Urinary Incontinence
Stress Urinary Incontinence
Many Indian women, especially in the older age group and after delivery, complain of leakage of urine on coughing, laughing or sneezing. This is called as stress urinary incontinence (SUI). The leak can be a few drops or more in amount, but irrespective of the amount it causes great discomfort and embarrassment to the lady. SUI develops during and after pregnancy due to the weakness of pelvic floor muscles (those which help in the control of urine and stools) during childbirth. In the older age group, menopause and past deliveries lead to weakness of the pelvic floor. Treatment of SUI can begin by simple and do it yourself exercises (called as Kegel’s exercises or Pelvic floor muscle exercises) which will be taught to you by your urologist. The most important thing to remember is that like with any other exercise, consistency is the key. There is no downside or side effect of exercises. These exercises should be done as told around 6 times every day (each set containing 10 repetitions) for a minimum of 6 weeks to show visible effect. Those patients who consistently do these exercises notice a remarkable improvement in their symptoms and these can be all that is required for mild cases. Surgery for SUI is required only in very few cases with severe problems.
Urge Urinary Incontinence
Many women complain of inability to hold urine once they get a feeling to pass urine. This is called as urge urinary incontinence (UUI). UUI is commoner in older women and is often associated with SUI. While evaluating you for UUI, the doctor will take a detailed history about your water and other fluid intake and urine output and ask you to make a voiding diary (to document the time, amount of fluid intake and urine passed). Voiding diary not only helps the doctor understand your problem, but also may give you an idea of how much fluid you are drinking. Sometimes, the patient is drinking more fluids than needed or at inappropriate time which may cause her complaints. Apart from the voiding diary, the doctor may prescribe a urine test and an ultrasound. The doctor may manage the condition with changes in your diet and fluids along with behavioral training or may prescribe some medications if he feels necessary.
What you can do to reduce your complaints of urgency and frequency?
Reduce water intake to moderate amounts (usually 2-2.5 L/d is sufficient for adults)
Avoid excessive fluids in evening (to avoid getting up frequently at night to pass urine)
Avoid excessive tea and coffee (these irritate the bladder can increase the complaints)
Avoid excessive spicy food
Avoid rushing to the bathroom when you feel the sudden urge to pass urine (instead distract yourself and rapidly tighten and relax your pelvic muscles till the urge passes and then normally walk to the urinal at an increasing interval) – this is called as bladder training and will be taught to you by your urologist
How to Perform Kegel Exercises
Urinary Fistulae
Any abnormal communication between the urinary system and either the genital or gastrointestinal tract is called a urinary fistula. The most common type of urinary fistulae we encounter is a connection between the urinary bladder and the vagina (vesico-vaginal fistula), mostly after a gynecologic surgery (hysterectomy or cesarean section). Rarely, such fistulae may develop due to cancer or other rare conditions. These patients have continuous leakage of urine, which not only causes significant discomfort to the patient but also causes socially embarrassment due to the urinary smell and wetness of clothes. Many patients delay seeking the treatment for socio-economic reasons as well. While very small fistulae may resolve with conservative management and some may be treated with laser treatment, majority cases require a surgical correction. With proper urological care, these patients can be successfully treated and their disease morbidity eliminated.
Urinary Tract Infections and Female Urethral Stricture
Urinary tract infections (UTI)
UTIs are extremely common in females, especially after onset of sexual activity. Several inherent factors predispose a patient to develop UTI. One episode of UTI predisposes to further episodes of UTIs. Most common symptoms include acute onset urinary burning, frequency, urgency and suprapubic discomfort or pain. If the infection becomes more severe or if it travels to the kidneys, then the patient may further develop fever or flank pain. Most uncomplicated UTIs require minimal investigations and are eminently treatable with oral antibiotics for 3-5 days. For more severe infections, the doctor may prescribe more tests and a longer course of oral or iv antibiotics (depending on severity of the infection). For patients who develop recurrent UTIs (more than 3 episodes in a year), the doctor may prescribe a longer course of low dose preventive antibiotics to protect against further episodes of UTIs. For patients who specifically develop UTI after sexual intercourse, a self-start single dose prophylactic therapy may be prescribed to protest against UTI instead of a long course of antibiotics. Along with antibiotics, certain supportive measures may be undertaken by the patient to further reduce the risk of UTI, as follows –
Maintain local hygiene
Cleaning of local area from front to back, instead of a back to front direction (to prevent soiling of urinary opening with fecal material)
Ensure adequate oral fluid intake
Passing urine after sexual intercourse
Uncomplicated UTIs do not usually increase the risk of kidney damage.
Female Urethral Stricture
Female urethral stricture are an underdiagnosed and improperly treated condition. Many females, especially after history of instrumentation and in post-menopausal age develop complaints of poor urinary flow and straining during urination. A uroflometry with postvoid residue may support the doctor’s suspicion and a calibration in the OPD may confirm the diagnosis. While mild cases may be managed with gentle urethral dilation, either at regular intervals in the OPD or by the patient herself (at home), gross undertreatment is prevalent for more severe cases. Many a times, these patients are maintained on frequent urethral dilation, with minimal long lasting improvement in symptoms. In these patients, urethroplasty (surgical management) may have a higher success rate and more long term durability. A successful urethroplasty can obviate the need for regular urethral dilation.