Urinary Incontinence

What is Urinary Incontinence?

Continence is able to hold, control.

Uncontrolled urine leakage causing inconvenience or embarrassment is called urinary incontinence.

How common is Urinary Incontinence?


Prevalence in Western World :

Category

Age yrs

% with UI

Men

15-64

1.5-5%

Women

15-64

10-30%

Non-institutionalised

65+

15-35% (70%♀)

Institutionalised

65+

53%


Urinary Incontinence in Women

1] (Nygaard, Thompson, Svengalis, 1994)

2] (Elving, Foldspang, Lam, Mommsen, 1989)











How about India ?

12% of women have Urinary Incontinence. (Asian Society for female Urology)


Urinary Incontinence in Southern Asia (Extrapolated Statistics at 5%)

Country/Region

Extrapolated Prevalence

Population   Estimated

Afghanistan

1,362,786

28,513,6772

Bangladesh

6,755,243

141,340,4762 

Bhutan

104,457

2,185,5692 

India

50,904,110

1,065,070,6072 

Pakistan

7,608,648

159,196,3362 

Sri Lanka

951,349

19,905,1652 


The causes are different in children, mainly due to some development defects or incorrect toilet training during early childhood.

Infections can cause incontinence at any age, which is temporary.

In women, multiple pregnancies, difficult child birth can cause urine leakage.

There may be incontinence due to injury to Spinal cord and nervous system diseases.

Again, data is not available for our population, but costs can be at individual level and at the society level.

Individual :

Financial : $ 1000-3000 annual exp. For absorbents

Psychosocial :

Fear of smell, embarrassment and sexual difficulties 2/3 sedentary women (24-64 age) stated SUI (Stress Urinary Incontinence, leakage on coughing and sneezing) as cause for their physical inactivity

Society :

US – 16.4 billion $ in 1996 41$ per inhabitant1
Sweden- 2 billion SEK in 1990 38 $ per inhabitant
1Agency for Health Care Policy and Research USA

Quite often, a simple clinical examination, by a competent doctor, is all that is required. Examination of urine is necessary and in some patients special tests may be necessary.

An Ultrasound examination (Scan) is useful, costs 1-1.5 K Rupees. In less than 10% patients, Urodynamics testing is required to get more information. Average cost of that test is about 3-4 K rupees.

Early cases of urinary leakage may be treated by simple exercises, done regularly. Some can be helped with medications. Some may need simple appliance to remain smell free. Only advanced cases, about 5-10% of total, will need surgery.

For large number of SUI (Stress Urinary Incontinence) an operation lasting 30 minutes, in which special tape is inserted to restore normal position of the bladder and the valve is done, as a day care procedure or an overnight stay. The cost of the tape. Varies from 4-8 K for indigenous ones to 20 -25 K for others. In some types if incontinence, Implantable Artificial Urinary Sphincter is also an option. Leakage due to VVF (communication between bladder and vagina) will require slightly longer operation, with an average hospitalization for 5 days.

To an extent, well supervised child birth programme can prevent some of these incontinence problems.

To prevent SUI(Stress Urinary Incontinence, leakage on coughing,sneezing, jumping etc) , there are exercises to strengthen muscles. These should be taught during Ante-natal (before birth) visits and done regularly after child birth.

Vesico-Vaginal Fistulas are due to prolonged labour and are prevented if child birth is well supervised and prolonged labour is avoided.

It is not normal at any age to be wet, smelly and be an outcast. Help is available... Awareness is the key.

Waterbirth

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