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
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
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
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
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.