DEAR DOCTOR,

Ever since I had my first child who is now three years old, I have some problems with bladder control. Even sneezing is an issue sometimes. Why is this so and how do I fix it?

AMINA

DEAR AMINA, 

Urine incontinence, that is, the inability to hold a full bladder, is a common problem among women for different reasons. There may be one or more underlying cause for it.

During pregnancy, weight is put on the urinary bladder due to its anatomical proximity with the uterus. This added weight can weaken the valve (sphincter) that controls the bladder, resulting in incontinence. During child birth there can be damage to the bladder and or the sphincter which manifests as incontinence. Risk is more where interventions like forceps is done for delivery. More the pregnancies and deliveries, greater is the risk for developing urinary incontinence later in life. A damaged or weakened sphincter is diagnosed by excluding other causes of incontinence. Where feasible to correct it by surgery, surgery is done. Otherwise there are specific exercises of the pelvic muscles that help to strengthen the bladder and its sphincter tone.

Infection of the urinary bladder (cystitis) is yet another cause for incontinence. As such, young women are prone to cystitis due to multiple reasons and pregnancy makes them more vulnerable.  There may be other symptoms like frequency of urination, pain in lower abdomen, and fever. It can be diagnosed easily by microscopic examination of urine passed first thing in the morning.  Taking a suitable antibiotic cures it completely. Drinking 8 to 10 glasses of water everyday helps to clear germs in urinary system and prevents cystitis.

Holding a full bladder for a long time continuously, tends to weaken the bladder valve over time, resulting in incontinence.  The risk enhances with age and also with multiple pregnancies. Hence, one should empty the bladder as soon as possible and not hold it for long.  

Toilet training, as for toddlers, helps to cure incontinence as well. One should visit the bathroom about every two hours, irrespective of the desire to pass urine or not. Sit for few minutes and try to pass urine. This will help to condition the bladder to empty at fixed intervals, thus preventing "embarrassing leaks”.

A balanced nutritious diet rich in vitamin B complex will help to keep muscles and nerves strong, including that of the urinary bladder.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk