Urinary Incontinence (Ui) Health Feed

While certain health conditions cause physical trauma, there are conditions that cause mental trauma as well. One such problem is urinary incontinence that causes embarrassment in the sufferer. Urinary incontinence is a clinical condition where there is a loss of bladder control which invariably leads to accidental leakage of urine. An individual suffering from this condition may feel an urgent need to pass urine right before passing a significant amount of urine.

The severity of the condition can be under control, or it could be a major concern. Some people are not able to take part in the day to day activities such as lifting heavy weights or exercising, and it leads to emotional distress. The condition may cause other issues and increase one's chance of developing other health issues like high blood sugar and obesity.

What are the possible causes?

• Urinary incontinence in men occurs when the brain fails to give the signal to the bladder for the sphincters to squeeze properly. It may cause contraction of the bladder muscles to a great extent or fail to contract altogether. If the sphincter muscles or the associated nerves are damaged, it can lead to various issues.
• Moreover, some people are born with problems in the urinary tract, which increases the chances of developing urinary incontinence. Also, a history of surgery involving the urinary tract or prostate cancer or radiation therapy for prostate cancer may cause this problem in men.
• It is important to note that urinary incontinence is not a disease. It is instead regarded as a symptom of some health issue or any incident.

Knowing the type is crucial to decide on the treatment
There are mainly four types of urinary incontinence in men which include:

1. Urgency incontinence: This happens when a person starts urinating involuntarily after the urgent need to urinate. It is primarily caused by involuntary bladder contractions triggered by abnormal nerve signals.
2. Stress incontinence: This may result from movements exerting pressure on the bladder and causing leakage of urine. This stress may result from coughing, sneezing, laughing or any other physical activity.
3. Functional incontinence: This type of urinary incontinence takes place when some physical disability or external obstacles or problems keep a person from urinating at the right time. For instance, a man in a wheelchair may face difficulties in going to the toilet in time.
4. Overflow incontinence: If the bladder is not able to empty correctly then it may result in the spilling of excess urine leading to urinary incontinence. People suffering from urinary incontinence may require frequent urination since they are only able to release a small part of what their bladder can hold.

What are the treatment options for urinary incontinence in men?
A healthcare professional may recommend behavioural and lifestyle changes along with other therapies such as pelvic floor exercises and bladder training to help reduce the severity of urinary incontinence in men. In severe cases, medications are prescribed to establish bladder control.

A pretty common condition in the elderlies, urinary incontinence can be treated and managed with awareness and medical help.

Urinary incontinence refers to a condition where an individual loses control of the bladder. UI is a common, distressing problem, which can largely affect your quality of life. A number of factors could be causing urinary incontinence – stress, obesity, or simply coughing/sneezing. The chances of developing UI increase with age.

PRP for Urinary Incontinence -
Platelet Rich Plasma or PRP treatment offers viable, safe management for urinary incontinence in people. It belongs to the branch of Regenerative Medicine. To put it simply, PRP therapy involves drawing out a tiny amount of blood, concentrating the platelets, and injecting platelet-rich-plasma into the targeted area for regeneration.

PRP therapy can be effective in eliminating or reducing incontinence, as it regenerates the healthy tissues in your body to alter a few changes leading to UI. The relatively painless, simple procedure rejuvenates muscles, nerves, and urethral/bladder/clitoral/vaginal interface.

What to Expect? 
Patients undergoing PRP treatment experience reduced symptoms of urinary incontinence. The therapy also works to improve and strengthen your orgasmic activity, clitoris sensation and reduce pain during sex.
The procedure typically does not involve side effects, as it is done using your own plasma/blood. In most cases, the results of platelet-rich-plasma procedure last from 18 months to 3 years.

Laser Treatment for Urinary Incontinence -
Laser therapy has gained recognition as a promising treatment approach for urinary incontinence. CO2 laser and ER: YAG laser are the two techniques usually used for the procedure.
Laser beam focused on the targeted area penetrates 10-11mm deep into the skin without damaging the vaginal mucosa and the internal organs. Based on photothermic effect, the laser treatment is performed smoothly without sewing and cutting through the skin.

Why Opt for Laser Treatment?
Laser therapy for urinary incontinence is a preferred choice of treatment due to the following reasons –

• It is a minimally invasive procedure
• Relatively painless – does not require anaesthesia
• No special preparation is needed prior to the treatment
• Relatively safe procedure – no risk of tissue damage
• It is an outpatient procedure

What to Expect Following Laser Treatment?
You can expect to get back to routine activities immediately after the treatment. Results are observed soon after the procedure, and become more prominent as time passes – usually in about six months. However, keep in mind that the results are not permanent. You may have to undergo laser treatment again after 2 years.

Urinary incontinence is seen in both men and women but usually affects the female population. If you have been encountering problems controlling the bladder, you can opt for any of the above procedures. Nevertheless, it is advisable that you discuss both the treatment methods with a certified medical professional, who in this case, is a gynecologist.

A common problem that is not restricted to older people is urinary incontinence, and many are not aware that behavioral strategies play an important role in controlling urinary incontinence. These include alterations in the diet, urinary habits, and lifestyle changes.

The required changes and alterations to be made are entirely dependent on the individual conditions of the patient. However, these are the most common tips as far as the diet to overcome urinary incontinence is concerned:

1. Have the optimum amount of water: If you do not drink enough water, you are likely to get dehydrated. When you have incontinence, drinking a lot of water can also be detrimental. It means that drinking the recommended dose of 6 to 8 glasses of water could also pose a problem. On the other side, when you drink little water, you may end up irritating the bladder. That is why it is important to ask the doctor how much water you must drink.
2. Avoid alcohol and smoking: Alcohol has a negative influence on the bladder as it can potentially affect the messages from the bladder which tells it to hold urine and to release it. When you are consuming alcohol, you are likely to lose the control over the signaling, and it would invariably result in incontinence. If you can cut out alcohol completely, it can definitely fetch the best results. If you cannot cut it down completely, you should consider reducing the amount considerably.
3. Shun spicy foods: When you have to deal with an overactive bladder, you should refrain from eating spicy foods such as chilli peppers and horseradish. This is because spicy foods irritate the lining of the bladder and therefore they should be avoided at all costs. A viable alternative to these could be salads and fresh fruits and vegetables.
4. Say no to caffeine: Caffeine makes you feel the urgency to use the toilet along with prompting the body to get rid of the liquid contents of the body. It is best to remove caffeine from the diet as much as possible. It is really difficult to get rid of teas, coffees, soft drinks and chocolate and if you feel that you are not able to cut it down, you should try to have your caffeine dose in the morning rather than night. It is, however, necessary to limit caffeine intake to one serving in a day.
5. Stay away from citrus: Though fresh fruits and vegetables are always recommended, you should not consume citrus fruits such as lemons, pineapple, oranges since they can bother your bladder and make you feel the urge to go.

Along with these diet changes, if you are overweight, you should try to lose some weight since overweight can cast pressure on the bladder and result in incontinence. Thus, by making such minor yet crucial changes, the condition can be overcome easily.

Anal fistulas or fistula-in-ano generally cause discomfort due pus or watery discharges and sometimes pain. This is a condition where a nodular swelling appears in area surrounding the anal opening. Intermittent pus discharged is noticed from this nodular swelling. Instead of a nodular swelling; there might be simply an opening in this region. An anal abscess is one of the most common causes for this condition. Here are seven things you should know about these anal fistulas:

1. It is curable through Ayurveda only: Till date many treatment options are tried to cure Anal Fistula which include Anal Fistula Surgery/ Glu technique/ cutting seton/ Colostomy/ Fistula plug/ VAAFT and many more. But all of these treatment methods have pretty high recurrence rate of about 20-25 %. However with Ksharsutra treatment for Anal Fistula; chances of recurrence are negligible. Other complications generally seen in surgery like bleeding, incontinence (inability to hold stool); are not seen with Ksharsutra Treatment. Clinical trials conducted by Indian Council for Medical Research (ICMR); at AIIMS New Delhi and PGI Chandigarh in 1992 have proved that Ksharsutra treatment is more convenient and more effective than Surgery in the patients of Anal Fistula. 
2. There are symptoms you can look out for: Some of the symptoms that indicate anal fistulas include appearance of a nodular swelling in area surrounding Anal opening. Intermittent pus discharge is also observed from this swelling. Usually pain subsides and opening closes after the discharges; and patient feels relief. But after certain interval of time again pus accumulates; swelling re-appears with some amount of pain which is again relieved after the discharge. This cycle is repeated at varying interval in the patient of anal fistula.
3. Medication can only provide temporary relief: Anti biotics and painkiller might give temporary relief from the symptoms. But after some time there will be again pus formation and associated swelling & pain in area surrounding anal opening. 
4. Anal fistulas can recur after surgical treatment: As discussed above all the treatment options tried by modern medicine (including most recent treatment VAAFT) have high incidence of recurrence (about 20-25%) Whereas there are negligible chances of recurrence after Ksharsutra Treatment for Anal Fistula. . 
5. Anal fistulas treated by Graded Ksharsutra do not recur: Ayurvedic treatment for anal fistulas is known as Kshar sutra therapy. This involves the use of medicated thread being ligated in Fistula Tract. The medicines present in this thread act as a strong debriding agent and induces healing of Fistula tract. In few weekly sittings of Ksharsutra change; Fistula gets healed completely and it do not recur. Pt. maintains his normal routine life during treatment period. 
6. Sitz bath can be beneficial: This involves sitting in a tub filled with warm water so that the affected site is submerged. An antiseptic and astringent agent like Triphala decoction may be added to the water if needed. A sitz bath soothes the skin and provides relief from pain. This also helps keep the area clean and thus reduces chances of infection. 
7. Oily and spicy foods should be avoided: When dealing with anal fistulas, you should try and take a diet that keeps your stool soft and regular. Hence use of oily and spicy foods should be reduced. Eat plenty of fiber and drink lots of water. Alcohol should also be avoided. 

Comparative Study: 

Ksharsutra vs Surgery in Anal Fistula Patients- 

1. Ksharsutra is done under Local Anesthesia. Hence complications of General Anesthesia are avoided. Surgical procedures are done under GA with all impending complications of General Anesthesia. 
2. Ksharsutra being a parasurgical procedure hence no bleeding/ cutting of tissue is involved. Surgery involves cutting/ bleeding. 
3. No hospitalization or bed rest is required in Ksharsutra Treatment. In Surgery hospitalization is must. 
4. In Ksharsutra; patient can continue his normal daily routine Surgery may require bed rest. 
5. Complications like incontinence (inability to hold stool) and recurrence are seen after surgery
6. Ksharsutra is a safe procedure and these complications are not seen. 
7. Ksharsutra Treatment is more economical as compared to VAAFT surgery. VAAFT Surgery is comparatively too expensive.

What is Urinary Incontinence?

Urinary incontinence is the unintentional discharge of urine. Urinary incontinence may manifest itself in different forms. This may include an overactive bladder, mixed or transient incontinence.

Causes of Incontinence-
Incontinence may be a result of weakened or damaged pelvic floor muscles or an obstruction in the bladder. It most often occurs in women after pregnancy and menopause. Rapid weight gain or a genetic pre-disposition can increase the risks of incontinence. With increasing age, the chances of incontinence increase.

Treatments-
Urinary incontinence can be non-surgically treated by a few simple measures. These include-

1. Lifestyle Modifications- Obesity has been linked to urinary incontinence in women. A healthy and balanced diet with an adequate amount of physical exercise will help control your weight. You should also cut down on the amount of alcohol and caffeine that you consume. You should also regulate the amount of fluids that you consume. Drinking too little or too much can worsen incontinence.
2. Pelvic Floor Muscle Exercises- The muscles of the pelvic floor are the ones that control urine flow. They are situated around the urethra and the bladder. Urinary incontinence may be caused by damaged or weakened pelvic floor muscles. Exercises designed to strengthen and tighten these muscles called kegel exercises are recommended by physicians to control urination. This exercise involves the repeated contraction and relaxation of the pelvic muscles.
3. Bladder Training- Bladder training is a behavioral therapy that helps increase the time interval between bouts of urination. It also increases the amount of fluids that the bladder can hold before you feel the urge to empty it. It requires that you follow a fixed schedule for urination irrespective of your urge to urinate. The intervals are progressively increased.
4. Incontinence Products- There are sanitary products like fluid soaking pads and pants that help manage incontinence. They help manage any accidental leakages that might occur.
5. Medications- There are medicines that help regulate urination and strengthen muscles that control urine flow.
   • Duloxetine is a medicine that increases urethral muscle tone and helps to keep it closed. It is an oral medicine that should only be administered under the doctor’s supervision.
   • Antimuscarinics which commonly include tolterodine, oxybutynin, and darifenacin help regulate urination if you urinate frequently.
   • Mirabegron might be prescribed by your physician in an attempt to relax the bladder muscles. This will allow it to store urine for longer periods of time.

Urinary incontinence is prevalent mostly in older women and its treatment is a big part of their health and well-being.

Urinary incontinence refers to the inability to control bladder movements. While it does not affect the person’s health, it can be an embarrassing condition. The severity of this condition can range from passing small amounts of urine every time you sneeze or cough, to getting a sudden strong urge to urinate without the time to get to a toilet. Urinary incontinence is not a disease by itself but rather is a sign of another underlying condition. It may be caused as a result of childbirth, age, menopause, prostate, or neurological disorder.

Treatment for this condition can take many forms:

1. Medication: Urinary incontinence may be treated by many different types of medications depending on the underlying cause. Anticholinergics may be prescribed to calm the bladder muscles and reduce the urge to urinate frequently. Alpha blockers are typically prescribed to men to help them relax the prostate and bladder neck muscles so as to be able to pass urine freely. For women suffering from incontinence due to hormone fluctuations, topical estrogen may be helpful.
2. Behavioural techniques: The patient will also be taught techniques to help control the bladder. This includes scheduling toilet visits every few hours rather than waiting for the urge to urinate. To avoid overflow incontinence, the patient may be advised to follow a double voiding process. This involves urinating, waiting for a few minutes and urinating again. Cutting back on diuretics such as alcohol, caffeine, etc can also help. In addition, regular exercise and physical activity can help ease the issue.
3. Pelvic Floor Exercises: Pelvic floor exercises or Kegel exercises can help strengthen the pelvic muscles and prevent leakage. This involves contracting the pelvic muscles, holding them for a few seconds and then releasing them. Ideally, the patient should be able to hold the contraction for 10 seconds. This exercise should be performed in three sets of 10 repetitions each. It is very effective in treating stress and urge incontinence.
4. Medical devices: Women suffering from severe urinary incontinence can consider the implantation of medical devices to help control the bladder. This includes a urethral insert to prevent leakage and a pessary or stiff ring to hold up the bladder muscles.
5. Surgery: Surgery is usually considered only as a last resort. This could be in the form of a sling procedure, bladder neck suspension, prolapse surgery or inserting an artificial urinary sphincter. These procedures may be used to treat many different types of incontinence.