Awareness is on rise about Urinary Incontinence

 

 

 

By Vikas Vaidya

The prevalence urinary incontinence in postmenopausal Indian women is as high as 59% according to studies done in India. The commonest type of urinary incontinence seen is Stress Urinary Incontinence (SUI) and the other type is urge incontinence.
Dr N Rajamaheshwari the first lady Urogynaecologist in the country and specialised in the procedure to prevent urinary incontinence. She says that the awareness about urinary incontenence is rising, people are coming forward.
After completing her post graduation she was working in a hospital in rural area, there she realised need and necessity to improve the competency and skill with reference to urinary system which is very close to genital tract. There she felt that the super specialisation is needed in urogynaecology. She then went on to acquire MCH in urology when she had already done Gynaecology post graduation. This way Dr N Rajamaheshwari became the first lady Urogynaecologist in the country who has urged Government to start super specialisation in Urogynaecology.
According to Dr Rajamaheshwari, the cure rate of the patient becoming continent i.e. not leaking urine, after the operation is between 95 to 97%.
Around 65% depending on different age groups, race and other factors suffer from incontinence. It is a social taboo because of which the women do not talk or seek help and thus isolate themselves. It is a common and distressing problem, which may decrease quality of life, says Dr Rajamaheshwari. Earlier the procedure for incontinence lasted long for over one hour. Now it takes 10-15 minutes. She was in city to deliver lecture organised by Nagpur Obstetrics and Gynaecological Society (NOGS) and also performed procedure at CARE hospital.
TVT has been replaced by Transobturator tape (or TOT for short) is similar to an operation called Tension-free Vaginal tape (TVT) but has some advanced components. The purpose of TOT and TVT is to treat the condition with which the patients have been diagnosed, namely, stress urinary incontinence (SUI). The way the tape is inserted and fitted is different in TOT.
It is felt that this makes TOT safer due to there being less chance of injury to bladder, bowel or blood vessels as the tape is inserted. TOT is a form of keyhole surgery which means that the operation can be performed as a day case procedure and usually is associated with a quick recovery. On average the operation lasts about 30 minutes from the start of the anaesthetic until the time you wake up.
There is lack of awareness among doctors too. If this problem is left untreated, it becomes worse and these women can not lead a normal social life properly. They keep themselves away from nearly everything. This isolation affects their mental health too making them depressed and frustrated, pointed out Dr Rajamaheshwari.
There are different types of incontinence of which stress incontinence and overactive bladder (OAB) are the most common types. Stress incontinence, also known as Effort incontinence which is more common in women, causes urine to leak on effort or exertion, like sneezing, laughing, or coughing. Urge incontinence, also called overactive bladder, is caused by urinary muscle spasms that causes the person to urinate for number of times, said Dr Rajamaheshwari.
Dr Rajamaheshwari said, “Surgery is the treatment of choice for stress incontinence, if pelvic floor exercises do not help. But surgery is not the solution for every patient. It differs from patient to patient.”
Incontinence can be caused by genetic weakness, over weight, multiple child birth, lifestyle, menopausal changes and aging, amongst others.

What is TOT Continence Surgery

TVT stands for Tension-free Vaginal Tape which is made of prolene. Now it has been replaced by Transobturator Tape (TOT). In both operations, TOT and TVT, a nylon mesh tape is placed underneath the urethra (the tube which allows urine to empty from bladder). The tape will act like a swinging couch or handing bed to support the urethra. The body makes scar tissue that grows into the mesh of the tape so helping it to stay in place. This scar tissue together with the tape give additional support to the urethra, making it less likely that leakage of urine takes place.