Mumbai, June 21: Urinary incontinence is something women rarely talk about. But it is an affliction that hampers them from doing even everyday things. World Continence Week, starting Monday, aims to encourage women to come out and deal with it.
Sheetal is careful not to laugh too much at parties. The 34-year-old entrepreneur (who didn’t want her last name to be used) suffers from a condition called stress urinary incontinence (SUI). Every now and then, she experiences an involuntary leak of urine. It’s brought on by sneezing, coughing, running or even laughing too hard. “It’s embarrassing and very inconvenient,” she says. “It happened once when I was running to catch a train and, instead of going to office, I had to go back home and change my clothes. My work requires me to visit places like construction sites, where there are no toilets sometimes. I keep worrying about having an ‘accident’.”
The problem began seven years ago, shortly after Sheetal had her daughter. But she kept ignoring it — as did the gynaecologist whom she consulted — thinking it would go away. But it got worse over the years till Sheetal realised she couldn’t do everyday things, like jogging or even walking fast, and had to take along a change of clothes.
Given the symptoms, it’s not unusual for women who suffer from urinary incontinence to refuse to talk about it. The International Continence Society has initiated a World Continence Week, starting June 22, to create awareness about this.
A 2007 study by the market research organisation Junicon showed that 22 million Indian women suffered from SUI, and the number increased by two per cent every year. “In 2009 the number has jumped to 23 million,” says Dr Abhijit Das, urogynaecologist and pelvic floor reconstruction surgeon with Le Nest Hospital, Goregaon, which is organising a week of check-ups during Continence Week. Whether they have SUI — where the involuntary leak is caused by pelvic muscles being weakened by childbirth, menopause or the shifting of the urinary bladder — or urge incontinence, the inability to hold it in, usually brought on by urinary tract infection, experts say it’s years before patients seek medical help. “I call it the silent, neglected disease because women rarely admit to it,” says Dr Sailesh Raina of Breach Candy hospital. “But you can always tell when a person has it. On the train, she’s the one sitting quietly by herself, or making sure her seat is closest to the toilet. Or standing with her legs crossed the whole time.” Among other things, he says, incontinence shatters a person’s self-esteem.
And now it’s happening to younger people as well. A 2005 study by the Post Graduate Institute of Medical Education and Research, Chandigarh, of about 1,979 women, shows prevalence of incontinence is highest in the age group 65 and above (18.6 per cent), closely followed by those between 45 and 54 (17 per cent), but it’s also significant in the age group of 35-44 (11.6 per cent).
“I never imagined that at 34 I would get incontinence,” says Sheetal. “I thought it was a senior citizen’s ailment.” Dr Duru Shah, gynaecologist with Jaslok Hospital, says little things — like not drinking enough water, lifting heavy things, weight gain or the lack of exercise — can first lead to urinary infections, and eventually become full-blown incontinence. “Then, even the slightest stress can cause a leak,” she says.
One patient complained of it while bending down to read the namaaz; it turned out the month of fasting, and not drinking water for long hours, had triggered incontinence. People who are constantly on a diet also need to watch out. “Being undernourished or less protein intake can make tissues in the pelvic muscles flabby and unable to control the flow of urine,” says Dr Shah.
Renuka first got SUI when she was 45. Though she’s not sure what brought it on, she feels that the fact that she is “on the heavier side” may have contributed. “Whenever I got a cold, I would have to rush to wear a sanitary napkin as well,” she says. “Just a sneeze would cause urine to run down my legs, sometimes during meetings at work. But it seemed like such a small thing in the beginning.”
It’s not, says Dr Shah, adding that almost 70 per cent of her patients complain of various degrees of incontinence. Dr Das now sees about 2-3 cases a day, up from maybe one in a week, five years ago.
According to the Chandigarh study, the most common reason for not reporting incontinence was that it was considered normal. Despite this, the fact that about 70 per cent of women reported not being able to get on with their daily activities was startling. With increased awareness, many women are now asking their doctors for solutions. For milder conditions, doctors usually recommend exercises to strengthen the pelvic floor muscles. But for SUI, the most popular treatment right now is the minimally-invasive procedure of inserting a trans-vaginal tape (TVT) [see box]. Renuka has undergone the surgery a few months ago, and now says the incontinence is almost gone. “I haven’t had the leak in a while, and maybe I’ll be able to tell you once I catch a cold,” jokes the HR manager adding, on a more serious note: “I feel like I can finally get on with my life.”
Remedies
– Diet and exercise can bring down SUI by about 70 per cent or more
– Kegel exercise which involves contracting and relaxing the muscles is the best remedy
– Drugs can reduce leakage or relax the muscles, leading to more complete bladder emptying. Other drugs tighten the muscles at the bladder neck and urethra
– Surgery can be used to pull the urethra up to a more normal position, which is the most common cause of SUI
– One of the more popular slings in India today is the tension-free trans-vaginal (TVT) sling. The procedure takes very little time, and is said to have an 86-95 per cent cure rate.
–Agencies