URINARY INCONTINENCE: AN OVERVIEW

Nearly half of all women experience urinary incontinence at some point in their lives, and for some, this condition seriously impacts their quality of life. It’s crucial to understand that urinary incontinence should not be accepted as a natural part of aging. It’s a health issue with solutions, not something you should simply endure. If you find yourself unable to hold your urine, experiencing constant leakage, or frequently waking up to urinate at night, it’s essential to consult a gynecologist. Urinary incontinence is a treatable condition, not something to suffer through. At my clinic in Kayseri, we evaluate and address the urinary incontinence concerns of many patients who come from surrounding areas like Niğde, Kırşehir, Nevşehir, Sivas, and Ankara.

Here, I’ll discuss the two most common types of urinary incontinence in women: stress urinary incontinence and overactive bladder (urge) incontinence.

BEFORE STARTING TREATMENT

Certain health conditions can exacerbate urinary incontinence. Discuss with your doctor in detail about treating these conditions and medications that may worsen your incontinence.

If numbness or weakness in the legs accompanies urinary incontinence, seek immediate examination by a gynecologist. Conditions like uterine prolapse can cause urinary incontinence and require medical attention.

INITIAL TREATMENTS

When it comes to treating urinary incontinence, surgery or medication isn’t always the first resort. Lifestyle changes, like losing weight and performing Kegel exercises, can significantly reduce urinary incontinence symptoms, as I’ll detail below.

Lifestyle Changes – Modifying certain aspects of your lifestyle can help reduce urinary incontinence symptoms.

Weight Loss: If you’re significantly overweight, shedding excess pounds through diet can alleviate urinary incontinence. Additionally, managing conditions like diabetes can help reduce urinary incontinence symptoms.

Limiting Fluid Intake: Women who consume excessive fluids daily may experience fewer leakage issues by reducing their fluid intake. However, consuming too little fluid can lead to concentrated, dark urine and bladder irritation. In hot weather conditions, it’s essential to increase fluid intake.

Avoiding carbonated beverages, alcohol, and coffee can also reduce urinary incontinence. Drinking excessive fluids before bedtime can lead to frequent urination at night. If you find yourself waking up to urinate more than twice a night, stop drinking water two hours before bedtime.

Preventing Constipation: Constipation can worsen urinary incontinence. Consuming fiber-rich foods is essential to prevent constipation. Foods like potatoes, bananas, and red meat can exacerbate constipation, while apricots, grapes, kefir, and oats can prevent it. Women with high blood sugar should avoid excessive consumption of high-sugar foods like apricots and grapes.

Scheduled Voiding: Emptying your bladder regularly instead of waiting until it’s full can reduce urge incontinence (overactive bladder) and stress incontinence during physical activities like coughing, jumping, laughing, or lifting heavy objects. Try to urinate every 2 to 3 hours during the day.

Pelvic Floor Exercises: Strengthening pelvic floor muscles can reduce urinary incontinence. Kegel exercises are a type of pelvic floor exercise that helps strengthen these muscles. Regularly performing Kegel exercises supports the urethra and prevents stress urinary leakage (e.g., when coughing, jumping, laughing, lifting heavy objects). If you feel an urgent need to urinate, you can also perform these exercises to temporarily control the urge. To do this, stop what you’re doing and perform four sets of pelvic floor contractions (Kegel exercises) until the urge to urinate diminishes. Using this squeeze-and-release technique can reduce bladder contractions and buy you more time to reach the toilet. It slows down the urge to urinate.

Bladder Training: The goal of bladder training is to increase the bladder’s capacity to hold urine and decrease the frequency of bathroom trips. It involves learning to delay urination and gradually increasing the time between bathroom visits throughout the day.

If you successfully avoid urinating, try extending your bathroom schedule by an additional 20 minutes. By gradually increasing these intervals by 20 minutes, we aim to return to a normal voiding frequency. If you can go 4 hours between bathroom trips during the day, you’ve achieved normalization. It’s considered normal not to urinate more than once at night.

Estrogen Cream: Administering vaginal estrogen cream to postmenopausal women with decreased estrogen levels can lead to improvement in urinary incontinence symptoms.

TREATMENTS FOR STRESS INCONTINENCE

For stress urinary incontinence resulting from increased abdominal pressure (e.g., coughing, sneezing, jumping, laughing), following the recommendations below can help reduce symptoms.

Seek Assistance with Pelvic Floor Exercises: If you’re having difficulty performing Kegel exercises correctly to strengthen your pelvic floor muscles and reduce urinary leakage, seek help from trained physiotherapists or nurses.

Vaginal Pessaries: Vaginal pessaries are silicone devices inserted into the vagina. They support the urethra and help reduce stress urinary leakage triggered by activities like coughing, sneezing, and laughing. If you prefer not to undergo surgery or are not a candidate due to age, pessaries are a suitable option. When properly inserted, pessaries are comfortable and easy to use.

They should be removed and cleaned with soap and water regularly. Women can learn to do this themselves comfortably. It’s recommended to clean them twice a week. Women who can’t clean them themselves should consult a doctor. Although rare, pessaries can sometimes cause vaginal irritation.

Medications: The benefit of using medication to treat stress-related urinary incontinence is minimal.

Interventions to Increase Urethral Volume with Infection: These procedures are performed with local anesthesia and don’t require hospitalization. By reducing urethral mobility with a filler, these procedures aim to prevent stress urinary leakage during activities like coughing, sneezing, and laughing. Although not as effective as surgery, they can reduce the amount of leakage occurring during these activities.

Surgery: Surgery offers the best outcome for treating urinary incontinence. There isn’t a single method for treating urinary incontinence surgically. Different surgical approaches can be used for patients with urinary incontinence, each with varying success rates and risks. Before deciding on surgery for urinary incontinence, I thoroughly evaluate patients at my clinic in Kayseri. We perform urinary incontinence surgeries for patients from neighboring cities like Niğde, Kırşehir, Sivas, Nevşehir, and Ankara in private hospitals in Kayseri. We plan urinary incontinence surgery for patients not planning pregnancy, as pregnancy and childbirth after urinary incontinence surgery can lead to recurrence.

Laser Treatments: Vaginal laser therapy is one of the most critical agents in the treatment of urinary incontinence. Vaginal laser therapy consists of three sessions for urinary incontinence treatment. I perform laser therapy in my clinic in Kayseri. Laser therapy is not painful and doesn’t cause pain afterward.

TREATMENTS FOR URGE INCONTINENCE AND OVERACTIVE BLADDER

In treating urge incontinence, medications and other treatments that stimulate nerves are essential. Urge incontinence, also known as overactive bladder, isn’t associated with factors that increase intra-abdominal pressure, like coughing or sneezing. Patients with an overactive bladder experience a sudden urge to urinate due to bladder stimulation but leak urine before reaching the toilet.

Medication for Urinary Incontinence: We prescribe medication for patients with urinary incontinence. While treatment is temporary for some patients, for others, it may be lifelong. Urinary incontinence medications can cause side effects such as dry mouth and constipation.

The most common side effects of urinary incontinence medications are dry mouth and constipation. Less common side effects include blurred vision, palpitations, numbness in the hands and feet, difficulty urinating, confusion, and decreased mental function. They should be used cautiously in individuals with heart rhythm disturbances and glaucoma. Although new drugs rarely cause dry mouth and constipation, they can also increase blood pressure.

Chewing gum can prevent dry mouth caused by urinary incontinence medications. Foods rich in fiber and oats are recommended to prevent constipation. Consumption of constipating foods like bananas and potatoes can be reduced.

If sufficient improvement isn’t achieved with medication, acupuncture therapy may also be tried.

Percutaneous Tibial Nerve Stimulation: In this nerve stimulation-based treatment for urinary incontinence, a thin needle is inserted near the ankle into a nerve connected to the bladder. This nerve is linked to the nerve in the back that stimulates your bladder. The needle is connected to a device that sends electrical signals to the nerve. This procedure isn’t painful. This treatment is carried out weekly in our clinic in Kayseri for three months and can be continued monthly if necessary.

Botox: Botox is a toxin that paralyzes muscles. When injected into the bladder, it can prevent urinary leakage due to involuntary contractions. This treatment can increase the frequency of urinary tract infections and may result in difficulty urinating.

Sacral Neuromodulation: Sacral nerve stimulation (SNS) is a surgically implanted device that improves urinary incontinence.