Urinary incontinence

Urinary incontinence is defined as the unintentional loss of urine.

How frequent is it?

1 in 5 women over 40 suffer from urinary incontinence. This number is even greater, considering that many women do not even report their problem to their doctor because of fear or shame. Also, many women have the wrong impression that incontinence is normal in old age and that it is incurable, which is a mistake.

Which is the normal mechanism of urination?

Around the bladder and urethra there are the pelvic floor muscles, which hold the urethra closed and prevent urination, except when the woman goes to the toilet to urinate.

When the bladder is filled nerve impulses are sent to the brain. The brain in turn sends stimuli to the pelvic floor muscles to relax while the bladder contracts and in this way the patient urinates.

How many kinds of urinary incontinence exist?

It is observed when any increase bladder pressure that occurs in various situations such as sneezing, coughing, physical activity (jumping or running) or sometimes with body movements can cause urine loss.

Some patients have stress incontinence during sexual intercourse.

The pelvic muscles can relax for various reason such as

  • Pregnancy and labor

  • Menopause

  • Old age

  • Obesity

Urge incontinence occurs when you have a sudden urge to urinate. In urge incontinence, the bladder contracts when it shouldn’t, causing some urine to leak through the sphincter muscles holding the bladder closed.

In most cases we do not know why this happens. Muscle and bladder seem to send wrong stimuli to the brain about how full the bladder is.

Urge incontinence also occurs in diseases of the brain and nerves, such as stroke or Parkinson’s disease, multiple sclerosis or spinal cord injuries.

The symptoms are

  • Need to pass urine very frequently, including several times during the night.

  • Sudden and very intense need to pass urine.

A combination of stress incontinence and urge incontinence. Many women complain of both types of incontinence. Depending on the case, one of the two types may be the primary problem.

Overflow incontinence, also called chronic urinary retention, is when the bladder cannot completely empty when you pass urine. This causes the bladder to swell above its usual size.

If you have overflow incontinence, you may pass small trickles of urine very often. It may also feel as though your bladder is never fully empty and you cannot empty it even when you try.

It is observed in patients with severe diseases which inhibit the brain desire to urinate. It often happens in patients with Alzheimer disease.

Diagnosis

It is very important to see the appropriate doctor. The urogynecologist is a gynecologist specializing in urological problems in women, while having a perfect knowledge of the female anatomy of the vagina and pelvic floor.

The first step is a very detailed history, including the symptoms and their duration. You will be asked about the liquids you drink, the amount and type (especially liquids containing caffeine, such as coffee, tea, wine and cola) and the frequency you urinate.

The patient will be asked to fill in a diary with the exact hours, frequencies and amounts of fluid consumed and urine produced. The patient is asked about symptoms of cystocele or rectocele, surgery, medical and obstetric history and general health problems.

Urine analysis is always done at the first visit to check for infections or hematuria.The first visit also provides a detailed clinical examination to check for anatomy, skin and tissue problems,urethral support, stress incontinence and pelvic floor muscle quality.

Then the urogynecologist performs the urodynamic control.

Treatment

Anticholinergic drugs are currently used as the first line of treatment for incontinence due to urgency. These medicines prevent unexpected bladder contractions that cause urine loss.

Anticholinergic drugs do not treat stress incontinence.

Botox (Botulinum Toxin A) is not only used in plastic surgery but also in urogynecology.

In urge incontinence bladder muscles are overactive and cause irregular bladder contractions, which cause urinary incontinence. The aim of Botox is to relax these muscles and by that reducing of even stopping bladder overactivity.

The botox injections are done in the bladder during a cystoscopy.

Free-tapes support the urethra so that it can hold urine in the bladder when the pressure rises, such as with sneezing, coughing, gymnastics, etc.

It is a small strip of synthetic polypropylene fabric that is placed just below the urethra through the vagina. It thus provides extra support under the urethra and in the middle of it.

As a result, the urethra remains closed to sneezing / coughing, so urine is retained in the bladder and there is no incontinence.

In the hands of an experienced urologist, TVT:

  • Minimally invasive

  • Perfect recovery

  • Success rate > 90%

  • The operation lasts 20 minutes.

  • All types of anesthesia can be applied (general; epidural or local).

  • Almost no complication risk.

  • The TVT is not visible at the end of the operation.

  • Direct result in everyday life.

These tapes are inserted through the vagina but not behind the pubic bone but horizontally, through the obturator foramen (opening). It is an alternative way of positioning the tape, safer and more efficace.