Urinary problems in male and female are major factors decreasing the quality of life. I am sure every one of us in our lives had trouble holding our urine. Think about the problems many people face who can not stop their urine leaking out even if they want to. The inability to hold urine from leaking out is called “incontinence”. Well except in the infancy, leaking urine without your control is never normal. When something is not normal, medicine is here to help you.
There are different causes of incontinence. To understand different types of incontinence lets go over how we hold urine and how we pee. The bladder is like a balloon, expands in volume as it fills with urine produces continuously by our kidneys without increasing the pressure inside it. This unique characteristic is called “compliance”. After reaching a certain fullness (about 500 mL in adults), an electric signal is generated to go through pelvic nerves to the spinal cord and from there to the “micturition center” in the brain. The stimulus is processed through our senses to check if the conditions and surroundings are OK to empty the bladder or not. If OK, then a response is sent back to the bladder through the same pathway. Once the bladder muscles receive the permission to empty, they start contacting while the outlet of the bladder relaxes, letting the urine flow out. If the person is not in a situation where it is OK to pee, another signal goes to the bladder to keep holding more urine. The holding capacity of the bladder may increase up to 1000mL’s in normal adults. To keep such a large quantity to outlet control of the bladder needs to be strong. There are anatomical and functional aspects of the bladder that constricts the bladder neck and helps us keep urine from leaking. In males, the muscles surrounding the tube (the sphincter muscles) we pee through (called the urethra) are the major factor providing the control whereas in females it is the anatomy and the muscles supporting the bladder and keeping it in its anatomical position. Therefore, incontinence in females and males is different and unfortunately more prominent in women.
Keeping in mind the mechanism, the reasons for incontinence are as follows:
- Stress incontinence: This is a type of incontinence when the patient leaks urine when he/she coughs, sneezes, lifts heavy objects or even when laughs. This is because the pressure in the belly exceeds the holding pressure of the bladder outlet. It is more common in female patients. Due to factors such as relaxation of the bladder supporting muscles, hormonal changes, multiple pregnancies, constipation bladder moves downward, and the continence mechanism is compromised. With the correction of the pelvic floor muscles and the right approach, this is a very correctable problem.
- Overactive bladder: This is a condition when the patient experiences a sudden urge to pee and can’t hold it. They also need to use the bathroom more frequently than their peers and usually wake up to use the bathroom at night. They typically pee in small quantities and usually feel like they have never emptied fully. This due to the misfiring of the electric signals from the bladder and poor control of these signals by the central nervous system. It is an annoying and very limiting condition for the sufferers. Whenever these patients go somewhere the first thing, the search is to locate the closest toilet. At a certain point, they are sick of this condition and avoid going out. Limiting their lives and destroying their quality of life.
- Overflow incontinence: Sometimes the bladder loses the sensation capacity or there is an obstruction to prevent complete emptying and the bladder reaches its maximum capacity, urine starts leaking from the tiniest opening they find without the control of the patient. This is a dangerous situation since there is not enough emptying of the bladder the kidney functions might also be affected.
- Mixed incontinence: this is the most commonly reported type especially in women. As the name suggests it is mixed symptoms of stress incontinence and overactive bladder. The treatment approach should be targeted to separate causes.
- Total incontinence: This is different from the rest as it is almost always a complication of a procedure such as surgery or radiotherapy. The underlying reason is a whole that connects the urinary system to the vagina or the rectum and the patient cannot even feel that he/she is leaking.
The main question is “Can incontinence be treated?” and the answer is short and clear: “YES-in more than 90% of the cases”. Finding the underlying cause, evaluating patient expectations are the key components to a successful result. At the initial visit, we usually assess the symptoms, their severity and any identifiable reason for them. The solutions differ from simple lifestyle changes to medical treatments, minimally invasive treatments to surgical corrections with high success rates.
Nobody should suffer from urinary incontinence in the 21st Century. A special cure for your personal needs will be provided, as long as you seek our assistance. Please take the first step and come, WE CAN HELP YOU.
Prof.Dr. Haluk Kulaksizoglu