Koru Hospital Incontinence Treatment Center provides services for the diagnosis and treatment of urinary and fecal incontinence issues through a multidisciplinary approach. For all conditions associated with pelvic floor dysfunction, our experienced staff, consisting of specialists in urology, gynecology, and physical therapy and rehabilitation, creates patient-specific treatment plans.
What is Incontinence?
Urinary incontinence is a health issue defined as the involuntary leakage of urine, which significantly affects the quality of life. Despite being common in the community, a significant portion of patients avoid seeking medical help due to feelings of shame. However, incontinence is a condition that can largely be controlled with proper diagnosis and treatment.
Urinary incontinence, which is seen much more frequently in women than in men, is directly related to factors such as pregnancy, childbirth, menopause, and pelvic surgery. In men, the incidence increases particularly in the period following prostate surgery.
Types of Incontinence
Stress Urinary Incontinence (SUI)
Stress incontinence is the involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, lifting heavy objects, or exercising. The primary cause of this type of incontinence is the weakening of the pelvic floor muscles and the urethral sphincter mechanism. A history of vaginal delivery, chronic cough, obesity, and advanced age are the main risk factors.
Urge Incontinence
Urge incontinence is the condition of leaking urine before reaching the toilet, accompanied by a sudden and severe need to urinate. In this clinical picture, which is closely related to overactive bladder (OAB) syndrome, the detrusor muscle exhibits involuntary contractions. Neurological diseases, urinary tract infections, and bladder irritation are among the triggering factors.
Mixed Incontinence
Mixed incontinence, where both stress and urge incontinence are present, is a condition frequently encountered, especially in middle-aged and older women. It is important to determine the dominant component in treatment planning.
Overflow Incontinence
Overflow incontinence manifests as the bladder becoming excessively full due to an inability to empty completely, resulting in constant dribbling of urine. Bladder outlet obstruction or detrusor muscle insufficiency are the underlying causes. In men, benign prostatic hyperplasia (BPH) is the most common factor.
Fecal Incontinence
Fecal incontinence (anal incontinence) is the loss of control over gas or stool. Obstetric sphincter injuries, neurological diseases, pelvic radiotherapy, and anal sphincter dysfunction are the primary causes. In our center, urinary and fecal incontinence are evaluated and treated together.
Diagnostic and Evaluation Methods
Proper treatment planning begins with a comprehensive diagnostic evaluation. The diagnostic methods applied in our center are as follows:
- Detailed anamnesis: Frequency of urine leakage, amount, triggering factors, and impact on quality of life
- Bladder diary: 3-7 day record of fluid intake and urine output
- Physical examination: Pelvic examination, cough stress test, Q-tip test
- Urodynamic study: Cystometry, pressure-flow study, urethral pressure profile
- Pelvic floor ultrasonography: Evaluation of muscles and sphincters via transperineal or endoanal ultrasound
- Cystoscopy: Visual evaluation of intra-bladder pathologies
- Pad test: Objective measurement of the amount of urine leakage
- Electromyography (EMG): Evaluation of pelvic floor muscle activity
Conservative Treatment Methods
Pelvic Floor Muscle Exercises (Kegel Exercises)
Pelvic floor rehabilitation is the cornerstone of incontinence treatment. Kegel exercises, performed under the guidance of a physiotherapist, aim to strengthen the pelvic floor muscles and improve their coordination. With a regular exercise program, significant improvement is achieved in a significant portion of stress incontinence patients.
Biofeedback Therapy
Biofeedback is a method where pelvic floor muscle activity is measured via electronic sensors, providing visual or auditory feedback to the patient. Through this technique, patients learn to contract and relax the correct muscle groups. Biofeedback therapy is highly beneficial, especially for those who cannot isolate their pelvic floor muscles and for patients with pelvic floor coordination disorders.
Electrostimulation Therapy
Electrical stimulation applied to the pelvic floor muscles is used to increase muscle strength and reduce symptoms of overactive bladder. Tibial nerve stimulation (PTNS) and intravaginal/intrarectal electrostimulation are among the methods applied in our center.
Bladder Training
Bladder training is the first-line treatment approach for urge incontinence. Gradually increasing the intervals between urination, techniques to suppress the urge to urinate, and regulating fluid intake are components of this program. Significant symptom improvement is observed in the majority of patients within a three-month period.
Pharmacological Treatment
Anticholinergic drugs (oxybutynin, tolterodine, solifenacin) and beta-3 agonists (mirabegron) are used in the treatment of overactive bladder. The choice of medication is made by considering the patient's age, comorbidities, and side effect profile. In postmenopausal women, topical estrogen therapy is an effective option for incontinence symptoms associated with urogenital atrophy.
Surgical Treatment Options
Mid-Urethral Sling Surgeries
For stress urinary incontinence that does not respond to conservative treatment, mid-urethral sling surgery is the gold standard surgical method. TVT (Tension-free Vaginal Tape) and TOT (Trans-Obturator Tape) techniques offer high success rates with a minimally invasive approach.
Burch Colposuspension
Burch colposuspension, performed via laparoscopic or open surgery, provides suspension of the bladder neck to the retroperitoneal tissue. It is a preferred method for patients requiring simultaneous pelvic surgery.
Botulinum Toxin Injection
In cases of overactive bladder resistant to pharmacological treatment, botulinum toxin (Botox) injection into the detrusor muscle is performed under cystoscopic guidance. This procedure controls symptoms of urgency and urge incontinence by reducing involuntary detrusor contractions.
Sacral Neuromodulation
Sacral neuromodulation (InterStim therapy) allows for the regulation of bladder and pelvic floor functions through electrical stimulation of the sacral nerve roots. It is used in the treatment of resistant overactive bladder, chronic urinary retention, and fecal incontinence.
Incontinence in Special Patient Groups
Pregnancy and Postpartum Incontinence
Increased uterine pressure and hormonal changes during pregnancy weaken the pelvic floor muscles, paving the way for incontinence. Perineal trauma and nerve damage that may occur during vaginal delivery increase the risk of postpartum incontinence. Postpartum pelvic rehabilitation programs are offered at our center.
Menopausal Incontinence
The drop in estrogen levels during menopause leads to atrophy in the urogenital mucosa and weakening of the pelvic support tissues. Local estrogen therapy and pelvic floor exercises form the basis of treatment during this period.
Incontinence After Prostate Surgery
Temporary or permanent stress urinary incontinence may develop in some men following radical prostatectomy. Pelvic floor exercises, biofeedback, and, when necessary, artificial urinary sphincter (AUS) implantation are among the treatment options.
Quality of Life and Psychosocial Support
Beyond physical discomfort, incontinence can lead to serious psychosocial consequences such as social isolation, depression, and sexual dysfunction. In our center, patient education, behavioral counseling, and, when necessary, psychological support services are integrated into the treatment process.
At the Koru Hospital Incontinence Treatment Center, with our expert staff, we provide comprehensive diagnostic and treatment services for urinary incontinence issues, ensuring our patients regain their quality of life.