, uterus and intestines. Regular pelvic floor muscle exercises may help stop urine leaking when you cough, laugh or do hard work.
It's important to make sure you're doing Kegel exercises the right way. This is how to do pelvic floor exercises correctly:
1. Take a comfortable position, either lying on your back or sitting upright in a chair.
2. Imagine that you are trying to stop yourself from passing wind or urine - you should feel the pressure from inside your body.
3. Press for 10 seconds as hard as you can. Repeat 10 times that.
Do the exercises three times a day, breathe normally while performing the exercises. You may get results within 3-5 months. Once results are visible, continue to exercise once per day. Losing weight makes pelvic floor exercises more successful. But if you undergo vaginal suspension surgery, you should avoid sudden weight changes afterwards, as it affects the subtle adjustments made by the surgeon.
If you are having difficulty with these exercises or are not sure how to do them. Ask your doctor for help with this.
What is the treatment of urinary incontinence in women in Turkey?
As we mentioned earlier, there are many treatments available for the problem of urinary incontinence in women, including conservative, some of which are medicinal or surgical, such as vaginal suspension.
What are the options for treating urinary incontinence in women in Turkey in case of failure of the vaginal suspension?
The results of long-term studies of vaginal suspension showed a high success rate of 81%, and a high cure rate and low postoperative complications were associated with choosing the right patient for the appropriate procedure. For some women, this procedure may not be effective for them, so your surgeon may suggest other options, such as a procedure to place cords from the patient's tissues, or use an artificial sphincter to close the bladder. Or you may be given a silicone injection (urethral) to prevent leaks. If you do not want any further surgical procedures, your doctor will give you advice on managing your symptoms.