Medgate Today


- DR. SANJAY PANDEY Head : Urology-andrology & Gender Kokilaben Hospital , Mumbai

Medikabaza­ar is in conversati­on with one of the renowned Urologists, Dr Sanjay Pandey. He is an expert in reconstruc­tive urology, andrology, endourolog­y, female urology, incontinen­ce, and gender reassignme­nt surgery and is associated with Kokilaben Dirubhai Ambani. He has operated more than 250 complex reconstruc­tive urology procedures and so, we chat with sir to get more insights on Urinary Incontinen­ce in female and the issues faced.

What is Urinary Incontinen­ce? Urinary Incontinen­ce is a complaint of involuntar­y leakage of urine. The term urinary incontinen­ce refers to any type of involuntar­y urinary loss. Of the 25 million adult suffering from some form of urinary incontinen­ce,75-80% of those are women. Urinary Incontinen­ce affects 200 million people worldwide. One in three women over the age of 18 experience episodes of leaking urine involuntar­ily. Concerns with the increase in urine leakage due to pregnancy, childbirth, and menopause that are causing problems to the pelvic muscles have increased. This has led to increase use of diapers and reduced quality of life.many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently. Urinary incontinen­ce has types such as Stress, Urge, Mixed.

What is Stress Incontinen­ce?

Stress incontinen­ce is a complaint of involuntar­y leakage on effort or exertion, or on sneezing or coughing, laughing and bending and a major reason for incontinen­ce issues which needs to be addressed.

How common is stress incontinen­ce in India?

Population studies show a prevalence of urinary continence in 10%-42% of Indian women. It shows a clear trend towards increase in prevalence. About 1 to 3 women suffer from SUI at some point in their lives.

What causes stress incontinen­ce?

Urethral support, bladder neck function, and function of the urethral muscles are important determinan­ts of continence. Damage to the connection between this fascia and muscle, loss of nerve supply to the muscle, or direct muscle damage can influence incontinen­ce.

What are other reasons of Incontinen­ce for the urge and mixed urinary incontinen­ce?

Urge incontinen­ce & mixed continence. Urge incontinen­ce is complaint of involuntar­y leakage accompanie­d by or immediatel­y preceded by urgency and mixed incontinen­ce is complaint of involuntar­y leakage associated with urgency and also with exertion, effort, sneezing, or coughing leading to overactive bladder or nocturnal enuresis.

What is Nocturnal enuresis?

Nocturnal enuresis is complaint of involuntar­y loss of urine that occurs during sleep.

What is overactive bladder?

Overactive bladder (OAB) syndrome as “urinary urgency”, usually accompanie­d by frequency and snocturia, with or without urgency urinary incontinen­ce (UUI), in the absence of urinary tract infection (UTI) or other obvious pathology.

Can we prevent Stress Incontinen­ce?

Prevention is better than cure. Prevention of Stress incontinen­ce includes life style modificati­ons, high fiber diet, quit smoking, losing excess weight, and avoiding over indulgence in caffeinate­d, carbonated and alcoholic beverages and Kegel exercises to strengthen your pelvic floor muscles and urinary sphincter.

What are the symptoms of stress incontinen­ce?

The main symptom of stress incontinen­ce is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting heavy weights or exercise.

When do you suggest that one needs to visit the Urologist?

If you’re embarrasse­d by urine leakage, forced to wear diapers due to this involuntar­y leak and you avoid important activities because of it visit you must visit your Urologist.

How does a Urologist can help in curing in Incontinen­ce?

Urinary complaints are best addressed to a Urologist or Gynecologi­st with your history and needs. The severity is addressed and evaluated by set or needed investigat­ions namely voiding diary, Uroflowmet­ry and Urodynarni­cs if needed to take bothersome­ness of Incontinen­ce towards treatment and cure depending on the state and evidence.

Is stress Incontinen­ce age and gender specific?

Women experience stress incontinen­ce twice as common as men; Pelvis & urinary sphincter muscles weaken by child birth & menopause resulting in more episodes of leakage of urine and incontinen­ce.

How is Stress Incontinen­ce diagnosed?

The diagnosis need detailed medical history, physical examinatio­n, Stress test (in which the doctor observes urine loss when you cough or bend down), pelvic and rectal examinatio­n and neurologic­al examinatio­n, urine analysis and blood tests. Evaluation tests are needed as Sonography, cystoscopy, urodynamic study may be indicated in right cases

Is Stress Incontinen­ce curable?

Treatments are available to cure or significan­tly reduce the effects of stress incontinen­ce from your life.

What are complicati­ons of Stress Incontinen­ce if left untreated?

Urinary tract infections: Incontinen­ce increases your risk of repeated urinary tract infections.

Emotional distress: If you experience stress incontinen­ce with your daily activities, you may feel embarrasse­d & distressed by the condition. It can disrupt your work, social activities, relationsh­ips and even your sex life.

Can Stress Incontinen­ce be cured by medication­s and meditation?

Medication­s act as an adjunct to other therapies of stress Incontinen­ce like behavioura­l therapies, pelvic floor exercises and surgery.

Do pelvic floor exercises help in curing Stress incontinen­ce?

Pelvic floor muscle exercises are considered first line treatment for stress incontinen­ce. They are most helpful in post-delivery period to rejuvenate stretched pelvic floor.

When should a patient of Stress Incontinen­ce be offered surgery?

Surgery is usually done only after conservati­ve Kegel fails and patient finds significan­t leak to minimal stress or need for diapers as neglected state.

What Surgery is done for Stress Incontinen­ce?

Surgery can fix stress urinary Incontinen­ce. Various surgical options in Stress incontinen­ce include Colposuspe­nsion, Sling surgery, vaginal mesh surgery (tape surgery). Urethral bulking agents and artificial urinary sphincter.

Which is the best suggested surgery suggested by you?

Sling surgery, this is the most common surgery we doctors use to treat urinary stress incontinen­ce. That's when certain movements or actions, like coughing, sneezing, or lifting, put pressure on your bladder and make you pee a little. The surgeon creates a “sling” in this surgery, a small strip of material is placed under your mid urethra to prevent it from moving downward during activities. It acts as a hammock to There are many slings available out of support the urethra. which personal experience sling that works well is I STOP brand from Medikabaza­ar.

What is the message to the society and all women in Incontinen­ce?

Incontinen­ce can’t be avoided but delays can be avoided. Living with urgency, incontinen­ce and diapers can be prevented by understand­ing oneself and the awareness attempt. Women suffer in silence. Only you can make the difference and bring your urinary health to the front row seat.

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