Urinary Incontinence

Urinary incontinence is a much more common and often embarrassing problem than most people realize. Urinary incontinence is the involuntary leakage of urine which is more common among women than men. It is common in approximately 30 percent of females who are aged between 30-60.

Treatments for urinary incontinence

Various factors such as the type of urinary incontinence, its severity, underlying cause, the patient’s age, general health, and their mental state are considered by the Urologist to define the line of treatment. Treatment options include the following:

Behavioral techniques

1. Bladder training:
   • A patient is made to learn how to delay or hold off for a few minutes whenever there is an urge to urinate. Bladder training helps the patient gradually gain back control over their bladder.
   • The patient is instructed to urinate every two to four hours in spite of waiting for the need to go.
   • Fluid and diet management
2. Pelvic floor muscle exercises
3. Medical devices
   Certain devices are designed to treat females with incontinence. These include:
   • Urethral insert: This insert is a Tampon like disposable device which acts as a plug to prevent leakage, and is removed before urination.
   • Pessary: It is a rigid ring which is inserted into the vagina. It is worn all day. The device helps hold the bladder up and prevent leakage
   • Bulking material injections: A synthetic material is injected into tissue surrounding the urethra which helps keep the urethra closed and reduce urine leakage. This method needs to be repeated regularly hence is less effective than other invasive treatments such as surgical intervention.
   • Botox (Botulinum toxin type A): Botox helps relieve urinary incontinence by relaxing the urinary bladder muscles. Botulinum toxin A (Botox) is injected into the sides of the bladder to treat urge incontinence and overactive bladder syndrome.Botox works by calming the nerves that usually overstimulate the bladder muscles and lead to an urgent feeling of needing to urinate. Its effect lasts for 5-6 months and can be Surgery.

If other treatment options are not effective then Surgery is the ultimate option to get rid of Urinary Incontinence.”

Few effective surgical procedures include:

1. Sling procedures: A sling is a strip of tissue or a mesh or synthetic material which is placed around the neck of the bladder to create a pelvic sling around the Urethra to support it hence prevents accidental urine leakage.This procedure is used to treat stress incontinence. There are mainly two types of sling procedures commonly performed in women are:
   • TOT – Transobturator Tape procedure (TOT)
   • TVT – Tension-free Vaginal Tape procedure or Retropubic Tape procedures links help hold the Urethra up in the correct position and help reduce the leaking of urine associated with stress incontinence. Sling procedures are the most commonly performed type of incontinence surgery in women and can be done under local anesthesia. Recovery time is fast.?
2. Bladder neck suspension/Colposuspension: This procedure involves an abdominal incision, so it is done during general or spinal anesthesia. In this, the neck of the bladder is lifted.
3. Prolapse surgery: Women who suffer from incontinence due to uterine prolapse, in that case, surgery may include a combination of a sling procedure and prolapse surgery.

Male Incontinence

After enlarged prostate surgery, Men often experience Urinary Incontinence because the urinary sphincter can be damaged during the surgery. Incontinence occurs commonly after radical prostatectomy but is less common after surgery to treat an enlarged prostate.

Following are the few surgical procedures for the treatment of male incontinence:

1. Male sling procedures: Sling procedures for men are relatively new but initial studies have shown a good success rate. It supports the sphincter valve, which was damaged during previous prostate surgery. This procedure is probably most satisfactory for Men with mild-to-moderate urinary incontinence. The male sling can be performed with a fairly short recovery and requires only a small incision in the groin.
2. Artificial urinary sphincter : An artificial sphincter is inserted to control the flow of urine from the bladder into the urethra. AUS replaces the damages sphincter to restore incontinence. AUS is a fluid filled device which is implanted under the Urethra. It opens and closes the Urethra to allow urine to flow through.
   For those patients where incontinence persists as a result of surgery, Artificial Urinary Sphincter (AUS) is considered as the best option of treatment.

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