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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 – PowerPoint PPT presentation

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Title: Sudden Urine Leakage? Urinary Incontinence


1
Sudden Urine Leakage? Urinary Incontinence
Too embarrassed to speak about it?
Dr. Sharda Jain Secretary
General, Delhi Gynaecologist Forum
2
I am afraid to talk to my kids
3
Her daughter- in-law is a gynaecologist. She
talked to her
Mrs. Usha Jain 75 years
Break Your silence. Take control
4
Break Your silence. Take control
5
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)
6
Urinary Incontinence Types
  • Stress Incontinence
  • Urge Incontinence
  • Mixed Incontinence
  • Overflow Incontinence
  • Total Incontinence
  • Functional Incontinence

7
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
8
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

9
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

10
Basic Evaluation of UI
  • History
  • Physical Exam (PE)
  • Cough Stress test
  • Urethral Mobility testing
  • Post void residual urine
  • Urine analysis/culture
  • Voiding diary

11
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 .

12
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
13
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

14
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

15
Thank You
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