International continence society urinary incontinence; It is defined as "a condition of involuntary urinary incontinence that is a social or hygienic problem and can be demonstrated objectively." Urinary incontinence impairs the quality of life, restricts the patient's social life and causes psychological problems. Urinary incontinence is more common in women than men and can affect women of all age groups. Its frequency is reported to vary between 10% and 30% among women aged 15-64. Urinary incontinence, which is a common condition among women as they get older, is defined as a problem by one in four women with urinary incontinence. However, if there is no bladder, uterine or anal prolapse or diseases that need to be treated with surgery, the problem of urinary incontinence can be ended with bladder rehabilitation.
The cause of urinary incontinence
Urinary. The bladder is a structure located in the lower part of our abdomen, in the area we call the pelvis. The function of the urinary bladder is to accumulate urine by keeping the urine outlet areas closed while the urine fills. While or when the urinary bladder is full, the muscle group called the pelvic floor, which supports it from below, supports the urinary tract outlet and helps keep the exit area closed. If the pelvic floor muscles weaken (due to pregnancy, excess weight, muscle weakness, difficult births, etc.), they cannot fulfill this support function and urinary incontinence occurs. Normally, when the bladder is full, the urination function, which occurs after the bladder body contracts and urine output opens, is impaired.
Types of urinary incontinence
Urinary incontinence is seen in 3 types. :
It is the type called stress urinary incontinence, which develops due to the inability of the pelvic floor to function adequately during activities that increase intra-abdominal pressure such as coughing, straining and laughing. Excess weight, multiple and difficult births, uterine prolapse, and surgeries in the pelvic area are the most common causes.
Urge incontinence (urinary incontinence) Sudden or strong desire to urinate. It is involuntary urinary leakage. The patient feels the urge to urinate, but incontinence occurs before he can reach the toilet. Diabetes, surgeries in the pelvic area, again Insufficiency of the elvic floor muscles may occur in problems of the bladder itself.
Mixed type urinary incontinence (mixed type) is the combination of stress incontinence and urge incontinence.
Risk factors for urinary incontinence
Age and gender: While it is more common in women than in men, its incidence increases with advancing age. Conditions such as heart failure, dementia, diabetes, kidney problems, and decreased mobility, which increase in frequency with age, cause incontinence to worsen.
Gender hormones: Hormonal changes that occur during the menstrual cycle and during neopause. These changes increase the risk by causing changes in the internal structures of the urinary bladder and urinary tract.
Number of births: Although giving birth normally reduces the risk of incontinence, it is reported that the rate of incontinence increases as the number of births increases due to traumas during birth.
Connective tissue structure of the person: It is reported that the risk of urinary incontinence increases in the presence of structural disorders of the connective tissue consisting of collagen.
Diabetes
Neurological diseases that cause involvement of the nerves feeding the urinary bladder and urinary tract
Obesity: When the weakening of the pelvic floor muscles is added due to the high pressure on the pelvic floor organs, the risk of urinary incontinence naturally increases.
Smoking: Due to frequent and strong coughing. It is thought to cause urinary incontinence.
Removal of the uterus: Weakness in the muscles and membranes and nerve injuries may cause urinary incontinence.
Urine. Tract infections: It may manifest itself with the inability to retain urine due to the edema it creates in the bladder and urinary tract.
It is appropriate for the patient to be evaluated first by Gynecology or Urology specialists, to discuss the need for surgery with these branches, and if there is no need for surgery, to start rehabilitation.
Evaluation of the patient with urinary incontinence
First of all, the cause of the patient with urinary incontinence should be known. It is necessary to have a stroke and to determine whether there is an infection by having a urinalysis. The strength of the pelvic floor muscles should be determined through a physical examination. Afterwards, the effects of urinary incontinence on functions and quality of life need to be evaluated so that the patient's progress can be recorded. In patients with urinary incontinence, pad testing and, if necessary, urodynamics and EMG examinations are also required for evaluation.
Recommendations for the treatment of urinary incontinence
It is recommended that the patient lose weight.
In the presence of diabetes, the patient is asked to pay attention to his diet and medications to ensure regular blood sugar levels
Fluid intake is controlled and the patient is given a A monitoring table is provided and recorded.
Beverages that irritate the bladder and cause excessive urine output, such as tea, coffee and carbonated drinks, are limited
If he/she smokes, it is recommended to quit.
If there is constipation, a diet rich in fiber, vegetables and fruits is recommended to prevent it
Orange, Citrus foods such as tangerine and lemon are also irritating to the bladder, so it is recommended not to eat them
Treatment of stress urinary incontinence
The main cause of stress urinary incontinence is pelvic urinary incontinence. Since there is weakness of the sole muscles, treatments that will strengthen these muscles are necessary. Treatments that can be done depending on the degree of muscle strength are passive strengthening of the muscles with electrical stimulation, biofeedback therapy and teaching exercises called Kegel exercises.
Treatment of urge urinary incontinence
Kegel exercises are also taught in this type of urinary incontinence. The nerves of the urinary bladder are stimulated with a method called Posterior Tibial Nerve Stimulation.
Mixed type urinary incontinence treatment
All the above-mentioned treatments are applied in combination.
Kegel exercises are exercises to strengthen the pelvic floor muscles and, in rough words, they are based on the principle of conscious and regular contraction of the person to hold urine. Kegel exercises from a doctor or physical therapist can be taught by. Exercises are described as lying down, sitting or standing. However, it is possible for the patient to do exercises while performing daily life activities. Exercises that can be done briefly and with few repetitions at first will turn into stronger contractions over time. If the patient does it persistently, it will help him recover faster. If the patient has too weak pelvic floor muscles to tighten as required by Kegel exercises, which will be understood by the doctor's examination, muscle stimulation should be performed until effective contraction is achieved. These consecutive treatments will be adjusted by your physician during follow-up.
Additional studies such as trying to delay urination, trying to hold urine, are also added depending on the condition of the patient's bladder and recovery parameters.
Urinary incontinence rehabilitation duration
Since the main reason is muscle strengthening, the treatment takes a long time. Generally, the recommended treatment is a total of 24 treatment sessions, 3 days a week. In some cases, it is possible for this period to be extended further.
NOTE: The information in this section is not given for urinary incontinence caused by spinal cord injury, multiple sclerosis and other neurological diseases that also involve the bladder. Since the cause of urinary incontinence in these patients is due to different reasons, what is explained here is not valid for these patients.
Read: 0
