Jun 28,2016

Myriad causes, myriad solutions

If there are numerous ways in which one’s ability to control urine passage can be impaired, ranging from arthritis of the knees and hips to cancer in different parts of the body, the affected people’s responses also cover a wide canvas. The latter can be as simple as timed visits to the toilet at fixed intervals or avoiding certain foods or beverages to very complex technologies such as the use of biofeedback signals.

Timed Toilet Visits: Much in the same way as a tiny tot is given its first toilet training, elderly people might need to be reoriented with regard to their toilet habits. This works best in people who have a difficulty in feeling the urge to pass urine (due to conditions such as Alzheimer’s Disease) or local nerve damage on account of diabetes, some degenerative disorders, etc. Since the average person’s bladder can hold a maximum of about 400 ml of urine, the individual would be required to estimate how long it takes to fill up. Starting with a higher than normal frequency, say, every hour, the interval can gradually be increased as long as feasible.

Diapers and other ‘soaking’ devices: No parent would think twice about using a diaper on an infant or even a child of two or three, but adult diapers are less easily accepted. However, in cases of urge incontinence, where the person is unable to reach the toilet in time, perhaps on account of a physical infirmity, adult diapers may be quite useful. Where the problem is nothing more than leakage of a few drops, even a diaper may not be required. A special device somewhat resembling a finger glove, known as a ‘drip collector, made of absorbent material may be quite sufficient. Alternatively, underwear with an extra padding to absorb the leakage can be used.

Bladder control exercises: These are most useful in cases of urge incontinence or people in whom there is a leakage of a few drops. One of the most commonly practiced is known as Kegel’s Exercises. This works as follows: squeeze the muscles of your genital area for 3 seconds, as if you are trying to stop passing urine or gas, and then relax for 3 seconds. Repeat this exercise until you can complete about 10 sets, and then slowly increase the duration of the exercises. In the beginning, it is better to do these exercises under the supervision of a doctor or nurse, who can show you the correct way.

Biofeedback: Here a therapist places an electrical sensor over your bladder and pelvic muscles, which is connected to a TV screen. You can then observe how your pelvic muscles contract and relax, and use the information to learn how to control them better.

Surgery and Medicines: Some medicines that can help the bladder muscles to relax, and therefore avoid spasms of contraction can help reduce some types of incontinence. But since they often cause rather uncomfortable side effects, they must always be used on the advice of a physician. Similarly, women with dribbles of urine may be able to use a pessary, which is a stiff ring inserted in the vagina. Again, the procedure should only be done by a qualified healthcare worker.

Surgery can be for option in both men and women patients in whom other, less drastic treatment options have been tried without success. In men, this is usually a follow-up of prostate surgery and involves the creation of an artificial (urinary) sphincter. An alternative is to inject ‘bulking agents’ into the urine passage, which make it a bit harder for the urine to pass through. In very aged patients, not considered fit for surgery, these may be used but are hardly chosen otherwise.

In women, the most useful surgical operation is ‘colposuspension’ which means a mesh of threads is created to provide support for the bladder entrance, where the urethra begins. This can take care of conditions where the pelvic floor muscles have become weak for a variety of reasons. Further, it can now be done through a Minimally Invasive technique as well.

Vaginal Tape: Working on the same principle is the Tension-free Vaginal Tape, which is inserted surgically through the pubic region and helps to support the bladder from below. It does not need general anesthesia and the patient can, therefore, go home the same day.

The creation of an artificial sphincter of bulking agents such as silicone or Teflon may also be used in rare cases, where nothing else works.

Additional reading:

  • Royal College of Obstetricians and Gynecologists (RCOG) position paper on surgery for incontinence (Feb 2005)
  • Urology Care Foundation