Urinary Incontinence Treatment in Nagpur

It is common, which is not the same as normal. Pregnancy, vaginal delivery, menopause, chronic cough, constipation, heavy lifting and weight all put load on the pelvic floor and on the support of the urethra, so leakage becomes more frequent with each of them. That is an explanation, not a reason to accept it. Being told that this is simply what happens to women after children is the single commonest reason a treatable problem goes untreated for a decade.

Stress incontinence is leakage when pressure rises inside the abdomen — coughing, sneezing, laughing, lifting, exercising — and the amount is usually small. Urgency incontinence is a sudden compelling need to pass urine with leakage on the way to the toilet, often with frequency during the day and waking at night. Many women have both, which is called mixed incontinence. The distinction matters because the first treatment is different for each.

More common than the consultation figures suggest. Reported prevalence in Indian women ranges from about 10 to 42 per cent depending on the population studied and how incontinence is defined, and one hospital screening study found that around two-thirds of affected women had never mentioned it to a doctor, most often because they assumed it was a normal part of ageing. The gap between how many women have it and how many are treated for it is almost entirely a gap in asking.

History first, in detail: when you leak, what triggers it, how many pads you use, how often you pass urine by day and night, your deliveries, your surgeries, your medicines and whether there is any prolapse. Then a urine test to exclude infection, a pelvic examination, and an ultrasound. You may be asked to fill in a simple bladder diary for three days before a decision is made, because what women remember and what the diary shows are often different.

To measure what is left in the bladder after you have passed urine, which is called the post-void residual. A bladder that does not empty properly can overflow and produce leakage that looks like urgency but needs the opposite treatment, so this is checked before any medication is started. The scan also looks at the uterus and ovaries, which matters because a large fibroid or a prolapse can be part of the picture.

For stress and mixed incontinence they are the first treatment and the evidence behind them is strong. What makes the difference is doing them correctly and doing them for long enough. Guidance is a supervised programme of at least three months, with a minimum of eight contractions three times a day. Dr. Kunda teaches the contraction in person and checks that you are using the right muscles, because a large proportion of women who say the exercises did not help were bearing down instead of lifting.

A structured programme of gradually extending the time between visits to the toilet, so that the bladder relearns to hold a normal volume. It is the first treatment for urgency and mixed incontinence and should be given at least six weeks before it is judged. It works better alongside a trial of reducing caffeine — tea, coffee and cola all count — and it works badly if you also cut your fluid intake drastically, which concentrates the urine and makes urgency worse.

There are, mainly for overactive bladder and urgency rather than for stress incontinence. Dr. Kunda prescribes them where they are indicated, usually after bladder training has been given a fair trial rather than instead of it, and she reviews the effect and the side effects rather than repeating the prescription indefinitely. After menopause, vaginal oestrogen is often useful for the urinary symptoms that come with thinning of the tissues. Doses are not published here and are decided individually.

A pessary is a soft device fitted into the vagina to support the pelvic organs. It is most useful when prolapse is part of the problem, and it can also help stress leakage by supporting the urethra. Dr. Kunda fits pessaries at the clinic. It is a reasonable choice if you want to avoid surgery, if you are not yet finished having children, or if you are waiting for surgery, and it can be tried and abandoned without anything being lost.

At a hospital in Dhantoli where Dr. Kunda is attached, under anaesthesia. No surgery of any kind is performed at Mayflower Clinic — the clinic is for consultation, scanning and outpatient procedures. Continence surgery for stress incontinence includes sling procedures and colposuspension; which operation is appropriate, and whether surgery is the right step at all, is decided after assessment and after conservative treatment has been given a proper trial. Assessment, surgery and follow-up are all with the same doctor.

When urine leaks continuously through the day and night rather than in episodes, when there is blood in the urine, when infections keep coming back, when passing urine is difficult or painful, or when leakage starts alongside new weakness, numbness or difficulty walking. Continuous leakage after a difficult delivery or after pelvic surgery needs specific assessment for a fistula. None of these should wait for a course of exercises.

You can say very little and it will still be enough — that you leak urine, and roughly when. You will not be asked to demonstrate anything, the examination is the same one done at any routine gynaecological visit, and you can bring someone with you. If it is easier, write it on a piece of paper and hand it over. Dr. Kunda asks about bladder symptoms routinely in consultations for other reasons, precisely because so few women raise it themselves.