Tuesday, January 27, 2015

Dr N K Mohanthy HOD Urology, Saket City Hospital, New Delhi

No more shame, frequent urination can be controlled
·         A neurological disorder, urinary incontinence or a loss of control over bladder can be debilitating and embarrassing but there are solutions after DGCI allowed use of Botulinum Toxin A for treating the problem in certain neurological conditions
New Delhi, April 2014: 55 years old Savita (name changed) took voluntary retirement at 50 to spend some of her life’s years travelling around the country and documenting her travelogues. But a neurological condition resulting in a urological disorder devastated her plans and dreams. Suffering from urinary incontinence that means she loses control over her bladder and has to urinate at frequent intervals, Savita is now mostly confined to her home. Medication could not improve her condition radically. Dejected by her life, she often slips into depression.

But, people like Savita have hope today of radically improving their quality of lives. There are options that can help them manage such a neurological condition and have normalcy return to their lives. The Drug Controller General of India (DGCI), the nodal agency for approving the use of a medical drug in India, recently gave a go ahead for the use of Botulinum Toxin for treating the symptoms of urinary incontinence. Though not a cure to the problem, the treatment can offer relief for up to 10 months enabling the patient to continue with her life in a normal way.

Dr N K Mohanthy HOD Urology, Saket City Hospital, New Delhi says, “A debilitating urological disorder, urinary incontinence affects a large number of people in India and can throw life completely off track. Not to talk of the embarrassment it causes, it also makes one unable to undertake journeys, confining the victim mostly indoors. The inconvenience and the embarrassment it causes is too much for some people.”

There are a number of reasons for urinary incontinence, and it may occur due to the loss of higher control of micturition, which normally controls urination. It could also occur due to a set of neurological conditions such as spinal cord injury [SCI], Multiple Sclerosis [MS], and Neurogenic Detrusor Over activity [NDO].

Normally the bladder stores urine at a low pressure. When the bladder is full, pressure in the urethra drops, the sphincter muscle at the bladder exit relaxes and the detrusor (bladder) muscle contracts to release urine. This process, and the series of muscle contractions and relaxations involved, is regulated by the nervous system.
In a healthy individual, the brain sends messages to the bladder to turn urination on and off. However, in some instances this regulation goes awry, creating problems of loss of control over the bladder. Sometimes, this problem arises in accident victims who have suffered injury to their spinal cord.

Urinary incontinence, the condition where one suffers losing of bladder control leading to involuntary urination affects more women than men.Often, at the time of childbirth when a woman undergoes mental & physical stress, loss of support of the urethra could lead to leaking of small amounts of urine during coughing, sneezing and lifting. It is also considered as a condition of stress incontinence. Whereas urge urinary incontinence is caused by uninhibited contractions of the detrusor muscle associated with a neurological condition, causing leaking of large amounts of urine without sufficient warning to allow the individual to attend nature’s call well in time.

Urinary incontinence associated with a neurologic condition of the bladder, such as multiple sclerosis [MS] or spinal cord injury [SCI], results when the spinal cord and bladder do not communicate effectively. For people living with Multiple Sclerosis, this occurs because they develop lesions on the spinal cord, while people with Spinal Cord Injury have irreversible nerve damage, resulting in the inability of the spinal cord and bladder to communicate effectively. As a result, the bladder muscle involuntarily contracts, increasing the pressure in the bladder and decreasing the volume of urine the bladder can hold, which causes the individual to leak urine frequently and unexpectedly.

Once injected into the bladder muscle, Botulinum Toxin A works as purified protein that blocks overactive nerve impulses that trigger excessive muscle contractions. Although the effect is not permanent, one injection of BOTOX may give relief up to 10 months, providing ample relief to the person suffering from the debilitating ailment.
This can be a great relief for patients who are in need of help to manage their condition better. This also gives doctors a viable option to help treat the symptoms of their patients. Loss of control over bladder can be a devastating ailment and can destroy one’s quality of life completely. We hope Botulinum Toxin A can bring some much needed relief in patients’ lives. Botox has to be injected into the muscle of the urinary bladder through an endoscopy and this procedure is performed by a urologist.

The treatment can help bring back the normal functioning of the urinary bladder from an overactive state, for as long ten months with no significant intervention required to follow during recovery period. However, it should not be administered when a patient has urinary tract infections.

For Savita, this means a lot. After five years of quitting her job to pursue her dream, she will now finally be able to think again on embarking on her pursuit. Many others like her, will be able to continue with their jobs, with their lives and with their daily routines in a much better way. Life will be easy and not embarrassing any more.

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