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Incontinence should not be summarily dismissed as an inevitable consequence of ageing. Basic tests should be done to rule out any correctable cause Dr Gita Mathai
The urge to urinate is under voluntary control and can be suppressed until a suitable opportunity appears…...click & see
Coughing, sneezing and laughing are normal, unavoidable day-to-day activities which cause a transient increase in intra abdominal pressure. Young people are unaffected, but in 25 per cent of women and 15 per cent of men above 65 years of age, the actions involuntarily produce embarrassing dribbling of urine or stress incontinence.
The bladder can normally accommodate 500 ml of urine. The urge to void appears when it contains 200 ml. If there is an obstruction to free voiding due to an enlarged prostate, an uterine or ovarian tumour, or even constipation, the bladder becomes overfilled. The urine can then leak from the full bladder in small quantities leading to overflow incontinence.
The urge to urinate is under voluntary control; it can be suppressed until a suitable opportunity appears. Hyperactivity of the muscles in the bladder can allow urine to escape even if the bladder is not overfilled, as soon as the urge is felt, before reaching the toilet. This can occur with increasing age especially if the person also has diabetes, stroke, dementia or Parkinsonâ€™s disease. It may be secondary to stones in the bladder or an urinary tract infection.
Incontinence is commoner in women. Statistics show that 50 per cent of women have occasional urinary incontinence and 10 per cent have frequent incontinence. The incidence increases until 20 per cent of women over the age of 75 years experience daily urinary incontinence.
This is because anatomically, women have a shorter urethra and weaker pelvic muscles. Damage can also occur as a result of childbirth. The onset of menopause decreases the levels of the female hormones, causing atrophy of the vaginal mucosa and loss of pelvic muscle tone. This causes the bladder to protrude into the vaginal space increasing incontinence.
Incontinence should not be summarily dismissed as an inevitable consequence of ageing. Basic tests should be done to rule out any correctable cause .
A physical pelvic examination to rule out abnormalities of the pelvic organs.
Blood tests to rule out diabetes.
Urinalysis and culture if infection is suspected.
A few simple lifestyle interventions can help to reduce stress incontinence .
Reduction in weight, such that the BMI (body mass index) is around 25.
Control over volume of fluids drunk and reduction in the quantity if it is more than two-three litres per day.
Prevention of constipation as hard faecal matter acts as an obstruction that aggravates stress incontinence.
Regular voiding, so that the bladder is never too full.
Women can increase the strength and tone of the pelvic muscles and re-train their pelvic musculature with Keegle’s exercises.
To perform these exercises correctly, the right muscles first need to be located. To do this, stop and start urination without using the stomach, leg or buttock muscles.
Squeeze these muscles. Hold for a count of 10. Relax for a count of 10. Do this 20 times, three-four times a day.
Alternatively, each time you go to the toilet to pass urine, stop and restart the process voluntarily several times, so that you exert control over the action.
The bladder can also be re-trained by consciously increasing the time between voiding.
Within four weeks, 70 per cent of women markedly improve and 15 per cent are permanently cured. The benefit disappears within a few days if the exercises are not consciously continued.
Medications can be used as an adjuvant to exercises. Tricyclic antidepressants and other groups of medications can be used to treat stress incontinence in patients with mild-to-moderate symptoms. Fifty per cent of the people respond favourably.
Oestrogen replacement, either taken orally as part of HRT (hormone replacement therapy) or applied locally in the vagina as a cream, improves urinary frequency, urgency, stress incontinence and burning in postmenopausal women.
Surgical treatment can be considered after a thorough evaluation, examination and investigation to determine the exact cause of the urinary incontinence. Surgery can help by correcting the anatomical abnormalities, supporting the bladder and urethra in the proper position, and tightening the urethral sphincter. This helps to achieve voluntary control. Surgery has a 75-95 per cent cure rate if the patients are carefully selected. The procedure involves anaesthesia and hospital stay and is not totally risk free. The eventual outcome is unsatisfactory in people .
With prior surgical failures
If there are other genital or urinary problems
In case of other complicating diseases that may prevent adequate healing or make the technical aspects of the surgery more difficult.
As age advances, the bladder capacity reduces; the urinary stream becomes weaker, and visits to the toilet more frequent. This does not, however, mean that urinary frequency, urgency and stress incontinence have to be accepted as an inevitable part of ageing.
Most incontinence problems, provided they do not require corrective surgery, can be cured by motivation, weight loss, dedicated re-training of the bladder and pelvic exercises.
Source:The Telegraph (Kolkata,India)