INCONTINENCE
It is defined as involuntary urinary leakage, urinary incontinence or loss of bladder control and is a very common health problem in the society. It is more common in women. Although its severity varies, it may occur as a drop of urine leakage (stress incontinence) when coughing, laughing or when the intra-abdominal pressure increases, or it may occur as a sudden feeling of urination and not being able to reach the toilet and urinary incontinence (urge incontinence). Sometimes both types of urinary incontinence may be combined (mixed type incontinence).
If the degree of urinary incontinence affects daily life and quality of life, a doctor should be consulted. In most patients, serious results can be achieved with simple lifestyle changes and simple medical treatments.
TYPES OF URINARY INCONTINENCE
Stress Incontinence
This type of urinary incontinence is defined as leakage of urine drop by drop or more in cases where intra-abdominal pressure suddenly increases, such as coughing, sneezing, standing up suddenly, laughing, lifting something heavy. Stress incontinence occurs as a result of insufficiency or weakness of the valves in the bladder and urethra (the channel that opens out of the bladder). THE MOST IMPORTANT CAUSE IS PREGNANCY, BIRTH, MENAPAUSE.
Urge Incontinence
Sudden urge to urinate. It is defined as the feeling of urinary incontinence. It occurs as a result of sudden involuntary contractions in the bladder and urinary incontinence occurs before the person can reach the toilet. With the distress caused by this type of incontinence, he goes to the toilet very often, including at night. Among the causes of urge incontinence; It can be caused by diseases such as urinary tract infections, bladder irritating substances (stones, sand in the urinary tract, etc.), intestinal problems, Parkinson's disease, Alzheimer's disease, stroke and Multiple sclerosis. Urge incontinence is also called hyperactive bladder syndrome if there is no causative disease.
Urinary incontinence negatively affects the quality of life. The person's self-confidence decreases and he/she avoids sexual intercourse for fear of urinary incontinence during sexual activity. In addition, diseases such as anxiety and depression occur more frequently in women with incontinence. � is determined.
DIAGNOSIS
Urina Analysis
With the urine analysis to be performed, Findings of urinary tract infections, blood or stones in the urine may be detected. Urine cultures must be performed in detail and factors such as ureaplasma - mycoplasma - clamydia-tbc must be excluded.
Blood Tests
It may be useful for investigating systemic diseases such as diabetes that may cause incontinence.
Ultrasonography
With ultrasonography, bladder capacity and anomalies, tumors, stones and obstructions in the bladder, kidneys and urinary tract can be detected.
Stress Test
It is a test based on observing whether there is urinary incontinence by increasing the intra-abdominal pressure when the patient coughs or strains during the gynecological examination.
Urodynamic Tests
These tests are based on measuring the pressures of the bladder during rest and urination. These are tests that require catheter placement in the urethra and bladder and special pressure measuring devices.
TREATMENT
Urinary incontinence treatment depends on the type and severity of incontinence. Various medical and surgical treatments are available and treatment should be individualized to the patient. In most patients, physical and behavioral therapies are preferred as the first step. In the next steps, surgery and combined treatments are preferred in patients with severe anatomical problems and severe incontinence.
Surgical Treatment
Surgical abdominal (abdominal), laparoscopic or vaginal surgery. It can be implemented by: Surgical operations are based on the principle of hanging structures that are lower than their normal anatomical locations (bladder - urethra - vagina - uterus) on solid anatomical structures or supporting them with hanging materials.
MMK (Marshal-Marchetti Krantz) is based on the principle of hanging the sutures passing through the bladder neck and urethra directly to the pubis (from the anterior abdominal wall).
Bladder Exercises
Bladder exercises include the technique of delaying urination and training the bladder by holding it for a certain period of time when the feeling of urination comes.
p>Fluid Intake and Diet Management
Reducing the intake of alcohol, acidic liquids and foods, and caffeinated liquids reduces the severity of incontinence. In some patients, incontinence problems can be overcome by reducing fluid consumption, losing weight, physical exercise and lifestyle changes.
Pelvic Floor Muscle Exercises Application of Kegel Exercises
1 . week: Contract your pelvic muscles for 6 seconds and relax for 6 seconds for 5 minutes (12 seconds total). Each movement should last a total of 12 seconds (5 contractions in 1 minute). Do 25 contraction movements 3 times a day (75 in total).
2nd week: Contract your pelvic muscles 50 times in total, 6 seconds in 12 seconds (5 times per minute), for 10 minutes. Repeat 3 times every day (150 times in total).
3rd week: Contract your pelvic muscles for 15 minutes, 6 seconds in 12 seconds, a total of 75 times. Repeat 3 times every day (225 times in total).
4.-24. week: Contract your pelvic muscles 100 times, 6 seconds in 12 seconds, for 20 minutes. Repeat 3 times a day (300 times in total)
After the 24th week: Train 3 times a day for 10 minutes or 2 times a day for 15 minutes for a total of 150 exercises a day.
Exercises of the pelvic floor muscles ''Kegel exercises'' are based on the principle of stopping urination and voluntary contraction of the pelvic muscles during urination.
Drug Treatment
Pharmacological drug treatments are often used in combination with behavioral and physical treatments. The drugs chosen may vary from patient to patient and sometimes can be used in combination. In drug selection, patient-centered thinking should be prioritized, not the disease, and combinations should be made accordingly. It should be explained to the patient that the treatment is long-term and the patient should be made to feel safe...
Urinary incontinence is an important health problem that affects 30-40% of women, especially over the age of 30. As a result of its frequent occurrence in society, it is almost perceived as a part of normal life. Women try to combat this problem by using absorbent pads, carrying extra underwear or reducing fluid intake. They do not need to consult a doctor with this complaint - this problem is a part of normal life. It is insufficient - both because of shame and embarrassment. Therefore, women with urinary incontinence make their daily activities and social life plans in the center of this problem, and their quality of life is seriously restricted. Psychological problems such as sexual problems, self-confidence problems, anxiety and depression are more common in women with incontinence. However, today, in parallel with the development of modern medicine and the development of surgical techniques, incontinence problems in women can be successfully treated. Studies have shown that there is a significant increase in women's social life, quality of life, self-confidence and sexual life after treatment. As a result, urinary incontinence in women is not a part of normal life but a treatable disease.
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