LETTER U- URINARY INCONTINENCE

Urinary Incontinence  is the involuntary leakage of urine. It means that a person urinates without will. This brings about not only physical and emotional effect but also has a social quotient causing discomfort, embarrassment and depression. It affects the quality of life and also burdens patients economically.

Some known risk factors are: Age more than 40 years, multiple childbirth, menopause, vaginal delivery, hysterectomy, body mass index more than 25, history of diabetes, habit of taking excessive tea, tobacco, some medications like diuretics, anti-hypertensive drugs, sleeping tablets, sedatives, and muscle relaxants.

To understand this condition better, it is essential to know some of its types. Following are clinically defined types of incontinence:

Stress Incontinence

When there is leakage of urine with physical stress like coughing, lifting heavy objects, laughing, etc.it is known as stress incontinence. Stress in this context is the exertion on abdominal region which increases internal abdominal pressure and causes leakage.

Urge Incontinence

In this type there is a very strong urge to go to urinal that interferes with patient’s ability to reach the toilet timely. Myofascial pelvic pain syndrome a condition which has symptoms like pelvic pain, heaviness, burning sensation has been associated with this type of incontinence.

Functional Incontinence

In this ,a mobility issue due to physical or mental disorder prevents patient from reaching the bathroom and urine leakage occurs. The urinary tract is functioning normally but other disabilities hinder in voiding urine at urinals.

Overflow Incontinence

Leakage that occurs due to inability to empty the bladder completely is the overflow type of incontinence. Generally males are affected more.

Mixed incontinence

Presence of combination of types at same time is categorized as mixed incontinence. For e.g. stress and overflow together will be termed as Mixed type. Females are prone to have this more than males.

Total incontinence

The bladder leaks constantly as it cannot store urine. This is the most disturbing type of incontinence as total loss of control over bladder occurs.

It can be from birth or serious injury to spinal cord ,urinary function ,nerves or even at times an abnormal fistula or an opening.

Incontinence rehabilitation includes a thorough assessment of the condition and categorizing the type of it along. Examination of the symptoms, pelvic floor muscle strength , frequency, quantity, endurance of muscles ,hesitancy,  perineometer (shown in diagram below) assessment etc. is necessary to sketch a proper treatment plan.

Many specific exercises such as Kegel, contract-relax ,Elevator ,muscle setting, pelvic floor strengthening have proved to be very effective in managing the symptoms. Rehabilitation consists not only of the exercises but also use of modalities such as IFT(Interferential therapy), Muscle stimulator, biofeedback etc. for re-educating the muscles and improving coordination for urination. A holistic approach using recent advances lends a helping hand to those who have incontinence. Remember an intervention by expert always proves useful to manage this condition with dignity.