Urinary incontinence

Stress urinary incontinence is a condition that can be successfully treated. Contemporary approaches make it possible to achieve complete control over urination and significantly improve the quality of life with timely diagnosis and appropriate therapy.

In the Milenković Clinic both conservative and surgical options are available.

What is urinary incontinence?

Urinary incontinence is a term behind which various disorders can be hidden, and in the most general sense it can be defined as any involuntary loss of urine, that is, any loss of control over urination. Furthermore, it can be a symptom or a sign of another condition, or a "disease" in itself, and it can also be a consequence of another disease or a complication of a specific treatment, it can be transient or permanent, it can occur in both men and women, in the young and in the elderly. Therefore, the term is very broad. 

Therapy of stress urinary incontinence

Treatment of stress urinary incontinence can be conservative and surgical. The first, non-surgical option is reserved for mild forms of the disease for those women who cannot or do not want to undergo surgery. 

So far, the best results are shown by the so-called behavioral therapy. In practice it is combined with: 

• exercises for strengthening the muscles of the pelvic floor
• by electrical stimulation of the muscles
• estrogen therapy
• by using a pessary (which stabilizes the proximal urethra). 

Surgical therapy of stress urinary incontinence

In case of more serious symptoms, i.e. in case of significantly impaired health or failure of conservative therapy, there are several surgical methods that can help with varying degrees of success.

The gold standard today is TOT sling operation – installation of a synthetic material sling under the urethral tube.

Minimally invasive, with quick recovery and a success rate of 98 %, this method enables an immediate effect and long-term urination control.

The operation is performed through three small incisions, under regional or general anesthesia, and the patients return to their usual activities on the same day.

More details about the procedure read here.

What causes stress urinary incontinence?

Mechanical tissue damage related to pregnancy and childbirth is usually blamed as the main culprit for stress urinary incontinence. However, the etiology of stress urinary incontinence in women is more complex than this assumption. 

It is most likely that the various characteristics of the mother, the size and position of the fetus, the peculiarities of the birth itself, and obstetric interventions during the birth define the probability of anatomical tissue damage. These damages, i.e. injuries in combination with some genetically defined factors (and above all - innate characteristics of the connective tissue) and many external factors (dietary habits, physical activity and exercise, state of the respiratory organs, etc.) lead to the manifestation of the symptoms of this condition. 

Furthermore, due to irritation of the urinary bladder, stress urinary incontinence can be aggravated by alcoholic beverages, caffeinated beverages, carbonated beverages, artificial sweetener, and cigarette smoking. Adequate endocrine function of the ovaries is required for the normal functioning of the urogenital system, so the state of reduced estrogens in the body is, among other things, also related to urination disorders. 

This is additional important information because the human population shows a trend of longer life and all disorders of the pelvic floor together with the problem of urinary incontinence will become a significant entity from the perspective of the individual but also in the context of public health. 

Is there a reason why women are more prone to involuntary urination?

Both men and women suffer from involuntary urination, but there are interesting differences in the frequency of different types of urinary incontinence. In general, women have the problem of involuntary urination three times more often. On average, one in ten men suffer from urinary incontinence, and most of them have urge incontinence. But since the topic of this text is specific to the type of incontinence, we will focus on it. It has already been said that the main cause of stress urinary incontinence in women is damage to the structures of the pelvic floor. Similarly, in men, stress urinary incontinence is a consequence of tissue damage, but due to radical surgical treatment of malignant prostate diseases. So, what is essentially stress urinary incontinence are injuries to the pelvic floor and it is already clear that women, due to damage during pregnancy and childbirth, are unfortunately predominantly affected by this condition. If we also add the weakening of tissue, which is estrogen dependent, it is clear that the problem will become more and more present with age, as statistics confirm. Unfortunately, there is no single or unique predictor of urinary incontinence. Hereditary tendencies and various risk factors were registered, a above all, lifestyle and obstetric history, which have already been mentioned, but there is still no universal indicator that this condition will occur.

Wider health problems in women with stress urinary incontinence.

All pelvic floor static disorders (including stress urinary incontinence) interfere with various social and physical activities. Women who suffer from this problem limit or completely stop their activities outside the home and in the most severe cases become extremely isolated and tied to the home. In addition to this restrictive behavior, many women introduce into their daily routine extensive preparations for certain activities they want to do. This refers to " forced urination " before leaving the house, they often carry pads or spare clothes with them, limit fluid intake, etc. Many scientific studies have linked involuntary loss of urine and various depressive symptomatology. There is also an unequivocal negative impact on sexual activity due to physical discomfort or feelings of shame. 

Does smoking or obesity affect the occurrence of involuntary urination?

A high body mass index (BMI) clearly correlates with the incidence of all pelvic floor disorders. Therefore, obesity is definitely a contributing factor to the disease. Many studies have shown that the degree, or severity, of stress urinary incontinence decreases as patients lose weight. This observation is quite logical, as the structures of the pelvic floor (and we know how important their integrity is in the mechanisms of continence) suffer significantly more mechanical stress in obese people. Furthermore, a Norwegian study (EPINCONT) is often cited in the professional literature, which investigated the connection between changing lifestyle habits such as smoking and involuntary loss of urine on a large number of subjects. This study proved a clear link between urinary incontinence and smoking, whether it was former or current smokers (with a relevant history of cigarette consumption over 15 years, and more than 20 cigarettes per day).