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Urinary incontinence refers to the phenomenon of urine leaking through the urethra regardless of the person's will. Although this does not directly affect life support, it is a problem closely related to the quality of life, causing withdrawal from social and interpersonal relationships and hygienic problems. can cause In Korea, the prevalence rate has also increased as the economic conditions have improved and the average life expectancy has increased, leading to an increase in the elderly population, and its importance has recently been highlighted.

Isn’t all urinary incontinence the same?

Although the symptoms the patient complains of are similar, not all urinary incontinence is the same and not all treatment methods are the same. There are many different causes that can cause urinary incontinence.

(1) Stress urinary incontinence: This refers to a symptom of involuntary urinary leakage when exercising, sneezing, or coughing. The main cause of this is weakened pelvic muscles after childbirth and sagging of the bladder and urethra due to pelvic relaxation, but it can also be caused by weakened urethral sphincter, which prevents urine from leaking. Many women are uncomfortable with urinary incontinence, but they often suffer alone without going to the hospital because they think it is a natural phenomenon that occurs as they age or because they are embarrassed. However, urinary incontinence is also a disease, and it is a disease that can be treated with various treatments available.

(2) Urge urinary incontinence: Refers to a symptom of involuntary urinary leakage occurring simultaneously with or immediately after urinary urgency. At this time, detrusor overactivity is observed in urodynamic tests. Due to involuntary urinary outflow associated with a sudden and strong feeling of urination, if you do not go to the bathroom quickly, you may wet your underwear or wet your underwear while taking them down in the bathroom.

(3) Complex urinary incontinence: Refers to a condition in which stress urinary incontinence and urge urinary incontinence exist together. Involuntary urinary leakage is triggered by urinary urgency, exercise, sneezing or coughing. When surgery is performed for stress urinary incontinence, in about 25% of cases, urge urinary incontinence remains the same or worsens, and new urge incontinence that did not exist before may develop. Most patients are more uncomfortable with symptoms caused by urge urinary incontinence, so it is better to treat this first.

(4) Involuntary urinary incontinence: This refers to when involuntary urinary incontinence occurs unrelated to urge urinary incontinence or stress urinary incontinence.

(5) Persistent urinary incontinence: This refers to when urinary leakage occurs continuously.

(6) Enuresis: refers to a condition in which uncontrolled urinary leakage occurs during sleep.

(7) Post-micturition key point: This refers to involuntary urinary leakage occurring immediately after urination.

(8) Overflow urinary incontinence: This refers to urinary leakage related to urinary retention.

(9) Extraurethral urinary incontinence: This refers to urinary leakage occurring through passages other than the urethra, such as fistulas or ectopic ureters.

How is stress urinary incontinence diagnosed?

◎ History taking and urinalysis: Detailed history taking is very important in diagnosing urinary incontinence. In acute cases, check fluid intake, urination pattern, acute urinary tract infection, and history of recent surgery or trauma. In chronic cases, congenital deformities, neurological diseases, past surgical history, general health status, and past history of neurological abnormalities that may affect the bladder and urethral sphincter, history of surgery in the vagina or pelvic cavity, and history of rectal surgery are checked. If there are any medications being taken, it is necessary to check whether they are drugs that may worsen urinary incontinence, and the patient's physiological condition is also checked. In addition, the birth history, type and frequency of childbirth, specific situations in which urinary incontinence occurs, the degree and pattern of urinary incontinence, and general urination status are also checked. Lastly, because urinary tract infections can temporarily cause urinary incontinence, urinalysis and urine culture tests are essential.

◎ Physical examination: A pelvic examination and neurological examination must be performed to identify anatomical or neurological abnormalities that may cause urinary incontinence.

◎ Vaginal examination: Performed with the bladder empty to examine the pelvic organs, and then performed with the bladder filled to check for urinary incontinence or cystocele. Then, a urinary incontinence induction test is performed by filling the bladder with saline solution on a lithotomy and having the patient increase abdominal pressure to observe whether urinary incontinence occurs.

◎ Urination-related symptom questionnaire: Symptoms subjectively felt by the patient are indicated on a standardized, internationally accepted questionnaire. In order to more accurately determine the condition and degree of urinary incontinence, the patient can economically and effectively determine the patient's urinary status by recording the amount of urine, urinary incontinence, time, and frequency for about 3 days.

◎ Urodynamic test: Performed to determine the exact cause of urinary incontinence, evaluate detrusor function, and predict the possibility of urinary dysfunction after surgery. The examination can also identify factors that may cause upper urinary tract abnormalities, such as detrusor sphincter coordination disorders, low bladder compliance, bladder outlet obstruction, or vesicoureteral reflux. To diagnose stress urinary incontinence, stress urinary leakage pressure is generally measured.

◎ Other tests such as Q-tip test, pad test, post-micturition residual urine volume test, cystourethroscopy, and transvenous urethrography are performed when necessary.

How is stress urinary incontinence treated? Isn’t it mandatory to have surgery?

One . Improving lifestyle habits

The goal is to control environments that pose a risk of worsening urinary incontinence. For example, eat a lot of vegetables or fruits to reduce the increase in abdominal pressure caused by chronic constipation, control your weight because you are prone to stress urinary incontinence if you are obese, or reduce excessive intake of carbonated drinks or water because it worsens urinary incontinence symptoms. Since the incidence of urinary incontinence is high in smokers, one way to do this would be to quit smoking.

2. Bladder behavior therapy

It is a complex treatment concept that includes education on the anatomy and function of the lower urinary tract, restriction of water intake, bladder training, timed urination, pelvic floor exercises, and biofeedback through a urination diary.

3. Peroneal pelvic floor exercises

It is often performed when surgery is not desired for mild or moderate stress urinary incontinence. It can be used for stress urinary incontinence, and in mild cases, complete cure is possible. There is no burden of surgery, but it has the disadvantage of not being effective in a short period of time and prone to recurrence.

4. Simple pelvic floor exercises (Kegel exercises)

The method is to keep both legs apart and not put pressure on your buttocks or leg muscles, then pull your anus up and tighten it with the thought of holding in a fart. Slowly count from 1 to 5 and then relax. Once you get used to this movement, tighten your vaginal muscles by pulling them up. Insert two fingers into the vagina and squeeze the vagina. If the fingers feel tight, the vaginal muscle exercises have been performed properly. When exercising, place your hands on your buttocks or lower abdomen and check to see if you are straining. It is known that 40-70% of patients who undergo this method are satisfied.

Electrical stimulation is performed to treat the pelvic floor and bladder by inserting electrodes into the vagina or anus and then passing an external current into the body, either directly or indirectly through the sacral reflex arc. It is known that it is better to combine it with pelvic floor exercise or biofeedback rather than use it alone. It is known that approximately 50% of patients who undergo the treatment are satisfied.

5. Biofeedback

Electromyography electrodes are attached to the pelvic floor muscles and the probe is inserted into the vagina or anus to simultaneously measure the electromyograms of the pelvic floor muscles and abdominal muscles and train to selectively contract only the pelvic floor muscles. However, this is a means of educating the patient, and the ultimate treatment goal, improving pelvic floor muscle strength and suppressing urinary incontinence, depends on the patient's efforts to practice it at home.

6. Extracorporeal magnetic field

When a patient sits on a treatment chair equipped with a magnetic pole coil, a magnetic field comes out from underneath the chair and irradiates the area where the pelvic floor muscles are distributed. Unlike electric current, the magnetic field has the advantage of receiving little resistance when transmitted through any material, and since there is no reduction in energy, it transmits stimulation to deep nerve tissue, so it is possible to use a smaller current than electrical stimulation, and it passes through clothing, so it can be used to You don't have to take it off. The effectiveness and role of extracorporeal magnetic fields in stress urinary incontinence have been verified, but the effectiveness decreases significantly after 6 months and additional treatment may be required on a regular basis.

7. Drug therapy

It is mainly effective in urge urinary incontinence or complex urinary incontinence, but in the case of stress urinary incontinence, it is difficult to expect complete symptom improvement. Anticholinergics are used as the primary treatment for urge urinary incontinence and mixed urinary incontinence, and in the case of stress urinary incontinence, surgical treatment is primarily performed with the advent of non-invasive mid-urethral slings, so drug treatment is selected considering the patient's situation. In postmenopausal women, female hormone therapy may be helpful.

8. Surgery

The purpose of surgery for female stress urinary incontinence is to restore urethral support, regenerate an appropriate support that can resist increased abdominal pressure, or restore urethral adhesion. There are various surgical methods for stress urinary incontinence, and among the conventional surgical methods, many methods show excellent results. Although each has its own pros and cons, the tension-relieving vaginal tape insertion method has recently been introduced and is receiving a lot of attention. This tape is a strip-shaped tape about 20cm long and 1cm thick made of a material that is harmless to the human body. It is a very simple method of hanging the tape from the middle of the urethra to the abdomen through the vagina. Recently, various methods that have modified this method have been developed, and long-term results are also being awaited.