Involuntary urinary incontinence is a very common problem in women. It is reported that 25 to 45% of women suffer from urinary incontinence when coughing or sneezing. Despite the frequency of its occurrence, complaints of urinary incontinence are quite rare. The reason why complaints of incontinence are not so frequent is that people either view this situation as a normal process associated with old age or do not seek treatment, believing that there is no such thing. Many patients do not mention this complaint even during gynecological and obstetric examinations. This situation is usually identified by conducting surveys.
What causes urinary incontinence?
After the urine is produced in the kidneys, it passes through channels called the ureters and then accumulates in the bladder. With the accumulation of urine in the bladder, the pressure begins to rise. When the pressure reaches a certain level, warning signals are sent from the bladder to the brain, so the person understands that the bladder is full and needs to be emptied. At this stage, if conditions allow, urination occurs – the pressure inside the bladder increases, and the pressure at its exit decreases, thereby ensuring the outflow of urine. In the absence of suitable conditions (inability to go to the toilet, lack of a suitable environment, etc.), the bladder expands, the pressure in it decreases, and the pressure at its exit increases – so the urine continues to accumulate in the bladder. This is a normal process of urination (the ability to urinate or hold urine in the bladder when we want to). In some cases, urine can be released involuntarily. In medicine, this problem is called urinary incontinence.
Is there only one type of urinary incontinence? Are there any varieties of it?
Urinary incontinence can occur for several reasons. Here are some of them:
- Stress urinary incontinence (when coughing, sneezing, laughing, with increased intra-abdominal pressure). The reason for this is that the bladder neck loses its normal position with a sudden expansion of the abdomen, which in turn leads to involuntary urinary incontinence. This is one of the most common types of this ailment.
- Urge incontinence occurs due to disorders of the above-mentioned mechanism of urine control. Most often, this happens on the way to the toilet after the person has realized that the bladder is full. In such situations, the process of increasing the pressure at the exit from the bladder does not occur, which does not allow the retention of urine inside. This is also one of the most common types of urinary incontinence.
- Mixed urinary incontinence is a simultaneous manifestation of the signs of the two types of urinary incontinence described above. It is also one of the most common types of urinary incontinence.
How is involuntary urinary incontinence diagnosed??
The diagnosis of urinary incontinence during the examination can be made by artificially increasing the intra-abdominal pressure (coughing, straining, etc.) of a patient with a full bladder. This is a good test for the presence of stress urinary incontinence. During this examination, you can also check the movement of the neck of the bladder with a cotton swab. This test also gives an idea of whether the operation will help the patient or not. In cases of diagnosis of urgent or mixed urinary incontinence, urodynamic studies are also useful. Since urinary tract infections can also lead to urinary incontinence, it is always useful to conduct tests to detect their presence.
Is it possible to prevent urinary incontinence? Can it be cured?
Avoiding situations that may increase the risk of urinary incontinence (prevention of obesity, smoking cessation, prevention of difficult labor, elimination of situations that increase constant intra-abdominal pressure) is at the heart of the preventive approach. As everyone knows, the prevention of the development of the disease is always better than any treatment of an already formed ailment. Exercises such as Kegel exercises help strengthen the pelvic floor structures and control urination. In cases of urgent (imperative) urinary incontinence and overactive bladder, medications are usually effective. In situations of stress urinary incontinence (urinary incontinence when coughing, sneezing) and mobility of the bladder neck, surgery is often required.
Are there any risks in urinary incontinence surgeries?
Like any other surgery, operations to eliminate urinary incontinence are also associated with risk, even if they are small. In addition to the common risks inherent in all types of surgeries, such as bleeding, infection at the incision site, lung problems, and blood clotting due to intubation, there are also risks specific to operations to eliminate urinary incontinence. So, sometimes injuries to the bladder, ureter, urethra, postoperative difficulties in urination, as well as the appearance of involuntary urinary incontinence (in the case of unsuccessful surgery or the onset of urgent urinary incontinence) are possible.