The most important thing that the doctor will do to establish the diagnosis of urinary incontinence is to take a thorough history. She will ask you specific questions about how often you pass urine (frequency), whether you have to rush to the bathroom the moment you feel like passing urine (urgency), whether you lose a few drops or a larger quantity of urine when you cough, sneeze or laugh (stress incontinence). She will ask you about other medical problems you may have which might have an effect on the leaking of urine. Women with chronic cough may need to get their cough taken care of before embarking on the tests and treatment.

What are the tests that are done?

Your gynaecologist will do a pelvic exam to make sure that there are no specific physical reasons for the incontinence. A uterus, which is significantly enlarged by fibroids, may press on the bladder and lead to loss of urine.

You will be asked to cough while being examined. This requires you to have a full bladder. If you lose urine when you cough or bear down, then stress incontinence is diagnosed.

If your gynaecologist is not able to establish what kind of incontinence you have, she may ask you to undergo urodynamic testing. During urodynamic testing, your bladder is filled up with water and tests are done to determine the pressure inside the bladder and the volume of urine the bladder can hold. This test can help pinpoint the best treatment that would ease your symptoms.

What are the treatment options?

Treatment depends on the type of incontinence you have.

Behavioural therapy is particularly useful in hyperactive (or overactive) bladder. With a hyperactive bladder, a woman has the urge to pass urine very frequently and will lose urine if she cannot get to a bathroom fast enough. In this condition, the muscles that contract the bladder are hyperactive. You will be asked to pass urine at set times, slowly increasing the intervals, so that your bladder can be trained to respond to you instead of you becoming a slave to your bladder.

Medications may need to be used if behavioural therapy fails. Drugs that help control muscle spasms can help prevent leaks. Some help relax a bladder that is too active. One of the common side effects of these medications is dryness of the mouth.

With mild stress incontinence, you will be asked to learn Kegel exercises. Kegel exercises tone your pelvic muscles. They strengthen the muscles around the openings of the urethra, the vagina and the rectum. This is how it is done:

When you are urinating, tighten the muscles to stop the flow of urine. Once you have learnt the sensation of tightening the muscles, you can do the exercise after you have emptied your bladder. Squeeze the muscles that you use to stop the flow of urine. Hold for up to 10 seconds, then release. Do this 10-20 times in a row, at least 3 times a day. Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. After 6-12 weeks, you should find that the amount of urine you leak has decreased significantly.

Some other lifestyle changes which help reduce stress incontinence are: losing weight, avoiding constipation, avoiding very heavy lifting (that cause urine leaks), drinking less caffeine (coffee and tea) and getting treatment for chronic cough.

Surgery for urinary incontinence

If lifestyle modification and Kegel exercises do not improve the symptoms of stress incontinence, surgery may be resorted to.

Bladder neck suspension is a procedure designed to provide support to the urethra and bladder neck, which is the area where the bladder connects to the urethra. For this procedure, an incision is made in the lower abdomen. Through this incision, stitches are placed in the tissue near the bladder neck. This is called the Burch procedure which has, over the years, proved to be the most successful surgical treatment for stress urinary incontinence.

Sling procedures use a pelvic sling, like the tension-free vaginal tape (TVT), around the bladder neck. The sling provides support to keep the urethra closed, especially during coughing or sneezing. The placement of this tape does not require major surgery.

The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

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