Urinary incontinence means involuntary leakage of urine. It is a common problem among females across ages. It is an embarrassing problem that has implications on one’s lifestyle as well as social and mental health. Most of women are too embarrassed to discuss it with anyone. They continue to suffer silently, make amends in their lifestyle, and keep enduring the problem. In elderly females, the problem is particularly common and it is passed off as normal. At no age, urine leakage should be considered normal and treatment should be sought.
Broadly there are three types of urinary incontinence:
1. Stress incontinence: It means leakage of urine upon a sudden increase in abdominal pressure. Urine may leak while coughing, sneezing, or lifting heavyweights. It is due to the weakness of the external urethral sphincter muscle (EUS). This muscle prevents leakage of urine upon an increase in abdominal pressure by tightly closing the urine outlet. The weakness of this muscle decrease the force of closure leading to leakage of urine. The commonest cause of the weakness of this muscle is delivery. Other reasons can be sudden weight loss, evacuation, old age. The leakage in such patients can be controlled by increasing the strength of EUS muscle. It can be done by regularly doing Kegal’s exercises. You can ding the tutorial of the same on YouTube. It may take up to 3 months to substantially increase muscle strength. So be patient. In the meantime, certain medications can help to decrease the severity of the problem. Another approach for treatment is the use of urethral slings. It is an operative procedure in which a mesh is placed in the mid part of the urethra which supports it and increases the force of contraction. It’s a daycare operation and patients can be discharged on the same day.
2. Urge incontinence: This implies whenever there is an urge to pass urine, it’s impossible to control it. One has to rush to the washroom, but before one can get prepared to void, urine leaks in undergarments. Urge incontinence can be due to overactive bladder, urine infection, diabetes, and sometimes as a sequel of stroke. The management is this problem can be medical or surgical. There is a class of medicines called bladder sedatives which decrease the overactivity of the urinary bladder. Apart from medicines, one has to regulate the fluid intake and avoid oily and spicy food. If despite medications there is bothersome urine leakage, a small surgical procedure that involves injecting botulinum toxin into bladder walls can be done.
3. Continues urine incontinence: Sometimes there is a continuous leakage of urine from the vagina. This follows operation for removal of uterus or ovaries or some other pelvic surgery. During surgery, some part of the urinary tract gets injured which leads to leakage of urine. This urine starts dribbling out from the vagina. This condition is called a genitourinary fistula. Treatment involves operation for repair/ reconstruction of the injured parts of the urinary tract. The operation can be open or keyhole surgery.
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