Sudden Urine Leakage? Urinary Incontinence

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Sudden Urine Leakage? Urinary Incontinence
Too embarrassed to speak about it?
Dr. Sharda Jain Secretary
General, Delhi Gynaecologist Forum
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I am afraid to talk to my kids
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Her daughter- in-law is a gynaecologist. She
talked to her
Mrs. Usha Jain 75 years
Break Your silence. Take control
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Break Your silence. Take control
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Urinary Incontinence

• Overall prevalence of Urinary Incontinence varies
  between 10-52 in adult women
• SUI gtcommon, occurring in 3 out of 4 women of UI
• SUI 14 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 20037no.21)
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Urinary Incontinence Types

• Stress Incontinence
• Urge Incontinence
• Mixed Incontinence
• Overflow Incontinence
• Total Incontinence
• Functional Incontinence

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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
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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

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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

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Basic Evaluation of UI

• History
• Physical Exam (PE)
• Cough Stress test
• Urethral Mobility testing
• Post void residual urine
• Urine analysis/culture
• Voiding diary

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Impact on life very profound

• Reduced self-esteem socially embarrassing
• Minimal leakage but bothersome
• Distressed, feeling of shame very few consult
  Dr (lt25)
• Develop coping strategies avoid going out 60,
  wear dark clothes, restrict fluids, frequent
  visits to toilet, avoid sex .

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Impact on life very profound

• Myth Misconception
• SUI Normal after delivery/with ageing
• Misconceptions or Ignorance Rx of SUI

Most Drs focus on objective cure (complete
relief) Subjective improvement in symptoms and
QOL is more important
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Medical Treatment

• Medical Treatment provides meaningful
• relief to elderly OAB patients
• To Devki, meaningful relief is..
• Attending her granddaughters school annual
  function celebration with less worry about having
  a wetting accident

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Surgery of choiceBurch colposuspension Gold
Standard (84-90success 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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Thank You