Just can't hold it in?

Just can't hold it in?

If urinary incontinence is brought about by a neural problem, InterStim Therapy can help, writes  Dr Ashish Sabharwal

Imagine the state of mind of patients who are not blessed with the luxury to perform natural and involuntary actions of the body, like sneezing, coughing and laughing, without triggering other involuntary functions. To call it embarrassment would be an
under-statement.

The most under-diagnosed and under-reported problem, urinary incontinence (UI) is a disorder that is far more than just a physical complication. The psychological ordeal it presents to the patient is beyond comprehension of those who are fortunate not to face this situation.

Obviously, it is a major barrier to social interests, entertainment, or physical recreation for the people suffering from it.

The severity of urinary incontinence ranges from occasionally leaking urine, while coughing or sneezing, to having an urge to urinate that's so sudden and strong it becomes difficult to reach a toilet in time.

There are different types of overactive bladders:

-Frequent urges to urinate (urgency-frequency)

-Inability to hold urine/ leaking (urge incontinence)

A research estimated that UI impacts 15 to 35 percent of the adult ambulatory population of 60 years and older that live in the community, with prevalence rates for women being twice that of men.

Despite being very common, the disease is seldom registered, due to conventional awkwardness linked to it, especially in case of women patients. While seeking
medical help, most women either go to a gynaecologist or, at most, to a
nephrologist, but the problem persists as it is often not linked with either of those specialties, and the resultant delay ends up aggravating the disease.

However, with timely reporting and diagnosis, UI is very much treatable,
depending upon the physiological factors involved in it. If UI is a neurological issue - which is the case more often than not - an InterStim surgery could be the answer.
InterStim, a neuromodulation therapy, works with the sacral nerves located near the tailbone.

The sacral nerves control the bladder and muscles related to urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves will not tell the bladder to function

properly, which can cause bladder control problems. InterStim Therapy modulates the sacral nerves with mild electrical pulses generated by a neuro-stimulator. This helps the brain and the nerves to communicate better so the bladder and related muscles can function properly.

When the patient has not had success with the more conventional treatments such as medication, changes in diet and exercise, and the condition is, indeed, caused by a neural problem, InterStim Therapy could help.

It is a reversible treatment that can be discontinued at any time, by turning off or removing the device. This treatment maybe first used as a basic test, using a temporary lead, which is removed after the test.

If the patient achieves good results from the trial, s/he is suggested long-term therapy.

With such an advanced therapy in place, it is high time people suffering from UI avail this treatment and resume an absolutely normal life. It is time to say goodbye to the frustration and embarrassment associated with uncontrollable bladder.

(The writer is chief consultant urologist and robotic prostate surgeon, Fortis Escorts Hospital, New Delhi)

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