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Incontinence

Dr. Venkatesh Krishnamoorthy

Dr. Venkatesh Krishnamoorthy

M.S., MCh (Urology), FRCS (Glasgow)
Sr. Consultant Urologist and Chairman, NU Hospitals
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Stress incontinence: Stress incontinence is the leakage of urine during exercise, coughing, sneezing, laughing, walking, lifting heavy objects such as lifting a bag of groceries, rising from a sitting to a standing position, or other body movements that put pressure on the bladder. The word ‘stress’ in this case does not mean emotional stress. The stress referred to here is physical in nature. It refers to an increased pressure on the bladder when ordinary physical activities are performed. The time period during which leakage occurs may be very short. This type of incontinence may be due to poor bladder support or a weak/damaged sphincter. It is the most common type of incontinence and can almost always be cured.Most women with stress urinary incontinence have weak pelvic muscles. These are the muscles that support the bladder, bladder neck and the urethra (the urinary passage). Pregnancy, childbirth and prior pelvic surgery are among the reasons for weakened pelvic muscles.

Another possible cause for stress incontinence in women is a weakened urethral sphincter muscle itself. Both of these, weak pelvic muscles and a weakened urethral sphincter muscle, may co-exist in the same patient.

Other types of Incontinence Right Arrow

Urge Incontinence: Urge incontinence is the inability to hold urine long enough to reach a toilet. In this type of incontinence, an overactive bladder contract without you wanting it to do so. You may feel as if you can’t wait to reach a toilet. There is the sudden strong urge to urinate, with an uncontrollable rush of urine. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson’s disease, and multiple sclerosis. It can also be a warning sign of early Bladder Cancer. In men, it is often a sign of an enlarged prostate. It can, however, occur in otherwise healthy, older people.

Overflow Incontinence: Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. It results when the bladder is allowed to become so full that it overflows. In this form of incontinence, the bladder never completely empties, and the urine stream is weak, with a frequent or constant dribble. Overflow incontinence can occur when the flow of urine from the bladder is blocked as in the case of a blocked urethra when there is a loss of normal bladder function in some people with diabetes, or due to bladder muscle weakness.

Functional Incontinence: Functional incontinence occurs in many older people who have normal urine control but who have difficulty reaching a toilet in time because of arthritis or other crippling disorders.

Total Incontinence: Total incontinence occurs when there is a complete loss of bladder control, usually occurring after some form of surgery to the lower urinary tract.

Mixed Incontinence: is a combination of urge and stress incontinence.

Tests to evaluate incontinence Right Arrow

Urinalysis: A sample of your urine will be tested for the presence of infection, blood or other abnormalities.

Uroflowmetry (Urine Flow Test): Uroflowmetry (urine flow test) is the simplest of the urodynamic tests. This test measures the rate of urine flow as well as the amount of urine passed. You will have to come to the clinic with a reasonably full bladder (as per what feels comfortable to you), sit on a modified toilet seat (called a micturition chair) and, in private, pass urine in the usual way, into a flow meter.

Residual Urine Measurement: This test is performed to find out whether any urine remains after you have attempted to empty your bladder. Residual urine is measured by placing a bladder scanner over your bladder – a painless procedure lasting only for a few seconds.

In our hospital, we do not combine uroflowmetry with residual urine measurement. This is because when you finish uroflow and come to scan room, there may be another patient undergoing scan and this may take 15 minutes to complete the scan. By then your bladder will start refilling giving false high residual urine.

So what we do in our hospital is, we advise you to do these tests separately, i.e., to fill the bladder once for uroflowmetry and again for pre and post void. We agree this takes more time, but I assure you, this will help us in accurately assessing the residual urine.

If your uroflowmetry and/or residual urine are abnormal, you will then require a voiding cystometry (Urodynamics) to determine the cause of your difficulty in passing urine.

Urodynamics are special outpatient tests used to assess the normal and abnormal function of the urinary tract, especially the bladder and the urethra (the ‘water-pipe’ leading from the bladder to the outside of the body). These range from the simple to the more sophisticated depending upon the complexity of your problem.

Treatment for Incontinence Right Arrow
  1. Treatment for stress incontinence: stress incontinence
  2. Treatment of Urge incontinence: The first step should be behavior modification like drinking less fluid, not drinking at bedtime and timed voiding around the clock. Exercising the pelvic muscle (Kegel exercises) also helps. The mainstay of treatment is medication called bladder specific anticholinergics. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient's permission. The most common side effect of the medication is dryness of the mouth, constipation or changes in vision. Sometimes, reduction of medication takes care of the side effects. In more difficult cases, the bladder can be made bigger using a segment of small intestine. This operation called augmentation cystoplasty, is very successful in curing incontinence, but its main drawback is the need in 10 to 30 percent of the patients to perform intermittent self-catheterization to empty their bladder. In patients who don’t respond to anticholinergics or those who cannot tolerate the side effects of these drugs, option of Botox injection to the bladder is available. The advantage is no need of medications and more sustained effect and the disadvantage is the dose may need to be repeated after 6-9 months.
For Both Men & Women Right Arrow

Incontinence may be brought on by an illness accompanied by fatigue, confusion, or hospital admission. Incontinence is sometimes the first and only symptom of a urinary tract infection. Curing the illness will usually relieve or clear up the incontinence.

Diseases and disorders involving the nerves and/or the muscle

A weakness of the pelvic floor muscles

Effects of medication

Constipation

Urethral Pressure Profile (UPP): UPP will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the case you are required to take it.

Video-Cystourethrography(VCU): VCU will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the case you are required to take it.

Stress Test: While your bladder is full, you may be asked to cough, stand and perform other activities to find out whether these stresses on the bladder cause leakage.

Ultrasound: This technique can be used to determine the size and shape of the kidneys, the bladder and the prostate.

Cystoscopy: A thin telescope-like instrument called a cystoscope is inserted into the bladder through the urethra.

NU Hospitals has been pioneering in Nephrology, Urology and Fertility (IVF) treatment over the last 20 years. Our highly specialised experts are richly experienced in treating rare and complex conditions. It was one of the first in Karnataka to conduct a successful kidney transplantation surgery and also the first to equip Urology department with the most advanced flexible endoscopes. Having a robust team of subspecialty specific urology team at NU has significantly improved the overall success rates. Men’s Health Clinic is one of its kind in South-India dealing with Men’s Sexual and Reproductive Health. Our Male and Female Fertility (IVF) specialists comprehensively support the couples with the latest treatment and heartfelt compassion every step along the path to parenthood. At NU, every aspect of healthcare is coordinated and the entire team works together to provide exactly the care one needs. We are constantly updating the policies and collaborations to ensure that people in need are getting access to the most cutting-edge care and treatment.


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