Ask the Doctor: I won’t stop leaking

Doctor, I gave birth about eight months ago and I regret that it has taken me this long to seek help for my problem. I kind of imagined it would go away with time. Ever since I gave birth, I sort of ‘leak’. I can’t hold pee for longer than a second and by the time I get to the bathroom, no matter how fast I get there, I have already leaked. What is going on with my bladder? This is so embarrassing because one time I was out with friends, I had to use the bathroom and when I got back, they noticed that I was a little wet behind, in a place that clearly told them what had happened. I now stay away from dresses and only wear jeans or black pants. It’s depressing. Any idea how I can get rid of this embarrassing situation? Alicia, 32, Kimihurura Dear Alicia, I understand your problem, it is really very embarrassing. But you are not the only one. Millions of women world over suffer from this problem due to multiple reasons. Pregnancy puts a load over the pelvic muscles that support the bladder and makes them lax and also the sphincter. Childbirth can cause trauma to the urinary sphincter (valve of the bladder controlling urination) or the nerve fibers regulating urination. These factors can result in incontinence. Severe infection of the urinary bladder can lead to increased frequency of urination, along with the urgency that is needed to void quickly as soon as one feels the urge. There is also an associated feeling of incomplete evacuation, i.e. once someone has voided, there is a feeling that the bladder is not emptied and the urge to void comes again. Along with urinary symptoms one may have associated pain in the lower abdomen with or without fever. During pregnancy and subsequent child birth, a woman has little more susceptibility to develop urinary tract infections including cystitis. Due to social and cultural traditions, women tend to hold a full bladder for a long time unless they find a suitable time and place to void. The repeatedly full bladder tends to stretch out the sphincter of the bladder. It may become lax over time thus losing its ability to hold back urine. The result is whenever the bladder is full; some amount of urine may come out. A woman can have one or two reasons responsible for incontinence. You need to get a urine sample tested to look for infection. The sample should be the midstream urine passed first thing in the morning to get accurate results. If it is positive, a complete course of a suitable antibiotic shall cure you. You also need to train your bladder to avoid incontinence. Whether there is an urge for voiding or not, go to the toilette at fixed intervals say every 40 or 60 minutes, sit and try to pass urine even if it is a very small quantity. This way, gradually the bladder shall become trained to empty only when you are sitting on a toilette and that too at a fixed time. A set of exercises known as kegels can help to strengthen the pelvic muscles and also the bladder sphincter. During sitting, lying down or in any comfortable position, hold the pelvic muscles tight for a few minutes and then relax them. Do it as one would do to hold back a full bladder in a public place. Start doing this for a few minutes every day and then gradually increase the frequency and duration. Gradually as these get strengthened, the problem of incontinence will also improve. Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital.

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Ask the Doctor: I won’t stop leaking