Table of Contents:
Incontinence Explained: What Does It Really Mean?
Stress Incontinence: Can Pelvic Floor Exercises Help?
The Right Way to Do Kegels: Frequency, Limits & Benefits
Beyond Kegel Exercises: Exploring Other Treatment Options
Male Incontinence: What Causes It and How Can It Be Managed?
Natural Remedies for Incontinence: Do They Really Work?
Behavioural Therapy: Managing Frequent Urination Through Daily Habits
What Medications Can Help Manage Urinary Incontinence?
Urinary Infections in Women: The Link to Urge Incontinence
Can Kidney Stones Trigger Frequent Urination or Urgency?
Bladder Stones: What Are the Early Warning Signs?
Diabetes and Urinary Incontinence: Understanding the Link
Understanding Weakened Immunity: Disease, Age or Both?
Does Poor Hygiene Cause Incontinence or Result From It?
Intimacy and Incontinence: Breaking the Silence
Prostate Problems & Male Incontinence: What's the Connection?
Managing Urinary Incontinence After Prostate Surgery
Postpartum Incontinence: How Long Does Recovery Take?
Could Your Medicines Be Affecting Your Bladder Control?
Finding the Root Cause: How Is Urinary Incontinence Diagnosed?
Urodynamic Testing: How Does It Help Diagnose Bladder Problems?
Urinary Incontinence in Children: What Are the Causes?
Bladder Anxiety: Why Does the Urge to Urinate Increase During Travel?
Urinary Incontinence: Let's Bust the Myths!
Dr. Hema Sathish:Hello one and all. Today we are going to talk about something which people even hesitate to whisper about, urinary incontinence. So let's welcome our guest today, Dr. Prabhu, who is a urologist with a decade of experience in treating many, many cases of incontinence. He has quite a few papers published in national and international journals and a number of talks given in multiple conferences. Welcome Dr. Prabhu.
Dr. Prabhu: Thank you, thanks for welcoming.
Dr. Hema Sathish:Dr. Prabhu, there are so many times we talk about incontinence, but what exactly is incontinence? Can you explain in detail what it would mean to, like for you to say a person has got incontinence, how would you categorize it?
Incontinence Explained: What Does It Really Mean?
Dr. Prabhu: So incontinence means involuntary urine leak. It is not aware whether the urine leak or not. So it is present both gender male and female.
Dr. Hema Sathish:Is it equally present?
Dr. Prabhu: Not most commonly in female because of they are having childbirth to weakness of the pelvic floor muscle weakness. So mostly they present with urinary incontinence. Male also can present due to some other pathology, like prostate enlargement, some neurogenic causes, and stone problem. It depends upon cause. It presents various types. Most commonly, it presents urge incontinence. Urge means due to bladder capacity reduced due to infection, some other stones, patient not able to hold the urine. Then suddenly urge to void.
Dr. Hema Sathish:Urge means urgency.
Dr. Prabhu: Suddenly urge to void associated with some urine leak. Another type is most commonly stress urinary incontinence due to multiple childbirth. There's loss of support to the pelvic floor muscles. Because of that during childbirth, most pelvic floor muscle means is a group of muscle that support the pelvic organs, especially females like uterus and bladder and rectum. These are the pelvic organ mainly supported by the pelvic floor muscle that form around ceiling like structure under the bottom of the pelvis. Whenever during childbirth, this muscle more stretched, especially during prolonged delivery. Some forceps delivery leading to damage to the nerve fiber to that muscles. So it's leading to the loss of support of the muscle to control the urethral closure mechanism. So suddenly they are able to laugh, finish time, do the workout, lift time. They are unable to control the urine. The urine is draining, itself causes urine leak.
Dr. Hema Sathish:So that is stress.
Dr. Prabhu: One more, another type is the overflow urinary incontinence. Mostly due to old people. It's mostly associated with the female pelvic organ prolapse, like uterine prolapse. They tell us something from my pelvic organ, something from the vagina. Usually it compresses the bladder. They're not able to avoid. So clinically present, I'm able to feel the sensation, but in spite of that I'm going to the bathroom, I'm not able to avoid. It's the most distressing condition. They're not able to avoid the present with the painful condition. In men, usually after age of 50 years, every man having prostate enlargement. In spite of some men to do hormone changes, they are progressing very fast prostate growth that block the urinary pathway. They are also clinically present with not able to void, with the painful distended bladder. So we can manage according to that which type of they are having incontinence.
Dr. Hema Sathish:Okay. So the treatment would vary for different types of incontinence, right? So let's start with maybe stress incontinence. Stress incontinence is most commonly present in men and women but more common in women, right?
Dr. Prabhu: Yes, ma'am.
Dr. Hema Sathish:So we talk about a lot of pelvic floor exercises. What would you advise?
Stress Incontinence: Can Pelvic Floor Exercises Help?
Dr. Prabhu: So pelvic floor exercise otherwise is called as a pelvic floor muscle training program. We can, medical term is called Hegel exercise. So it's provided strength to the pelvic floor muscles. Provide support to the pelvic organ like I told you say uterus, bladder, rectum these are the pelvic organ whenever this muscle loss bladder will come down to the pelvis or uterus will come down to or rectum will come down based upon which organ coming down they present with the clinical various presentation so these are the exercise program mainly adapted for the those patient present the stress leak only. So based upon steps we can progress along with the pelvic floor physiotherapist. We can which muscle they are able to contract. So this is one of the most proper technique, proper muscles they have to contract. Otherwise method not work for all peoples. So you have to identify which muscle support the pelvic floor muscle, especially muscle around the urethra and vagina along with the pelvic floor physiotherapies, the biofeedback therapy. Under the observation, we can start the therapy initially. Initially, we can go for three times per day, minimum eight contraction per morning session. Slowly, they contract and relax the pelvic floor muscles. Then relax associated with strong contraction so it can useful initial stage only once not respond to belly muscle training program we can upgrade we can progress other type of management
Dr. Hema Sathish:So there are different treatments for different stages of incontinence. So the first stage would be Kegel exercises. So that is done, taught and then they can keep doing it again and again. You can do it as much as you want or it's like you have to have a restriction or it can make it bad.
The Right Way to Do Kegels: Frequency, Limits & Benefits
Dr. Prabhu: I told you that proper contraction and proper technique is more important. Otherwise it will not work out. Also it is not suitable for other incontinence. Like I told you, urge and overflow incontinence. Main purpose is stress-urinary incontinence. Especially it works for postnatal mothers. Special postnatal mother they feel loss of support and urinary they feel quality of life reduced. So we can proper technique, proper correction under pelvic floor therapies. We can start therapy up to three months then we can observe. Improper technique, improper contraction leading to the another problem.
Dr. Hema Sathish:Like what?
Dr. Prabhu: Like they will feel not able to void the urine.
Dr. Hema Sathish:Oh my, okay.
Dr. Prabhu: So increased contraction, they feel painful bladder sensation. Sometimes they are not able to void the urine.
Dr. Hema Sathish:Okay. And if with Kegels or this kind of exercise it doesn't help, what would you recommend next?
Beyond Kegel Exercises: Exploring Other Treatment Options
Dr. Prabhu: So initially we start, once it's not well worked, we can go for other type of management. Especially we form the sling, means it's a tap procedure. We can artificially make sling like baby catheters. We can support the pelvic organ, make it sling, support the pelvic organ.
Dr. Hema Sathish:So it's a surgical procedure?
Dr. Prabhu: Yes, surgical but various forms. It's a minimal invasive surgery. Small incision, make it small tap, we can control that. Some people they respond to this type of tap. So we can use patient's own tissue.
Dr. Hema Sathish:So this tape is a material which is available and which can be used?
Dr. Prabhu: Yes, this is a ready-made artificial material. It is called as a mesh. It is a polypropylene mesh. But some people not respond to the vaginal irritation, mesh complication. So those people we can go for the autologous disease. This part we can harvest the tissues from patient's own body.
Dr. Hema Sathish:Okay, from where would you take that tissue then?
Dr. Prabhu: Mainly lower abdomen it's called rectus sheath or thigh in a respect of thigh is called facial atop the thigh both are very useful less complication surgery also is a better surgery your rate also
Dr. Hema Sathish:So once you do this is a permanent technique and it will help you for the years to come till you live
Dr. Prabhu: I told is depends on type and severity of the incontinence. Well worked with some people. Some people need for long-term follow-up to assess the response. They need some alternative process. So we have robotic and laparoscopic technique. We can use alternative technique to support the pelvic organ.
Dr. Hema Sathish:Okay. So there's a lot more than we have heard or seen before. Okay. That's quite interesting, Dr. Prabhu. When you talk about male incontinence, what are the causes in them? You did explain few causes. So what would you advise in cases with male incontinence?
Male Incontinence: What Causes It and How Can It Be Managed?
Dr. Prabhu: Male incontinence can present any age group. So in paediatric cases, especially associated with birth defect, some neural defect, spinal cord damage, it can present with the urinary. In old age, most probably I told you, it's named prostatic enlargement. Prostate is one of the most common presentation in the male age group. So we have to correct the prostate enlargement in the form of either laser therapy, new advance, we have endoscopy management, laser fibers. We can restrict the portion of the enlargement. Sometime in case, malignancy associated with malignancy, we can go for laparoscopy and robotic surgery. We can correct the bladder outlet.
Dr. Hema Sathish:Now in case if in spite of the surgery there is a leakage what would you ask them to do?
Dr. Prabhu: I told them mainly we can proper diagnosis is the most important thing before going to put knife to the patient. So proper diagnosis, all type of no need for surgery. So initially we can start with pelvic floor muscle training, unplanned training protocols, then we can start medication, then we can go for minimal invasive surgeries. That not responsible, we can go for finally go for laparoscopic and robotic reconstruction.
Dr. Hema Sathish:So reconstruction is the ultimate thing of the pelvic floor for the neuropathy.
Dr. Prabhu: Yes, ma'am.
Dr. Hema Sathish:Now when you talk about medications, are there any natural medications available which you can consume and make it feel better that the bladder will function better? Because you keep hearing all this so much on all channels.
Natural Remedies for Incontinence: Do They Really Work?
Dr. Prabhu: People also believe that any problem, urinary problem, they believe if there is an increased intake of fluid, it can reduce the all urinary problem. Not like that much. It also aggravates some problem. So proper fluid intake, proper fluid assessment, proper fluid intake is most one of the behaviour therapy. So we can start as a behaviour therapy. Initially, how do they take fluid, make them bladder diary protocol. How much they are taking the fluid, how much they are voiding, how many times they are able to void, they are able to hold the urine, how many do this, how long they are able to hold the urine. So we can assess and then based upon that we can start.
Dr. Hema Sathish:Now, you said that you know, you, behaviour therapy. So in behaviour therapy, it's only the water intake or you train yourself to pass urine after every certain point in time so that you don't have to void again and again, especially when you're in public or in a different place.
Behavioural Therapy: Managing Frequent Urination Through Daily Habits
Dr. Prabhu: No, it's not like this. Behaviour training program is a program. So we can start step by step. Start of initial step, we can, I told you, say bladder diary protocol. They have to initially, first three days, they keep the note to themselves, how much they are taking, how much they are voiding, when they are feeling urinary frequency, urgency, then urgency, contingency. Next, they can fix the time interval. Initially, they fix around one hour duration, I can hold the urine. So initially, they can hold. Next procedure, going first, suppress the urgency in the form of-- slow exercise, breathing exercise. Whenever they are able to avoid, at least they can hold, control the units few times, some more time. At some attraction, you can some attraction, reading the books and just walk around relax the muscles. Then don't want to go to avoid. As much possible they can avoid. Once not able to hold, they can go. Then finally they increase the duration. Initially one hour then go for one and half hours, two hours, three hours whatever that able to hold it finally reassess the program how they are responding to the our response bladder planning protocol based upon we can start the program.
Dr. Hema Sathish:Okay if this doesn't work this behaviour therapy so what tablets do you think medications would help them.
What Medications Can Help Manage Urinary Incontinence?
Dr. Prabhu: Medication is not for all urinary incontinence. It is purely for purpose of urge incontinence. Especially those diabetic patients, initial diabetic stage it will work. So especially drugs, usually urgency should be because of the bladder control program which is lost. Reduce the bladder cover. It's a maturation. Otherwise, maturation is a coordination between the bladder and brain. Whenever the bladder fills, it sends receptor to the brain. Again, brain stimulates the muscles, the bladder, able to make the contract and relax the urethral sphincter. Whenever we want to go to urine, brain will automatically coordinate where we'll void the urine. Otherwise, we will not be able to go. So the coordination between the bladder and brain is the most important. So we have to reduce the sensation, increase the bladder capacity using some bladder relaxant drugs. So we can increase the capacity of the bladder, along with it good glycaemic control.
Dr. Hema Sathish:But that means you are talking about diabetics in this case?
Dr. Prabhu: Yes madam. Diabetes is one of the most common overactive bladder, urge incontinence. Most common in our population. Along with some urinary infection, stone, it will cause urge incontinence.
Dr. Hema Sathish:You said infection, so urinary tract infection is so common in women right? Especially after a certain age. So for them the urge incontinence, how would they differentiate that they have an infection that's why they got this? Because many a times it's very silent right? And sometimes it's very chronic also.
Urinary Infections in Women: The Link to Urge Incontinence
Dr. Prabhu: That's what I told is a painful urination. Urinary become painful. Whenever they've infected with some infection, it's a painful urination. Painless urine leak adjust as to why it usually not associated to infection. So painful along with hematuria, blood in the urine, it usually associated with some infection.
Dr. Hema Sathish:So if you have blood in the urine or if you are having painful micturition that is pain while passing urine then you have to think of infection. So then they have to take treatment and go to the doctor.
Dr. Prabhu: Usually postmenopausal movement lack of estrogen support. So estrogen deficiency is one of the most reducing factor for the prone for urinary infection. Then they have to apply the estrogen cream something. They have to consult proper.
Dr. Hema Sathish:So they have to consult a doctor, take proper treatment for that if the incontinence or the general infection is chronic and it keeps happening again and again and again. Now when you said kidney stones can cause urinary incontinence, how would you explain that?
Can Kidney Stones Trigger Frequent Urination or Urgency?
Dr. Prabhu:I told you, urinary stones, especially bladder stones, large stones, they irritate the bladder muscle fibers. So once irritation they feel reduced bladder capacity, long standing stones, then feel large incontinence. Sometime large stone would come down drop to the bladder outlet. It block the pathway of the urine.
Dr. Hema Sathish:Oh my. That must be very painful right?
Dr. Prabhu:Yeah, one of the most distressing condition.
Dr. Hema Sathish:Oh my, that's so sad.
Dr. Prabhu:Whenever they feel inability to void, they should come immediately to the our department.
Dr. Hema Sathish:Okay. So if you are not able to pass urine all of a sudden then you should run to your doctor and not wait or take any home remedies for that. So now you said the stone can descend down. Now if it's a big stone you think it will break down itself and then descend down?
Dr. Prabhu:No madam. It's a multiple. Whenever it becomes an obstruction it forms multiple small small size stone inside the bladder. Usually large big size like we can experience like fetal size we can open that and remove that soon. But a large stone does not cause much problem. Whenever it becomes complicated, it will come to ourselves. So, like a mouse is an elephant, an elephant does not cause problems. A mouse is the most important problem.
Dr. Hema Sathish:So, the small ones are the ones which create the biggest ruckus. So, now how does a... Person who has got a urinary stone, I mean a stone in the bladder, understand that there's a stone in the bladder, I mean the initial symptoms, are there some symptoms for that?
Bladder Stones: What Are the Early Warning Signs?
Dr. Prabhu:Yeah, sure madam. The initial I feel like I told increased frequency. Normally, most of them are not able to get up in the during night time. Those having problem usually associated with old age, prostate enlargement, they will indicate knock to the other way, increase frequency of urination during night time.
Dr. Hema Sathish:But that can increase due to diabetes also.
Dr. Prabhu:Diabetes also. We can go for initially, whatever they feel symptom, we can come to consult. We can go for clinical examination. We can assess the clinical enlargement. Along with some additional investigation, especially x-ray and ultrasound form, we can look for the stone. All patients, all problems lead to same complaints only. But we need proper evaluation and proper diagnosis.
Dr. Hema Sathish:So if you are passing urine often in the night, don't take it very lightly. It could be because of diabetes also, but then you have to rule out probably a urinary stone also. So it's advisable to just have a checkup, right?
Dr. Prabhu:Any patient, single episode of hematuria should come and consult the doctor after age of 40.
Dr. Hema Sathish:So after the age of 40, even if you bleed once while you're passing urine, then it's something which you need to take care of. So that's something very important.
Dr. Prabhu:Painless cross-hematura. Without they are feeling any painless blood in the urine, you can also rule out any cancer in the urinary tract pathway.
Dr. Hema Sathish:No, that's all the more scary. So if it's painful also you have a reason and you can do something about it. But if it's painless then it should be alarming I guess. So then you should run. So that's something which everybody should understand. So if it's painless bleeding, don't think that blood is there in the urine and you have no pain so you can just leave it. On the contrary, you have to be more cautious about that is what the doctor is warning about. So that's something which I have also learnt new.
Dr. Prabhu:Sure.
Dr. Hema Sathish:Now coming to diabetes, usually if it is not controllable then it is a problem. But even in control cases over a period of time they develop lot of bladder issues.
Diabetes and Urinary Incontinence: Understanding the Link
Dr. Prabhu:Diabetes impacts two types madam. One to increase the urine production. So it makes them increase frequency and urgency. Another one is damage to the nerve fibers. I already told you that it is a pathogen in the blood and brain connection. So, almost it damages both the sensory and motor fibers. Sensory means the initial stage it produces involuntary urinary contraction. So, urgent incontinence. Late stage provides motor failure. Otherwise, it is a bladder muscle weakness. So, they are not able to empty the bladder. So, two types they can present both stress, urge and overflow in the convalescent. So, I told diabetics, head to foot every organ.
Dr. Hema Sathish:I know.
Dr. Prabhu:So, our system also most vulnerable to the diabetics.
Dr. Hema Sathish:And I think India, so many Indians have diabetes. It's so common now to have diabetes. And so one has to be aware that they have to take care. But you think that if the diabetes is under control and you have kept it under control for years to come, so it's going to be comfortable for the bladder or in spite of that you can develop it?
Dr. Prabhu:In spite them, whatever duration, because of duration, prolonged duration, micro vessel damage, nerve pathway become damaged. So they have to assess properly, along with the old age, so immunosuppression along with. So whatever they are controlled, they need consult. Based upon symptoms they have to consult a proper healthcare professional.
Dr. Hema Sathish:When you say immunocompromised, so what do you mean when you say immunocompromised? I mean you have to have an immunocompromised disease or it's just generally because of age also immunity comes down?
Understanding Weakened Immunity: Disease, Age or Both?
Dr. Prabhu:Along with the age, along with some immunity diabetes, hypertension, whatever, compared to other normal population, they have some immunity power will last. So resistant to the microorganism, resistant to the infection, they are having power is very less. They are more prone to, compared to general population, they are more prone to infection.
Dr. Hema Sathish:Urinary incontinence as it is is quite embarrassing right? So some people will think that it is because of bad hygiene they get it or because of the incontinence they have bad hygiene?
Does Poor Hygiene Cause Incontinence or Result From It?
Dr. Prabhu:Personally, it is a personal hygienic not related to the urinary incontinence but hygienic not a sign for incontinence. They are making hygienic to avoid the, improve the quality of life and you reduce the irritation due to the urinary incontinence. So even though they are having personal hygienic, we can address the appropriate underlying causes, physical causes. We can focus on the physical cause and we can treat the causes. Personal hygienic itself does not treat the urinary incontinence.
Dr. Hema Sathish:So both ways?
Dr. Prabhu:Both ways.
Dr. Hema Sathish:And we sometimes recommend patients to use diapers or pads or something. So how hygienic is that?
Dr. Prabhu:Absorbent pads, as I told you, improve the quality of life. They are going to public places and they reduce the Smell is an embarrassment, they can use the absorbent pad. But it is not reduce the cause, treat the cause only.
Dr. Hema Sathish:Okay, yeah. So in spite of that you will need to treat it. So this is just to help you go in public and not embarrass yourself. That's fair enough. But the treatment has to continue. So when you said Kegels, it's only pelvic floor exercises we're talking about. So if a person is very used to going to the gym, carrying weights and doing everything and develops this, unfortunately. So what can he or she do?
Dr. Prabhu:So, suppose they are going to gym that aggravate the leg anything, they felt that like, then can call consult a pelvic floor physiotherapist. I already told you how to integrate the proper muscles. It's muscle more contraction the prone to leg. How to avoid that contraction? Still they are coming to other type of contraction that can do routine exercise everything. So, avoid over exercise. Prevent the over contraction of that muscle itself would cause painful urination or some problem leading to some other condition
Dr. Hema Sathish:As it is once you have an incontinence it's quite emotionally distressing right?
Dr. Prabhu:Sure madam
Dr. Hema Sathish:Most patients come and tell you that
Dr. Prabhu:Yes
Dr. Hema Sathish:Ok And then what about intimacy? I mean when they are with their partner, it must be so embarrassing for them. So what do you recommend for such a scenario?
Intimacy and Incontinence: Breaking the Silence
Dr. Prabhu:Urinary incontinence can occur with the intimacy itself. So promote the bladder irritation, prone for urinary leak. So those patients we can properly manage. First main thing go for counselling the patient. Proper counselling along with the emotional support.
Dr. Hema Sathish:Okay.
Dr. Prabhu:We can bring them back to the normal life.
Dr. Hema Sathish:Okay.
Dr. Prabhu:Otherwise, they are most emotionally bonded. Family itself is most distressing one of the condition. So, provide emotional support and along with proper causes and symptoms, you have to evaluate that one.
Dr. Hema Sathish:So, it's not the end of the world. You can still take support, you can still take help from others. And emotional support has to be given by the family also. So now coming to male incontinence, there are several reasons we spoke about in general also. When coming to male incontinence, there's a very big prostate factor over there, right? So could you explain like how a prostate problem can cause urinary incontinence?
Prostate Problems & Male Incontinence: What's the Connection?
Dr. Prabhu:So prostate itself not cause urinary incontinence. Initially it can present with a increased urinary frequency, urgency. Whenever they are not, properly late stage only it will make them incontinent so we can properly address the early symptom thorough clinical examination along with ultrasound we can assess the post void rest of urine post void mean after voiding almost they are retaining the bladder urine usually not able to empty the bladder completely
Dr. Hema Sathish:Okay in spite of the physical obstruction due to the prostate
Dr. Prabhu:Yeah Some of them are not able to come to the bladder. After voiding, still more urine is accumulated in the bladder. So more time takes, more prone for infection. Finally, they will come to the not able to void along with the urinary incontinence. So based upon enlargement size, main symptom score is one of the most assessment. Even though big size, we are not worried about that. It makes small size even though 50 gram it make more symptom 300 gram not at all cause any symptom. So we can address based upon symptom score only not size not criteria. So those patients not able to tolerate I am no time not able to sleep in spite of I am drinking less water still I am going to 10 times to the bathroom during night time. So these are the most horrifying the symptom to the patient we can go and correct the prostate. So we have many modalities to treat the prostate obstruction. So we are doing any laser form of surgery, endoscopic surgery, and laparoscopic technique also is useful for the large size prostate.
Dr. Hema Sathish:So once the surgery is done, everything is taken care of or I mean I have seen lot of patients who come post-surgery also with urinary incontinence. So what would you do to help them?
Dr. Prabhu:Yeah, I told you it's a diabetic, mostly they are associated with diabetic.
Dr. Hema Sathish:Okay, so it's more with the prostate surgery and if they are diabetics then they get...
Dr. Prabhu:So we can properly evaluate the patient.
Dr. Hema Sathish:Okay.
Dr. Prabhu:Surgery is not solution for the neurogenic function.
Dr. Hema Sathish:Oh yeah, yeah. The bladder function through the nerve is not fine then again that is not good.
Managing Urinary Incontinence After Prostate Surgery
Dr. Prabhu:We can opposite we can do surgeries mostly end up in the urine leak. So we can properly address the problem which won't cause the trouble to the patient. We can treat that cause. Post surgery, sometimes cancer prostate, we can do radical prostate robotic surgery. After that, initially, during surgery, we can damage some nerve fiber around the tissue, around the urethral muscle. Initially, they present with incontinence due to nerve fiber damage. So we can start the early program. Like pelvic floor muscle training, proper follow up, proper counselling the patient, education, we can recover them from urine leak, proper counselling.
Dr. Hema Sathish:Now some people have very transient urinary incontinence also, especially women post birth.
Dr. Prabhu:Yes ma'am.
Dr. Hema Sathish:So how long do you think that would take to recover organically?
Postpartum Incontinence: How Long Does Recovery Take?
Dr. Prabhu:Minimum I told is we can go for belly flow muscle training protocol, we can exercise, we can start, along with proper belly flow physiotherapist. Initial proper session we can start. Minimum I told is 3 times per day, 8 contraction per session, proper contraction and relaxation is must. Along with physiotherapist. So we can, minimum duration is 3 months.
Dr. Hema Sathish:So that can happen in men also post prostate surgery right?
Dr. Prabhu:Yes Madam. Because that time the urethra. Sphincter, we are doing around the mechanism only. We are doing all surgery around the Sphincter mechanism. Sphincter one of the most powerful to control the, maintain the continence. So probably female is only one Sphincter maintain their mechanism continence mechanism. In male also we are having two Sphincter, internal Sphincter and external Sphincter. With the pelvic floor muscles support. These are the main purpose for the urine leak. So sphincter one of the most.
Dr. Hema Sathish:Yeah, so it's just post-surgical or post some issue like childbirth or something. So if they take proper care, then by three months you can expect to get back to normalcy. And if that doesn't happen, then I think you should take help which is required, right?
Dr. Prabhu:Yes ma'am.
Dr. Hema Sathish:Okay. So doctor, when you take medications, it causes so many problems in so many different ways. So can urinary incontinence be caused by certain medications taken for certain conditions?
Could Your Medicines Be Affecting Your Bladder Control?
Dr. Prabhu:Yes Madam, sure. Most of the time, nowadays most commonly chronic kidney disease and diabetes. Mostly they are using diuretic therapies, drugs. Diuretic itself causes increased urine production.
Dr. Hema Sathish:Can you explain what a diuretic drug is for everybody's benefit?
Dr. Prabhu:Whenever the kidney not able to empty the urine, push the urine outside, we can use some drugs to... Increase the output of the urine. So it itself causes increased urine production, increase the urine frequency. So you can modify the dose drug according to your consult. Don't stop drug immediately yourself only. Please consult your expert doctor and modify the dose. We have alternative drugs. So we can alternate drug reduce the certain complication. So drug itself promote some urine leak but we can switch over to other alternative drugs with the proper consultation.
Dr. Hema Sathish:So if a person has got incontinence and because of certain reasons and you already started the person on medications so how hopeful can they be that they are going to become absolutely fine?
Dr. Prabhu:Medications only work for some type of urinary incontinence only, not all type. Especially well work for urgent urinary incontinence. It not work for the stress and overflow urinary incontinence. So you can start initially single drug, either we can assess the response. If not respond well, single drug. We can add multiple drugs with the proper dose titration. We can manage them properly. In spite of they are not responding well, we can assess another type. We can which type they are having. We can go for further investigation. We can manage with the other form of drugs. Surgery, slings, anything. We are having many drugs, many treatments available.
Dr. Hema Sathish:So now you told me so many things. So now a person comes and they do not know what they have, right? So they'll just walk into your chamber and then ask you that, tell you their problem. So how will you assess like what exactly is causing this?
Finding the Root Cause: How Is Urinary Incontinence Diagnosed?
Dr. Prabhu:Yes, this is the most important question madam. We can go for mainly based upon patient symptom category. What they are having most predominant symptom, whether they are having urgency or stress leak or whether they are having overflow. We can go for the clinical examination. Clinically we can find it prostate enlargement or pelvic organ prolapse or something. We can go for basic investigations like X-ray, KUB, ultrasound. Ultrasound mainly focuses on the post-vascular uric. Whether they are able to empty the bladder. Need some urodynamic test means we can assess the sometime they are having mixed difference. So we can go for a further invasive test like urodynamic something we can go for that.
Dr. Hema Sathish:So there are tests which can assess and let you know what is the cause and why it should be treated and how it should be treated above all. So when you spoke about urodynamic testing, so can you explain a little more in detail about it?
Urodynamic Testing: How Does It Help Diagnose Bladder Problems?
Dr. Prabhu:Urodynamics is one of the most invasive tests like surgery is invasive test. Ultrasound is non-invasive. Invasive means we can do something put in the patient body. This is called invasive test. So Urodynamics mainly assist the bladder filling and emptying capacity. How much they are holding the urine, how they are avoid the urine, they are able to properly avoid the urine, they are not able to avoid the urine probably either due to some nerve or motor dysfunction or muscle failure. We can assess everything properly to the urodynamic. This is test not for all patient. Once those patient needed go for urodynamic, otherwise it's not basic test. Based upon urodynamic, whether we are going to which procedure only, we can do urodynamic.
Dr. Hema Sathish:So mainly you assess what the procedure should be.
Dr. Prabhu:Especially those patients having mixed urinary incontinence, both urge and stress. We can identify which one is most predominant. Based upon clinical finding, urodynamic, we can go for, we can treat the cause.
Dr. Hema Sathish:That's quite useful to know. There are so many things available. So henceforth, we shouldn't, I don't think we should hesitate to speak about this or go and meet a doctor for this. So that's nice to know Dr. Prabhu.
Dr. Prabhu:Sure.
Dr. Hema Sathish:So urinary incontinence is not only for adults, right? It can be in children also. So what are the causes in children do you think?
Urinary Incontinence in Children: What Are the Causes?
Dr. Prabhu:Most children are usually associated with some birth defects. Spinal cord defects, some conjunctive defects are usually associated. Even normal side is called Enuresis. Enuresis means even though after attaining proper age, they are bed wetting.
Dr. Hema Sathish:So bed wetting is also a urinary incontinence.
Dr. Prabhu:Yeah, it's involuntary urinary. So you have to adjust proper age. You can't wait up to age of five years. Even though after five years, still they are bedwetting, you have to come consult the doctor. You have to adjust which one cause. I already told you, maturation is a pathway between the blood and brain. Some of them take deep sleep. During deep sleep, not able to focus on the brain, not able to respond during deep sleep. So you have to focus as early. Otherwise, it makes them psychologically very... To the person. The psychology is very impactful. Even though 10 years girl come to me, I am still bed waiting with the embracing to the school or something.
Dr. Hema Sathish:The child must be feeling so difficult to handle.
Dr. Prabhu:Their parents are scolding. But it is most properly managed the parents itself. We can end with the parents. We can start with the behaviour therapy. We can teach both parents and kids. So after age of 5 years they are bed wetting and they should come to the consult the doctor.
Dr. Hema Sathish:So that's something which we all have to be aware of. So if a child is bed wetting beyond 5 years of age, you should go and meet a doctor. Many a times people complain that they have just used the restroom and then they get into the car for a travel and then they have this phobia. Oh my god, I want to go to the bathroom. What can I do? How is it possible now? And that thought I think the whole journey they think about it so much that the journey becomes very stressful. Why is that so and what can be done in a situation like this?
Bladder Anxiety: Why Does the Urge to Urinate Increase During Travel?
Dr. Prabhu:Urine leak, some of them are having some trigger point. Some they feel like taking key itself is a trigger point. Travel itself is a trigger point. Riding the vehicle is somewhat a trigger point. They own that trigger point to aggravate the stimulation to the bladder to brain connection. So we can avoid that using bladder training protocol. So based upon avoid the trigger point, itself their intake of water become reduced much. They can restrict themselves not taking during travel time around three hours I'm not taking any water because I want to go to bathroom every time every five minutes. They restricted that only. So we can properly counsel the patient and some trigger point they are having, they are going for the bladder training protocol. We can avoid, can modify the some pro muscle training program.
Dr. Hema Sathish:Well, there are so many myths about, you know, urinary incontinence and all these issues which happen because I think it is not like a discussion which people have, you know. So they have all these thoughts in their mind and they just believe that this is true. So let's bust few of those.
Dr. Prabhu:Sure.
Urinary Incontinence: Let's Bust the Myths!
Dr. Hema Sathish:Okay. So to begin with, menopause per se can cause urinary incontinence.
Dr. Prabhu:Menopause itself not cause madam. But old age...
Dr. Hema Sathish:So that's a myth.
Dr. Prabhu:Old age itself some cause for weakness, pelvic floor weakness. But we can identify the proper factor, we can manage that.
Dr. Hema Sathish:So menopause is not the only, like menopause per se, just because you attend menopause you are going to have incontinence is a false thing. So urine leakage is a very normal part of aging, is it?
Dr. Prabhu:It's not normal part of aging. Age is one of the factors for the urine leakage.
Dr. Hema Sathish:Women are the only people who get urinary incontinence?
Dr. Prabhu:No madam, men are also prone for the urinary incontinence. So like I told you, it's a prostate obstruction, some stone problem, urethral pathology leading to the men urinary incontinence.
Dr. Hema Sathish:Can you tell me what's the ratio of women and men? I mean, do you have the numbers with you?
Dr. Prabhu:Out of 10 men and women, around 60% of women more prone for urinary incontinence compared to the men.
Dr. Hema Sathish:Oh, that's quite a large number. So urine leakage after childbirth cannot be treated, is it?
Dr. Prabhu:It's a normal pathology, madam. After childbirth, I told you, pelvic floor weakness, they are having urine leakage. But proper pelvic training protocol, we can treat them appropriately with a physiotherapist.
Dr. Hema Sathish:Drinking lesser water will stop urine leakage is it?
Dr. Prabhu:Not like that madam. Drinking less water is prone for the urinary damage, kidney damage also leading to the constipation. Proper fluid intake, proper hydration must avoid such complications.
Dr. Hema Sathish:I wanted one more thing to be asked was when you take coffee or have alcohol does that also increase the incontinence?
Dr. Prabhu:Individual have some trigger point based upon individual response some trigger point to aggravate the bladder contraction especially caffeine and alcohol but not only that cause so individual you have to assess the individual those are triggering point to the person individually you can assess them.
Dr. Hema Sathish:So every person who has got in urinary incontinence will need surgery is it?
Dr. Prabhu:No madam not like that we can assess the type and severity of the urinary incontinence based upon that we can go for treatment.
Dr. Hema Sathish:Urinary leakage means the bladder muscles are very weak is it?
Dr. Prabhu:Bladder muscle weakness itself cause urinary but we can go for other causes it can be overactive bladder, nerve dysfunction, drug related and prostate obstruction, follicular muscle weakness. Urinary leak not only cause for the bladder weakness.
Dr. Hema Sathish:So Kegels exercise is something you spoke about so much. So you think that exercise is more than enough to treat any type of urinary incontinence?
Dr. Prabhu:Kegels exercise only works for some incontinence only, not all types. It will work with proper technique, proper contraction, it will work for some urgent incontinence only.
Dr. Hema Sathish:Urine leakage happens only in people who are over 60 years of age, is it?
Dr. Prabhu:Age is not a criteria for the urine leak, but it can occur in any age group. Even paediatrics in adolescent, old age, all age groups are more prone for the urine leak. But persistent leak, any age, we can go for intervention.
Dr. Hema Sathish:So if someone leaks only a few drops, so that's not a medical problem?
Dr. Prabhu:Even few drops, it makes them quality of life worst ma'am. Also it impacts the quality of life.
Dr. Hema Sathish:That's so true.
Dr. Prabhu:Yeah, so we can go proper, assess the cause and go for consultation, proper consultation.
Dr. Hema Sathish:So frequent urination and urinary incontinence, are they same or they're different?
Dr. Prabhu:Both are different madam. Frequency is voluntary. Patient is able to voluntarily go urinary. Incontinence means involuntary. Involuntary they are not filtered the urine. So both are simultaneously occur together. But both are different conditions.
Dr. Hema Sathish:Coffee is the only drink that can worsen the bladder symptoms.
Dr. Prabhu:Individual having trigger point to stimulate the bladder. Caffeine some of them more prone for trigger point. We have to address the other causes also.
Dr. Hema Sathish:So if a person wakes up often in the night, it is understood that they have a weak bladder, is it?
Dr. Prabhu:Weak bladder is one of the causes but we can go for, I'll tell you, medication, some overactive bladder, nerve dysfunction, prostate pathology. Also other causes go for the nocturia. Nocturia otherwise is an increased frequency of the during night time.
Dr. Hema Sathish:Urine leakage in men is because of enlarged prostate only is it true
Dr. Prabhu:No madam so one of the factors for the urine incontinence we can go for other causes like your taking drugs medication we can rule out other causes because mostly old age is due to mostly they are come for only pph.
Dr. Hema Sathish:So if they are able to manage with the diapers or with pads then they don't need to see a doctor?
Dr. Prabhu:Using pads only improves the quality of life, reduces the physical irritation. So we have to focus on the underlying causes, we can treat the underlying causes, otherwise they are not able to improve that. So pads only improve the quality and reduce the irritation purpose only.
Dr. Hema Sathish:Urinary incontinence is always permanent, is it?
Dr. Prabhu:Based upon type, we can treat them. Most of them cure well with, depends upon the severity type of that. Some of them need long-term follow-up to assess the response to treatment.
Dr. Hema Sathish:So if there is no pain, the urine leakage is harmless, is it?
Dr. Prabhu:No pain is one of the worst condition. How to come to immediate relief? Painless means it's a long-standing process. It ends up nerve damage. So once the nerve damage, it does not feel anything. It's called overflow urinary incontinence. Mostly end up in the renal failure.
Dr. Hema Sathish:Oh, that's very scary.
Dr. Prabhu:So any patient without any painful urination should come that.
Dr. Hema Sathish:Come immediately to the doctor then. So doctor, I want your advice to everybody. I mean as a urologist, what would be your advice to everybody who's listening?
Dr. Prabhu:So urine leak otherwise urinary incontinence is one of the most treatable condition. You can start with the pelvic floor muscle training with the proper address the problem. Many treatment is available. So any persistent urine leak please don't ignore it. Don't assume yourself nothing can be done. Please consult as early as possible to the healthcare professional.
Dr. Hema Sathish:So we have to know that this urinary incontinence is a proper medical condition and it's not something to be ashamed about. So please make it a point to go and seek help, seek a medical professional and make sure you're living a good quality of life. As we always believe that whatever be the problem, you have the right to live a good life. Thank you, Dr. Prabhu. It was wonderful having you.
Dr. Prabhu:Thank you, mam. Thank you.
