What is Urinary Incontinence?
Urinary incontinence, medically known as "üriner inkontinans," is the inability to control urination, resulting in involuntary leakage. The bladder, often referred to as the "urinary bladder" in everyday language, is a sac-like structure where urine from the kidneys is stored. The bladder muscles contract and relax under the control of the nerves and the brain. The muscles at the bottom of the bladder, which help keep the opening closed, also expand as the bladder fills with urine. Urinary incontinence is defined as the involuntary and uncontrollable leakage of urine.
This condition affects between 15% to 30% of women aged 65 and older, and around 50% of individuals receiving home nursing care. Urinary incontinence can have significant social, clinical, and psychological impacts on women. There are different types of urinary incontinence, including stress incontinence, urgency incontinence, overflow incontinence, mixed incontinence, and incontinence resulting from anatomical abnormalities of the urinary tract. Depending on the cause, specialists such as gynecologists, urologists, and neurologists can help in managing this condition.
What Causes Urinary Incontinence?
The primary cause of urinary incontinence is the weakening of the pelvic floor and the support tissues of the bladder. In stress incontinence, a person may leak urine involuntarily when coughing, sneezing, or exerting pressure. This condition is often related to multiple births, delivering large babies, home births, difficult labor, assisted births, or untrained birth attendants. Other contributing factors include heavy physical work, advancing age, menopause, chronic constipation, obesity, lung diseases like asthma and bronchitis, and smoking.
In countries like Turkey, where the birth rate is high, stress incontinence is more prevalent, particularly in younger women of reproductive age.
A wide range of factors, including aging, menopause, childbirth, smoking, gynecological surgeries, neurological and gastrointestinal diseases, lung diseases, professional and environmental factors, and medications, can all contribute to or worsen urinary incontinence.
Urinary tract infections, foreign bodies in the bladder, and tumors should also be ruled out as potential causes. Medications may either cause or exacerbate urinary incontinence, and if possible, they should be avoided.
If you're experiencing urinary incontinence, there are several things to avoid. For instance, heavy exercise and lifting heavy loads can trigger incontinence. Therefore, healthcare providers typically advise against lifting heavy objects.
Obesity and weight gain are particularly harmful for individuals with urinary incontinence. Maintaining a healthy diet and engaging in regular physical activity can significantly help alleviate the condition. Increased abdominal pressure from weight gain can directly affect the bladder and trigger leakage.
Lack of sleep can also hinder the control of bladder muscles, as research has shown that poor sleep quality impacts bladder function. Therefore, consistent and adequate sleep is essential.
Drinking excessive amounts of water can increase the frequency of urinary leakage in individuals with incontinence. While staying hydrated is important for overall health, people with urinary incontinence should manage their fluid intake carefully. Furthermore, avoiding long periods without using the restroom can exacerbate symptoms, as it's essential to attend to the body's needs when they arise.
Is There a Treatment for Urinary Incontinence?
Urination is a complex physiological process involving not only the urinary organs but also the brain and spinal cord. Normally, urine is held in the bladder because the pressure in the urethra is higher than that in the bladder. When the pressure in the urethra decreases and the pressure in the bladder increases, the act of urination occurs.
It is known that women are affected by this condition more than men, primarily due to the structural characteristics of female genitourinary organs. Women have a shorter and wider urethra compared to men, making it harder for the muscles surrounding the urethra to effectively control the pressure in the bladder.
Urinary incontinence can significantly affect the quality of life for both men and women, leading to social, clinical, and psychological consequences. Various treatment options are available, including non-surgical methods that focus on addressing the underlying causes of urinary incontinence. These may include correcting contributing factors such as excess weight, constipation, alcohol consumption, and smoking. Pelvic floor exercises are often recommended to help balance intra-abdominal pressure.
One such non-surgical treatment is Kegel exercises, which strengthen the pelvic muscles located between the pelvis bones. By regularly performing Kegel exercises, the pelvic muscles can be trained to contract and relax, enabling better control over urination. For effective results, these exercises should be performed 150 to 200 times per day.
Kegel exercises can be especially helpful for women after childbirth, as they can prevent urine leakage triggered by actions like laughing or coughing. These exercises are known to provide significant benefits in treating urinary incontinence.
Another common treatment is medication. If appropriate for the patient, medications such as bladder relaxants may be prescribed as part of the treatment for urinary incontinence.
In more severe cases, surgical interventions may be required. For stress incontinence, surgical procedures can be an effective solution. There are different types of surgeries, and the most appropriate method will be chosen based on the individual’s condition. Most of these surgeries are performed vaginally, avoiding the need for abdominal incisions. The procedure typically lasts about 90 minutes, and patients are usually able to return home the same day. After the surgery, a urinary catheter may be left in place for a few days. Generally, there are no major complications, and patients are advised to rest for at least a week after the procedure.
If urinary incontinence is left untreated, it can lead to various negative consequences. One of the most significant effects is embarrassment. Individuals may fear going out in public due to the possibility of accidents, leading to feelings of shame. Constant worry about accidental leakage can significantly reduce one’s quality of life, affecting both personal and professional aspects, and may result in a loss of self-confidence. In some cases, sexual problems may also arise.
Urinary tract infections are also common in individuals with untreated urinary incontinence. Those who use a urinary catheter for extended periods are at a higher risk of infection. While the catheter can prevent leakage, its prolonged use can increase the likelihood of infections. Additionally, individuals with incontinence are more likely to develop skin rashes, sores, and infections, as their skin is often moist or damp. Left untreated, these conditions can worsen, delay healing, and increase the risk of fungal infections.
At our clinic, urinary incontinence treatments are managed under the guidance of Op. Dr. Engin Sarıca, with Fzt. Beste Melek Kumak overseeing pelvic physiotherapy processes.
If you have any questions or need further support regarding urinary incontinence treatments, please feel free to contact our clinic.
