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 Women's Health

october 2010
The Trickle-Down Theory
Urinary Incontinence in Women
Dr. Rajagopal
 
So much for all those TV commercials – the women are always laughing in them. Do they know that there are other women afraid to laugh – for they might accidentally pee if they do?

For all those women living with the involuntary trickle, here’s news that is both good and important: you don’t have to live with it. Today, there are many treatment options that can help you gain control over accidentally passing urine.
Since this is an embarrassing condition, patients do not actively seek medical help.  Hence, statistics about the incidence are heavily skewed, but the accidental trickle is believed to affect around 40 percent of women - with a steady increase from 30 to 40 years and reaching a peak in those above 60. Menopause is considered a risk factor. Delivery, obesity, diabetes, chronic cough, constipation and any abdominal or pelvic surgery are the other culprits.

Preliminary Notes
Urinary incontinence, according to the International Continence Society, refers to any involuntary loss of urine. They also recommend that doctors take note of these details when the patient describes her incontinence:
  1. Type
  2. Severity
  3. Precipitating factors
  4. Social impact
  5. Effect on hygiene and quality of life
  6. Measures used to contain the leakage
  7. Whether or not the individual desires help
Typecast
  1. Stress Urinary Incontinence: Involuntary leakage of urine during the increase in intra-abdominal pressure such as exertion, sneezing, coughing or even laughing (known as giggle incontinence).
  2. Urge Urinary Incontinence: Involuntary leakage of urine accompanied by or immediately proceeded by urgent desire to urinate.
  3. Mixed Urinary Incontinence: Involuntary leakage of urine associated with urgency and also during exertion.
  4. Other types: Like leakage during nights (nocturnal enuresis), dribbling of urine after passing the urine, overflow incontinence (very common in diabetics) and occasionally leakage from other organs like vagina or rectum, usually after some operative procedures.
Tests & Counselling
A gynaecologist or urologist could run you through these routine physical examinations to ascertain the type of incontinence:
  • Routine urine and blood tests
  • Urine culture to check infection
  • Ultrasound scan of abdomen
The urologist may advise a cystoscopy (endoscopy of the urinary bladder via the urethra) and stress test (telescopic examination of urinary bladder) before finalising the appropriate treatment needed for each patient.

A detailed discussion of the problem, causes, preventive treatment plans, and if necessary, surgical treatment should be discussed. Every woman seeking help for urinary incontinence must understand her problem, remedial measures and outcome of treatment.

Here’s Help
Treatment depends upon many factors, the main being the cause and nature of incontinence. Treatment towards strict control of diabetes, diet and weight reduction – staying fit and healthy - is more important here, than any other problem.

Urge Incontinence, also known as overactive bladder, has symptoms of frequency, urgency, excessive urination at night, and incontinence.
  • Medication would be sufficient to treat this. There are many good medicines available now which can relax the bladder and the bladder muscle.
  • Correct fluid intake, avoiding bladder irritants, maintaining a Bladder Diary (how often, when, where) are very useful.
  • Pelvic floor muscle exercises, yoga, voluntary control and physiotherapy are also helpful.
Genuine Stress Urinary Incontinence is essentially a surgical condition. Some measures like weight reduction, pelvic floor exercises with vaginal cones and medicines can be tried; they may work, at least temporarily.
  • The revolutionary surgical treatment of stress incontinence is fairly simple and effective. Popularly known as TVT (TransVaginal Tape) Placement, it is about placing a tension-free vaginal tape around the urethra, with small incisions. The TVT works like a hammock compressing the urethra (urine pipe) during exertion, thus avoiding urinary leakage.
Dr. Rajagopal is Consultant – Urology at Apollo Health City, Hyderabad


    
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