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Urinary Incontinence

The Specialists

Dr.Anshumala Shukla-Kulkarni - M.D (O&G),FCPS,DGO
Dr.Anshumala Shukla-Kulkarni has done her Fellowship in Minimally invasive surgery from Singapore and Australia. She holds her specialty in Gynecological Laparoscopy Surgery. Find out more about Dr. Anshumala


Dr.Maya PL Gade - M.B.B.S., MD (Gyn & Obs)

Dr.Shantala Vadeyar - M.B.B.S. , MD (Gyn & Obs), Advanced Obstetric Ultrasound Diploma, FRCOG, DM (UK), CCST
Dr.Shantala Vadeyar, specialist in Advanced Obstetric Ultrasound (RCOG /RCR),adept at performing fetal ultrasound including 3D / 4D scans, interventional ultrasound guided procedures (prenatal diagnosis,amniocentesis, CVS). She has worked in the UK for 14 years and as a Consultant in the UK for over 5 years in Obstetrics, Feto-maternal Medicine (High risk pregnancy) and general gynaecology. Find out more about Dr. Vadeyar

What is Urinary Incontinence?

Urinary incontinence is the loss of bladder control. This means that you can't always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate, that are difficult to control. This can be embarrassing, but it can be treated.
Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.

What causes incontinence?

Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. Refer to the common causes listed below.

  • For women, thinning and drying of the skin in the vagina or urethra, especially after menopause Weakened and stretched pelvic muscles after childbirth
  • Certain medicines
  • Build-up of stool in the bowels
  • Being overweight and obese increases pressure on the bladder and muscles that control the bladder
  • Urinary tract infections
  • Vascular disease
Are there different types of incontinence?

Yes. There are 5 types of urinary incontinence:

Stress Incontinence
Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise.Stress incontinence usually occurs when the pelvic muscles are weakened,for example due to childbirth or surgery.Stress incontinence is common in women.

Urge Incontinence
This occurs when the need to urinate comes on very suddenly, often before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of a urinary tract infection or an overactive bladder.

Overflow incontinence

Functional incontinence

Mixed incontinence

Is urinary incontinence just part of growing older?

No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesn't mean you'll have urinary incontinence just because you're aging. With treatment, it can be controlled or cured.

How can it be treated?

Treatment depends on the type of incontinence and cause of the incontinence. Various treatment modalities are:

Pelvic floor exercises (Keigel's exercises):The pubococcygeus muscle (the levator ani muscle), present in both men and women, is a muscle that provides support to the bladder, vagina, and rectum. By contracting this muscle, you can interrupt your urinary stream completely. This muscle is also the muscle that is used to tighten up the vagina and rectum. You must first learn awareness of this muscle and after this step is achieved, exercise it to increase its strength. This is not the muscle of the abdominal wall (rectus abdominus), the muscle of the buttocks (gluteals), or the muscles that bring the thighs together (adductors).

While urinating, try to stop the flow of urine midway. The muscle contracted to do so is your pubococcygeous.

Once you are fully aware of the location and nature of this muscle, you can then exercise it at times when you are not urinating. These exercises can be done anywhere and at any time and in various positions such as lying down, sitting, or standing.

Squeeze and hold the muscle for a count of 10, then relax for a count of 10.

Repeat this 10-20 times in a set, at least 3 sets in a day.

The benefits of these exercises will continue only so long as you do them.'Use it or lose it' applies here. As in any muscle conditioning program, it may take 6 to 12 weeks of exercising before noting an improvement in urinary incontinence.

Bladder training: These are sets of behavioral therapy to train the bladder to hold increasing quantities of urine.Ask your doctor for a detailed therapy best suited to you.

Surgery: 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.

  • Laparoscopic Burch Colposuspension: In this operation,the loose tissue around the urethra is supported by sutures to strengthen pubic bone ligaments. It takes about 2 hours to perform and requires minimal stay in hospital.
  • TVT & TOT: These are vaginal synthetic mesh slings introduced through a cut in the vagina and they provide support to the mid-urethra.If you have pelvic prolapse, your surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy.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 of mentioning their problem. They may have urinary incontinence which can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments, or diapers. This practice is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises.
Points to Remember
  • Urinary incontinence is common in women
  • All types of urinary incontinence are treatable
  • Incontinence is treatable at all ages
  • You need not be embarrassed by incontinence
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