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Urinary Problems

 

Q1 A 70 year old lady gets severe pain during micturition.Pain continues in spite of anti biotics . What could be the cause? What should be done?
Urinary infection is a common reason for getting painful micturition. However, at this age, many other factors need consideration. 1. The opening of the urethra, called urethral meatus, sometimes gets tightly closed at this age. This may be secondary to lack of the hormone oestrogen, following menopause. 2. The nerve supply to the bladder also may be affected at this age weakening the contractions of the urinary bladder. A visit to the urologist is necessary at this stage. A cystoscopy may be necessary. Cystoscopy essentially means insertion of an instrument, into the bladder to see if there are any abnormalities in the urinary bladder. If the urethra is tight, it can be dilated and made large enough for easy passage of urine. Diabetes has to be ruled out. 3. There could be deficiency of the hormone oestrogen in the local tissues, causing pain. This oestrogen deficiency should be treated with local oestrogen preparations.


Q2. A 72 years old lady had, severe pain during urination and a urologist enlarged the urinary opening 2 years back. Now she is beginning to get discomfort during urination. Is there some way she can prevent it from becoming worse?
Using local oestrogen creams can prevent atrophic vaginitis and this may be tried with the help of a gynaecologist.


Q3. A 60 year old woman is unable to control herself when she feels like passing urine.She is taking drugs for it, and she is slightly better. How long will she have to take these drugs? Will there be side effects if they are taken for long?
The inability to control urination is called urge incontinence. This may happen in the later stages of menopause due to deficiciency of hormones. Drugs used to treat this condition may have to be taken for years together.


Q4.A 65 year old woman keeps getting repeated attacks of urinary infection. What could be the cause? Is there something she can do to prevent this?
In the late post menopausal woman, deficiency of the hormone oestrogen could be a factor in causing recurrent urinary tract infections(UTI). Good local hygiene , proper control of diabetes, treatement of incontinence if any could help. Cranberry juice is said to be helpful in these situations.


Q5. I get wet everytime I cough, laugh or sneeze. Is it because of menopause,and what can be done?


Stress urinary incontinence, or SUI is the word used for involuntary passage of urine with increased strain, like coughing, laughing or sneezing. It is not necessarily related to menopause and oestrogen creams may not be enough to cure it. There are exercises which may help control SUI. It should be done in the following way:
Close around the back passage as if you are trying to stop the release of wind. Then close the front passages as if stopping the flow of urine. Lift the passages and hold them for as long as you can, up to a maximum of 10 seconds. Release and rest for a few seconds. Repeat this exercise as many times as you can, to a maximum of 10. While doing the pelvic-floor exercises do not hold your breath, tighten your buttocks or thighs, or pull in your upper abdominal muscles. Do not routinely attempt to stop midstream while passing urine, as this may prevent complete emptying of the bladder and lead to infection. These exercises can be performed in any position, but you should concentrate on doing them correctly and should not do them while engaged in some other activity (e.g. while washing up).


For patients for whom exercises don’t help, using vaginal tampons may be useful as a temporary measure.

 

There are drugs which can help in a few patients, but some patients may feel drowsy while taking them.


The final cure for patients with SUI is surgical. The current surgical modality most frequently practiced by gynaecologists and urologists is the insertion of tension free tapes in front of the urethra. These tapes are made of a particular material. After surgery, the patients generally can go home in a day or two.


Questions and Answers compiled by:

Dr.Shobhana Mohandas. MD.DGO.FICOG.
Consultant Gynaecologist, Sun Medical centre, Unit of Thrissur heart hospital, Thrissur, Kerala.
Email: shobhanamohandas@yahoo.co.in.

 

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