What is urinary incontinence?
Urinary incontinence is the involuntary loss of urine. It can range from a few drops to enough to soak underwear completely. It is more common in women but also affects men. It is a very common problem, yet many people do not see a doctor for years because they are embarrassed or believe it is a natural consequence of ageing.
In fact, urinary incontinence is not a normal part of ageing. It can have a negative impact on social life, work, sleep and sex life, and can lead to skin irritation and urinary tract infections. With the right diagnosis, symptoms can be reduced considerably in most patients.
Risk factors
Urinary incontinence does not have a single cause; several factors often play a role together. The main risk factors are:
- Pregnancy and vaginal delivery
- Hormonal changes after the menopause
- Being overweight
- Chronic cough, constipation and jobs involving heavy lifting
- Prostate enlargement and prostate surgery
- Conditions affecting the nervous system, such as diabetes, stroke, Parkinson’s disease, multiple sclerosis and spinal cord problems
- Medications such as diuretics and some sleeping tablets
- Excessive consumption of caffeine and alcohol
Temporary incontinence can occur due to correctable causes such as a urinary tract infection, constipation or a newly started medication, so these are investigated first during the assessment.
Types of urinary incontinence
Stress urinary incontinence
This is leakage of urine during activities that increase pressure in the abdomen, such as coughing, sneezing, laughing, lifting or exercise. It is the most common type in women; childbirth, the menopause and excess weight can weaken the pelvic floor muscles and the tissues that support the urethra.
Urge urinary incontinence (overactive bladder)
This is leakage of urine before reaching the toilet, together with a sudden, strong urge to urinate that cannot be postponed. It is usually accompanied by frequent urination and getting up at night to pass urine. This picture is called overactive bladder.
Mixed urinary incontinence
This is the combination of stress and urge incontinence. Treatment usually starts with the symptom that bothers the patient most.
Overflow incontinence
This is dribbling leakage of urine because the bladder does not empty completely and overflows. In men, the most common cause is obstruction due to prostate enlargement; conditions that affect the nerves, such as diabetes, can also be responsible. In this case, relieving the obstruction is the priority. See the enlarged prostate page for details.
Urinary incontinence in men
In men, incontinence is most commonly due to overactive bladder, prostate enlargement and prostate surgery. Incontinence may occur in particular after radical prostatectomy for prostate cancer; in most patients this improves over time and with exercises.
How is it diagnosed?
- History and examination: The doctor asks in which situations leakage occurs, how often, how many pads are used, about childbirth, previous operations and medications. In women, a gynaecological examination checks for prolapse; in men, the prostate is examined.
- Bladder diary: Fluid intake, the times and volumes of urination and episodes of leakage are recorded, usually over three days. It is a simple method that contributes a great deal to the diagnosis.
- Urine test: Performed to rule out infection or blood in the urine.
- Post-void residual measurement: The amount of urine left in the bladder is measured with ultrasound; this helps to identify overflow incontinence.
- Urodynamics: A test that assesses the filling and emptying function of the bladder in detail, used in selected patients when the diagnosis is unclear, after previous surgery or when surgery is planned. It is not needed for every patient.
Treatment options for urinary incontinence
Treatment is planned individually after examination, according to the type and severity of incontinence and the patient’s expectations. It usually starts with the simplest and least invasive methods.
Lifestyle changes and bladder training
Losing excess weight, cutting down on caffeine and fizzy drinks, spreading fluid intake evenly over the day, treating constipation and stopping smoking can reduce symptoms. In bladder training, the intervals between visits to the toilet are gradually extended according to a plan so that the bladder learns to hold more urine; this is particularly effective in overactive bladder.
Pelvic floor exercises
These exercises, also known as Kegel exercises, strengthen the muscles that support the urethra. They are the first-line treatment for stress and mixed incontinence. To be effective, the muscles need to be identified correctly and the exercises done regularly for at least several months; ideally, they should be learned with the help of a physiotherapist.
Medication
In overactive bladder, antimuscarinic medicines or beta-3 agonist medicines, which relax the bladder muscle, can be used. Antimuscarinic medicines can cause side effects such as a dry mouth and constipation; in older patients, the choice of medicine is made with particular care. The effect of the medication is usually assessed within a few weeks.
Botulinum toxin injections into the bladder
In patients with overactive bladder who do not benefit sufficiently from medication or cannot tolerate it, botulinum toxin can be injected endoscopically into the bladder wall. Because the effect wears off over time, the treatment may need to be repeated after some months. In some patients, the bladder may temporarily not empty completely and intermittent self-catheterisation may be needed; patients are informed about this beforehand.
Sling surgery for women (TOT, TVT)
In women with stress incontinence who do not benefit sufficiently from exercises, the urethra can be supported with a thin sling tape placed beneath it (mid-urethral sling). TOT and TVT are methods named after the route by which the tape is placed. The procedure is performed vaginally through small incisions and the hospital stay is usually short.
Surgical options for men
For persistent incontinence after prostate surgery that affects daily life and does not improve despite exercises, surgery is usually considered at least 6–12 months after the operation. A male sling is among the suitable options for mild to moderate incontinence, and an artificial urinary sphincter for more severe incontinence.
Risks and follow-up
Every treatment has its own side effects. After sling surgery, temporary difficulty passing urine, infection or, less commonly, problems with the tape involving the vagina or urinary tract may occur. With an artificial urinary sphincter, further surgery may eventually be needed because of mechanical problems with the device or infection. In all patients, the effect of treatment is assessed at regular check-ups and the treatment steps are adjusted if necessary.
When should you see a doctor?
If incontinence affects your daily life, sleep or social relationships, or you have to use pads, there is no need to wait to be assessed. If incontinence is accompanied by blood in the urine, pain when passing urine, frequently recurring infections, difficulty passing urine, or weakness or numbness in the legs, an examination is advisable sooner.
Urinary incontinence treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. In Bursa (Nilüfer), he sees women and men with urinary incontinence and overactive bladder at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your appointment in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share any previous reports via WhatsApp (+90 541 622 54 82) beforehand. More information is available on the international patients page and the contact page.
