CHENNAI : The science of uro-gynaecology may have emboldened more women to discuss a medical problem that used to be hushed up due to social taboos. However, urinary incontinence, or involuntary loss of urine, which seriously mars quality of life and dents the victim's confidence, continues to be suffered in silence by hundreds of thousands of women, specialists said on Thursday.

"Many women fail to recognise it as a medical problem that requires treatment. Instead it is confused for a discomfort to be lived with," said Karthik Gunasekaran, uro-gyanecologist and founding-secretary of the Indian Urogynaecological Society (IUGS).

According to international surveys, 10 to 15 per cent of all women and approximately 5 per cent of men experience urinary incontinence.

The incidence is projected to increase over the next 10 years, with a significantly higher percentage in the elderly. The Asian Society of Female Urology has put the incidence of urinary incontinence in India at around 12 per cent.

Loss of bladder control is more common among older people. Biologically, women are far more predisposed than men to develop urinary incontinence because of the smaller size of urinary tube and the higher chances of pelvic floor trauma during childbirth.

The prevalence of the disorder in the U.S. alone is around 20 million adults who spend close to 31 billion U.S. dollars for treatment. Less than 40 per cent of people with the problem actually reported to physicians while 58 per cent imagined the condition to be a natural consequence of ageing.

Though ageing by itself does not lead to incontinence, the risk advances with age. Incontinence can occur due to a host of factors such as urinary tract infection, vaginal infection or use of certain medications. It is also attributed to reasons like weakness of bladder muscles, overactive bladder, prolapse of pelvic organs, blockage from enlarged prostate or damage to nerves that control bladders. The disorder is more commonly seen in those who underwent a hysterectomy or are post-menopause.

"It is now estimated that around 40 per cent of women who have had normal delivery will gradually develop urinary incontinence, and this has increased the demand for Caesarean sections," said Dr. Karthik. However, obstetricians weigh in a lot of other factors before choosing a Caesarean over a natural delivery, he added.

Stress Urinary Incontinence, where the loss accompanies a slight exertion as in a cough or sneeze, and Urge Incontinence as in inability to hold and bedwetting are common forms of the disorder.

The management of the disorder involves a combination of drugs, behavioural therapy and surgery.

Biofeedback which determines pelvic pressure points using sensor electrodes in the advocacy of exercises and uro-dynamics, a study of bladder functions, are helping specialists address the problem more effectively.

Dr. Karthik runs the Guna Associates in Uro-gynecology and Research for Incontinence (GUNA), a centre for continence and pelvic health, at 1, Crescent Park Street, T. Nagar (Tel: 30904166).

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