Embarassing Woes

 What are the common causes of dribbling (incontinence) and how do they occur?
 The two varieties of incontinence (urge and stress) are caused due to different mechanisms, but they may co-exist. Urge incontinence refers to a condition where a person feels like going to the toilet (urge) but is unable to hold on to the urine for the appropriate period, leading to leakage of urine. The main mechanism involved is considered to be over-activity of the bladder, leading to urgency with incontinence. Sometimes, the mere thought of a toilet nearby can cause someone to dribble. This can be very debilitating for patients who prefer to remain in familiar surroundings with easy access to the toilet. 
The other type of incontinence is known as stress incontinence. This is commonly seen in women after childbirth, usually following multiple normal deliveries, which may weaken the tone of the pelvic floor muscles. Here, the person experiences dribbling during bouts of raised intra-abdominal pressure, viz. laughing, coughing, sneezing, etc. However, in extreme conditions, women can even dribble while standing up from a sitting position. This is more common in females than males, because women only have one muscle complex around the urethra controlling continence. This mechanism of control is also dependent on the tone of the neighbouring muscles of the pelvis. These muscles become weak after repeated childbirth, and due to age. Increased intra-abdominal pressure further contributes to this condition, which can occur if someone is overweight or obese.


 What can I do about this condition?

 Although this is an embarrassing condition, it is imperative to seek help. A proper history on the part of the patient goes a long way in establishing the type of incontinence. The doctor may then examine you, and ask you to do certain manoeuvres to demonstrate leakage of urine. Following this, it may be necessary to look into the bladder (cystoscopy) to rule out any other causes of leakage. During this test, the doctor may ask you to cough to see the state of the urethra (outside passage) and leakage of urine. However, sometimes even after this, it may be difficult to come to a diagnosis, so a further test known as urodynamic studies is done to evaluate the pressures within the bladder, and to detect any abnormal behaviour of the bladder. Usually after these tests, a distinction can be made regarding the type of incontinence, and treatment can be initiated. Treatment consists of medicines to soothe or relax an over active bladder in the case of urge incontinence. Nowadays, even botox is used if regular medication fails. In extreme cases, surgery is done.
In stress incontinence, mild to even moderate cases can improve with pelvic floor exercises, which are taught by the doctors or physiotherapists. These exercises must be done on a regular basis, and they improve the tone of the pelvic muscles supporting the urethral complex. Weight reduction for obese patients is also helpful. If these measures fail, then surgery is contemplated. Surgery for this condition can be done as a day procedure, involving putting in a tape through various techniques to correct the defect. Some doctors prefer conventional surgery, which will require admission and hospital stay. Sometimes, in the case of mixed incontinence, surgery may have to be augmented with medicines to relax the bladder.

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