On 04 May, 2024 Seniors Today hosted their weekly Health Live webinar with Dr Percy Jal Chibber who spoke on and answered questions about Incontinence Concerns for Senior Women and Men.
Dr Percy Jal Chibber is Senior Consultant Urologist at the Breach Candy and Sir H N Reliance Foundation Hospitals. He is also Director of Urology at the Jaslok Hospital. He has been Honorary Visiting Urological Laparoscopy Specialist to the Tata Memorial Cancer Centre. Although he has been practising in all aspects of urology over the last four decades, his special interests are Endourology, Urologic Laparoscopy/ Robotic Surgery and Renal Transplantation.
Dr Percy Jal Chibber took his undergraduate medical education (MBBS) in Mumbai at the B Y L Nair Hospital. He did his postgraduate degree in general surgery (MS) at the same hospital; standing first in the university was awarded four gold medals.
He did his specialist training in Urology at the University of Edinburgh Department of Urology at the Western General Hospital, Edinburgh with the world-renown Professor G D Chisholm and also obtained his fellowship of the Royal College (FRCS). He returned to Mumbai and started his urological practice in 1981, and was soon appointed Honorary Assistant Professor of Urology at the Grant Medical College and the Sir J J Group of Hospitals, where he was later to hold the position of Professor and Head of Urology and Renal Transplantation between 1995 and 2007.
In 1983, Dr Chibber trained in the techniques of Percutaneous Renal Surgery, in UK, and the USA, with Mr J E A Wickham and Dr Arthur Smith, respectively, both of whom have been described as pioneers of Minimally Invasive Urological Surgery.
Since 1983, he has developed and pioneered the techniques of Percutaneous Renal Surgery and Radiology in India, and has one of the largest personal series of the procedure in the world. Since January 2000, he has been performing and training students in the techniques of Laparoscopic Urological Surgery. Dr Chibber was invited by the Cleveland Clinic to spend six weeks as an International Scholar in the department of Laparoscopic Urology in May 2001. He trained in Robotic Urology at the OLV Institute, Alst, Belgium in 2011. He was the President of the Urological Society of India for 2015-2016.
Dr Chibber has published numerous papers in peer-reviewed national and international journals, and has authored chapters in books.
Incontinence in senior men and women is an increasingly common condition, which can be a concern in the younger population as well.
Involuntary loss of urine either day or night is known as urinary incontinence.
It is a major problem for the elderly, anybody over the age of 60 years.
It is a common cause for older people getting admitted to old age homes and care facilities.
Despite the fact that it is such a troubling symptom, less than 50% of people will seek medical attention for the same.
Patients are often embarrassed, they don’t like to tell even their family. They are shunned because they smell because of the incontinence or are embarrassed because they have to wear adult diapers.
There is a lot of misconception and misunderstanding about incontinence- women seem to feel that it is a part of growing up, having had 2-3 children and that makes it common, but so is not the case.
Even older men with prostatic enlargement seem to think that a little bit of incontinence is quite alright.
But these are not facts. Incontinence is a complaint which can be and should be addressed.
If left unattended, incontinence can lead to complications such as:
- Urosepsis (infection in the urine)
- Rashes
- Pressure sores
- Falls- due to the urgency to pass urine
- Psychological complications- low self esteem, low confidence
Risk factors:
- Anybody over the age of 50. Women are affected twice more commonly than men
- Obesity
- Diabetes mellitus type II
- Genitourinary symptoms of menopause- where in incontinence is a common complaint
- Enlarged prostate
- Neurological conditions
- Previous history of genitourinary surgery
- Some of your regular medications for other comorbid conditions can also lead to urinary incontinence as a side effect
The bladder goes through 2 phases
- Filling and storage phase: the urine collects in the bladder, the muscle of the bladder relaxes and the sphincter (the muscles that control the outlet) contracts. When you feel like passing urine, your brain receives a signal and this leads to the second phase
- Voiding phase: The muscle of the bladder contracts, and the sphincter relaxes completely leading to the urine flowing out. At the end of voiding, the external sphincter (the one that controls the passage of urine) contracts immediately, and you don’t leak any urine at all after the last drop.
Unfortunately in males, there is a little urine in the bulbar urethra of the penis and therefore it is common practice for males to shake out the last few drops of urine.
4 conditions where mean and women can be embarrassed by incontinence:
- Overflow incontinence: this occurs due to obstruction of the bladder, slowly and insidiously, for whatever reason, for example an enlarged prostate.
- Stress incontinence: common in younger females (40-45 years of age) who have had 2-3 children, because of which the support of the bladder has loosened and they did not do any exercises to bring the tone of the bladder muscles back again. As a result of which, when they laugh/ cough/ bend down to pick something- a small squirt of urine comes out and that embarrasses them
- Urge incontinence: normally your bladder muscle will remain quite until your bladder collects around 200-250 ml of urine before it gives the first signal, but in people with urge incontinence, by the time bladder is filled with 150-200 ml urine, they have to rush to the loo. There is an urgency of voiding urine. And also an increase in the frequency of voiding as well.
- Functional incontinence: incontinence unrelated to urinary tract disorders. Old age and related diseases cause a lot of incontinence, such as- an arthritic patient or a patient with bradykinesia or Parkinsonism- will have slow movements and will therefore not be able to rush to the bathroom.
Neurological incontinence is something special, which can be seen with a variety of neurological conditions, some of the common ones are- Parkinsonism, Alzheimer’s and brain stroke
Other causes of urinary incontinence:
- Delirium
- Infections
- Atrophic vaginitis
- Pharmaceutical agents
- Psychological factors
- Excessive urine input/ compulsive water drinkers
- Restricted mobility
- Stool impaction- severe constipation
- Heart failure
