Urinary Incontinence (Bladder Weakness) in Women – Modern Treatment in Istanbul, Step by Step

What does urinary incontinence mean – and how common is it really?

Urinary incontinence refers to the involuntary loss of urine and is one of the most common complaints in women. In the UK about 25 percent of women are affected during their lifetime, with rising frequency at an older age.

Involuntary loss of urine as a common, treatable problem

Bladder weakness is not an unavoidable sign of ageing, but in most cases is treatable well. Many of those affected experience a clear improvement as soon as the right therapy begins.

Why the topic is often a taboo

Out of shame, many women wait years before seeking help. This silence often leads to unnecessarily late treatment, even though effective methods are available.

Source: ICS – International Continence Society, standards on urinary incontinence

Which form of bladder weakness do I have – stress, urge or mixed?

The most important question at the start is the one about the form, because the entire treatment depends on it. In women, stress incontinence and mixed incontinence are the most common at around 31 percent each, while pure urge incontinence is about 14 percent.

Stress incontinence (coughing, sneezing, lifting)

Here urine is lost involuntarily when coughing, sneezing, laughing or lifting, usually in small amounts. The cause is a weakness of the pelvic floor muscles and supporting ligaments that close the urethra.

Urge incontinence / overactive bladder

With this form a sudden, barely suppressible urge to urinate occurs, often followed by loss of urine. The bladder signals even though it is not yet full.

Mixed incontinence (combination of both forms)

Many women have parts of both forms at the same time. The treatment is then tailored to the more burdensome component.

Why is the precise diagnosis so decisive?

A wrong classification almost inevitably leads to an unsuccessful treatment. Because stress and urge incontinence are treated completely differently, a careful diagnosis always comes first.

Different forms, different therapy

A sling operation helps with stress incontinence, but not with urge incontinence. Conversely, bladder medication works with urge but hardly with pure stress.

Which investigations bring clarity

Besides a conversation and a gynaecological examination, a voiding diary, an ultrasound and, where needed, a bladder pressure measurement (urodynamics) help. These steps classify the form reliably and avoid unnecessary procedures.

What are the most common causes in women?

The pelvic floor muscles and the connective tissue play the central role. Pregnancies, births and hormonal changes weaken these structures over the course of life.

Pregnancy, birth and the pelvic floor

Pregnancy and birth are among the most important risk factors for a later stress incontinence. The pelvic floor is heavily strained in the process and loses its tone.

Menopause and hormones

With the drop in oestrogen during the menopause, the tissue around the urethra becomes thinner and less elastic. This can trigger or worsen symptoms.

Bladder prolapse as a common companion

Often a bladder prolapse is connected with the incontinence. If a prolapse is also present, it is included in the treatment planning, since both can be treated together.

Source: National Institute for Health and Care Excellence (NICE) – guideline on urinary incontinence in women

When should I have symptoms medically assessed?

In principle an assessment is worthwhile as soon as the loss of urine burdens everyday life. The earlier the form is determined, the more effective and simpler the treatment usually is.

When a doctor's visit makes sense

Even mild but recurring symptoms are a good reason for a conversation. No one should wait years out of shame, because early measures are often particularly successful.

Note: With blood in the urine, pain, fever or suddenly new loss of urine, you should see a doctor promptly – regardless of any planned trip.

Can urinary incontinence be treated without surgery?

In most cases the answer is yes, especially with mild to moderate stress incontinence. With all forms, the conservative, that is non-surgical, treatment comes first.

Pelvic floor training as the first choice

Guided pelvic floor training over more than three months is the most important non-surgical measure. It has no side effects and can clearly improve or even eliminate the symptoms.

Biofeedback, electrical stimulation and pessary

Biofeedback and gentle electrical stimulation help to activate the right muscles in a targeted way. A pessary inserted into the vagina can additionally support the urethra.

Weight and lifestyle factors

Weight loss relieves the pelvic floor and can noticeably reduce symptoms. An adequate fluid intake of about 1.5 to 2 litres a day is also important, since concentrated urine increases the urge to urinate.

How well does pelvic floor training work – and when is it not enough?

Pelvic floor training works, but it requires patience and consistency. With regular exercise, cure or improvement rates of about 46 to 75 percent can be achieved, entirely without side effects.

Realistic prospects of success

Success depends strongly on motivation and regular participation. First noticeable improvements often show after about six weeks, clear effects after two to three months.

When the next step makes sense

If the symptoms persist despite consistent training or are strong from the start, the next step can make sense. Medication or an operation is then discussed together.

Which medicines help – and with which form?

Medicines are used above all with urge incontinence, less with the stress form. The choice depends precisely on the form present.

With urge incontinence

So-called anticholinergics or more modern agents calm the overactive bladder and reduce the sudden urge to urinate. They act in a targeted way on the bladder muscle.

Local oestrogens after the menopause

After the menopause, locally applied oestrogens as a cream or pessary can strengthen the tissue and relieve symptoms. Oestrogen tablets taken by mouth, on the other hand, are not suitable, since they can rather worsen incontinence.

When is an operation sensible – and which methods are there?

An operation comes into question above all when conservative measures are not enough or the stress incontinence is strongly pronounced. Several established methods are available for surgical treatment.

Mid-urethral sling (TVT / TOT)

With the sling operation, a narrow synthetic tape is placed tension-free under the urethra and supports it like a hammock. The procedure takes only about 15 to 30 minutes and is regarded as an established standard method for stress incontinence.

Alternatives: Bulkamid (bulking agent) and colposuspension

Instead of a tape, a bulking agent can be injected into the wall of the urethra, which takes about 10 to 15 minutes. With colposuspension the urethra is lifted with sutures, which is also possible laparoscopically and thus in a particularly gentle way.

Source: EAU – European Association of Urology, guideline on stress incontinence

Is the tape operation (mesh/sling) safe? An honest assessment.

This question concerns many women, and it deserves an open answer. The mid-urethral sling is a long-established method with good long-term results, but like any operation it carries possible risks.

What the tape achieves and how established it is

The narrow tape stabilises the urethra and restores continence reliably in many women. It is important to distinguish this thin tape from the large-area meshes that have caused discussion in the past.

Possible risks named openly

The possible complications include bladder emptying disorders, urinary tract infections and pain in the operating area, each in under about 5 percent of cases. More rarely, in under around 1 percent, there can be an injury to the bladder or urethra.

How we weigh benefit and risk together

We discuss benefit, risks and alternatives openly with you and push for no procedure. Which method – or whether an operation at all – is the right one, we decide together and calmly.

How high are the prospects of success of a sling operation?

The sling operation has high prospects of success with stress incontinence. In long-term observations of up to 20 years, the success and cure rates remain at about 80 to 90 percent.

Success rates and long-term results

In one study, around 91 percent of the operated women reported a noticeable improvement, and about 85 percent felt cured after one year. The operation thus often performs better than training alone with pronounced symptoms.

What "success" realistically means

Success usually means that no or only very rarely urine is lost and pads become unnecessary. A complete freedom from symptoms cannot be promised in every case, which we address openly.

How does the procedure in Istanbul work?

The process is clearly structured and well plannable for patients from abroad. From preparation to discharge, usually only a little time passes.

Preparation and anaesthesia

Before the procedure, a preliminary examination and information about the course and risks take place. The sling operation can be carried out under local or brief general anaesthesia depending on the method.

The procedure step by step

Through a small incision in the anterior vaginal wall the tape is gently placed and set tension-free. A short monitoring then follows, before you can recover.

What does our treatment approach look like?

Our approach follows a clear principle: first conservative, then surgical. We recommend a procedure only when gentler paths are not enough, and we put your quality of life at the centre.

First conservative, then surgical – step by step

We begin with the precise diagnosis and the gentlest measures. Only when these are not enough do we talk about an operation and choose the suitable method together.

One responsible surgeon and quality of life at the centre

With us, Associate Professor Dr. Cengiz Andan accompanies you personally from the first assessment to the follow-up. With 18 years of experience in minimally invasive gynaecological surgery, we pay attention to a safe, gentle treatment.

How quickly do I recover after the procedure?

Recovery after a sling operation is usually rapid. Because the procedure is minimally invasive, the symptoms afterwards are as a rule mild.

The first days after the operation

Often only a short hospital stay of about one to two days is needed, some methods are carried out as a day case. Mild discomfort in the operating area subsides in the first days.

When you are fit for everyday life again

Light activities are often possible after just a few days, heavy lifting and sport after about four to six weeks. The exact course depends on the chosen method.

Typical course:

• Day of the procedure: rest, short monitoring
• Day 1 to 3: back to light everyday activities
• First weeks: no heavy lifting, no intense sport
• After about 4 to 6 weeks: usually full capacity

How safe is the procedure – and what if something happens after the return journey?

The sling operation is one of the safe standard procedures of urogynaecology. Serious complications are rare and overall are under about 2 percent.

How rare serious complications are

The more common complaints such as temporary emptying disorders are usually treatable well, while serious complications occur in under around 1 percent of cases. A careful preliminary examination lowers the risk further.

Reachability after the journey home and coordination with your local doctor

Should a question or abnormality arise after your return journey, we are reachable for you and coordinate where needed with your doctor at home. In this way the follow-up stays well supported even from a distance.

Home country or Istanbul – where does the difference lie?

With a planned procedure abroad, the question of quality and safety is at the forefront. The quality is equally very high in your home country and in Istanbul, because treatment follows the same international guidelines.

Same quality, same international guidelines

The methods used and the professional standards correspond to those in the home country. The difference lies not in the treatment itself, but in the surrounding conditions.

The difference lies in waiting time, continuity and cost

In Istanbul long waiting times fall away, and a single responsible surgeon accompanies the whole course. Through lower operating costs and the exchange rate, the prices are often up to about 50 to 60 percent lower – with the same technique and the same standard. As a guide, a sling operation in Istanbul costs roughly USD 1,800 to 3,200.

A second opinion from abroad – when is it worthwhile?

A second opinion is especially helpful when you have been advised directly to have a mesh or tape operation. Precisely because gentler paths should be examined first, an independent assessment often creates clarity.

When a second opinion makes sense

If the recommended treatment does not fit your form or a procedure seems premature, a second look is worthwhile. In the online consultation we look at your findings and tell you openly whether conservative measures are enough or an operation makes sense.

Process of the paid online consultation and documents for home

The consultation with Associate Professor Dr. Cengiz Andan takes place online and for a fee; it is not a free service. You send your documents in advance, and after any treatment you receive an understandable report that you can present to your doctor at home.