Complaints Seen in Women

Female patients most frequently present with the following complaints:

• Incontinence while coughing or laughing

• Sudden urge to urinate and inability to reach the toilet in time

• Waking up at night to urinate (Nocturia)

• Constant need to use hygienic pads

• Avoidance of social life

These complaints are not a sign of aging.

Types of Urinary Incontinence in Women

• Stress Type: Incontinence triggered by increased intra-abdominal pressure.

• Urge Type: Incontinence accompanied by a sudden, intense urge to urinate.

• Mixed Type: A combination of both types.

How is Diagnosis Made in Women?

Diagnosis is usually established step-by-step:

1. Detailed patient history

2. Physical examination

3. Urinalysis

4. Ultrasound

5. Urodynamics (in necessary cases)

Goal of Diagnosis: To clarify the underlying cause of the incontinence.

Behavioral Treatments in Women (First-Line)

Pelvic Floor (Kegel) Exercises

• Strengthens the muscles that hold urine.

• Must be performed regularly.

• No side effects.

Bladder Training

• Teaches how to extend the intervals between urination.

• Helps control the sensation of urgency.

Pharmacological (Drug) Treatments in Women

Antimuscarinics and Beta-3 Mimetics

• Used for urge-type incontinence.

• Reduces overactivity of the bladder.

Duloxetine

• One of the rare drugs that can be used for stress-type incontinence.

• Supports the function of the muscles that close the urinary tract.

• Not a permanent solution.

Note: Medications are not suitable for every patient and are selected on an individual basis.

Surgical Treatment in Women

When is Surgery Necessary?

• If stress-type incontinence is present.

• If there is no improvement despite exercise and medication.

Sling Surgeries

• Support is placed under the urethra (urinary tract).

• Return to daily life is fast.

• Success rates are high.

URINARY INCONTINENCE IN MEN

What is Urinary Incontinence in Men?

In men, incontinence is usually seen following:

• Prostate surgeries

• Prostate enlargement (BPH)

• Bladder muscle disorders

Complaints Seen in Men

• Incontinence while standing or moving

• Sudden urge to urinate

• Frequent urination at night

• Need to use pads

How is Diagnosis Made in Men?

• Physical examination

• Uroflowmetry (Urine flow test)

• Ultrasound

• Urodynamics (if necessary)

Behavioral Treatments in Men

• Pelvic floor exercises

• Fluid management

• Weight control

Pharmacological Treatments in Men

• For Urge Incontinence: Antimuscarinics / Beta-3 mimetics.

• For Prostate Issues: Appropriate prostate medications.

Note: Medications are generally insufficient for stress incontinence following prostate surgery.

Surgical Treatments in Men

• Male Sling Surgeries: Suitable for mild-to-moderate incontinence; provides support to the urethra.

• Artificial Urinary Sphincter (AUS): The most effective surgical method for severe incontinence.

NEUROGENIC BLADDER AND INCONTINENCE

What is Neurogenic Bladder?

The inability of the bladder to function normally due to diseases of the nervous system.

Causes:

• Stroke (Paralysis)

• Parkinson’s Disease

• Multiple Sclerosis (MS)

• Spinal cord injuries

• Diabetic nerve damage

Complaints in Neurogenic Bladder

• Uncontrolled incontinence

• Inability to urinate (Retention)

• Frequent infections

• High pressure within the bladder

If left untreated, it can cause kidney damage.

Treatment for Neurogenic Bladder

• Medications to calm the bladder.

• Intermittent Catheterization (IC).

• Surgical interventions in some patients.

• Urodynamics is indispensable for these patients.

URODYNAMICS

What is Urodynamics?

Urodynamics is a detailed test that shows how the bladder and urinary tract fill and empty.

How is it Performed?

• The bladder is filled via thin catheters.

• Pressures are measured.

• Evaluations are made during voiding (urination).

The procedure takes approximately 20–30 minutes. It is not painful, and the patient can go home the same day.

What Does Urodynamics Provide?

Urodynamics reveals the true cause of incontinence, indicates which medication will be most effective, and clarifies whether surgery is necessary. This helps prevent unnecessary or poorly planned surgeries.

It is a highly valuable diagnostic tool, especially for patients with mixed-type incontinence, neurogenic bladder, or those scheduled for surgery.

Urinary incontinence is not a situation to be ashamed of. It is not a natural consequence of aging. It can be brought under control with the correct diagnosis and appropriate treatment.

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