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WHAT IS URINARY INCONTINENCE?

Urinary incontinence means involuntary leakage of urine and loss of bladder control. It is more common in women than men and negatively affects daily life. The frequency and severity of urinary incontinence varies from person to person, sometimes it can be in the form of drops after excessive straining, and sometimes it can be in the form of sudden compression and not being able to reach the toilet and all the urine is discharged. There may be many reasons for urinary incontinence. Some of these can be corrected with simple lifestyle changes and medication, but some require surgery.

TYPES AND SYMPTOMS OF URINARY INCONTINENCE

There are many subtypes of urinary incontinence. Their treatments are different from each other. All have involuntary urinary leakage and loss of bladder control. Some patients may occasionally leak a small amount of urine, while others may experience incontinence in large amounts of urine that causes them to wet their beds or flow down their legs.

The most common types of urinary incontinence in women are as follows:

• Stress incontinence: Urinary incontinence occurs when intra-abdominal pressure increases. It is generally caused by weakness of the pelvic floor muscles and inadequate closure of the bladder neck-urethra. There is no urinary incontinence under normal conditions. However, in such patients, urinary incontinence occurs in situations where intra-abdominal pressure increases, such as coughing, sneezing, laughing, lifting heavy items, or getting up from sitting.

• Urge incontinence: Sudden going to the toilet in these patients. They have urge, excessive urgency, they cannot reach the toilet and they have urinary incontinence. This is because the bladder muscle (detrussor muscle) contracts involuntarily and empties the bladder. There may be many reasons for involuntary contraction of the detrussor muscle. These need to be corrected.

• Mixed incontinence: The combination of more than one incontinence type.

WHY DOES URINARY INCONTINENCE HAPPEN?

Urinary incontinence is not actually a disease in itself, it is a symptom of another underlying disease or problem. Therefore, the main cause of urinary incontinence must be found. The underlying cause may be a simple habit or a problem that we may encounter in daily life, or it may be a physical problem or a serious illness. It may also be a sign of urination.

Some habits and drinks cause temporary urinary incontinence. This type of temporary urinary incontinence can be corrected by changing habits and simple treatments. Urinary incontinence caused by some medications can be corrected by changing medication. Some of the things that cause temporary urinary incontinence include:

• Alcohol

• Caffeinated beverages (coffee, tea, cola, etc.)

• Sodas

• Artificial sweeteners

• Chocolate

• Excessively spicy foods

• Excessively sugary, acidic drinks and foods

• Citrus fruit juice

• High doses of vitamin C

• Some blood pressure and heart medications

• Sedatives and muscle relaxants

• Urinary tract infection

• Pregnancy

• Excessive constipation

In some cases, urinary incontinence occurs constantly. This may be a sign of an underlying physical problem or another important disease. Some of the conditions that cause permanent urinary incontinence in women are as follows:

• Pregnancy and vaginal birth

• Aging and menopause

• Genetically prone to prolapse

• Having undergone hysterectomy

• Urinary tract and bladder Masses and tumors that compress and obstruct urine flow

• Some neurological diseases: MS (multiple sclerosis), Parkinson's disease, stroke, cerebrospinal diseases, etc.

WHAT ARE THE RISK FACTORS CAUSING URINARY INCONTINENCE?

Some people have a higher risk of incontinence. Some risk factors that cause this are:

• Gender: The risk of urinary incontinence is higher in women. In women, conditions such as short urethra, pregnancy, birth, and menopause cause more wear and weakening of the pelvic floor muscles, which causes incontinence to be more common.

• Age: As we get older, sagging begins; sagging may occur in the bladder, pelvic floor, and uterus. Bladder capacity decreases with aging e decreases. The muscles surrounding the bladder and urinary tract begin to weaken and work irregularly. These also cause urinary incontinence.

• Being overweight: Excess weight increases intra-abdominal pressure, making it difficult for the muscles surrounding the bladder neck and urethra to contract urine, causing urinary incontinence.

• Smoking: smoking weakens the pelvic floor muscles and reduces the estrogen hormone, which provides muscle strength and tissue strength. Thus, it causes urinary incontinence.

• Some neurological and systemic diseases, diabetes, blood pressure, etc.: drugs used in these, increase in urine flow and amount, impairment of the mechanism that provides urine control, cause urinary incontinence. Why does it occur?

WHAT COMPLICATIONS DOES URINARY INCONTINENCE HAVE?

Continuous urinary incontinence can seriously affect a person's daily social life. Even going out of the house, going to work, or doing routine daily tasks can become a problem. Constant urinary incontinence can cause hygiene problems, skin irritation, and bad odor. Skin infections, wounds and urinary tract infections are also more common in these patients.

HOW CAN WE PREVENT URINARY INCONTINENCE?

Preventing urinary incontinence is always a must. It may not be possible. But we can reduce the chances of it happening with some lifestyle changes. These are as follows:

• Being at normal weight, losing weight for overweight people

• Not smoking

• Eating healthy, consuming fibrous foods, not being constipated

• Staying away from caffeinated, acidic drinks and alcohol that cause bladder irritation

• Doing pelvic floor exercises (kegel exercises)

HOW IS URINARY INCONTINENCE DIAGNOSED?

For the diagnosis of urinary incontinence, the patient's complaints and the severity of the complaints are needed. , its frequency, its effects on the patient's daily life and examination are important. The frequency of urinary incontinence, the amount of urine missed, how long the urinary incontinence has been happening, the situations in which urinary incontinence occurs, factors that increase and decrease the problem, systemic diseases, medications used, and surgeries, if any, are questioned. Gynecological The genital area and urethra-bladder are evaluated by examination. It is checked for sagging, infection or atrophy. During the examination, some tests and ultrasound are performed to try to understand the cause of the problem. A urine test is performed to determine whether there is a problem such as infection. A bladder diary is kept in eligible patients. The amount and content of daily fluid intake, time, daily urine amount, frequency, and frequency of urinary incontinence are all recorded. If necessary, other detailed tests are requested in suitable patients. The most appropriate form of treatment is decided according to the results of all these tests.

URINARY INCONTINENCE TREATMENT

Treatment of urinary incontinence varies depending on the severity, type and underlying cause of incontinence. While appropriate diet and behavioral treatment are sufficient for some patients, some patients require drug therapy and some require surgery.

First of all, treatments that have the least side effects, are easiest for the patient, and are the lowest cost are preferred. However, if there is no response to the treatment given, the next treatment step is taken.

In the treatment, first of all, lifestyle changes, weight loss, quitting smoking and alcohol, exercises especially kegel exercises are given. Diet adjustments are made. A bladder diary is kept and the diet is adjusted accordingly. Some medications used may cause urinary incontinence, and their adjustments are made. Patients who do not benefit from such methods are switched to other treatments. In patients with urge incontinence, appropriate medications for urinary incontinence are started. In some patients, incontinence is tried to be corrected by reducing muscle strength and the degree of sagging by giving electrical stimulation. Surgery is preferred in patients with stress incontinence that does not improve with these treatments. The surgical technique is decided based on the patient's examination and whether there is any accompanying sagging. Generally, prolapse surgery is performed along with urinary incontinence.

Pessary is placed in patients who are too old or seriously ill to undergo surgery. Pessary is a ring-shaped device made of rubber or silicone that is inserted into the vagina. It prevents urinary incontinence by compressing the bladder neck.

APPLICATIONS THAT CAN BE DONE AT HOME UNTIL TREATMENT IS COMPLETED IN PATIENTS WITH URINARY INCONTINENCE

In the sense of alternative medicine or complementary medicine, it can prevent urinary incontinence. There is no cure that can cure it. Methods such as acupuncture have a low success rate in the short term.

Patients with urinary incontinence and poor bladder control can use absorbent pads or panties during the treatment.

To prevent irritation that may occur on the skin due to urinary incontinence, patients are more comfortable. They need to pay more attention to hygiene rules. After cleaning the genital area, dry it using a soft clean towel. The genital area should be left open and loose cotton clothing should be worn to allow that area to air and dry. Excessive cleaning and frequent washing cause irritation in the genital area, disruption of the normal flora, and more frequent infections. Ointments such as vaseline and cocoa butter can be used to reduce skin irritation in areas touched by urine.

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