Why is urinary incontinence more common in women?

The lower urinary tract in men is longer than in women (18-20 cm). Just below the bladder outlet, the urethra is surrounded by the prostate. Due to these two anatomical differences, urinary incontinence is less common in men.

In women, however, the urinary tract is much shorter (3-5 cm). Since the tissues supporting the urinary tract weaken after normal childbirth or menopause, urinary incontinence is more common in women.

What are the different types of urinary incontinence and how do they differ?

The most common types of urinary incontinence are: stress incontinence, urge incontinence, and mixed incontinence (a combination of both urge and stress incontinence). In stress incontinence, the patient leaks urine during activities like coughing, sneezing, or lifting heavy objects. In urge incontinence, the patient experiences a sudden, strong urge to urinate due to frequent and forceful contractions of the bladder muscles, and they may not reach the toilet in time to avoid leakage. Mixed incontinence refers to a combination of both stress and urge incontinence occurring together. In addition to these, there are two less common types of incontinence: continuous incontinence and overflow incontinence. Patients with continuous incontinence, as the name suggests, experience constant leakage of urine. Overflow incontinence is the least common type. It occurs when there is an obstruction in the urinary tract, preventing proper urination. As the bladder fills with urine, the pressure increases, and when the pressure exceeds the force obstructing the urinary flow, the patient starts leaking urine in drops.

It is a condition that is very common, especially in women over the age of 50; however, many patients do not seek treatment because they feel embarrassed and do not consult a doctor.

At what age and how frequently does urinary incontinence occur?

What causes urge incontinence and how is it treated?

In urge incontinence, the problem is the contraction of the bladder muscle even when the bladder is not completely full, and the person does not want to urinate. If this situation is not caused by an underlying condition (such as infection, neurological disorders, etc.), it is defined as overactive bladder (OAB) syndrome. To gain an idea of whether you might have OAB, you can fill out the Overactive Bladder Assessment Questionnaire.

In treatment, medications that weaken the bladder muscle contraction are used. Although very rare, these medications can sometimes cause difficulty urinating. These medications reduce the function of the bladder muscle, but unfortunately, they can also reduce the function of the salivary glands and large intestines, leading to dryness in the mouth and constipation.

What can be done if medication is not successful in treating urge incontinence?

Botulinum toxin (BOTOX), which is commonly used for various aesthetic procedures, is also used for medical purposes. BOTOX works by blocking the nerve signals that stimulate muscles, effectively paralyzing the muscles. When applied to the bladder muscle, it prevents the muscle from contracting, thereby helping to treat incontinence.

How is Botox applied to the bladder?

A camera is inserted into the bladder through the urinary tract, and using a needle passed through the camera, Botox is injected into the bladder muscle at multiple points. The procedure can be performed under general or spinal anesthesia and takes approximately 15 minutes. The patient can be discharged on the same day as the procedure. Since the effects of Botox are not permanent, the procedure may need to be repeated approximately every 6 months, depending on the individual.

What is the cause of stress urinary incontinence?

The bladder and lower urinary tract are supported from below by tissues known as the pelvic floor. In situations where abdominal pressure increases, such as standing up, coughing, or lifting something heavy, this pressure increase is reflected in the bladder and urinary tract as well. When the support tissue is strong and the urinary sphincter contracts properly, there is no urine leakage. However, if the supportive tissue of the urinary tract weakens, the increased abdominal pressure can cause the urinary tract to open, and if the sphincter is not strong enough, it may lead to urinary incontinence.

How is stress urinary incontinence treated?

There are two main goals in treatment: strengthening the urinary sphincter (muscle) and reinforcing the supportive tissues. To achieve these goals, three methods are used: exercise, medication, and surgery.

EXERCISE

Exercise can be done to strengthen the sphincter. These exercises are called Kegel exercises. They can be roughly described as contracting and relaxing the muscles you use to hold in urine when you are trying to avoid urinating. This will strengthen the urinary sphincter. These exercises need to be done every day for life.

MEDICATION

Some medications, called serotonin reuptake inhibitors, can also help strengthen the sphincter muscle. This medication must be taken every day for life.

SURGERY

The goal of surgery is to strengthen the relaxed supportive tissue beneath the lower urinary tract. This is done by placing synthetic material under the lower urinary tract during the surgical procedure.

There are several methods for placing this material. The most commonly used methods are TOT and TVT. Both methods are performed vaginally, so there are no visible scars after the surgery. In the TVT method, the ends of the synthetic material are passed through the back of the front part of the pelvic bone, while in the TOT method, the ends of the synthetic material are passed through a region known as the obturator foramen in the pelvic bone. The success rates after both surgeries are similar.

Are there any treatments outside of medication, exercises, or surgery?

Although not highly successful, a procedure involving synthetic materials to support the lower urinary tract during surgery can also be done with a device called a pessary, which is placed in the vagina.