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Urinary incontinence, often called loss of bladder control, is the unwanted loss or leak of urine. It is a symptom, not a disease, caused by a variety of conditions, common in millions of women which can be a source of great embarrassment. 1 out of every 4 women has urinary incontinence after the age of 30 years, and 8 out of 10 who are affected, mistakenly believe that incontinence is a normal part of ageing!
They believe that it is a temporary problem which would go away on its own or they would have to just live with it.
Different Types Of Incontinence:
Urge incontinence is the loss of urine when there is a strong need to go to the restroom, especially whilst on the way to the restroom, at night or even on hearing or touching running water.
Stress incontinence can occur during exercise or movement in certain ways, or on sneezing, coughing or laughing.
Overflow incontinence creates a feeling of never completely emptying the bladder and can cause loss of small amounts of urine throughout the day.
'Here are some examples of what various women have told me in my clinic. These are commonly experienced by women:
"...I leak a lot when I develop a cough or cold..."
"...I leak when I go for my daily walk..."
"...I do not drink water for fear of leaking. I am always thirsty..."
"...I have to think before selecting a good saree to wear, suppose I wet myself ..."
"...I am embarrassed because of the foul smell, I avoid social functions..."
"...I can not cook spicy food, it makes me leak onto the kitchen floor.."'
Urinary incontinence affects women of all ages, may they be young mothers or premenopausal women or older women.
A general loss of pelvic muscle tone because of ageing, nerve or muscle damage resulting from injury or previous surgery may be the reasons for the incontinence. The other risk factors for incontinence include childbirth, especially vaginal delivery, obesity, chronic coughing, constipation and even certain medications.
All these weaken the muscles, which normally keep the outflow tract closed, thus leading to incontinence. The impact on women is dramatic. 90% of sufferers are women, often affected in the prime of their lives! Their problem increases during menopause and peaks with ageing.
Various Causes Of Urinary Incontinence:
I Infections (urine, vagina)
A Atrophic vaginitis (due to reduced estrogen)
P Psychological causes (especially depression)
P Pharmaceutical agents
E Endocrine conditions (diabetes)
R Restricted mobility
S Stool impaction
Women may wear pads, reduce their fluid intake or make changes in their social lives. Incontinence may discourage women from doing things that they would ordinarily do to stay healthy.
They may give up outdoor exercise, limit lifting their children or groceries and/or avoid sexual intimacy. They may struggle with issues ranging from loss of self confidence and self-esteem to frustration, a sense of defeat and financial concerns, due to loss of productivity.
The history of the patient involves determining the number of childbirths, delivery type and prior pelvic surgery. Physical examination is carried out to determine vaginal health. Various tests can be carried out to determine the cause of incontinence which then ultimately helps to decide the line of therapy.
Various Tests Done Can Vary From Simple Tests To Very Specialized Tests Which Include:
Q-Tip test (positive if C T scan/ RI >30 degrees)
Current treatment options range from pelvic muscle exercises, behavioural modifications, treatment of urinary infection, local hormone therapy, neo-control therapy and surgery.
Surgery offers the best cure rates for stress urinary incontinence even in elderly women. Surgical treatment involves the use of TVT (tension-free vaginal tape) which is an innovative, effective and simple solution for stress incontinence.
It entails a day care surgery which is minimally invasive. It is a simple surgical option to treat incontinence which is completed in 30 minutes and can be done under local anesthesia. The patient returns home the same day and has minimal post-operative pain.
It has a 96% success rate with 85% patients completely cured and about 11% patients experiencing significant improvement.
Newer medical therapies are also available for urge incontinence and make the woman's life more manageable.
Use of adult diapers/pads to prevent a leak
Avoiding exercise/physical activity
Reducing tea/coffee intake
Changing lifestyle as needed
Every affected woman wants the freedom from sudden urine loss, a normal, active social lifestyle, freedom from shame, embarrassment of a sudden leak, a safe and simple treatment, no scar, short hospital stay, no complications and above all a better quality of life. Though incontinence is a common problem in women, it has a big impact on women's lives! Most women suffer in silence due to lack of awareness on available treatment options.
It is heartening to know that women can now control their lack of control!
SOURCE: Dr Duru Shah
Center for Assisted Reproduction & Women's Health
Panel Consultant - Breach Candy Hospital & Jaslok Hospital