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    Everything you need to know about Urinary Incontinence with Dr Marlain

    The experience of uncontrollably leaking urine can be embarrassing. This involuntary leakage of urine is sadly a common problem.  Causes include urinary tract infections (UTIs), pelvic floor disorders, and an enlarged prostate, delivery of large babies or plain simple ageing. 

    Urinary incontinence is the involuntary leakage of urine, meaning a person urinates when they do not want to.

    The urinary system is made up of kidneys, ureters, bladder, and urethra. All these parts filter, store, and remove waste from your body. The kidneys act as the filters and flush the waste products from the body in the form of urine, which then passes through two thin tubes called ureters. The ureters are connected to the bladders, where the urine is collected till it is time to leave the body. Once the bladder is full, the brain sends a signal to urinate. The urine leaves the bladder when the sphincter muscle opens, allowing it to flow freely out of the body through the urethra. When the whole system is functioning properly, you usually have time to get to a bathroom before needing to urinate and do not experience any leakage of urine. 

    Incontinence happens when the bladder muscles tighten, and the sphincter muscles are not strong enough to shut the urethra. This causes a sudden urge to urinate that you may not be able to control. The pressure caused by sneezing, laughing, coughing, or exercising can cause you to leak urine. Urinary Incontinence may also happen if there is a problem with the nerves that control the muscles around the bladder and urethra. It means you leak a small amount of urine or release a lot of urine all at once.

    The types of incontinence include:

    Urge Incontinence:

    It is caused by a condition called overactive bladder, which can result from weak pelvic muscles, an infection, nerve damage, low levels of estrogen after menopause or heavier body weight. It can result from some medications and beverages like caffeine and alcohol. This is characterized by the intense need to urinate right away. Often, this happens too quickly for you to make it to a toilet, and you end up leaking urine.

    Stress Incontinence:

    This is when you leak urine during certain activities like laughing, coughing, sneezing, exercising or lifting weights, jumping, and running. In this, your pelvic floor muscles are weak and no longer support the pelvic organs as they should. Women who have given birth and men who have had prostate surgery are at a higher risk of having stress incontinence.

    Overflow Incontinence:

    People with overflow incontinence never empty their bladder placing them at risk for a spill resulting in small amounts of urine dripping out over time instead of one big gush of urine. If your bladder does not empty each time you urinate, you could develop overflow incontinence. This is common in people with chronic conditions like stroke, diabetes, or multiple sclerosis and men with a large prostrate.

    Mixed Incontinence:

    This is a culmination of several problems. When you have mixed incontinence, you might be dealing with an overactive bladder and stress incontinence. Identifying which activities and what triggers them is usually the best way to manage them.

    Having gone through incontinence after the birth of my children I’m one of the lucky ones who got fixed. I do understand how embarrassing it can be. 

    I recently tried Platelet Rich Plasma Therapy (PRP therapy) which is a regenerative treatment that helps women control their flow of urine by tightening vaginal tissue and rebuilding their body’s natural collagen. Not painful and worth a go. 

    So, here I am in conversation with Dr Marlain, who is an award-winning Arabic Speaking Consultant Obstetrician and Gynaecologist at King’s, with extensive experience in Laparoscopic/Hysteroscopic surgeries. She talks about the different ways to treat this and sheds light upon many other things around incontinence.

    In this video, she gives insight into the topic of urinary incontinence and clears the air around it by answering many questions.

    To begin with, Marlain addresses the issue of heavy bleeding amongst some women and how they go around wearing heavy pads. These women are basically in the perimenopause and menopause phase, and they also complain about passing urine during activities like coughing, laughing or sneezing, which is a symptom of stress incontinence. Urinary incontinence is a very complex problem, and the reason can be some medications or tablets or childbirth (having a huge baby), which weakens the pelvic floor muscles, ageing, lack of oestrogen, or vaginal dryness.

    She throws light on the TVT (tension-free vaginal tape) and TOT

    (trans obturator tape) procedures, which are lifting a

    woman’s sagging bladder or urethra into a normal

    position. During surgery, a narrow band of tape

    is placed under the urethra. The tape supports the

    urethra and bladder like a hammock, specifically highlighting that is not carried out anymore in the UK due to the complications from the tape a lot of women had to get it removed after some time, as their bodies rejected it. 

    Whenever you experience symptoms like dryness in the vagina, pain during sex and feel the urge to pass urine frequently, it should be investigated immediately. There are non-surgical operations for vaginal dryness. For example, we can use vaginal oestrogen cream. It improves the dryness of the vagina and various other problems that come along with it. For pelvic floor weakness, non-surgical treatment like radiofrequency can help to a great extent, where a tube is put inside the vagina and is heated up to 43 degrees, coupled with shots of hyaluronic acid lasting for 20 minutes. It helps the tissue and muscles of the vagina, around the urethra and on both sides of the G spot and O spot. 

    First assess the pelvic floor muscles and the ultrasound are taken before and after the passing of urine, and then decide whether to go for the surgical or non-surgical route. She enunciates the importance of hormonal replacement treatment and how much it is undervalued because if we start at an early stage along with pelvic floor exercise and physiotherapy, we can drastically reduce the chances of incontinence. Also, flags how this issue is not being widely or openly communicated and to consult a good gynaecologist and explore the non-surgical options. Furthermore, elucidates the BTL EMSELLA treatment, which uses High-Intensity Focused ElectroMagnetic Energy (HIFEM) to stimulate and strengthen all the pelvic floor muscles, not just the subset that can be exercised with voluntary contractions (Kegel exercises). These stronger pelvic floor muscles restore continence and the confidence to enjoy normal daily activities without fear of losing bladder control. During each 28-minute session, you sit comfortably on the Emsella chair while it generates thousands of supramaximal pelvic floor muscle contractions. Each session is equivalent to doing 11000 pelvic floor exercises but without the hard work! The procedure is non-invasive, and you remain fully clothed throughout. No drugs are required and the most you will feel is a slight tingling during the treatment. With no recovery time needed, you can leave immediately after each session and resume normal daily activity. Many people need a course of six sessions over three weeks to see optimum results, with most people seeing and feeling results after just two or three treatment sessions. 

    In the end, she casts light on how Arabic women are not just interested in maintaining their face, but their intimate areas are well looked after compared to the other women from different parts of the world. They are very well versed and educated about it and explore the various non-surgical options to keep their private areas healthy and well maintained.

    Mother of two grown-up children and wife, for nearly thirty years of a now retired, senior British Army officer. Modelling for the first time at the age of 53 she led a full-page campaign in eight editions of British Vogue, and in Tatler, Hello and White Magazines.

    Mother of two grown-up children and wife, for…

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