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Urinary Incontinence in Women

Dr. Nidhi Luthra

Loss of control over the outflow of urine from the bladder is known as urinary incontinence.The problem can be categorised according to the cause into urge incontinence and stress incontinence. The problem, of urinary incontinence can be relieved by proper management, exercises and ofcourse with the help of homoeopathic medicines.

Loss of control over the outflow of urine from the bladder is known as urinary incontinence. Though it affects both the s*x*s but is more common in females, mainly because the muscles that control urination are often damaged during pregnancy and childbirth.

Normally, urinary continence is maintained due to the proportionate increased in intraurethral pressure to the intravesical pressure. The intraurethral pressure of rest and with stress is much higher (20-50 cm of water) than the intravesical pressure (10 cm of water). The difference in pressure is maintained by many anatomical and physiological factors.

The problem of urinary incontinence can arise due to abnormality in the anatomical structure on could be functional or phsycosomatic also. The problem can be categorised according to the cause into urge incontinence and stress incontinence.

Physiology of Micturition
There are two phases in the normal act of micturition, the storage phase and the voiding of urine.

Storage Phase: In the storage phase the urine enters the bladder through the ureteric openings at the rate of 0.5 ml -5ml/ minute from the ureter. The pressure in the bladder on the intravesical pressure is kept lower than that of the urethra by the relaxation of the bladder muscles (detrusor). This pressure is maintained by the muscles of the vesico urethral unit and by way of nerve supply.

Voiding phase: When the volume of the bladder reaches about 250 ml, a sensation of bladder filling is perceived. A desire to void is experienced. The sensation passes up the spinal roots and a set in motion a reflex which contracts the detrusor that results in voiding. This urge to void can be suppressed in adults and the action of detrusor can be voluntarily inhibited. When the person desires to pass urine, the detrusor contracts to raise the intravesical pressure to 30-50 cm of water which is further raised to 100 cm of water by voluntary contracts of the abdominal muscles.

Stress Incontinence
Stress incontinence is the involuntary passage of urine when the pressure inside the urine increases, for example, when we cough, sneeze or laugh. There is a sudden rise in intra abdominal pressure in the absence of detrusor activity. Stress incontinence is more or less an anatomical problem and there is a distortion of the normal urethro- vesical anatomy. Another reason is the lowered intra urethral pressure below the intravesical pressure. These problems could be related to the developmental abnormalities of the supporting structures, child birth trauma, pregnancy, post menopausal,surgery or obesity. Infact, stress incontinence occurs due to any reason that stretches or weakens the urinary muscles.

The patients are usually parous, may be postmenopausal. Often the complaints date back to the last childbirth or some va***nal plastic operation. This problem is more common in obese women.

The only symptom is the escape of urine with coughing, laughing or sneezing. The amount of urine passed is usually small but depends upon how much the pelvic floor has been weakened and how much the pressure in the abdomen increases. and is unassociated with a desire to pass urine.

Urge Incontinence

Urge incontinence is the loss of bladder control as soon as the urge to urinate is felt. The urge comes on without warning and is usually over-whelmingly strong. It comes from an unstable bladder that contracts inappropriately before it is filled to capacity. Urine loss can range from dribbling to uncontrollable flooding.

Other common symptoms are urgency, frequency, nocturia and bed wetting.

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