Urinary incontinence, that is, the inability to hold back urine is fairly common in women, especially after middle years. It is so embarrassing that mostly women do not want to talk about it unless the problem becomes very severe. They avoid going out for this reason. There are many underlying causes.

During delivery, particularly after the first baby, some trauma occurs to the vagina, lower part of uterus and sometimes to the urinary bladder sphincter(valve that holds back urine) due to close proximity to the uterus. This leads to incontinence. Laxity of bladder sphincter is also a very common cause. The reason for this development is social etiquette. It is not considered "lady-like” for a woman to go for urination in any public place. Therefore she would hold back the urine maybe for hours together till she finds a suitable place to void herself. Result is that the sphincter becomes lax over time because of the constant pressure. Consequently as soon as the bladder becomes full, small amounts of urine starts dribbling.

Uterine prolapse also causes incontinence in women in middle years. In women having borne many children, supports to the uterus become lax over the years. This causes the uterus to come out during any exertion, like walking or coughing. This presses on the bladder causing recurrent infections and urinary incontinence.

Urinary tract infections are more common in women, as short length of the urethra facilitates the ascent of bacteria to the bladder. Menstrual bleeding also facilitates the growth of infections. Resultant infection of the bladder causes incontinence along with other symptoms.

Incontinence is further aggravated by uncontrolled diabetes or those on diuretic drugs. Whatever may be the reason, it is a very embarrassing situation. Because of the constant dribbling, sufferers remain "wet” all the time.

Due to this, they are prone to develop chronic fungal infections locally. There is resultant itching, burning and pain on genitals and inner sides of thighs.

Once urinary incontinence starts, there is no medical cure. Only its exacerbation can be prevented. Anything which can aggravate the problem like coughing, constipation, lifting weights should be avoided. Uterus has no support externally. When one sits with legs spread forwards uterus is put in a relaxed position and further prolapse is avoided. This removes the pressure on the bladder and thus prevents incontinence.

Drinking plenty of water helps eliminating bacteria from the body thus preventing cystitis.

If pregnant, one should opt for delivery by skilled professionals thus minimising trauma to the cervix and bladder sphincter. Having few children keeps the uterus toned up with no risk of developing either prolapse of uterus or urinary incontinence.

Women should not keep their bladders full for long. It is healthy to void the bladder after every 2 to 4 hours. This prevents infection and also laxity of the bladder sphincter in later years.

An exercise can be done simply at home at any time which helps to tone up the perineal muscles and the bladder sphincter. While sitting or standing straight with the breath held for about few seconds one should exert pressure on the perineum as one does for holding the bladder in a public place. Of course the bladder should be empty before doing this exercise. This can be done for about 5 minutes per day, initially and can be augmented up to 20 minutes daily.

Once urinary incontinence develops repair is only possible by surgery and that too is not very useful as chances of relapse are high if causative conditions persist. Therefore it is better to be careful about this condition right from a very young age so that this embarrassing problem does not develop later in life.

Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital