Sudden Urine Leakage Urinary Incontinence Too embarrassed to
Sudden Urine Leakage? Urinary Incontinence Too embarrassed to speak about it? Dr. Sharda Jain Secretary General, Delhi Gynaecologist Forum
I am afraid to talk to my kids
Her daughter- in-law is a gynaecologist. She talked to her Mrs. Usha Jain 75 years Break Your silence. Take control
Break Your silence. Take control
Urinary Incontinence • Overall prevalence of Urinary Incontinence varies between 10 -52% in adult women • SUI >common, occurring in 3 out of 4 women of UI • SUI 1: 4 women in general. • SUI and prolapse • Rarely seen in nulliparous women • SUI and pregnancy- 23 -67% antenatally - 6 -30% postnatally (Cody J et al; HTA 2003; 7: no. 21)
Urinary Incontinence: Types • • • Stress Incontinence Urge Incontinence Mixed Incontinence Overflow Incontinence Total Incontinence Functional Incontinence
Stress Urinary Incontinence Immediate loss of urine with …. • • Coughing Laughing Exercise Sneezing Intercourse Walking Kneeling for Puja Lifting objects at home If severe: Just positional change i. e. gravity
Urge Incontinence Inability to control urine with strong urge… • Loss of urine before reaching the toilet • Frequent urination of small amounts of urine • Night time urination greater than 2 x/night • Bedwetting
Mixed Urinary Incontinence Combination of Stress UI and Urge UI Symptoms of both Stress & Urge – 4 -30 % of patients – One factor predominates – Leak larger volumes of urine & more incontinence episodes per week
Basic Evaluation of UI • • History Physical Exam (PE) Cough Stress test Urethral Mobility testing Post void residual urine Urine analysis/culture Voiding diary
Impact on life – very profound • Reduced self-esteem & socially embarrassing • Minimal leakage but bothersome • Distressed, feeling of shame – very few consult Dr (<25%) • Develop coping strategies: avoid going out 60%, wear dark clothes, restrict fluids, frequent visits to toilet, avoid sex.
Impact on life – very profound • Myth & Misconception SUI Normal after delivery/with ageing • Misconceptions or Ignorance Rx of SUI Most Dr’s focus on objective cure (complete relief) Subjective improvement in symptoms and QOL is more important
Medical Treatment • Medical Treatment provides meaningful relief to elderly OAB patients To Devki, meaningful relief is………. . • Attending her granddaughter’s school annual function celebration with less worry about having a wetting accident
Surgery of choice Burch colposuspension – Gold Standard (84 -90%success rate) TVT – 95 -96% replaced Burch as primary choice TVT-O - Rapidly taking over from TVT - outside in -2001 - inside out – 2003 ↑ 1 Million Cases- Over 90% success
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