Bladder control is the key

A student of tenth standard – bright, ebullient and sincere, who laughed and made others laugh. He was full of confidence and was popular among his class mates, until one day when an embarrassing incident changed the way others looked at him. He accidentally wetted his pants during daytime in the classroom, when he could not control the function of his bladder. It affected him to the extent that, a student who never missed a day in school, ended up dropping out of it. He was suffering from Urinary Incontinence.

What is urinary incontinence?

The act of going to the bathroom is an everyday routine for us. However, for a person suffering from urinary incontinence, this ‘routine act’ becomes so erratic that it can turn their lives into a perpetual nightmare. Urinary incontinence, as the name suggests, is a condition in which a person cannot always control when he or she urinates. Also referred to as involuntary urination, it involves any uncontrolled leakage of urine. It is not a disease in itself, but a symptom….. a life-changing symptom. The main issue with this condition is that it remains under-reported and hence, undiagnosed in a number of cases. People suffering from this state feel embarrassed in telling a physician or even a family member that they are suffering from urinary incontinence. This leads to needless and prolonged suffering and can further aggravate the situation.

What causes urinary incontinence?

This condition is especially common in women, with pregnancy, childbirth and menopause being the major risk factors as these biological processes reduce the strength of the bladder. Among men, damaged or overactive bladder muscles, prostrate conditions and nerve damage are some underlying causes of urinary incontinence. Lifestyle habits such as the intake of diuretic substances (materials that promote diuresis, that is, the increased production of urine) such as beverages and alcohol can also affect the occurrence of this condition. Obesity, urinary tract infections, constipation, specific types of surgeries such as prostatectomy, neurological and musculoskeletal conditions, diabetes, stroke, heart conditions and prostrate problems are other factors that aid the prevalence of urinary incontinence.

Urinary incontinence, as the name suggests, is a condition in which a person cannot always control when he or she urinates. Also referred to as involuntary urination, it involves any uncontrolled leakage of urine.

Types of urinary incontinence

In normal anatomy, the bladder capacity is 300 mL to 600 mL and there is a strong urethral support to the bladder. This support remains unaffected when there is an urge to urinate due to pressure on the bladder. The severity of involuntary urination can vary ranging from occasional minor leaks to the frequent wetting of clothes. Based on the acuteness of the condition and the functioning of the bladder, urinary incontinence is divided into six categories. Urge urinary incontinence: Caused by an overactive bladder, which leads to a frequent feeling of the need to urinate for no apparent reason. This ‘urge’ to urinate extends to such a degree that it negatively affects a person’s life. This oversensitiveness of the bladder can be a result of minor conditions such as infections or more severe medical conditions such as diabetes. The urine may leak while one is rushing to the bathroom. Stress urinary incontinence: Caused due to the insufficient strength of the pelvic floor (muscles that hold the pelvic organs) that leads to poor closure of the bladder. Hence, when the intraabdominal pressure increases such as during coughing, sneezing or lifting weight, the weak pelvic floor muscles are unable to prevent the passage of urine, and the urine involuntarily leaks. The pelvic floor just sags and does not support the bladder. Mixed incontinence: This type of involuntary urination has characteristics of both stress and urge incontinence. Overflow urinary incontinence: When the bladder does not empty completely, either due to poor bladder contraction or blockage of the urethra, the person experiences dribbling of the urine i.e. loss of small amount of the urine even after emptying the bladder. Functional urinary incontinence: This category of urinary incontinence is different because it occurs when the person is unable to reach the bathroom in time to urinate because of physical and/or mental limitations. For instance, if someone has severe arthritis, the person may find it difficult to reach the bathroom on time. Total urinary incontinence: Perhaps the most severe of all types of urinary incontinence, it refers to the complete loss of urinary control. This complete loss of control may be caused by a severe spinal cord injury, severe form of stroke or multiple sclerosis (a long-lasting condition that affects the brain, spinal cord and the optic nerves of the eye).

Women and the elderly in general are the most vulnerable groups to suffer from this condition. And if you are suffering from urinary incontinence, you are not alone. Among females, about 20% of young adults, 30% – 40% of middle-aged group and 30% – 50% of elderly women suffer from this dysfunctionality.

Who all are affected?

Women and the elderly in general are the most vulnerable groups to suffer from this condition. And if you, too, are suffering from urinary incontinence, you are not alone. Among females, about 20% of young adults, 30% – 40% of middle-aged group and 30% – 50% of elderly women suffer from this dysfunctionality. The figures indicate that the condition is less common in younger women, peaks around menopause and steadily rises after 60 years of age. About 15% – 20% of men are at the risk of being affected. Incontinence among men, too, is more common as they grow older. The statistics, however, may be misrepresented. A large number of cases go unreported, thus it remains a hidden condition. As high as 60% of sufferers do not seek treatment as they feel that the disease is incurable. Hence, they resort to self-medications and change their lifestyle choices such as voiding (discharging urine) frequently, wearing pads and reducing their fluid intake.

Can urinary incontinence be cured?

Depending on the type and severity of urinary incontinence, the treatments may also vary and in certain cases, a combination of treatments may be employed, which can improve and prevent the condition from getting worse. Your doctor may recommend: Behavioural techniques, which include bladder training (trying to hold urination after you feel the urge to go), double voiding (urinating, then waiting a few minutes and then urinating again to avoid overflow incontinence) and fluid and diet management. Pelvic floor muscle therapy which comes under conservative management of incontinence, full results of which are noticeable only after 6-12 weeks. Medications such as topical estrogen, alpha blockers such as Flomax, anticholinergics such as Detrol, medical devices like urethral insert and pessary, electrical stimulation, absorbent pads and surgery cater to the different types of urinary incontinence.

How incontinence affects lives?

Urinary incontinence can have a devastating effect on the quality of life. Some people are forced to recluse into their homes. To make situation worse, there is a lot of stigma attached to the state. Instead of being sensitive to people’s sufferings, people make them feel guilty for something over which they absolutely have no control. Social and economic affects include embarrassment, social isolation, financial distress due to high cost of preventive measures and avoiding intimacy while physical complications such as skin break down and rashes, urinary tract infections may also occur. In addition the condition creates major emotional distress such as anxiety, bathroom mapping (always looking for a bathroom which by all means can be an exhausting exercise). Living with the constant fear of involuntary leakage can take away the “life” from someone’s life. Their self-esteem and confidence gets shattered. This can lead to depression and in many unfortunate cases, suicide. Therefore, the least that we, as a society, can do is to be considerate and empathetic enough to understand the condition of the other person. Let us educate ourselves and others around us, create awareness and help those afflicted with urinary incontinence in whichever way possible.

A guide to Muscle Control Exercises (Kegel Exercises)

Kegel exercise strengthens pelvic floor muscles i.e. the muscles that stretch during child birth. They help improve sexual pleasure by making the muscles stronger and more elastic. They would not actually make your vagina smaller, but can make the opening tighter. Incorporating Kegel exercises into your everyday routine can help ward off pelvic floor problems like uterine prolapse, including urinary incontinence, and is beneficial for women who have difficulty achieving orgasm. Many things can lead to weakened pelvic muscles, and kegel exercises, when performed regularly can help in strengthening the pelvic muscles. Though, it takes some effort and time to learn how to do Kegel exercises properly, but it is definitely worth the effort.

Steps:

1. While urinating, try to stop the flow. This tightening is the basic move of a Kegel. Place your finger in your vagina and squeeze your muscles. You should feel the muscles tightening and your pelvic floor move up. Relax and you will feel the pelvic floor move back again. Tighten and relax these muscles daily. Try and work up to 100-200 times a day. 2. Get into a comfortable position. You can do these exercises either sitting in a chair or lying on the floor. Make sure your buttock and tummy muscles are relaxed. 3. Concentrate only on the pelvic floor muscles and try not to tighten any other area of your body. Breathe normally during the exercise. 4. To do a quick Kegel, quickly squeeze the pelvic floor muscles and release 10 times in a row. This should only take about 10 seconds. 5. To do a slow Kegel, squeeze the pelvic floor muscles for 5 seconds and release. Do this 10 times. It should take about 50 seconds to complete a slow Kegel.