Stress urinary incontinence in women

Involuntary urinary incontinence is called stress urinary incontinence when the intra-abdominal pressure increases such as laughing, coughing, sneezing, and taking a step.

The most common cause of this condition is the weakening of the muscles surrounding the base of the pelvis (pelvic) bones. When the muscles are strong, it strongly supports the urinary tract (urethra) at the bladder outlet from below and prevents the urethra from moving and helps to close, preventing urinary incontinence. The most common causes of weakening of the muscles are damage to muscles, nerves and tissues due to pregnancy and childbirth (especially overweight baby births and difficult births), pelvic surgeries such as weight gain, constipation, removal of the uterus, and physical changes resulting from menopause. Apart from these floor muscles, the cause of involuntary urinary incontinence is the weakness of the muscles (sphincter) at the exit of the bladder that control urination. These muscles keep the urethra closed as the bladder fills, relax when it’s time to urinate, allowing urination to occur. When these muscles are weak, they cannot do their job, and when the intra-abdominal pressure increases, urine is leaked.

It is estimated that the frequency of urinary incontinence in middle and elderly women is between 30% and 60%. Approximately 40% of these patients have stress urinary incontinence.

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Diagnosis:

The voiding diary is looked at to learn about fluid consumption, frequency of voiding, and how many pads they use. Urinalysis is checked for urinary infection.

The physical examination is performed on the gynecological table while the patient is slightly urinating. It is evaluated in terms of prolapse of the bladder (cystocele), prolapse of the uterus (uterine prolapse) and prolapse of the rectum (rectocele). Stress test is done by coughing or straining and urethramobility is checked.

Urodynamics is not necessary in those with stress urinary incontinence only. In case of concomitant urge urinary incontinence, possibility of neuropathic bladder, previous back and pelvic surgeries, difficulty urinating and residual urine in the bladder, urodynamics may be requested.

Treatment :

Kegel exercises are taught to strengthen the pelvic floor muscles in stress urinary incontinence. In addition to these exercises, some lifestyle changes that may affect bladder function are recommended, bladder training is tried to be provided. The drug used together with pelvic floor exercise in stress urinary incontinence is duloxetine. It is also approved in our country and European countries, and it acts by increasing the urethral closure pressure. Studies have suggested that it is not effective alone, and it is recommended to be used together with pelvic floor exercise. The rate of discontinuation of the drug in the first year due to side effects such as abdominal pain and nausea is around 56%. In addition, local estrogens are used in the treatment.

The most frequently performed surgeries are those in which the middle urethra is suspended. These surgeries are Tension-free vaginal tape-TVT and Trans-obturator tape (TOT). After these surgeries, patients can be discharged the next day.

Pubovaginal sling surgeries are applied in case of continued urinary incontinence, erosion of the tape used, and urodynamic sphincter insufficiency after these surgeries.

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Image: How the Transobturator Tape looks

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