Urinary incontinence means involuntary leakage of urine. In other words, it is inability to hold back urine under certain conditions.
This problem affects millions of women all over the world. Almost 20 to 30% of young women and 50% of the elderly suffer from this condition though many do not report it even to their doctors due to embarrassment. Some are forced to use pads throughout the day while others learn with experience, to empty their bladder frequently or squeeze their pelvic muscles every time they cough or sneeze, to prevent that leak!
When a woman often leaks urine at any time, any place, she gradually lose her confidence to go out or socialise. In severe cases, she may end up depressed and become a social recluse.
How does our system control urine?
The urinary bladder is the bag which stores urine. It is made up of muscle fibres known as the ‘detrusor’ muscle, the contraction of which pushes urine out of the bladder. Another muscle, the ‘internal urinary sphincter’ surrounds the outflow passage from the bladder and helps to close the urinary passage and hold back urine.
When the volume of urine reaches a certain amount in the bladder and the person finds a suitable place to relieve herself, the detrusor contracts, the sphincter relaxes and urine flows freely.
Why do some women lose urine control?
Women are much more likely to develop incontinence because excessive stretching during pregnancy and childbirth can result in weakening of pelvic muscles which hold back urine. After menopause the pelvic floor can weaken further worsening the condition. Apart from this, weakness of nerves or muscles due to aging or uncontrolled diabetes can contribute to loss of urinary control in both sexes.
Incontinence does not happen to all women with aging and women suffering from it should seek treatment.
Commonly, incontinence in women can be of the following types:
Stress incontinence means loss of urine whenever the pressure inside the abdomen increases such as while sneezing, coughing, lifting weights or laughing aloud. This is usually the direct result of weakness of the pelvic floor and is common after childbirth and menopause.
Urge incontinence means that when the person gets the urge to pass urine, she senses urgency and leaks small amounts of urine even before she can reach the toilet. It is often accompanied by frequency (having to pass frequently).
It is usually the result of an ‘overactive detrusor muscle’ caused by urine infection or irritation, or nerve damage due to conditions like multiple sclerosis, spinal cord injury or Alzheimer’s disease. It is common among women in the fourth decade onward.
Mixed incontinence is the presence of both stress and urge incontinence. Thus, she may leak urine in response to cough, sneeze, and may also not be able to hold urine till she reaches the toilet. This is the most common type of incontinence among women.
Urinary leaks may often be accompanied by weakness of pelvic floor muscles leading to prolapse or ‘something coming out from the vagina’.
Please understand that the diagnosis of the type of incontinence is critical as treatment depends entirely on the type of incontinence. Your doctor may tell you to maintain a ‘urinary diary’ in which you would need to write down day-to-day details of your urinary habits and leak episodes. Besides, routine tests and a sonography of the urinary tract, you may need to undergo cystoscopy (visualisation of the inner lining of the bladder through a telescope).
Urodynamic study is a special test to measure pressures within the bladder and urethra and it helps to determine the type of incontinence. This test is done in specialised hospitals and clinics and may take many hours to perform.
In general, treatment for stress incontinence is surgery to support the pelvic floor muscles, while treatment for urge incontinence is medication to relax the detrusor muscle. However, treatment has to be individualised as each case is unique and a combination of medical and surgical treatment is often needed.
Pelvic floor exercises (Kegel’s) help to strengthen the pelvic muscles and offer relief to many women with mixed and stress incontinence of the mild variety, but are largely ineffective in severe cases.
Many new simpler surgeries (slings, tapes, injections, laparoscopic and cystoscopic suspension) are available now which entail minimal anaesthesia, low risk and good results too. If you have prolapse, we would need to surgically correct that as well at the same sitting.
It is very important that you discuss with your doctor the various options and have a clear idea of what to expect from treatment, especially surgery. Treatment should take into account your needs and preferences. Surgery for incontinence may not always be completely successful and may cause difficulty in passing urine in the immediate post-operative period. Medical treatment may need to be taken over prolonged periods.
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