A silent disability
DR. HARSHDEEP JOSHI WRITES ON STRESS URINARY INCONTINENCE
Stress Urinary Incontinence is a disorder when a woman complains of sudden involuntary leakage of urine during any heavy physical activity like coughing, sneezing or laughing and finds herself in a socially embarrassing position.
Many Indian women sprinkle in silence due to this silent disability. One out of every three women suffers from Stress Urinary Incontinence, Incidence being 60 to 70 percent. Stress Urinary Incontinence can occur at any age.
Mechanism of Incontinence
The ability to hold urine and control urination depends on the normal function of the lower urinary tract. Average adult bladder can hold upto 2 cups of urine that is between 350 to 550 ml. Two muscles are involved that control the urine flow.
The sphincter which is a circular muscle surrounding urethra (4 cm long tube that is connected to bladder and voids urine). One must be able to squeeze the sphincter muscle to prevent urine from leaking out.
The other muscle that is detrussor muscle of the bladder must stay relaxed so that bladder can expand. In Stress Urinary Incontinence, the sphincter muscle and the pelvic muscles which support the bladder and urethra are weakened .The sphincter is not able to prevent urine flow and can’t cope up with increase pressure from abdomen such as during coughing, sneezing and laughing. The weakening and malfunction of pelvic floor is mostly due to repeated child births and vaginal deliveries. It is like holding a balloon full of liquid with neck of balloon between fingers and thumb. The balloon is bladder, the neck is urethra, fingers and thumb are pelvic floor muscles. When the fingers and thumb get tired, one can’t hold the balloon tightly and if someone presses down the balloon the liquid will leak out.
How a woman knows she has Incontinence?
If a woman experiences sudden leakage of urine during sneezing, coughing, laughing, lifting up her baby, gymming, running, changing her position or any other heavy strenuous activity then she has stress urinary incontinence.
This can be socially and hygienically unacceptable and a woman may find herself socially alienated as her normal lifestyle gets restricted due this disability.
This disorder is diagnosed by a simple test known as Marshall and Bonney’s test.
In this test 2 fingers are placed in vagina at urethrovesical junction on either side of urethra and bladder neck region elevated. On straining and coughing absence of leakage of urine indicates positive test .
Patients with positive Bonney’s test are the ones who require surgical correction.
Repeated child births, vaginal deliveries, deliveries that are not conducted under supervision of a gynaecologist, obesity, smoking ,alcohol, lung diseases leading to chronic coughing are all associated with stress urinary incontinence.
Stress Urinary Incontinence is treatable
Aim of the surgery is to reposition the bladder neck or to enhance urethral sphincter function. A simple sling procedure can suffice.
Choice of the procedure depends on the variables such as expectations of the patients, her daily activities and severity of the problem.
Minimally invasive procedure like TVT sling to reposition the bladder are available. This procedure is simple , cost effective, requires day care and patient can be discharged next day. Almost 98% of patients were relieved of this problem after undergoing sling surgery.
Patients are dry soon after the surgery and can lead a normal life thereafter.
The only doctor who has successfully treated this disability through a surgery in Jammu and Kashmir is Dr. Sapna Khullar. She has done over seventy surgeries with 99% success.
Tahira, a 42 year old female got her surgery done and she said “Earlier I could not perform my day to day activities and found difficult to offer prayers due to soiling of clothes time and again. Immediately after the surgery I was dry and could resume my normal lifestyle”. Many patients like Tahira have been benefitted after the surgery and have recommended it to their friends and all of them felt that they wished they knew it before.
Why is it Important to Treat Stress Urinary Incontinence
Stress urinary Incontinence can hamper normal life, restrict a woman’s routine and can have a negative impact psychologically leading to depression. Patient gets mentally disturbed as she can’t attend social gatherings due to recurrent wetting. Patients find it hygienically unacceptable and a social embarrassment. So it’s advisable that they should get this treated well in time and not let themselves flow with the flow.
Lastupdate on : Sun, 17 Jul 2011 21:30:00 Makkah time
Lastupdate on : Sun, 17 Jul 2011 18:30:00 GMT
Lastupdate on : Mon, 18 Jul 2011 00:00:00 IST
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