Uncontrolled loss of Urine in Women- Why suffer, let us talk about it to seek solution

Millions of women experience uncontrolled loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running, coughing or physical exercise. Others may feel a sudden and strong  urge to urinate just before losing a large amount of urine. In fact many women experience both symptoms. This condition can be either slightly bothersome or totally devastating. For some women, the risk of public embarrassment keeps them away from enjoying social   activities and interactions with family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress to the couple.

It has been observed that women experience this distressing problem twice as often as men. Pregnancy and childbirth, menopause, and the anatomical structure of the female urinary tract are mainly responsible for this difference.  One out of four has this problem after the age of 30 years and eight out of 10 who are affected , mistakenly believe that incontinence is a normal part of ageing. Many believe that it is a temporary problem which will go away on it's that they would have to just live with it. It's not that only women suffer from incontinence, both women and men can suffer from urinary incontinence  due to a variety of diseases and physical problems associated with ageing.

Middle aged & older women experience UI more often than younger women. But incontinence is not inevitable with age. It is a medical condition. Your doctor can help you find a suitable solution. No single treatment works for everyone, and a majority find improvement without surgery.

Incontinence occurs because of problems with muscles and nerves that help you to hold or release urine. The body stores urine in the bladder, a balloon-like organ, till it is voided. The bladder connects to the urethra, the tube through which urine leaves the body.

During normal urination, muscles in the wall of the urinary bladder contract, forcing urine out of the bladder into the urethra. At the same time, sphincter muscles which surround the urethra and act like check valve relax, letting urine pass out of urethra.  

Urinary Incontinence will occur if your bladder muscles suddenly and involuntarily contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged. Obesity, which is associated with increased abdominal pressure, can worsen this problem. Fortunately, weight loss can reduce its severity.

What are the types of Urinary Incontinence?

Stress incontinence

 

Leakage of small amounts of urine during physical movement (coughing, sneezing, laughing, exercising and normal household chores like lifting some heavy object) which increases pressure inside the abdominal cavity.

Urge incontinence

 

Leakage of large amounts of urine at unexpected times

Mixed incontinence

 

Occurence of  stress and urge incontinence together

Functional incontinence

 

Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevents a person from reaching a toilet, often a problem in old age or people with physical debility.

Overflow incontinence

 

Unexpected leakage or dribbling of small amounts of urine from a full bladder.

     

Transient incontinence

 

Leakage that occurs temporarily because of a situation that will pass ( urinary tract infection, taking a new medication, colds with coughing).

How is incontinence evaluated?

The first step toward relief is to see a doctor who has experience in treating UI, to learn what type you have. A urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary and associated pelvic problems in women. Family doctor sees patients for all kinds of health conditions. Any of these doctors may be able to help you.

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem—including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often your treatment will begin  at the first medical visit.

Your doctor may instruct you to keep a diary for a day or more, sometimes up to a week—to record when you void. This diary should note the times you urinate and the amounts of urine you produce. You can also use the bladder diary to record your fluid intake, no of times you leak, and estimated amounts of leakage.

If your diary and medical history do not define the problem, the treating doctor will  suggest which tests you need. Your doctor will physically examine you for signs of medical conditions causing incontinence. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. Usually this condition is more common after multiple pregnancies.Your doctor may measure your bladder capacity and  the residual urine for evidence of poorly functioning bladder muscles. Your doctor may also recommend other tests:

Bladder stress test—You cough vigorously as the doctor observes loss of urine

Urinalysis and urine culture—tests for evidence of infection, urinary stones, or other contributing causes.

Ultrasound—This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.

Cystoscopy—The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.

Urodynamics— Various techniques measure pressure in the bladder and the flow of urine.

Not all these tests are required in everyone with incontinence

How is incontinence treated?

Depending on the type of UI, your doctor may recommend  the following

Behavioral Remedies: Bladder Retraining and Kegel Exercises

By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.

How do you do Kegel exercises?

This is a simple exercise regimen  to strengthen your pelvic muscles. While your doctor can advise you how to do these exercises, you can try practising on your own. The information is also available on the internet. Squeeze your pelvic muscles as if you are trying to lift the floor of your pelvis or trying to hold urine .Try not   to squeeze other muscles at the same time such as  tighten your stomach, legs, or buttocks. Just squeeze the pelvic muscles. Don't hold your breath. Do not practice while urinating. Repeat, but don't overdo it. At first, find a quiet spot to practice—your bathroom or bedroom—so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. When your muscles get stronger, do your exercises sitting or standing.

Be patient. Don't give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks. These exercises are not harmful for you.

Medicines for Overactive Bladder

If you have an overactive bladder, your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency. Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. They are generally well tolerated though dry mouth, and constipation may occur. These medicines are prescribed by your doctor and are not over the counter remedies.

Pills to treat swelling (edema) or high blood pressure may increase your urine output and contribute to bladder control problems. Talk with your doctor; you may find that taking an alternative to a medicine you already take may solve the problem without adding another prescription.

Biofeedback

Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Neuromodulation

For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients. Although neuromodulation can be effective, it is not for everyone.

Vaginal Devices for Stress Incontinence

One of the reasons for stress incontinence may be weak pelvic muscles, the muscles that hold the bladder in place and hold urine inside. A pessary is a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure reduces stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.

Injections for Stress Incontinence

A variety of bulking agents, such as collagen and carbon spheres, are available for injection near the urinary sphincter. The doctor injects the bulking agent into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence.

Surgery for Stress Incontinence

In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position.

Catheterization

If you are incontinent because your bladder never empties completely—overflow incontinence—or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while or on a constant basis.. These treatments are decided by your treating doctor, usually specialists.

Other measures

Many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers. This leads to low self esteem & cut off from social activities. Some women resort to wearing adult diapers. This practice is unfortunate, because diapers can lead to diminished self-esteem, as well as skin irritation and sores. Not only that it may further compound problem due to smell of urine, cumbersome to use and dispose as well as  high cost of daily use.

A recent development brings hope back for a trouble free management of uncontrolled leak of urine in all age groups and both sexes. This is possible through I.M.E.C. Safety Pants marketed by Incontinence Textiles Pvt. Ltd. India, In collaboration with I.M.E.C. Germany. These I.M.E.C.® Safety Pants have been developed by  Professor Dr.H. Madersbacher, Germany who is also 1st Chairman of the medical society for Incontinence help, Austria & member of the committee " Continence Worldwide ").

These IMEC Safety Pants are fashionable, reusable, and washable underwear made of 100 % fibres ( anti-micro bacterial, odour and perspiration absorbing textile)  and free from PVC and HCFC. After each laundry these outstanding characteristics renew themselves. In Europe, people are wearing these to the beaches without any embarrassment or fear of uncontrolled leakage and wetting of clothes. These are 100% water tight, highly absorbent and can absorb liquid up to 500 ml which can be further increased by inserting slips to  soak up to 1.5 liters of liquid, amazing! The combination of material provides wearer a pleasant feeling in the garments, the same as normal underwear. These products are 100 %, enormously suction strongly with no perspiration or dampness escape, small or no moisture build up, air-permeable, highly respiration-actively without accumulation of heat, extremely skin-friendly, inconspicuously, discretely, appear not under tight clothing and have an optimal stretch comfort, as well as a long life span. These products have received recognition by German insurers and 100 % claims are given by the National Health Service. Very shortly the same approval is expected from medical authorities and insurers in other European countries and USA.  These safety pants can be used in both medical conditions as well as in the social setting, and can restore feeling of self confidence and quality of life.

For further information You can write to: 4, Deen Dayal Upadhyaya Marg, New Delhi- 110002 Help Desk- 9899016873, 9899013674 or email e mail: cpscmail@bol.net.in.

Article written by: Dr Sunila Khandelwal Uro Gynecologists Jaipur Ex- President Indian Menopausal Society

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