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Female urinary incontinence

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Female Urinary Incontinence Treatment in Bangalore | Nelivigi Multispeciality Hospital. Female urinary incontinence or urine leakage in women is a common condition occurring in a majority of women at some point in their life. It can occur at any age but more common in middle age and increases in old age. When severe it results in significant social and emotional problems.

There are many causes for the leak but the most common are the following:

  • Urge urinary incontinence: The leak of urine occurs without any provocation. The person gets a sudden, immediate urge to pass urine which cannot be postponed. Any attempt to do so results in significant discomfort and pain in the lower abdomen and genital region. It ends up with leakage of a few drops or even a significant quantity of urine.

This results in a serious social problem with the affected individual avoiding outdoor activities, social functions, and meeting with friends. She prefers staying indoors to avoid a socially embarrassing situation. Over a period of time; the individual becomes depressed and becomes a recluse.

There are many causes for this type of urine leak. Any condition that results in sudden contraction of the urinary bladder results in this. There are many diseases which cause such bladder contractions. Urinary tract infections, stones in the urinary bladder or lower ureter, bladder tumors, food allergies, mental stress are some of them.

  • Stress urinary incontinence: In this condition, the leak occurs when the person coughs, sneezes, laughs, or strains. In worse cases, the leak occurs even when the person gets up from bed or during any activity. The cause for this leak is the weakness of pelvic floor muscles which are responsible to keep the urine inside the urinary bladder. Pelvic floor muscles can be compared to the valve of a car tube which leaks when the valve is defective. The reason why the muscles become weak is due to repeated childbirths. Each childbirth stretches and weakens the muscle so that after a few years the women develop urine to leak. The problem becomes more severe if the childbirth has been conducted using a forceps or if the labor is prolonged.
  • Overflow urinary incontinence: The urine leak occurs when the bladder is full. For many reasons, the person is unable to empty the bladder. One of them is the neurogenic bladder where the nerve supply to the bladder is damaged. This commonly occurs in diabetes. Myogenic failure is when because of chronic over-distention of the bladder; the bladder muscle weakens and cannot contract to empty the bladder.
  • Urinary tract fistulas: There is an abnormal communication between the urinary tract and neighboring organs like the vagina and cervix. There is a constant urine leak from the vagina.

Evaluation

The urologist takes a detailed history and if needed does a physical examination to find out the cause of incontinence. Tests like urine examination, ultrasound exam will be enough most of the time. However, in more complicated cases special and more advanced tests like urodynamics, CT scan, and even an MRI will have to be done to come to a diagnosis. CT scan is especially useful to diagnose urinary tract fistulas. Cystoscopy is sometimes used to evaluate urinary incontinence as some cases can be difficult to diagnose.

Treatment or Female Urinary Incontinence Treatment in Bangalore

Medical treatment is given in cases of urgency and urges urinary incontinence. In the past few tears, medical treatment in the form of tablets has evolved and become highly effective. The disadvantage is that these tablets will have to be taken on a long term basis and have side effects which are minor.

  • Bladder training: The patient is taught to hold urine for progressively longer periods of time so that the frequency of urination becomes manageable.
  • Pelvic floor exercises: These are also called Kegel exercises and are used to strengthen pelvic floor muscles which are responsible for urine control. These exercises are prescribed for stress urinary incontinence and prolapsed of pelvic organs like uterus, bladder, and vagina. These exercises have to be done regularly and show effects only when done for a long time.
  • Biofeedback: This is a type of therapy where the patient is given audiovisual feedback that helps in controlling the sphincteric contractions and tone. Urinary sphincter is responsible for the control of urine and it can be trained to increase its tone to control urination.
  • Injections: Botulinum toxin is injected in the bladder to control muscle contractions. This is used when medical treatment fails. The injection effects last for about six months after which it has to be repeated.
  • Neuromodulation: This is a technique where an electrode is placed in the spinal cord to control bladder contractions. This is done by subjecting the patient to surgery under x-ray guidance. This is akin to placing a pacemaker to control heart rhythm.
  • Surgery: Surgery is done in stress incontinence when conservative treatment fails. They are commonly called sling surgeries wherein a sling made of polypropylene is inserted through the vagina to support the urethra. This is a minor surgery which can be done on a daycare basis.

Incase of urinary tract fistulae, the primary modality of treatment is a surgery where the fistula is disconnected and the defect is closed by stitches. This can be done by open technique or laparoscopic technique.

  • Self-catheterization: In patients with neurogenic bladder, there is no effective treatment to enable patients to pass urine on their own. This is because of the damage to the nerves of the urinary bladder which cannot be reversed. In such cases, the only way to empty the bladder is by inserting a catheter 3-4 times a day.

Conclusions: Female urinary incontinence is a common and distressing problem but with a thorough evaluation almost all of them can be treated effectively.