Mother’s Day to be Celebrated Incontinence in women a neglected but treatable problem
Incontinence in women is a neglected but a treatable problem, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.
By: HEART CARE FOUNDATION OF INDIA
He released a few tips for the women to overcome this.
1. Urinary incontinence in women is a neglected problem, but doctors can play a crucial role in treatment
2. Incontinence is extremely common, affecting about 20% to 25% of women before menopause and more than twice that after menopause.
3. Age itself does not cause incontinence. Urinary tract changes that accompany age, such as increased involuntary contractions and decreased bladder sensation and contractility, make incontinence more likely.
4. Workup for incontinence is a multistep process.
5. At the first visit, when a patient mentions incontinence, the doctor should set her up with a voiding diary and schedule a follow-up visit in a few weeks. At that next visit, in addition to reviewing the diary, the doctor should do a history and physical, perform a stress test and measure postvoid residual.
6. The doctor should first address possible transient, reversible causes, illustrated by the DIAPERS pneumonic: delirium, infection, atrophic urethritis or vaginitis, pharmaceuticals, excess excretion, restricted mobility, and stool impaction. Treating these can cure incontinence completely in one-third of patients and alleviate it in the remainder.
7. Established urinary incontinence is caused by either storage problems, such as overactive detrusor and stress incontinence, or emptying problems, such as underactive detrusor and urethral obstruction.
8. In women of any age, 90% of incontinence is in the storage group.
9. Woman who has overflow urinary incontinence, indicated by a postvoid residual of 100 mL or greater, should be referred to a subspecialist. In those with a positive stress test and a low postvoid residual, the presumed diagnosis is stress incontinence. Those with a negative stress test and a low postvoid residual are presumed to have detrusor overactivity.
10. If the transient causes have been addressed but the urinary incontinence persists, internists should treat appropriately according to type. For urge incontinence caused by detrusor overactivity, the cornerstone of treatment is behavioral. Physicians should consult the voiding diary and start with bladder retraining, prompted voiding regimens, and urgency suppression methods. Anticholinergic bladder relaxants should be used only as a last resort. The only place for drugs is at the very, very, very end, after you’ve done the rest. Desamino d-arginine vasopressin (DDVAP), he noted, has no role in treating urinary incontinence.
11. For stress incontinence, conservative treatment works.
12. Overweight women need to lose only 5% to 10% of their weight to achieve a 50% decrease in urinary leakage, according to a recent New England Journal of Medicine article.
13. Tampons and pessaries can be effective, especially for exercise-induced incontinence. Crossing the legs and tightening the pelvic floor before coughing or sneezing can also help, as can Kegels, although women need to do 30 to 50 a day for several months to see results.
14. Surgery can be an effective option, but patients need to understand that “it’s not going to be 100% and it’s not going to last forever. Drugs should not be used to treat stress incontinence.
15. The bottom line is that although incontinence is common, it’s never normal. The causes are multifactorial. With a positive, persistent approach, one can cure or help the vast majority of the patients.
About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 50118 people since 1st November 2012.
The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”