While causes like injury, stroke and pregnancy, which lead to Urinary Incontinence, cannot be controlled, some factors that augment the problem can be checked. Urinary Incontinence can be managed with effective medication, pelvic muscle exercises, lifestyle modifications and interventions like Botox, says Dr. NK Mohanty, Consultant & HOD, Dept. of Urology, Safdarjang Hospital, Delhi. Urinary Incontinence – the loss or weakening of bladder control - is a relatively common health disorder, especially among women and the elderly. The involuntary actions of the bladder muscles may be the result of damage to the nerves or muscles of the bladder, or to the spinal cord and brain. Multiple Sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke and injury can also harm bladder nerves or muscles. Women often suffer from Urinary Incontinence after pregnancy, because this weakens their pelvic muscles. Urinary Incontinence can lead to several kinds of problems of the urinary system - including sudden urination, slow but steady leakage of urine, or the dripping of urine when one undertakes a physically stressful exercise like lifting a weight. Though the underlying causes cannot be controlled in most cases, efforts can be made to pre-empt the factors that augment the problem. However, with the subject considered taboo in Indian society, some continue to suffer in silence - living out a poor life with restricted movements. While some factors that cause Urinary Incontinence are natural (like pregnancy) and therefore cannot be controlled), there are others that are controllable. Some remedial measures are:
Checking medication: If you have a problem of Urinary Incontinence and the symptoms have become worse, you need to check with your doctor about the medication or drugs that you are taking. Some of these may be exacerbating the problem. Certain drugs that treat high blood pressure are linked to an increase in incontinence. The ‘alpha blockers’ dilate the blood vessels, to help reduce blood pressure, but they also often relax the muscles of the bladder. Some drugs that treat depression can also contribute to worsening incontinence symptoms, like leakage and overflow. Anti-depressants work by relaxing the nerves of the mind and may also as a by-product affect the ability of the bladder muscles to contract. Diuretics are another set of drugs that are associated with increased urination. In fact, these drugs are also called ‘water pills’, and are designed to flush out excess salt from your body, to treat conditions like high blood pressure. For those suffering from Type 2 Diabetes, remember that this disease also increases the risk of Urinary Incontinence, as well as its severity.
Limiting Caffeine: Caffeine is an important component of our daily lives, as most of us consume it through coffee, tea or chocolates. Excessive consumption of caffeine is also associated with the problem of increased urination; it can affect the Renal system. Caffeine is a stimulant; it stimulates the cardiovascular system, thereby increasing the heart rate as well as blood pressure. This increases the rate of blood for filtration, and also relaxes the bladder’s detrusor muscles, causing them to feel fuller more frequently. So, it is important to limit caffeine intake.
Behavioural changes: for example, decreasing the fluid intake to average levels, urinating more frequently (to decrease the amount of urine that is leaked), and keeping regular bowel habits (as constipation can worsen the problem).
Pelvic muscle training exercises: These can specifically help victims of stress and urge incontinence. They help patients exercise better control of their detrusor muscles.
Weight loss: Excess weight puts extra pressure on the pelvic muscles and weakens them; weight loss helps decrease the symptoms.
Botulinum Toxin A injections: When the loss of bladder control is due to a neurological condition, these injections can provide relief for up to 10 months. Once injected into the bladder muscle, Botulinum Toxin A works as purified protein, which blocks the overactive nerve impulses that trigger excessive muscle contractions.
Bladder augmentation surgery: This may be considered in some cases, when other solutions have failed to yield any result.