Many women feel scared just thinking about going out somewhere or travelling.
Especially during a long journey, the first question that comes to their mind is what will happen if they lose control over urination?
Many times, women leak urine when they cough or sneeze, while climbing stairs or when they laugh loudly. Even while lifting heavy objects, they fear leaking urine.
Such women gradually start avoiding doing these things. But due to fear and shame they do not even want to talk about this problem with anyone.
In fact, pelvic floor muscles can become weak due to reasons like pregnancy, delivery, menopause, increasing age, obesity or diabetes.
This affects the ability to control urination. In medical language it is called 'stress urinary incontinence'. In common parlance it is called leakage of urine or urine leakage.
Many women think that leaking urine is 'normal' as they age or after childbirth.
Therefore, instead of getting treatment, they continue to suffer this problem. But according to experts, involuntary urination at any age is not a problem that should be ignored.
By getting timely diagnosis and treatment, this problem can be controlled to a great extent. Pelvic floor exercises, lifestyle changes, medicines and if necessary, even surgery can be effective in its treatment.
Therefore, instead of accepting urine leakage as 'it happens with increasing age', it needs to be taken seriously as a health problem.
Many women feel that 'there is no cure for this' or 'this will have to be endured', but it is not necessary.
The problem of urine leaking often increases gradually. Initially, a few drops of urine leak only while coughing or exercising, but later it starts affecting everyday life also.
For some women, this can make it difficult to travel, exercise, attend social events or even leave the house.
If leakage of urine is accompanied by burning sensation, pain, blood in urine, frequent infections or incomplete emptying of the bladder, then it becomes even more important to consult a doctor.
Experts say that the sooner the treatment is started, the better the results can be. Many women can also get relief from simple measures like pelvic floor muscle exercises, keeping weight under control, treating constipation and chronic cough.
In some cases, medicines or some special medical procedure may also be required. The most important thing is that this type of leakage of urine is not a problem on which one should remain silent out of shame.
This is a medical condition and its treatment is possible. Therefore, instead of continuing to endure the pain, the first and most important step is to consult an expert.
What happens when you laugh, cough or sneeze?
Laughing, coughing, sneezing, running, jumping or lifting heavy objects suddenly increases the pressure inside the stomach.
Normally, the pelvic floor muscles and tissues supporting the urinary tract handle this pressure and prevent urine from leaking out.
But if this support becomes weak or the coordination between the muscles there gets disturbed, then urine starts leaking.
This does not mean that there is anything wrong with the bladder itself, but it is due to the weakness of the system that supports the bladder and urinary tract.
The most common types of urinary incontinence in women are urinary incontinence caused by sudden urge to urinate, urinary incontinence caused by pressure or strain, and a mixed type of both. Mixed urinary incontinence is the most common type.
What treatments are available?
How this problem will be treated depends on the type of urine leakage, its severity and the reason behind it.
Initially, it is advisable to adopt pelvic floor exercises, bladder training, lifestyle changes and some behavioral measures.
Some women may also benefit from medications or special medical devices. If stress urinary incontinence persists for a long time, treatment options such as injections or sling surgery may also be considered.
However, before starting the treatment, it is very important to find out the exact disease and this test should be done by a doctor only. One should not start treatment or exercise by guessing about the disease on one's own.
What is pelvic floor?
The pelvic floor is a group of muscles and ligaments present in the lower part of the pelvis. Pelvis i.e. the part of bones and muscles present in the lower part of the abdomen, below the waist.
In simple language, if the pelvis is considered as a building, then the pelvic floor is a flexible network of muscles and tissues present in its lower part.
This part is connected to the lower end of the spinal cord and the bones of both thighs. Along with supporting the body weight, it helps in keeping the important organs of the lower abdomen in place.
In simple language, these muscles support the organs of the lower part of the body. The pelvic floor plays an important role in controlling urine and stool, supporting the organs when pressure increases inside the abdomen and maintaining normal sexual function.
Pelvic floor muscles can become weak due to pregnancy, delivery, increasing age, obesity, long-term constipation or certain surgeries. However, it is not necessary that the problem occurring in every person is due to weakness of muscles.
In some people, the pelvic floor muscles become too tight or overactive. In such a situation, there may be problems like pain in the pelvic area, difficulty in urinating or pain during sex.
Therefore, it is not necessary that strengthening exercises i.e. strengthening the pelvic floor muscles is the right method for every type of problem.
What changes occur in the bladder and urinary system with aging?
Whatever be the type of problem of urine leaking, it is important to get it checked by a doctor. This should not be ignored.
Dr. Soni Mehta informed us about the changes that occur in the urinary system of women with increasing age.
She works as a Urologist and Andrologist Consultant at P. D. Hinduja Hospital and MRC, Khar, Mumbai.
Speaking to BBC Marathi, he said, "With increasing age, the support of the pelvic floor muscles reduces. Due to this, problems like cystocele and rectocele can occur. This can cause difficulty in emptying the bladder completely. Apart from this, problems like narrowing of the urinary tract, frequent urinary infections and inability to drain urine completely can also occur."
"Due to hormonal changes after menopause, the urethra may become narrower and the ability to control urination may decrease."
Apart from aging and delivery, are there any other reasons for this?
On this question, Dr. Mehta said, "Long-lasting cough, chronic constipation, obesity, metabolic syndrome and diabetes are some important reasons that increase the risk of urine leakage."
"Obesity and metabolic syndrome affect all organs of the body, including the bladder. Due to this, the nerves that control the bladder can be affected and many types of urinary incontinence problems can occur. "
Regarding what tests may be required to detect this problem, Dr. Soni Mehta said, "For its diagnosis, many tests may be required, from initial tests like simple urine test, urine culture and ultrasound to detailed tests like urodynamic study."
"The advice and guidance of a urologist is necessary to correctly interpret the results of these tests."
What is the effect on the pelvic floor during pregnancy and what is its relation to urinary control?
During pregnancy, there is a lot of pressure on the pelvic floor. As the size of the uterus increases, the pressure on the pelvic area also increases.
Along with this, hormonal and physical changes also affect the muscles and tissues that play an important role in controlling urination.
Some women start having the problem of urine leakage even before delivery.
If such a problem occurs during pregnancy, the risk of it persisting even after delivery may increase. Age, weight and previous pregnancy also have an impact on it.
We spoke to Dr. Maya P.L. about women in whom this problem starts after delivery. Asked Gade some questions.
She works as a consultant gynecologist and obstetrician at Kokilaben Dhirubhai Ambani Hospital, Mumbai.
After all, is the risk of this problem different in normal delivery and cesarean delivery?
Dr. Maya P.L. Gade told that according to research, the risk of urinary incontinence i.e. inability to control urination after normal delivery is higher as compared to cesarean delivery.
In a joint analysis of many studies, this problem has been seen more after normal delivery.
However, this risk is not completely eliminated by cesarean delivery, because pregnancy also affects the pelvic floor.
Every woman's situation may be different due to symptoms present before delivery, mother's health and complications during delivery.
Is urine leakage after delivery always temporary?
In response to this question, Dr. Gade says, "In the first few months after delivery, the problem of urine leaking may reduce on its own with the healing process of the pelvic floor. But it is not necessary that this happens every time. According to research, this problem can persist for a long time in many women."
"Therefore, if urine is leaking after delivery, it should not be ignored by considering it as 'normal'. By getting tested, the exact type of urinary incontinence and its treatment can be detected."
If which symptoms appear, should a doctor be consulted?
On this he said, "If the problem of urine leaking is persistent, increasing or is affecting exercise, work, sleep, relationships or daily life, then a doctor should be consulted. Apart from this, pain or burning sensation while urinating, blood in the urine, bladder not emptying completely, frequent urine infections, other problems related to the pelvic area or sudden change in control over urination are also important symptoms. Through proper investigation, The reason for this can be found out."
What are Kegel exercises?
Kegel exercises are exercises based on contracting and then relaxing the pelvic floor muscles. In the 1940s, Dr. Arnold Kegel first recommended these exercises for the treatment of urinary incontinence in women.
Today, women as well as men are advised to do Kegel exercises, especially after prostate surgery.
When done correctly, it can improve urination control, aid in recovery after delivery, and in some cases, even reduce sexual health problems.
However, many times people start contracting the wrong muscles. Tightening the muscles of the stomach, buttocks or thighs is considered Kegel exercise. Apart from this, some people do these exercises continuously and excessively.
For people who already have a tight pelvic floor, if they continue doing tightening exercises, the pain, discomfort or problems related to urination may increase.
Therefore, before starting Kegel exercises, it is important to find out what the real problem is. It is also important to seek proper guidance from a pelvic floor physiotherapist if needed.
The basic structure of the pelvic floor muscles is the same in men and women, but in women these muscles are more flexible for pregnancy and delivery.
How much help do Kegel exercises help?
"Combining pelvic floor muscle contractions with pelvic tilts and core activation exercises like bird-dogs and glute bridges can help improve muscle strength and coordination during everyday activities."
He further said, "Biofeedback is also a useful method. With the help of EMG or pressure-based devices, it helps women understand in real time whether they are using the right muscles or not, whether they are able to relax them properly or not. This can be more helpful especially for those women who have trouble identifying how to activate the pelvic floor muscles properly."
After this, Dr. Kannaujiya draws attention to an important thing.
He says, "It is not necessary that every pelvic floor needs strengthening. In some women, the muscles may be too tight or overactive. In such a situation, it may be better to relax the muscles and create proper coordination between them. Physiotherapists can examine the condition of the person and prepare the right exercise plan accordingly."
He adds, "Pelvic floor weakness can also be related to pelvic organ prolapse. However, not every urinary problem means that the pelvic floor muscles are weak."
"In some women, these muscles may become tight rather than weak. Therefore, it may be beneficial to have a checkup with a pelvic health physiotherapist to understand what the real problem is."
If you want to make any major change in lifestyle, change your diet, take medicines or start exercising, then it is important to take the help of a doctor and the right trainer.
After getting your body and symptoms properly examined by a doctor, it is better to make lifestyle changes as per his advice. Treating yourself without consulting a doctor can be harmful.
