Stress urinary incontinence A small amount of urinary incontinence occurs during physical activities such as coughing, sneezing, and exercise.

Urge incontinence is the involuntary incontinence that develops after the sudden urge to go to the toilet when the bladder is full or empty. Especially the sound of water (eg washing dishes), cold drinks or exposure to cold can trigger this condition. In this situation, which can occur unexpectedly, even during sleep, excessive urinary incontinence is seen.

Stress and urge urinary incontinence are seen together in mixed urinary incontinence.

Functional urinary incontinence: Untimely urinary incontinence due to physical disability, external obstacles, or thinking or communication disorders that prevent the individual from going to the toilet. It can be seen in conditions such as limitation of movement, diabetes, heart failure, hypercalcemia (higher than normal calcium level in the blood), atrophic urethritis, constipation (constipation), acute confusion (blurring of consciousness). In some cases, the triggering cause is temporary or reversible.

Overflow urinary incontinence is an unexpected low amount of urinary incontinence due to the obstruction of bladder outlet or the inability of the bladder muscle to contract, due to a full bladder.

Transient urinary incontinence is occasional urinary incontinence, often due to infection or drug use.

Continuous urinary incontinence Fistulas, which often develop following pelvic surgery or difficult delivery, can cause Continuous urinary incontinence.

Often, causes such as mood disorders or depression can cause loss of urinary control. Sudden fear or emotional changes may be accompanied by urinary incontinence.

Urinary incontinence while laughing: It is rarely seen, usually in young girls. It is the occurrence of partial or complete urination during or immediately after laughing.

Urinary incontinence during sexual intercourse Incontinence that occurs during vaginal penetration or orgasm (sexual intercourse or masturbation)

The ideal treatment for this type of urinary incontinence is surgery. For this purpose, the most common and most effective surgical treatment is the placement of a patch under the urinary tract. Resembling a small fishing net, this patch also supports the urethra and prevents urinary incontinence. This patch can be put in 4 ways:

TVT (Tension free Vaginal Tape):

The operation is performed vaginally. A small 1 cm incision made under the urethra is entered with a needle, and the patch is placed under the urethra and the patch arms are kept behind the pubic bone.

TOT (Trans Obturator Tape):

The operation is performed vaginally. The patch is placed under the urethra by hooking through the "obturator" hole on both sides of the pelvis.

Mini-sling: The operation is performed vaginally. It is the placement of a patch piece shorter than 20 cm in length and approximately 1 cm in width under the urethra. Since a short patch is used in this surgery, long anatomical distances are not covered.

Prepubic sling: Operation is performed vaginally. A small 1 cm incision made under the urethra is inserted with a needle, the patch is placed under the urethra, and the patch arms are kept in the anterior part of the pubic bone.

It is the situation where a part of the patch is visible (excursion) due to the inability to cover the placed patch by the body. It is not usually a life-threatening condition. Under local anesthesia, it is sufficient to cut the visible part and simply suture the tissue. If the apparent size of the patch is less than 0.5 cm and the patient is in menopause, estrogen cream treatment may be sufficient without the need for surgery.

Bleeding may occur, especially if the hook injures a vital vessel during the operation. After the operation, inability to urinate, abdominal and groin pain, fistulas, numbness in the feet and difficulty in walking may occur. It is very important that this operation is performed in a fully equipped center and by doctors who are experts in their field.

“Burch colposuspension” is one of them. Which operation will be performed on which patient is decided after the evaluation of the patient.

This examination should be performed in appropriate patients. For example, patients who have had surgery for urinary incontinence before, but whose complaints continue, those with urinary incontinence with a sudden urge to void, those with severe genital organ prolapse, those with unclear complaints on this subject; These tests can be applied in the presence of a history of urinary retention (inability to pass urine even though the bladder is full), the patient is older than 65 years, urinary incontinence at night, and in the presence of known or suspected neurological disease.

There are various opinions about the place of medical treatment in stress urinary incontinence. In particular, drug treatment can be planned in urinary incontinence with a sudden urination, which is called overactive bladder.

Medications can have some side effects in the medical treatment of urinary incontinence. These can be listed as:

• dry mouth
• Constipation
• blurred vision
• Headache
• feeling dizzy
• clouding of consciousness
• Tiredness
• memory impairment
• psychotic behavior
• Insomnia
• Nausea
• Tachycardia (Increased heart rate)
• Orthostatic hypotension (lower blood pressure when standing up)
• mental disorder called delirium

Who should not use drugs in the medical treatment of urinary incontinence?

• closed angle glaucoma
• muscle disease called myasthenia gravis
• Heart diseases with conduction disorder
• These drugs should not be used in case of gastrointestinal obstructions (stomach or intestinal obstructions).

There is no clear information on when the drug should be discontinued if the patient's complaints subside. Because the symptoms may reappear shortly after stopping the drug intake. With the consent of the patient, it is appropriate to discontinue these drugs 3 months after the end of the complaints.