Nobody's talking ( Article about In Continence meaning Uncontrolled Urination) by Dr. KARTHIK GUNASEKARAN in the Health Watch, The Hindu, Sunday Magazine Section dated 8.1.2006
SHEELA (35) is a kindergarten teacher and mother of two. Sheela loves her job and is good at what she does. But over the past few months she is having a difficult time. She is not able to raise her voice to keep order and is not able to share a funny moment with the kids. In the middle of the class she runs out only to return with a forlorn look. Her sleep is disturbed and she is depressed.
Sheela knows what her problem is. But how can she tell her husband or her friends? What will they think? Her mother told her that most women who go through labour and delivery suffered from this problem. Is
leakage of
urine such a simple issue? If so, then, why doesn't she hear about it more often?
Sheela is not alone. She and a million other women
suffer from a condition medically termed as
urinary incontinence. This refers to the involuntary leakage of urine, which becomes a social and hygienic problem for adult women. In the U.S., it is estimated that at least 10 million women suffer from distressing urinary incontinence. The Asian Society of Female Urology puts the incidence of urinary incontinence in India at 12 per cent. Millions suffer in silence and embarrassment. Urinary incontinence often takes over the patient's life limiting social activity and even work. It threatens self-confidence and self-esteem, inhibits sexual activity and exercise, and can even affect the way people dress. Not normal Urinary incontinence is not a normal part of aging. The aging process merely predisposes a woman to urine loss. Weak muscles, childbirth, poor nutrition and fluid intake, gynaecological surgery, urinary tract infections, spinal cord injuries and emotions all play a role in the aetiology of incontinence. Although incontinence occurs in men, its prevalence is less than one third that of women and in most cases has a defined aetiology.
The two most common causes of incontinence involve
bladder instability (Urge Incontinence) and anatomic lack of urethral support (stress incontinence). Overflow urine loss and lack of tone in the
urethra (bladder tube) can happen as age advances. Stress incontinence is the leakage of urine with activities that increase pressure inside the abdomen like coughing, sneezing and laughing. Women can also lose urine while engaging in sports, bending, getting up from a seated position and lifting weights. Urge incontinence is leakage of urine accompanied by a sense of urgency.
Physicians as well as patients should understand that urinary incontinence is not life threatening. However, it severely affects quality of life (QOL).
A three-day diary that gives details of the frequency of urination, quantity, urgency, stress or related events and the quantity of fluid intake is mandatory Simple tests like urine dip, culture, blood sugar and thyroid function tests can be done. A bladder scan can be done to check the post-void residual.
Higher investigations would include a cystourethroscopy to look inside the bladder and urethra. Probably the most favoured investigation would be Multichannel urodynamics. Treatment for urinary incontinence can either be surgical or conservative.
Behavioural modification including regulation of fluid intake and avoiding caffeinated drinks, spicy food, citrus fruits and chocolates help in reducing bladder spasms. Timed voiding reminds the patient to void at frequent intervals and helps in training the bladder. Appliances like pessaries and bladder neck support prosthesis may offer a temporary solution.
Surgical treatment involves either anchoring the bladder supports to a higher point as in Burch Colposuspension or supporting the urethra by means of a small polypropylene tape kept under it. The tape, which is in the form of a sling, acts as a backstop and prevents leakage of urine during rises in intra-abinpressure. . Injectables like collagen and silicon polymecan be used to bulk up the urethra and provide tone. As this problem "comes out of the closet" it is the responsibility of physicians to inform patients of the choices available for
Currently all women with incontinence can be helped if not cured. Finally, one should never think of incontinence as something they have to put up with or as part of growing old
More reviews about the The Hindu dated 8.1.2006, Sunday Magazine, The Health Watch Section.