Urinary incontinence: Treatable and preventable

Millions of women with this common problem can find relief with proper treatment:

By Carol Aloysius

Urinary incontinence (UI) the unintentional passing of urine, is a common problem affecting millions of people worldwide. In the UK alone, the National Health Services estimates between three and six million people may have some degree of urinary incontinence, and in Sri Lanka too medical experts believe the numbers of persons with this condition are rapidly increasing.

UI affects both men and women, but it tends to be more common in women, who are not only reluctant to admit they have this problem but shy away from seeking medical help, thus affecting their quality of life.

But the plus point is that UI is treatable and can be successfully managed even in advanced cases, by physiotherapy and an exercise regime geared to improve and strengthen the weakened pelvic floor muscles which are chiefly to blame for urinary incontinence.

Chartered Physiotherapist, Dr GOPI KITNASAMY discusses the management of Urinary Incontinence with physiotherapy and electropathy, along with its causes and symptoms in this interview with the Sunday Observer.

Excerpts…

Q. Urinary Incontinence is now an increasingly common problem worldwide and in Sri Lanka. What does Urinary Incontinence mean in medical terms?

A. Urinary incontinence means the accidental leakage of urine. While this condition affects millions of people, the majority of them are women.

Q. Why are women more vulnerable to this condition?

A. Mostly due to their weakened pelvic floor muscles.

Q. What are pelvic floor muscles? Where are they located?

A. The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and back passage (rectum). The pelvic floor is a sheet of muscles that extend from your tail bone (coccyx) to your pubic bone at the front and between the two ‘sit bones’, forming a diamond shaped platform between your legs. It provides the floor to your pelvis (the bottom part of your abdomen / tummy) and your bladder, uterus (womb) and rectum rest on it. Pelvic floor muscles are also responsible for controlling the movements of your urethra, anus and the vagina itself. Hence, they are key to controlling urination and bowel movements, as well as in the process of intercourse and birth.

Q. What causes these muscles to become weakened?

A. Stress incontinence is the main cause. Pelvic floor muscles are often weakened by childbirth. Stress incontinence is common in women who have had children, particularly if they have had several vaginal deliveries.It is also more common with increasing age, as the muscles become weaker, particularly after the menopause.

Q. What are the different types of UI?

A. They include the following:

1. Stress Incontinence

Stress incontinence may happen when there is an increase in abdominal pressure - such as when you exercise, laugh, sneeze, or cough. Urine leaks due to weakened pelvic floor muscles and tissues.

Causes of stress incontinence include pregnancy and childbirth, which cause stretching and weakening of the pelvic floor muscles. Other factors may also increase the risk for stress incontinence, such as being overweight or obese, having had prostate surgery, and taking certain medications.

2. Urge Incontinence

Urge incontinence is often referred to as overactive bladder: You have an urgent need to go to the bathroom and may not get there in time, leaking urine.

Causes of overactive bladder include:
Damage to the bladder's nerves
Damage to the nervous system

Damage to muscles

Other causes include medical conditions and diseases such as multiple sclerosis, Parkinson's disease, diabetes, and stroke, spina bifida and spinal cord injury can all interfere with the nerve function of the bladder, leading to urge incontinence.

Bladder infections, bladder stones, and use of certain medications can also contribute to symptoms.

Some women have both of these types of urinary incontinence - stress and urge. Doctors call this mixed urinary incontinence.

3. Overflow Incontinence

You may have overflow incontinence if you are not able to empty your bladder appropriately.

As a result, you may have leakage once the bladder is already full. This is more common in men with symptoms of frequent dribbling of urine.

Causes of overflow are:

Weak bladder muscles

Blockage of the urethra, such as by prostate enlargement

Medical conditions, such as tumors, that cause obstruction of urine flow

Constipation

4. Functional Incontinence

With functional incontinence, physical problems such as arthritis, or cognitive problems such as dementia, prevent you from getting to the bathroom in time.

Stress urinary incontinence is the most common type of incontinence and is the uncontrollable loss of urine when you cough, sneeze or laugh.

Any activity that results in an increase in pressure in the abdominal cavity may contribute to stress urinary incontinence. This happens when pelvic floor muscles have been weakened. Obesity is also another cause.

Q. Can Stress Incontinence occur in men as well?

A. Stress incontinence though more common in women, can also occur in men.

It can also be caused due to repeated lifting of heavy objects, chronic persistent cough (such as chronic bronchitis and asthma) and Constipation or repeated straining during urination or bowel movement.

Q. What are the symptoms that indicate pelvic floor muscle weakness?

A. You will know you have a weak pelvic floor when you experience the following:

An aching or dragging sensation in your vagina.

A feeling of something coming down inside your vagina - may be due to a prolapse

Frequent urination accompanied by a sense of urgency.

Urinary incontinence - leaking when you cough, sneeze, laugh

Inability to control passing of wind

Reduced sexual response

Q. How can you prevent this condition?

A. Do the following:

*Keep body weight within healthy limits. By doing so, the weight of the abdominal contents pressing against the pelvic floor is lessened and prevents the pelvic floor from weakening further.

*Eat a diet rich in fibre and drink between 1.5 - 2 oz of fluids per day.

*Seek early treatment for prolonged cough, and stop smoking preferably.

* Tighten up your pelvic floor before lifting heavy objects, changing positions, coughing or sneezing - this can be taught by our hospital physiotherapists.

* Pelvic floor exercises especially during and after deliveries.

Don't do the following:

*Lift heavy objects repeatedly.

* Strain when moving your bowels.

Q. How do you use physiotherapy as a cure for incontinence?

A. We use physiotherapy and pelvic floor muscle electrical stimulation to help patients.

In the case of physiotherapy, as each patient’s condition differs physiotherapy will be tailored to suit each individual depending on his/her medical and ophysical condition, age etc. Your physiotherapist will advise you on the appropriate exercise program for your specific condition.

Q. Give us some examples of the kind of exercises you recommend for strengthening pelvic floor muscles.

A. It’s important to focus on the right group of muscles when exercising your pelvic floor. You shouldn’t be working the muscles in your legs, buttocks or above your tummy button and you mustn’t hold your breath. Feeling some slight tension in your lower abdominal muscles is normal.

1. Tighten the muscles around your back passage (as if trying to stop yourself passing wind) and draw them up and forwards.

At the same time, tighten the muscles around your front passage (as if trying to stop passing urine). You should feel a ‘lift and squeeze’ inside. Once you’ve identified the right muscles, try and see what they can do. How long can you squeeze the muscles for? How many times can you repeat this? Work towards being able to complete the following routine:

2. Squeeze and lift your pelvic floor muscles as hard as you can. Hold for a count of 10 seconds. If your muscles feel too weak to hold for 10 seconds, aim to build up the time slowly. Repeat this exercise up to 10 times.

3. Tighten and lift your pelvic floor muscles as quickly and as strongly as you can, then relax. Do this up to 10 times

Aim to perform these three times over the course of a day, every day. Each set of exercises takes about 2 ½ minutes.

4. Try to squeeze and lift your pelvic floor muscles each time you pick up anything heavy (including babies, car seats) and before you cough, or sneeze. This helps your pelvic floor muscles to support the increasing downward pressure on your body.

Q. What is Electropathy Stimulation in the context of pelvic stimulation?

A. It means electropathy stimulation of the pelvic floor muscles using an electrical frequency with the help of a pelvic floor muscle stimulator. We use a special electrode for this purpose.

It can only be done in a physiotherapy department in a hospital setting.

Q. Your message to the public?

A. Like in any exercise program, don’t expect instant results. It will take weeks of regular exercise to improve your pelvic floor muscles and perhaps several months to regain their previous strength. If you do your exercises three times a day then you should notice a difference after about six weeks. And then you can drop to doing the exercises once a day. The reality is that you need to do these exercises, every day, for the rest of your life.

Diabetes ages the mind and can bring on earlier dementia

Major American study shows direct link between the conditions

Diabetes in middle age can “age the mind” by five years, potentially hastening the onset of dementia in later life, a new study has shown. More than three million people in the UK are living with diabetes and there is mounting evidence that the illness is linked to memory and thinking problems in old age.

In a new analysis of health data from nearly 16,000 people in the USA, who have been followed up since the 1980s, researchers saw direct links between the condition and cognitive decline.

They found that, on average, a 60-year-old with diabetes experienced a decline in their brain function that was on par with a 65-year-old without diabetes.

Type 2 diabetes, the most common form, is closely linked to being overweight or obese, and maintaining a healthy diet and exercising regularly are among the best ways to prevent the illness.

The authors of the study, from Johns Hopkins Bloomberg School of Public Health in Maryland, said that their research proved “that to have a healthy brain when you’re 70, you need to eat right when you’re 50.”

Their findings, add to mounting evidence that a number of physical health conditions increase a person’s risk of developing dementia.

People with diabetes have trouble regulating levels of sugar in their blood.

This can cause damage to the veins, including those in the brain – an effect which may explain diabetes’ link with dementia.

Dr Laura Phipps of Alzheimer’s Research UK, said: “This study adds to a large body of evidence linking diabetes to thinking and memory problems in later life, and suggests that controlling blood sugar levels in midlife may also have long-term benefits for our brain health.

“Evidence suggests we can lower our risk of dementia by keeping healthy: eating a balanced diet, exercising regularly, not smoking, and keeping blood pressure and weight in check.”

- The Independent

Renewed hope for patientsparalysed by spine injuries

‘Unprecedented and exciting’ results for drug that helps people regain muscle

A drug that could eventually help paralysed people regain muscle movement has been discovered by scientists.

In a study described as “unprecedented”, researchers were able to activate the paralysed muscles of disabled rats, using a daily injection of a newly-developed chemical compound they believe can reconnect nerve connections. They said that the “very promising” compound was now being moved forward into larger trials.

It is the latest in a string of recent discoveries that have given renewed hope that people disabled by spinal cord injuries could be helped to walk again. Previous studies have focused on therapies using stem cells or electronic stimulation. Earlier this year, doctors reported on the case of a man in Poland with a severed spine who was able to walk again, following treatment with an implant of regenerative cells.

However, the discovery of a candidate drug opens up new ground.

So far the compound, known as intracellular sigma peptide (ISP), has only been tested in a small number of rats, so it is too early to say for certain whether it would work in humans. However, scientists have described early evidence as “exciting”.

Of 26 rats injected, 21 regained the ability to walk, balance or control their bladder movements. Some regained all three; others two of the three.

Jerry Silver, professor of neurosciences, who led the research team, said these rates of recovery were “unprecedented”.

“Each of the 21 animals got something back in terms of function,” he said. “For any spinal cord-injured patient today, it would be considered extraordinary to regain even one of these functions, especially bladder function.”

The rats were injected daily with the ISP for several weeks. Thousands of people are left disabled by spinal cord injuries every year.

The injuries crush and sever nerve fibres - long slender projections of nerve cells - that facilitate communication between the brain and the body and enable muscle movement and function.

After injury, nerve communication is blocked off by scarring around the injury site. Build-ups of proteins called proteoglycans in scar tissue react with enzymes in nerve tissues and cut off nerve signals. The ISP drug appears to work by blocking this enzyme, enabling nerve communication across this previously impenetrable barrier.

The researchers said that if development into a drug were successful, ISP could be used either as a standalone treatment or potentially in combination with other ground-breaking therapies to give spinal-injured people in the future the best possible chance of recovery.

Dan Burden, 38, from Hertfordshire, who broke his back 13 years ago and is a spokesperson for the UK’s Spinal Injuries Association, said that the possibility of a drug therapy - as opposed to surgery or electrodes - was particularly promising.

“An eventual treatment for spinal cord injury may come from a combination of things - for example, this drug therapy combined with the surgical intervention we’ve seen in Poland,” he said. “It’s very promising to hear all of these different methods that are having beneficial results.

“In this study they have also specifically mentioned that the rats were able to regain control of their bladder function. This is a really big issue for spinal cord injured people. Time and time again when research priorities are sought from spinal cord-injured people, bladder function, bowel function and sexual function will figure more highly than walking.”

- The Independent