Treatment of Urinary Incontinence

Urinary incontinence is more common than it is estimated in society. About half of all women will experience urinary incontinence throughout their lifetime. Many of these can be tolerated in daily life, but a discomforting urinary incontinence will develop in the 10-20% the patients.

Urinary incontinence is NOT a natural phenomenon that comes with aging. Urinary incontinence is not normal at any age. Treatment options are available to cure completely or at least reduce urinary incontinence based on the age group and patient characteristics.

There are generally two types of urinary incontinence in women: Stress incontinence and urge incontinence. Often these two types coexist (mixed incontinence).

Evaluation Before Treatment

Patients with urinary incontinence should be evaluated in detail. Some diseases can aggravate urinary incontinence. A detailed history of the woman with urinary incontinence is obtained. There are many drugs that can affect urination. Drugs that are regularly used and their dosages are questioned. Urinary tract infection can be a major cause of urine leakage. Therefore, urinary tract infection should be excluded first.

Lifestyle Changes: In fact, many patients will benefit from simple recommendations. It will make a difference to have the ideal weight for those who are overweight, to regulate the fluid intake in patients who consume excessive amount of fluid and to limit the consumption of liquids containing alcohol and caffeine. In addition, it is recommended to prevent constipation and to schedule urination in advance if necessary.

Pelvic Muscle Exercises: These pelvic-floor exercises are also known as Kegel exercises. We teach these practices to the patients during office visits (‘squeeze, hold and relax’). They are quite effective methods. A few weeks of exercise can resolve the symptoms in many patients who might have required surgery. These exercises prevent urine leaks occuring with laughing, coughing, sneezing. They hinder urine leaks for which surgery is often recommended by putting the related muscles to work.

Bladder Training: With bladder training, more urine retention in the bladder is achieved. So the patient goes to the toilet less often.

Topical Vaginal Estrogen: It is a method that is effective especially in women who are about entering menopause or just entered.

Treatment of Urinary Incontinence

If urinary incontinence continues despite the recommended methods, treatment options are evaluated. Treatments for urinary incontinence should be customized according to the patient and the type of urinary incontinence.

Vaginal Pessary: Pessaries are made of silicone and placed inside the vagina. They can be beneficial in urinary incontinence by supporting urethra (urinary tract). Pessary is recommended when surgical treatment should be postponed. When using pessary, it should be removed at intervals and washed with soap and water. Education on how to use a pessary is given to the patient.

Drug Treatments: Although there is no FDA approved drug in stress incontinence, there are some medications that benefit. In urge incontinence, we have many drug options. While some medications are only taken until complaints improve, many of them need to be continued. These medications have some side effects such as constipation and dry mouth.

Synthetic material injections: Some synthetic materials such as carbon-coated zirconium, calcium hydroxyapatite, polydimethylsiloxane are injected under and around the urethra. The support under the urethra holds up the tissue and bladder neck, preventing the incontinence. It is a very easy technique and can be applied with a local anesthesia in 5 minutes under office conditions, but the intervention should be repeated frequently in certain periods. Success rates are around 60%.

Botulinum toxin type A: Botox application to the muscle layer of the bladder is especially useful in hyperactive bladder syndrome and urge incontinence. However, if too much Botox is applied, the patient may have difficulty in urinating. It should be repeated every 6-9 months.

Nerve stimulating devices: These are devices that stimulate the sacral nerve, which is responsible for bladder nerve impulses, and nerve stimulators that can be applied to the leg and hip, however their use is extremely limited.

Surgical treatment

Surgical treatments are the treatment options with the highest success rates in patients with stress incontinence. Today, in parallel with the advancement of surgical techniques and the advancement of synthetic mesh technology, surgical treatment is the most common and most effective treatment. However, patient selection and choosing appropriate surgery are extremely important. As we mentioned earlier, many patients can overcome urinary incontinence with simple suggestions and training.

There are many surgical treatment options in stress incontinence. Appropriate surgical options are assessed according to the type of stress incontinence. Each procedure has its own benefits and risks. These issues discussed in detail with the patient. Surgery can be performed through abdominal, laparoscopic or vaginal route. Today, the most effective methods are surgical techniques performed vaginally. Patients can be discharged on the same day or one day after the operation and return to their daily life immediately.

The most commonly used surgical procedures today are Sling operations. These are operations based on creating a pelvic sling using synthetic or bio-materials, supporting the bladder neck and urethra. TVT, TOT and mini-sling techniques are popular operations. It can be applied in operating room conditions under general or spinal anesthesia and lasts about 15 minutes. The patient is discharged very next day. Success rates are over 90% and long term results are extremely successful. It is one of the most frequently applied gynecological operations worldwide. Complication rates are extremely low. Especially the most common type of incontinence, stress incontinence and mixed type incontinence, the results and the effects on the patient’s quality of life are satisfying.

Laparoscopically, BURCH operations also have success rates equivalent to vaginal surgery. It is performed safely in suitable patients. We do not recommend open method in incontinence surgery.


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