Loss of control over urination is called urinary incontinence. An extremely distressing condition, it unfortunately does not get the attention it deserves; mainly due to the social stigma associated with it. Worldwide, several million dollars are spent on its treatment. Though it is seen in all age groups, the causes of the same are different at different age groups. When seen in children, the causes are more likely to be due to some urological or neurological birth defect. With advancing age, the causes vary depending upon the sex of the patient. Young men & women may suffer from urinary incontinence due to some form of damage to the nerve control of bladder behaviour. This can sometimes follow an accident involving the spine. Middle-aged women may develop urinary incontinence due to damage to pelvic floor muscle, which may occur during pregnancy & childbirth. Also, changes associated with menopause can lead to urinary incontinence in some women. After the age of 75 years, men & women may certain age related bladder changes, leading to incontinence of urine. Some diseases seen in the elderly, such as diabetes mellitus, stroke, Parkinsonism, often have associated loss of bladder control.

Normally a person passes urine every 2-4 hourly, at his or her will, & rarely wakes up in the night to urinate. In between these times, he remains dry. With age, the night frequency may increase up to 2 times in most normal people. If you pass urine more frequently than this, find it hard to hold it & also have urinary leak on straining, you need to be seen by a urologist. A urologist will see you clinically, & suggest some routine tests, to rule out urinary infection, diabetes etc. Depending on the clinical evaluation, a sonography of the bladder, uroflowmetry may be advised. All patients are asked to maintain a record of their urination, to document the volume voided each time, as well as to record any episodes of leak. Some patients may need a sophisticated test called urodynamic evaluation.

Patients with neurological disease need appropriate treatment of their disease, along with urological medication. Some patients may need intermittent bladder catheterization & occasionally surgery to enlarge the bladder capacity or to strengthen the muscle in the urinary passage. In middle aged women, stress urinary incontinence [SUI], that is loss of urine on cough or sneeze, sometimes even with running, is the commonest cause. These patients often respond to pelvic floor exercises to strengthen the urinary control muscles. To facilitate learning these exercises, vaginal cones can be used. Those with severe form of SUI may need surgery, which involves placing a tape just under the urethra to support it. In elderly patients, bladder is usually at fault due to age related changes. This condition is called urge incontinence of urine & it may be due to overactive bladder. These patients usually respond to simple measures such as change in lifestyle, fluid intake, exercise etc. Some patients may respond to magnetic therapy. Others may need medication belonging to anticholinergic group. [Oxybutinine, Tolterodine, Solifenacin etc] Nowadays, Botox can be injected in bladder muscle to alter its behaviour. The effects of Botox are short lived & most patients need repeat injections. Very rarely, patients need surgical enlargement of bladder using a patch of intestine. Some patients may require injection of a bulky agent such as Macroplastique, deflux or collagen.

This is indeed a myth. In fact with modern treatments, most of the patients can be offered appropriate treatment, which can dramatically improve their quality of life. The important thing is to get the right doctor involved in your care at the right time.