Controlling incontinence
PREVENTION AND TREATMENT
Treatment depends on the type of incontinence you suffer from. To begin with, alcohol, caffeine and foods that irritate the bladder should be avoided. A healthy diet coupled with a workout routine can also prove helpful.
In ‘stress incontinence’, common in women, a vaginal tape can be used. After the tape is internally applied, related nerves are alerted and awareness of the need to urinate increases. Or, the bladder may be surgically repositioned, which involves pulling it up and securing it with a string attached to muscle, ligament or bone. For severe cases, the bladder may be secured with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage. One option is a collagen jab around the urethra to add bulk to the area, which compresses the urethra. This increases resistance to urine flow. As the body slowly absorbs collagen, this may have to be repeated every three months.
‘Urge incontinence’ is treated with medication. ‘Anticholinergics’ are used to relax the bladder by blocking certain nerve impulses. Also, small doses of electrical stimulation to the vagina and rectum can stabilise overactive muscles and stimulate contraction of urethral muscles. This method can reduce both stress and urge incontinence. Limiting fluid intake also helps. For ‘overflow incontinence’, a catheter may be used to empty the bladder. For women, the urethra may be widened with minor surgery.
Timed voiding and bladder training regimens may be practiced. You start by urinating at set intervals, such as every 30 minutes to two hours, irrespective of the need. Then, the time is lengthened gradually, until the person is urinating every three to four hours. Bladder training may take three to 12 weeks.
People suffering from incontinence can also use absorbent undergarments or disposable diapers available at chemist shops. Though absorbent undergarments help make you less self-conscious, diapers are more absorbent and eliminate the possibility of leakage. However, both can lead to skin irritation and sores if proper hygiene is not maintained.
Incontinence in patients of Alzheimer and Parkinson’s is treated through Sacral Neuro Modulation, where nerve supply of the bladder is stimulated with an electrode, which directs the brain to help you identify the need to urinate. These treatments should be discussed with a doctor.
KEGEL EXERCISES
One popular method to treat incontinence is Kegel, a pelvic floor exercise developed by American gynaecologist Arnold Kegel over 50 years ago to aid women to rebuild vaginal muscles after childbirth. These muscles are attached to the pelvic bone and act like a hammock, holding in the pelvic organs. You first identify the muscles that need to be contracted. For that, you must try and stop the flow of urine while in the washroom. Once control over the right muscles is achieved, these exercises can be done otherwise too. While doing them, you should be able to feel your pelvic floor move upward. Then, muscles should be relaxed and you should feel the pelvic floor move down.
Kegel is to be practiced only in the early stages of incontinence when pelvic muscles are not very weak. Women with marked incontinence should be treated through medication. Also, it should not be performed with a full bladder as it could weaken muscles or lead to incomplete emptying of the bladder, increasing risk of urinary tract infection.
Ultimately, suffering in silence is not the solution. Even families of persons who suffer from incontinence should assist them in seeking correct medical help. It’s time to regain control.
YOGA CAN HELP!
These asana fight incontinence by toning pelvic muscles.
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Downward facing dog (adhomukha svanasana)
Also called mountain pose (parvatasana) or the inverted-V pose. Kneel and lean forward, placing palms flat on ground. Exhale and hoist hips off floor, pushing down shoulders as you continue breathing. At the same time, push down your heels; focus your attention on your stomach while applying pressure from your shoulder blades; and move your head as close to the ground as possible. Hold the pose as long as you can. Do several times and, later, build up the stamina to hold the pose for longer, up to 30 seconds for real impact.
Wide-angled pose (upavista konasana)
Sit on the floor. Use a cushion if you suffer from back or respiratory problems. Spread legs apart as much as you can comfortably. Place palms flat on ground on either side of each thigh. Close your eyes. Relax and focus on your breathing. Breathe evenly, holding pose for a few seconds. Increase time in pose for a half a minute or so with sustained practice.
WHAT'S NEW?
Botox, a drug developed by US pharmaceutical company Allergan to (temporarily) zap wrinkles and fine lines, is proving to be useful in fighting incontinence too. Dr Shailesh Raina, urological surgeon, andrologist and renal transplant surgeon at Jaslok Hospital, Breach Candy Hospital, Lilavati Hospital and Saifee Hospital, all in Mumbai, first tried it as an alternative in India about three years ago. A 2-ml shot of Botox is injected into the urinary bladder by endoscopy. The procedure takes only about 15 minutes and the patient can walk back home the same day. Depending on the ‘urodynamics’ of the patient, including bladder pressure capacity, pressure and compression, the patient may have to take two to three shots after a few months. However, Botox is only for ‘urge incontinence’ as it prevents the bladder from contracting. Also, it must be administered by an experienced surgeon who is familiar with the drug and its side-effects — it can even prove fatal if administered incorrectly.
With inputs from Dr Shailesh Raina, urological surgeon, andrologist and renal transplant surgeon at Jaslok Hospital, Breach Candy Hospital, Lilavati Hospital and Saifee Hospital, all in Mumbai; and Dr Phiroze F Soonawalla, consultant urologist, Jaslok Hospital and Breach Candy Hospital and emeritus consultant (urosurgery) at Saifee Hospital, all in Mumbai.
CONTACT DETAILS
Dr Shailesh Raina
Consultant Urologist at Jaslok,
Breach Candy,
Lilavati and Saifee Hospitals,
Mumbai |
Incontinence Clinic - 307
Doctor House
Peddar Road
Mumbai - 400026 |
Tel: 022-23525735 |
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Dr Phiroze F Soonawalla
Consultant Urologist at Jaslok
and Breach Candy Hospitals,
Mumbai
Emeritus Consultant,
Urosurgery at Saifee Hospital, Mumbai |
Empire Estate
August Kranti Marg
Near Shalimar Hotel
Cumballa Hill
Mumbai - 400036
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Tel: 022-23677779, 022-23639400 |
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