Urinary incontinence (incontinence)

Urinary incontinence is the involuntary leakage of urine from the bladder. The bladder is an organ responsible for holding the urine until the person wants to urinate. Urinary incontinence can occur at any age. Although it mostly occurs in children, elderly patients or some women, it can be seen at any age and in both sexes. In the same age group, urinary incontinence complaints are more common in women than in men. Although urinary incontinence is not a life-threatening event, it is more of a social problem. It can be embarrassing, undermine self-confidence and change social behavior.

TYPES OF INCONTINENCE

Urge Incontinence This type of urinary incontinence occurs when the person cannot involuntarily delay the evacuation signal from the bladder. The person expresses that he cannot reach the toilet when the feeling of urine comes. Usually, this condition is observed in children who have nocturnal or daytime urinary incontinence. It is the most common type of urinary incontinence that can also be seen in the elderly. However, it is observed in every age group due to various reasons.

Stress Incontinence Situations in which urinary incontinence occurs as a result of increased intra-abdominal pressure, such as coughing and laughing, are called stress incontinence. Generally, it occurs due to relaxation in the genital area muscles due to births in women or aging. Excess weight can also be an effective factor here. Stress urinary incontinence in men is rare and almost always occurs as a result of a surgery or impact on that area. Patients may have complaints of both stress and urge urinary incontinence.

Other types of incontinence Transient incontinence is a phenomenon that can be seen frequently in the elderly and may be due to many reasons such as dementia, infection, drug use, inactivity, constipation and so on. Overflow incontinence, as the name suggests, occurs as a result of the bladder overflowing its capacity in those who have problems in urination. These types of complaints may occur as a result of the enlargement of the prostate. Considering other factors that cause urinary incontinence, these include neurological (diseases of the nervous system) disorders, spinal cord diseases, and diabetes.

EVALUATION

A good medical history and physical examination are very important in the evaluation of urinary incontinence. After this, various tests are requested to reveal the function and appearance of the urinary bladder. These methods include measuring the pressures inside the bladder or imaging the bladder with special films.

TREATMENT

The treatment of incontinence should be adjusted according to the specific type of incontinence that causes it. Simple causes such as infection are easily treatable. Urge incontinence can be treated with behavioral therapy or medication. Urinary incontinence due to prostate enlargement can also be prevented surgically and/or with medication. Stress urinary incontinence can be treated with special exercises, medications, or surgery (bladder suspension procedures). Recently, injection of various substances around the urethra (the tube connecting the bladder to the external environment) can be applied in the treatment of some special types of stress incontinence.

Interventional Treatments
a) Botulinium toxin administration
It is performed in the bladder under local or general anesthesia. It has found use in overactive bladder.

b) Use of occlusive material
Agents such as collagen and carbon-coated materials are squeezed into the bladder outlet to provide occlusion. It can be used in special cases of stress type urinary incontinence.

c) Sacral Nerve stimulation
With the implantation of a pacemaker-like device, the sacral nerve, which has an important place in bladder control, is stimulated. The device, which is placed under the skin and produces electricity with a battery, transmits a signal to the nerve with a cable.

Surgical Methods
It can be used in cases where other methods have failed. Frequently used methods; Low tension sling, lifting the bladder sphincter muscles, artificial urinary incontinence control system is the most popular method in the world for the last 10 years.
a) Suspension operations
It is the process of placing a synthetic patch or a piece taken from the patient’s body into the bladder outlet or under the urethra without tension.

b) Protective pad application – Special underwear
In case the above treatments are ineffective or cannot be used, pads with good absorption properties and special underwear with full protection can be used.

c) Catheter insertion
Clean intermittent catheterization may be attempted for overflow incontinence due to incomplete emptying of the bladder.

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