Urinary Incontinence- Dr. Venkatesh Krishnamoorthy

Dr. Venkatesh Krishnamoorthy - Senior Consultant Urologist & Chairman, NU Hospitals, Bangalore

Urinary incontinence beyond the age of toilet training in children, is an abnormality, that needs to be treated. It can cause a lot of embarrassment, especially for people in the social domain and causes embarrassment, leading to curtailment of the person's social activities. This condition is more in women, and in the elderly. It is also common in people with neurological disorders.

The severity of this condition may range from occasional, and small quantity urine leak, to sudden and complete emptying of the urinary bladder.

Types of urinary incontinence:

1. Stress incontinence: When there is urine leak during any physical stress such as sneezing, coughing, laughing, or physical exercise

2. Urge incontinence: When you feel the urge to urinate suddenly, and some or a large amount of urine leaks without your ability to stop it.

3. Mixed incontinence: When the involuntary urine leak happens due to more than 1 cause. This may be because of a combination of high bladder pressures and weak sphincters.

Ensure that you consult your urologist:

1. If this condition is more than minimal, and bothers you

2. If the urine leak is a result of other associated medical problems, such as previous pelvic surgery, neurological disorder, infection and inflammation in the lower urinary tract etc.

Causes of urinary incontinence:

Urinary incontinence may be for a short period, or for a long duration.

Short periods of incontinence are:

1. Excessive alcohol intake

2. Excess fluid intake

3. High caffeinated drinks

4. Urinary tract infection

5. Constipation

It may be also due to a combination of all these factors.

Long term urinary incontinence is due to the following:

1. Repeated pregnancies or damage to the pelvic muscles due to childbirth

2. Old age

3. Past pelvic surgery

4. Neurological problems

5. Lower urinary tract obstruction and overflow

Treatment for urinary incontinence:

Good therapy is available, with excellent outcomes. Very few of these problems are untreatable.

1. Most important is to make lifestyle changes. Reduce the amount of fluid that is consumed, make a habit of timed urination, so that the bladder is not kept full.

• Avoid foods that contain a lot of liquids like fruits and raw vegetables
• Avoid lifting heavy weight and activities such as jumping and running

2. Medications - medications are the next level of therapy after the lifestyle changes suggested have been done.All medications are invariably for the long-term, and it should be resorted to only when the lifestyle changes do not result in relief. There are some medications which increase the urine output, prescribed for other medical conditions. Talk to your doctor to see if these can be stopped or the dosage changed.

3. Nonsurgical therapy. Exercises to strengthen the pelvic muscle if done regularly and under proper supervision can help relieve your symptoms to a significant extent. Kegel's exercises are the most well-known of these.

4. Avoid constipation. A full rectum can also affect the function of the urinary bladder.

5. Surgery. If all the treatments fail, this will be the last option. It is so because, these are non-reversible to a large extent. Some of the interventional therapies are:

• Bulking material injections in the urethra
• Botulinum toxin type A, to decrease pressures in the bladder
• Nerve stimulators to reduce an overactive bladder
• Urethral sling surgeries, when the sphincter muscles in the urethra are weak
• A combination of the above therapy

Remember all treatments must be under the supervision of a medical professional, specialized in this field.