Monday 22 June - Sunday 28 June 2009
The International Continence Society Announces First World Continence Week

The ICS recently announced the designation of June 22 - 28, 2009 as the First World Continence Week.
World Continence Week will help promote global awareness of continence by providing contact points for those seeking treatments and information, creating a network of events and organizations, and by promoting a multi-disciplinary approach to treatment.

What is Urinary Incontinence?

Continence is able to hold, control. 
Uncontrolled urine leakage causing inconvenience or embarrassment is called urinary incontinence.

How common is Urinary Incontinence?

Prevalence in Western World:

28% of 144 female exercisers bet. 18-21 yrs1
26% of 3100 females bet 30-59 years2

Urinary Incontinence in Women

1  (Nygaard, Thompson, Svengalis, 1994)
2  (Elving, Foldspang, Lam, Mommsen, 1989)

How about India ?

12% of women have Urinary Incontinence.
(Asian Society for female Urology)

What causes urinary incontinence?

• The causes are different in children, mainly due to some development defects or incorrect toilet training during early childhood.
• Infections can cause incontinence at any age, which is temporary.
• In women, multiple pregnancies, difficult child birth can cause  urine leakage.
• There may be  incontinence due to injury to Spinal cord  and  nervous system  diseases.

How expensive is this problem of Urinary Incontinence?

Again, data is not available for our population, but costs can be at individual level and at the society level.

Individual:
Financial: $ 1000-3000 annual exp. For absorbents

Psychosocial:
Fear of smell, embarrassment and sexual difficulties
2/3 sedentary women (24-64 age) stated SUI (Stress Urinary Incontinence, leakage on coughing and sneezing) as cause for their physical inactivity

Society:
US – 16.4 billion $ in 1996        41$ per inhabitant1
Sweden- 2 billion SEK in 1990   38 $ per inhabitant

1Agency for Health Care Policy and Research USA

How is it diagnosed?

• Quite often, a simple clinical examination, by a competent doctor, is all that is required. Examination of urine is necessary and in some patients special tests may be necessary.

What special tests, Are they expensive?

• An Ultrasound examination (Scan) is useful, costs 300 -500 Rupees. In less than 10% patients, Urodynamics testing is required to get more information. Average cost of that test is about two thousand rupees.

How about treatment?

• Early cases of urinary leakage may be treated by simple exercises, done regularly. Some can be helped with medications. Some may need simple appliance to remain smell free. Only advanced cases, about 5-10% of total, will need surgery.

What types of surgery may be required?

• For large number of SUI (Stress Urinary Incontinence) an operation lasting 30 minutes, in which special tape is inserted to restore normal position of the bladder and the valve is done, as a day care procedure or an overnight stay. The cost of the tape. Varies from 3-4 K for indigenous ones to 15 K for others.
• In some types if incontinence, Implantable Artificial sphincter is also an option.
• Leakage due to VVF (communication between bladder and vagina) will require slightly longer operation, with  an average  hospitalization for 5 days.

Can we prevent these leakage problems?

• To a large extent, well supervised child birth programme can prevent most of these incontinence problems.

Any Specific Measures to prevent the incontinence?

• To prevent SUI, there are exercises to strengthen muscles. These should be taught during Ante-natal (before birth) visits and done regularly after child birth.
• Vesico-Vaginal Fistulas are due to prolonged labour and are prevented if child birth is well supervised and prolonged labour is avoided.

Final Message:

• It is not normal at any age to be wet, smelly and be an outcast. Help is available... Awareness is the key.