Urinary incontinence, which can occur in women of all age groups, is expressed as a serious public health problem affecting people worldwide. This problem, which is experienced by about 50 percent of adult women, occurs in 25 percent of young women, 44-57 percent of middle-aged women and 75 percent of older women. Pointing out that the global economic burden of urinary incontinence will increase in parallel with the increase in average life expectancy in many parts of the world, Dr. Sultan Can pointed out that the disease will continue to be an important problem for public health.
THERE IS A STRONG RELATIONSHIP BETWEEN AGING AND DISEASE
Saying that many reasons, from genetic factors to obesity, from diabetes to smoking, can pose a risk for urinary incontinence, Gynecology and Obstetrics Specialist Dr. Can reminded that there is a strong relationship between aging and the prevalence and severity of disease. Regarding the reason for this, Dr. Can said, “Due to the decrease in estrogen hormone with age, loss of elasticity in the secondary developing connective tissue, weakening of the pelvic muscles and the muscles of the urinary bladder can cause urinary incontinence. However, advanced age alone is not considered an independent risk factor for urinary incontinence. “Lifestyle is much more effective,” he said.
PREGNANCY IS AN IMPORTANT FACTOR
Stating that urinary incontinence can be seen due to hormonal changes during pregnancy, total weight and intra-abdominal pressure caused by the baby and its appendages, and damage to the nerves and muscles in the pelvic region at birth, Dr. Can said, “In parallel with the increase in the number of pregnancies, the risk may increase. There are no healthy data on the protective effect of cesarean delivery in patients with urinary incontinence during or before pregnancy.
RISK OF OVER WEIGHT INCREASES
Stating that there is a serious relationship between lifestyle and dietary habits and urinary incontinence, Dr. Can said, “Excess weight, chronic constipation, smoking-alcohol use, caffeinated food consumption, chocolate/sugar or foods with high acid content are among the risk factors. Moreover, the first management to be made following the evaluation in patients who apply with the complaint of urinary incontinence is a lifestyle change.
Noting that obese women are at approximately 3 times more risk than non-obese women, Dr. Sultan Can continued his words as follows:
“Although the mechanism of its relationship with urinary incontinence is unknown, it is thought that excess body weight increases abdominal pressure, which in turn increases urinary bladder pressure, leading to urinary incontinence. Weight loss is known to be an effective treatment for urinary incontinence. However, the symptoms seem to increase depending on the intensity of smoking. Especially in young women (20-49 years old), there is a significant reduction in symptoms after quitting smoking. Caffeine/alcohol intake is known to exacerbate urinary incontinence due to its stimulant and diuretic effects. In patients with symptoms, a plan should be made to reduce the caffeine-containing fluids consumed during the day.”
ENVIRONMENTAL FACTORS PREVENT GENETIC RISK
Reminding that genetically inherited connective tissue diseases, differences in collagen types and amounts are another important factor in urinary incontinence, Dr. “The twin studies show that genetics is effective in urinary incontinence, but this situation can change with environmental factors such as overweight, smoking, physical exercise, diet, and the number of births,” said Can. He talked about studies that show that especially urge urinary incontinence can change with environmental effects, and coughing-sneezing (stress type) urinary incontinence is less affected by environmental effects and is more prone to genetic basis. “There are studies reporting a 2-3 times increase in frequency in first-degree relatives of women with stress urinary incontinence,” he said.
IT CAN ALSO INDICATE DIFFERENT DISEASES
Noting that urinary incontinence can also be a precursor to the presence of different diseases, Dr. Can, “In particular, conditions such as diabetes affecting the vessels and nerves, neurological diseases, coughing lung diseases, pelvic region masses, urinary tract infections, and psychological disorders can also present with urinary incontinence. People who have frequent urinary tract infections are also at increased risk of developing the disease.
LABOR LOSS, DEPRESSION, SEXUAL REluctance
Stating that this problem, which is dependent on many different factors, is not treated, it can cause loss of labor as well as disrupting the quality of life socially and sexually, Dr. Sultan Can said, “Besides this, skin infections can also be seen. In addition, some symptoms may develop depending on the restriction of fluid intake. Insomnia experienced in the patient group who urinate at night can lead to anxiety and depression in the long term.
Explaining that the patient presenting with urinary incontinence should be questioned in detail, including all systems, and treated for the underlying cause, Dr. Can gave the following information about the treatment approach:
“The type of urinary incontinence is determined by questioning whether the patient is incontinence before he can reach the toilet, laughing/sneezing, or both ways. The first-line treatment is lifestyle changes, pelvic floor muscle exercises, and bladder training. If symptoms persist with these; Depending on the type of urinary incontinence, it can be treated either with medication or surgically.
A LIFESTYLE CHANGE IS A MUST!
Pointing out that no matter what the treatment approach is, lifestyle changes must be made to solve the problem, Dr. Sultan Can concluded his words as follows:
“The best example of this is again shown in twin studies. In individuals with the same genetic structure, differences may occur, especially in urge urinary incontinence, due to environmental factors. It is possible to alleviate or eliminate the existing symptoms with behaviors such as restriction of gaseous and diuretic fluids, avoidance of constipation, smoking cessation, weight loss (body mass index <25), pelvic muscle exercises, regular urination, and restriction of fluid intake before going to bed.