Urinary Incontinence

Urinary Incontinence is the involuntary loss of urine which is objectively demonstrable and causes a social or hygienic problem. It is estimated that anywhere between 25-70% of women suffer from this problem. However the prevalence of urinary incontinence in the community has been severely underestimated. This is because 40% women feel embarrassed to talk about this problem to their doctors and >60% women perceived urine loss as a normal consequence of ageing. Less than half the individuals living in the community with Urinary Incontinence seek treatment.

The medical consequences of Urinary Incontinence include rash, pressure sores, skin and urinary tract infections and falls. Psycho-social consequences include restriction of social and sexual activity and depressive symptoms. There are three major types of urinary incontinence.

Stress Urinary Incontinence is the involuntary loss of urine with any activity that increases intra-abdominal pressure like coughing, sneezing and laughing. Lifting weights can also contribute to this. The majority of women affected by Stress Urinary Incontinence find it a problem. Stress Urinary Incontinence can have a major impact on all aspects of well being. Since Stress Urinary Incontinence is mainly prevalent in young and middle aged women who have an active professional or social life, this might have a greater impact. These women may experience limitations in terms of physical (playing sports, lifting heavy weights) occupational and social activities because of fear of leakage of urine and related consequences (e.g. smell of urine, wetness, visibility of pads etc.). Stress Urinary Incontinence can also affect a woman’s sex life, social activities and interpersonal relationships.

What Causes Stress Urinary Incontinence?

The two most common causes that have been sited so far have been increased mobility or descent of the urethra or defect in the sphincter mechanism of the urethra. Recently diminished activity of the nerve (pudendal nerve) that supplies the sphincter has also been shown to cause Stress Urinary Incontinence.  This happens because the pelvic floor muscles and tissues supporting the urethra lose strength due to various reasons including prostate surgery, pregnancy and vaginal child birth.

During the pregnancy, there is tremendous pressure that is laid on the tissues and muscles in the pelvis region as the baby grows inside. A lot tissues are torn during the vaginal child birth. This results in immediate Urinary Incontinence in women.  The resilience nature of the muscles in this region grow stronger with time but not as strong and intact as they were before child delivery.

To know how pregnancy and child delivery affects the pelvic floor muscles in women, visit the following article:

Effect of Pregnancy and Child birth on pelvic floor

Men who undergo prostate removal (as a part of treating prostate cancer) can result in incontinence. Visit the following article to know how men can manage incontinence:

How Men can manage Urinary incontinence?

Burch Colposuspension

This has been the gold standard for treatment of Stress Urinary Incontinence. The procedure can be done by the open or laparoscopic technique. This entails suspending the bladder to a higher position thereby providing support to the urethra.

TVT (Tension free Vaginal Tape)

The procedure described in 1995 caused a landmark change in the management of Stress Urinary Incontinence. This involves support of the urethra by means of a polypropylene mesh placed at the mid-urethra. The tape acts like a backstop and prevents leakage of urine during increase in intra- abdominal pressure. The procedure can be done on an outpatient basis and success rates over a 7 year period have been in the range of 85-95%.

 

TOT (The Transobturator Tape)

This is the latest procedure on the block. The needle used in the TOT does not travel a great deal inside the abdomen and hence complications noted with the TVT procedure are minimized. The tape lies like a hammock beneath the midurethra. This procedure is also done on an outpatient basis.

 

Injectables

These are substances that are used to bulk up the urethra in patients with incontinence. They are also done as day care procedures. However the success rate of this procedures is low . A variety of substances from collagen, Teflon, carbon beads, fat and blood can be injected.

Mixed incontinence is a combination of stress and urge incontinence. Though SUI is the most common type of incontinence, typically people walking into a referral center have mixed incontinence. These women typically lose urine while coughing, sneezing laughing and also leak with a sense of urgency.