Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Urinary incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and mentioned to doctors often only after many visits for other more socially acceptable diseases. Incontinence is usually associated with the old man lying semiconscious in a nursing home bed. But it is far more common in women, and many relatively young women in their thirties or earlier can be victims.

Incontinence is the loss of urine from the bladder at times when such loss is not desirable. It can vary from constant bed-wetting, to the occasional dribble when a woman jumps, coughs or laughs.

The most common cause of incontinence is the damage done to the genitals during childbirth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy anddamage to the spinal cord in paraplegics and quadriplegics.

The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only 1 to 2 cm long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra and allow the urine to escape. The stretching that occurs during childbirth can cause this critical angle to be lost and the urethra to become a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately this straightened tube can also allow bacteria and infection to enter the bladder more easily and cause the pain and discomfort of cystitis (bladder infection).

Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence.

As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth. These can also be done in the early stages of incontinence to help control the bladder function as normally as possible. A patient can start by practising stopping and starting the urinary stream several times whenever they go to the toilet. Physiotherapists can teach the finer details of these exercises.

If the problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted and regularly checked by a doctor.

In intractable cases it may be necessary to insert a semi-permanent catheter (tube) into a woman’ s bladder that drains urine into a collecting bag. A woman’ s concern about incontinence can become a significant mental problem and a social barrier, and should therefore be treated sooner rather than later.

Men can also have an operation, but it is not as successful as in women. In elderly and paralysed men, it is often more practical to use a collecting bag, as this can be easily attached to the penis.

Once a month, just after a woman releases the egg (at ovulation) from her ovary, the lining of the womb (uterus) is at its peak to allow the embedding of a fertilised egg.

If pregnancy does not occur, the lining of the womb starts to deteriorate as the hormones that sustain it in peak condition alter. After a few days, the lining breaks down completely, sloughs off the wall of the uterus, and is washed away by the blood released from the arteries that supplied it. Contractions of the uterus also help remove the debris.

After 3 to 5 days, the bleeding stops, and a new lining starts to develop ready for the next months ovulation.

First of all, let me clear the misconception that lifting dumbells will make the female species look like body builders. Women do not have the testosterone levels for it, and you most certainly cannot build big muscles by lifting 2-lb dumbbells (You’re probably toting more from the grocery store — consider that 1 kg potatoes + 1 kg onions = 4.4 lb weight). In order to reduce weight, you need to do aerobic activities most days of the week, in addition to resistance training 2-3 times a week. Along with your exercise regimen, your food intake has to be carefully monitored. Also critical to a successful weight loss programme is consistency. So being ‘on’ an exercise programme — and not ‘off — is the key to success.
Since exercising at home is your preference, maybe an exercycle, treadmill or Spinner would be a good investment. Vary your aerobic activity with brisk walks on other days for about 45-60 minutes (break it up into two 30-min slots if you can’t devote a whole hour at one go). Exercise at intensities that make you feel slightly breathless for the entire duration (think hurrying to catch a bus). Refer to previous issues of Health & Nutrition, for pictorial representations of weight training for various body parts. You can use dumbbells or Resistance tubing (elastic bands are available at most sports goods stores). For maximum results, lift weights heavy enough to experience muscle fatigue (muscle failure) by the end of the set (16-20 reps/set).

LESS IS MORE : Just how hard should your exercise intensity be? Good news. A recent study showed that when people on treadmills and stationary bikes were able to chat comfortably, they were working within the recommended intensity range “When you speak, you have to regulate your breathing,” says researcher Carl Foster, PhD, professor in the Department of Exercise and Sport Science at the University of Wisconsin-La Crosse. Exercise forces you to breathe faster — and if you’re breathing so fast that you can’t speak, it’s a cue that you’re working too hard. Don’t slow down too much, though. “For a good workout, we think most people should be able to speak comfortably, but only just” Foster advises.

From the description of your symptoms it appears like you have a fungal infection, but without an examination one cannot be certain. It would be ideal if you can consult your gynaecologist at the earliest. Meanwhile you can
1. Get a blood sugar test done(since you have family history of diabetes).
2. Take a course of oral antifungals like Forcan 150 mg, one tablet once a week for 3 weeks, when you notice the white  flaky discharge.
3. Apply Canesten S cream after washing the area, twice daily for 7 days.
4. Drink plenty of water, buttermilk or curd to improve the pH balance in the area and allow good bacteria to grow.

Bedwetting has nothing to do with food allergies. Severe food allergy patients never report bedwetting as a symptom. Bio resonance therapy is an alternate medical treatment which is controversial. Bed wetting is usually associated with problems with the psyche — lack of self-esteem, insecurity, etc. Your daughter needs to discover herself and move around independently to develop the desired self confidence. Your unconditional acceptance of her personality and problems will also reassure her. Yogasana and meditation may come to her rescue in acquiring the necessary tranquility. Rather than a psychiatrist, a good psychotherapist(counselor) will be able to help her.

To explain all of PCOS in this column would be very complicated. Also, you have not sent details regarding your daughter’s height and weight. But the advice you have been given is correct: Control her weight, have her take up regular exercise — at least 1 hour of walking daily. And put her on a restricted carbohydrate diet, as in, she should avoid bread, biscuits, also chocolates, sweets, etc., The only sweet foods to be allowed are fruits, and even then, she should choose the high fiber, low glycemic index kind like apples, oranges, semi ripe guavas, etc.
PCOS causes the over production of insulin which is why insulin sensitizing agents are recommended. A gynecologist and/or an endocrinologist should regularly monitor your daughter’s health. Keeping a menstrual cycle diary, frequent checks on blood sugar and serum insulin levels are also essential, as many women with PCOS will go on to develop either impaired glucose tolerance(a prediabetic condition) or diabetes by age 40.

Except under special circumstances, HRT should not be used in women who have had:
• Cancer of the breast, uterus or cervix.
• Hormonal mastitis (breast pain).
• Endometriosis.
• Blood clots (thromboses), liver disease or strokes.

Question: Why can’t all women who have troubles with the menopause have hormone replacement therapy with oestrogen? Why can’t they stay on treatment until they are 60, 70 or indefinitely?
The vast majority of women can take hormone replacement therapy with both an oestrogen and progestogen to overcome their problems. It is necessary to take both hormones to prevent some of the long-term complications of constant oestrogen use. Women who have had a hysterectomy need only take oestrogen.
There are a small number of women who should not use hormone replacement therapy, including those who have had breast or gynaecological cancer, blood clots or liver disease.
Most GPs are sympathetic to these women, who may suffer flooding, cramps, depression, flushes, headaches, irritability etc. etc. etc.!!!
There are a number of different types of oestrogen, and vaning dosage regimes, and it sometimes takes a little trial and error to get the dosage just right for an individual woman. Oestrogens also protect against osteoporosis, heart disease, and dementia, skin ageing and improve the libido (sex drive) of older women.
There is a great deal of controversy about how long this treatment should continue, but there is no reason why they should not be continued beyond 70 years of age. Oestrogens are not a long term ‘youth pill’, but cm certainly help women through a difficult period in their lives and prevent l lot of the complications of ageing.