Urinary Incontinence Treatment in Women

Urinary Incontinence

Urinary incontinence is commonly observed in women who have given birth. However, even women who have not given birth may experience frequent urination complaints.

What Are the Causes of Urinary Incontinence?

Urinating more than 8 times a day, waking up at night to urinate, and being unable to hold urine in inappropriate situations are defined as incontinence. The causes include:

• Most commonly, urinary tract infections
• Presence of stones or sand in the urinary tract (urolithiasis)
• Irritation due to dryness after menopause
• Neurogenic – hypersensitive bladder
• Stress incontinence
• Urge incontinence
• Overflow incontinence (in advanced cases of bladder prolapse, stage 4)

Urinary Tract Infection and Urolithiasis

A urine test should be performed for every patient presenting with urinary complaints to rule out the presence of stones or infections. It should be remembered that the most common causes of urinary irritation and frequent urination are infections. Urine analysis and culture should be checked, and the infection should be treated before it reaches the kidneys.

Urinary Incontinence Due to Dryness After Menopause

After menopause, estrogen deficiency causes dryness in the vagina and vulva, especially in the area where the urethra, the opening of the bladder, is located. This dryness leads to irritation, which can cause urgency and urinary incontinence. Treatments include vaginal and vulval lasers, estrogen creams, and collagen creams. The response to treatment is dramatic. Additionally, vaginal laser therapy is particularly beneficial for patients with hypersensitive neurogenic bladder conditions. Vaginal laser therapy is very effective for patients with incontinence after menopause without prolapse, and it can eliminate the complaints.

Neurogenic Bladder - Hypersensitive Bladder

In patients with disc herniation or neurological disorders, the bladder's ability to detect and empty urine becomes impaired. Normally, the bladder has a capacity of 750cc to 1000cc, but due to transmission issues, the bladder does not relax, leading to a constant feeling of urgency, inability to hold urine (urgency),and sudden urges to urinate. This condition significantly affects the quality of life and is treated with medication and vaginal laser therapy.

Stress Incontinence - Urinary Incontinence Due to Vaginal Prolapse

In women who have given birth, the bladder may drop due to tears in the supporting ligaments. The cause of bladder prolapse is the uncontrolled tearing of the supporting ligaments during vaginal birth. Especially when the ligaments of the urethra (the opening of the bladder) are torn, coughing or heavy lifting can cause the movable urethra to drop downward, leading to urine leakage.

The treatment involves surgically repairing the supporting ligaments and lifting the bladder back up. In cases of urinary incontinence, a cystocele surgery that repairs the supporting ligaments and returns the bladder to its proper place is often sufficient. However, in some patients, if the urethra is mobile enough, a TOT surgery may be needed. Incontinence surgery cannot be planned without a thorough quality-of-life assessment, POP-Q examination, and Q-tip test.

Detailed complaints must be listened to, and the most appropriate surgery to improve the quality of life should be performed.

Overflow Incontinence - Urinary Incontinence

This is seen in patients with advanced vaginal prolapse or obstruction in the urinary outlet. In advanced stage 4 prolapse, the bladder neck is obstructed, and the bladder cannot empty. In such cases, the patient may either strain to urinate, which further increases intra-abdominal pressure and worsens the prolapse, or may try to urinate by pushing the bladder inward with their hand.

Most patients with advanced prolapse urinate by manually placing the bladder in the vaginal area. The treatment for this type of incontinence is surgical. A cystocele surgery to correct bladder prolapse and treat incontinence is a definitive solution.

Can Urinary Incontinence Be Treated?

Urinary incontinence is a treatable condition. Incontinence negatively affects the quality of life and can disrupt women's social and sexual lives. Many patients develop depression and anxiety disorders. Urinary incontinence during sexual intercourse is also common and severely impacts sexual quality of life.

Unfortunately, many people are unaware that urinary incontinence resulting from childbirth or aging is treatable. Women who experience urinary incontinence at an early age due to traumatic vaginal delivery suffer significant effects on their life and sexual quality. From this perspective, urinary incontinence is treatable, and when properly treated, it is one of the patient groups with the highest satisfaction in the medical literature.

What Are the Types of Urinary Incontinence?

• Neurogenic Bladder: Hypersensitive bladder
• Stress Incontinence: Bladder prolapse-related incontinence
• Mixed-type Incontinence: Both neurogenic bladder and stress incontinence (typically seen in older patients or those with disc herniation or neurological disorders who have also had vaginal deliveries)

How Is Urinary Incontinence Treated?

There are two treatment methods:

1. Medications for neurogenic bladder that reduce bladder sensitivity. These may include daily medications for urinary incontinence or botox injections into the trigone zone of the bladder, which is a collection area of nerves.
2. Surgical Methods such as cystocele, TOT, and TVT sling surgeries, which are performed after a thorough examination. When the correct diagnosis is made and the appropriate surgery is performed, the improvement in life and sexual quality, as well as the resolution of urinary incontinence, will be immediate.

For mixed-type incontinence, both medication and surgery are used together.

Is Urinary Incontinence Surgery (Cystocele and TVT) Painful?

Cystocele surgery is not a painful process. Most patients do not require pain medication after the 3rd day and can return to work by the 5th day.

What Should Be Considered After Urinary Incontinence Surgery?

After surgery for urinary incontinence, patients can return home and shower the next day. Sexual intercourse and heavy lifting are prohibited for the first three weeks. Light exercise can begin in the 2nd week. Since it is not a painful process, patients from other cities can return home the next day, and patients from abroad can return 2 days later.

Does Urinary Incontinence Surgery Relapse?

If the surgery is performed correctly and the bladder’s supporting ligaments are repaired properly, the likelihood of recurrence is very low. Once the supporting ligaments of the bladder are repaired, the incontinence will not recur, even after many years.