Urinary Incontinence Center

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Zion Women셲 Hospital, Serving with Love

Urinary incontinence refers to the condition of having unintended urinary leaks, which interfere with normal everyday life or cause hygienic problems. It is diagnosed based on the objective evidence. Since it occurs regardless of one셲 intentions, there is not only a daily discomfort but also a rapid decrease in sexual satisfaction, which may harm the couple셲 relationship. Middle-aged women may lose confidence and enthusiasm and possibly suffer from a social phobia. The elderly may experience emotional issues such as embarrassment or shame. The concern over the condition may actually lead to a decrease in physical activity and may also cause social isolation due to the fear of being in a social environment.

The major cause of incontinence is because of the muscles surrounding the vagina as well as anus being stretched when the head of a baby comes through the pelvis.
The pelvic muscles, “which play an important role during urination in the case of women”, refer to the muscles that envelop the vagina and support the bladder, urethra and vagina from below.
When these muscles become weak after a natural delivery, the bladder becomes sensitive and the functionality of the urethra declines, resulting in the development of urinary incontinence.
In addition, incontinence can also occur due to a disability from the urinary tract.
Problems in the urethral sphincter, “which has the role of a doorkeeper during the process of the bladder storing and releasing urine”, is thus responsible for controlling the urethra셲 opening and shutting functions, this may contribute considerably to the development of incontinence.
Additionally, incontinence may occur when the bladder becomes more sensitive and decreases the storage capacity for urine, making that person unable to withhold even the smallest urge to urinate.

01. Stress Urinary Incontinence
This type refers to incontinence that occurs during exercise or sudden movements and may be caused by aging, pregnancy, childbirth, menopause, chronic coughs and excessive exercise. 85% of such cases develop due to the weakening of the pelvic muscles that support the bladder as well as the urethra or due to the weakening of the urethral sphincter.
Incontinence occurs during coughs, sneezes and laughs.
Incontinence occurs when standing up from a chair or when one is getting up from the bed.
Incontinence occurs when walking or exercising

02. Overactive Bladder
An overactive bladder refers to the state of being unable to withhold oneself when the urge to urinate appears and incontinence occurs before arriving at the actual bathroom, this condition is caused by nervous system diseases such as infections, tumors, neurogenic bladder, foreign bodies, bladder outlet obstruction, a stroke, multiple sclerosis, and Alzheimer셲 disease or it can develop without a cause.
Urine leaks on the underwear before even arriving at the bathroom to urinate.
The person frequently wakes up in the middle of the night to urinate.
The person must go to the bathroom within every 2 hours.
The person is reluctant to drink fluids in order to avoid frequent urination.
The person wets the bed while sleeping.

03. Mixed Incontinence
Mixed incontinence refers to a combination of stress urinary incontinence and an overactive bladder, this is prevalent among elderly women.

04. Overflow Incontinence
This type of incontinence refers to the condition where the urine has continuously accumulated in the bladder due to a dysfunction in the bladder셲 ability to release the urine, and when the bladder is full, the urine overflows from the bladder without the person even knowing.
This condition can be accompanied with a bladder outlet obstruction caused by urethral stricture, tumors, or benign prostatic hyperplasia, an intake of drugs that tighten the urethra or reduce bladder contractility, severe constipation, diabetes, neurological disorders “such as sexual neurosis”, spinal cord injury, and multiple sclerosis.

The following symptoms may indicate urinary incontinence or an overactive bladder.
01. Urine leaks during coughs or sneezes.
02. Urine leaks whilst exercising.
03. Urine leaks when standing up from sitting as well as getting up from lying down.
04. When the urge to urinate appears, it is intense.
05. Urinating is not accompanied with the sense of a full discharge.

Basic tests include physical checkups, urinalysis, post-void residual urine tests, and abdominal CT scans. Uroflometry tests, urine cytology tests, urodynamic tests, urethroscopy or cystoscopy, cystourethrography, ultrasounds and intravenous urography are also used for a diagnosis.

01. Medical History
It is checked whether or not the patient feels sudden urges to urinate but cannot withhold urination before arriving at the bathroom and also if the urge to urinate does not occur often but there are still urine leaks while coughing or sneezing.
Also checked is whether the leak is approximately the amount of a teaspoon, whether the leak is to the extent that it trickles down the leg or if the leak flows considerably while walking.

02. Frequency Volume Chart (FVC)
The patients themselves check the frequency and volume of urination over 24 hours, they also mark the frequency and volume of the leaks, if there were any, on a timetable for every hour.

03. Urinalysis
Urinalysis is conducted to determine if the patient has cystitis.

04. Post-void Residual Volume (PVR) Measurement
Urine is examined to determine the residual volume of urine in the bladder.

05. Ultrasound
The interior of the bladder and the prostatic urethra are examined to find any kind of abnormality.

06. Urodynamic Testing
This test is a general simple way to make an accurate differential when the type of incontinence cannot be determined. It has been conducted in cases where there is a problem with bladder function, such as when the patient is over 60 or the surgery for incontinence was unsuccessful, when the patient previously went through pelvic surgery, or when an abnormality appears on a neurological examination.

The treatment methods for stress urinary incontinence can be divided up into conservative treatment, such as medication, pelvic muscle exercise (Kegel exercise), biofeedback therapy using electrical stimulation, magnetic field therapy, and surgical treatment.
The most effective way to treat stress urinary incontinence is through surgery. However, conservative treatment is also effective for relatively young women, incontinence occurring after childbirth, and less severe cases of incontinence.

01. Lifestyle and Home Remedies
Pelvic muscle exercise
Bladder training
Weight loss
Restriction of food intake

02. Medication
Medication to the lower bladder sensitivity
Bladder stabilizer
Medication to increase the bladder contractility
Medication to tighten the urethra

03. Non-pharmacological Treatment
Behavioral therapy: time-managed urination, cleansing urination, prevention of constipation, avoidance of sharp tastes
Physical therapy: pelvic muscle exercises at home, learning pelvic muscle exercises
Training the pelvic muscles by using equipment: biofeedback therapy, use of a vaginal cone (double cone)
Electrical stimulation therapy

04. Surgery
The current tape surgery is divided into 쏷OT and 쏷VT according to the method. Nevertheless, the division only recognizes the location of the tape and so there is no real significant difference between the two methods. The TOT surgery incorporates a local anesthesia since the pain involved is minimal and hospital admission is unnecessary since the surgery only takes approximately 30 minutes.

* The high-tech TOT Surgical Procedure for Incontinence, originates from France
The special material easily combines with the tissues of the body without the sensation of a foreign body or any side effects, its flexibility automatically moderates the pressure level of the urethra to allow easy control of urination.
There is also the advantage that the tape can be freely adjusted within 3 months.
After 3 months, it naturally combines with the body셲 tissues and continuously suppresses urinary incontinence.

05. Advantages of Urinary Incontinence Surgery
15 minute surgery
1 day admission
Painless surgery
Permanent effect
Hardly any complications
Vaginoplasty can also be performed during the surgery

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