Imagine not being able to perform simple activities, such as taking a walk, attending a business meeting or going to the cinema without worrying about whether there is a bathroom nearby? This happens daily with about 5% of the world population and 30 million Indians who have urinary incontinence (UI). Studies show that this condition harms many people, as it directly affects social life.
Urinary incontinence is the sudden loss of urine involuntarily through the urethra. The condition also happens when there are small leaks daily, not just a large and uncontrollable loss of urine.
Although it is common in both sexes, research has shown that women have more UI, with around 40% of women over 50 having urine loss.
According to the best urologist in Delhi, it affects about 5% of men who undergo prostate removal surgery (prostatectomy). In addition, with age, the strength of pelvic muscle contraction decreases, which makes many elderly people incontinent.
Urinary incontinence affects approximately 5% of the world population of all ages, affecting women and the elderly more frequently, according to data from the World Health Organization (WHO).
UI can also appear as a symptom of some disease, such as urinary tract infection, bladder stones, bladder tumors, polyuria and other neurological diseases such as Parkinson’s, stroke sequelae or spinal cord injuries.
Anyone can have UI, but it is not the same at all. There are three main forms of urinary incontinence:
- Stress urinary incontinence: this type of urinary loss occurs when the person does not have pelvic muscle strength to retain urine. Therefore, urinary losses will be triggered by activities such as sneezing, coughing, laughing, lifting weights or doing something that puts the bladder under pressure or stress.
- Urgent urinary incontinence: it is such a strong and sudden urge to urinate that the person cannot reach the bathroom. It can also occur when there is a small amount of urine in the bladder.
- Mixed incontinence: urinary losses occur during an effort and also in the presence of urgency.
Urinary incontinence in high impact athletes
Those who perform high-impact physical activities are also not free from urinary incontinence. During sports, there is an increase in intra-abdominal pressure, which can impact the pelvic floor three to four times more than the athlete’s weight.
Sports that include repetitive maximum abdominal contraction, such as athletics, martial arts, bodybuilding, basketball, football, increase the occurrence of UI.
It is possible to identify some risk factors for urinary incontinence. Know and avoid them:
- HYPERATIVE BLADDER: this term is used for people who have a sudden urge to urinate and have difficulty controlling the pee. They are more likely to have urge urinary incontinence.
- CONSEQUENCE OF SURGERIES: One of the treatments for tumors in the prostate is radical prostatectomy (total removal of the prostate). Such surgery can lead to sequelae, such as sexual impotence and urinary incontinence.
- CONSTANT CONSTIPATION: Constipation can negatively influence the functioning of the bladder. That’s because the intestines and the bladder share the same connections in the spinal cord.
- DIABETES MELLITUS: the disease can impair the functioning of the bladder nerves due to the accumulation of sorbitol (which derives from glucose metabolism).
- NERVOUS SYSTEM DISEASES: The nervous system controls the functioning of several organs, including the bladder. When there is a spinal cord injury, the person may lose the ability to feel a full bladder.
- AGE: the probability of having incontinence increases with age. In 10 older men, 1 to 3 report having urinary incontinence.
- URINARY INFECTION: also known as cystitis, it is possible that it worsens the involuntary loss of urine. Treatment can improve or cure urinary incontinence
- HEART FAILURE: generates fluid retention during the day, causing swelling in the extremities of the body. At bedtime, these fluids are reabsorbed and filtered by the kidneys, which increases the need to get up at night to urinate.
- WEAKNESS OF MUSCLES OF THE PELVIC REGION AND ADVANCED AGE: the muscles of the pelvic region help to maintain urinary continence. Generally, the elderly suffer from the weakening of this region, which can cause urinary loss and urinary urgency.
- MEDICINES: Some medications can make it difficult to empty your bladder. Thus, there is chronic urinary retention, and UI can occur due to overflow, causing continuous dripping. This type of incontinence is more common in men who have an enlarged prostate and find it difficult to empty their bladder.
- OBESITY: Obese people usually have increased intra-abdominal pressure, which can compress the bladder and other pelvic organs. 5% weight loss improves UI.
- SMOKING: Tobacco use can cause chronic obstructive pulmonary disease, causing severe coughs. This symptom can worsen urinary incontinence.
It is possible to add to the day-to-day routine a series of habits that prevent urinary incontinence. Stay in:
- Control your fluid intake at night.
- Avoid alcoholic and caffeinated drinks.
- Control diabetes and body weight.
- Give up smoking.
- Adjust the intervals between urination. Don’t just wait for the urge to urinate in the bathroom.
- Keep a healthy diet with plenty of fiber.
- Perform physical activities regularly.
- Recognize and avoid some factors that cause UI, such as the use of diuretic drugs or mobility problems in the elderly.
Pelvic Floor Exercises
This training is based on exercises to strengthen and improve the coordination of the pelvic floor muscles, preventing or improving dysfunctions in that region.
It is widely used in cases of urinary incontinence, fecal incontinence and pelvic dysfunction, both in men and women. It is important to seek a physical therapist to perform the exercises correctly.
How to do the exercises
- Lie on your back with your knees bent and feet flat on the floor.
- Tighten your pelvic floor muscles for 5 seconds, without straining your belly, butt and thighs.
- Relax for 5 seconds. Repeat 10 times.
- Sit down and keep your feet parallel and apart. Tighten your pelvic floor muscles for 5 seconds, without straining your belly, butt and thighs.
- Relax for 5 seconds. Repeat 10 times.
- Be careful with your posture. This option allows you to do the exercises while driving, at home or even at work.
- It is done in the same way as the others: contract the pelvic floor muscles for 5 seconds without forcing the belly, butt and thighs. Relax for 5 seconds. Repeat 10 times.
- Be careful with your posture.
The choice of urinary incontinence treatment in Rohini occurs after diagnosis and identification of the cause and type of urinary loss. It changes according to the clinical condition of each patient.
It is possible for the same person to do a combination of several procedures to treat this condition. The main methods for treating incontinence are:
- Electromyographic biofeedback: the device allows the real-time reading and interpretation of the electrical activity of the pelvic floor muscle fibers by means of auditory and / or visual signals. Thus, it is possible to identify the muscles to be worked, reestablishing voluntary coordination and motor control.
- Electrostimulation: it is performed through techniques that aim to strengthen the pelvic floor muscles, as muscle dysfunction represents an important characteristic of stress urinary incontinence.
- Medicines: the doctor may choose a pharmacological treatment to reduce the problem.
- Behavioral techniques: it involves training the bladder to control urination, how to schedule trips to the bathroom so that you don’t have to go only when you feel like urinating; control the consumption of liquids; avoid caffeine and alcohol and start physical activity.
- Intervention therapies or surgery: injection of synthetic material into the tissue surrounding the urethra, botulinum toxin (botox) and nerve stimulators can be used. In addition, there is the option of surgical procedures, such as sling (strips of synthetic or mesh fabric applied around the urethra and bladder neck, which prevent urination out of time), suspension of the bladder neck, prolapse surgery and artificial urinary sphincter.
- Bladder training and pelvic floor exercises: through pelvic physiotherapy, the person with UI performs specific exercises to identify and strengthen the muscles in the region and to control urination. It is a simple, low-cost and non-invasive treatment. It is important to seek a physical therapist to perform the exercises correctly.
When looking for a doctor, the patient with suspected urinary incontinence will report on his symptoms and medical history, as well as how the bladder is functioning and the loss of urine.
Based on this information, the urologist in Rohini can order a urine test to detect any abnormalities, such as infections or blood. It can also indicate that the patient writes down for several days the amount of liquid ingested and the amount of urine produced, how many times he urinated and it was possible to control this desire. In addition, residual post-voiding measurement can be performed, in which the amount of urine produced and the rest in the bladder are verified.
To complement the analysis, the doctor may order the following tests:
- Complete urodynamic examination: evaluates the various phases of the act of producing, transporting, retaining and excreting urine.
- Cystoscopy: endoscope examination of the lower urinary tract.
- Cystography: diagnostic procedure that uses x-ray images to examine the urinary dynamics of the bladder.
- Abdominal and pelvic ultrasound.
The patient may also have an active role in the diagnosis and treatment of urinary incontinence. See how:
- Take a companion, who can help you understand and write down the main points of the consultation.
- Take a list of all symptoms, along with a prediction of how long ago they appeared.
- Keep your medical history, latest exams and medications you take regularly.
Ask your doctor
During the medical consultation, do not leave with doubts. It is the patient’s right to be aware of his condition and the next steps to overcome the disease. If necessary, take your questions in writing, so as not to forget any details.
- How many times is it necessary to urinate a day?
- Can I do anything right away to improve the symptoms?
- What types of tests do I need to do?
- My temporary urinary incontinence?
- What treatments are available and their side effects?
- Is there a generic alternative to the drug you are prescribing?
- I take other medications. Will this treatment you are indicating influence their effect?
After having urinary incontinence, will the problem remain?
No. Episodes of transient urinary incontinence may occur. There are cases of UI due to psychological disorders, limited mobility or excessive fluid intake.
Can playing sports cause urinary incontinence?
Yes. High impact sports can cause involuntary loss of urine. The athlete can practice pelvic floor strengthening exercises to avoid the problem.
How is urine controlled?
To fill and empty the bladder, perfect coordination between the muscle and the sphincters (smooth and striated urethra) is necessary, in harmony between the sympathetic, parasympathetic nervous system and voluntary relaxation of the skeletal sphincter. Thus, for there to be adequate continence (storage) and urination (emptying) it is necessary that the neuronal network and anatomical structures are preserved.
After prostate surgery, can the patient have urinary incontinence?
As with impotence, urinary incontinence is one of the side effects that can result from radical prostatectomy (removal of the prostate). However, incontinence presents itself at different levels, such as stress after surgery, when urine escapes after straining the body. As well as overflow, in which the flow of urine is blocked at the exit of the bladder by the tumor or by scarring in the tissue. In the case of urge incontinence, the bladder is sensitive and does not hold urine.
Is it possible to control the UI with exercises?
Yes. With the practice of exercises it is possible to improve the performance of the pelvic floor muscles.
Are there complications in other parts of the body due to UI?
In frequent contact with the skin, urine can cause wounds and rashes and skin infections. It also increases the risk of urinary tract infections.
What is the need and what is the urodynamic study?
It is an examination performed to assess the functioning of the lower urinary tract. In it, a small catheter is inserted into the bladder and a rectal balloon to assess intra-abdominal pressure. The test is painless, causing only discomfort. Through it, the doctor is able to determine what is the best treatment.
What behavioral measures can help to control involuntary urination?
Initially, it is necessary to assess the factors that cause UI. Patients can observe some daily attitudes that can increase the need to go to the bathroom, such as the use of some medications, diuretics or drinking excess fluids. In some cases, by recognizing the causes, the patient may avoid some actions and be able to control urine.