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Living with a fibroid

What are uterine fibroids?

Fibroids are benign tumors made of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is estimated that 70-80% of women will develop fibroids in their lifetime—however, not everyone will develop symptoms or require treatment. The most important characteristic of fibroids is that they are not cancer, and they do not have the potential to become cancer. Because of that, it is reasonable for women without symptoms to opt for observation rather than treatment. Studies show us that fibroids grow at different rates, even in the same woman, and can range from the size of a pea to the size of a watermelon.

Who is at risk for uterine fibroids?

As women age their likelihood for developing fibroids increases. Studies have demonstrated that women with a family history are more likely to develop fibroids. Fibroids are also more common in African American women. Obesity has also been linked to an increase risk of fibroids. There are no foods or diets that are known to increase a woman’s risk of developing fibroids.

Symptoms

Some women never realize that they have fibroids because they have no symptoms. In other women, uterine fibroids are discovered either during a routine gynecologic exam or during prenatal care.

When symptoms of fibroids occur, they can include:

  • Pelvic pain or pressure
  • Heavy menstrual bleeding
  • Bleeding or spotting between menstrual periods
  • Unusually frequent urination
  • Abdominal swelling
  • Low back pain during intercourse or during menstrual periods
  • Fatigue or low energy from heavy periods and excessive bleeding
  • Infertility, if the fibroids are blocking the fallopian tubes
  • Constipation
  • Repeated miscarriages

Diagnosis

Usually, a woman doesn’t realize that she has a fibroid until her gynecologist feels it during a pelvic exam. If your gynecologist thinks you have a fibroid, several tests can confirm the diagnosis:

  • Pelvic ultrasound — In this radiology test, a wand-like instrument will be moved over your lower abdomen or may be inserted in your vagina to view the uterus and other pelvic organs more closely. The instrument produces sound waves that create an image of your pelvic organs.
  • Hysterosalpingogram— In this X-ray procedure, a dye is injected into your uterus and fallopian tubes to outline any irregularities.
  • Hysteroscopy— During this procedure, a narrow instrument that looks like a telescope is inserted through your vagina into your uterus. This lets the doctor look for abnormal growths inside your uterus.
  • Laparoscopy— In this procedure, a thin tube-like instrument called a laparoscope is inserted through a small incision in your belly so the doctor can look inside the abdomen.

Expected Duration

The number of fibroids, their size and how fast they grow varies among women. Female hormones encourage fibroids to grow, so they continue growing until menopause. Some fibroids shrink after menopause. However, larger fibroids may change little or become only slightly smaller in size. If a woman has had fibroids removed surgically, new fibroids can appear any time before she enters menopause.

Prevention

There are no proven measures you can take to prevent fibroids from developing. Studies show that athletic women seem to be less likely to develop fibroids than women who are obese or who don’t exercise.

Treatment

If fibroids are small and are not causing any symptoms, they do not need to be treated. Your gynecologist may do a pelvic examination every six months to a year to make sure that your fibroids are not growing rapidly. In some cases, medications can be prescribed to control any abnormal bleeding and temporarily shrink the fibroids.

Medications used to shrink fibroids, such as leuprolide (Lupron), create a temporary menopause by stopping the ovaries from making the female hormone estrogen. While estrogen levels drop and menstrual periods stop, menopausal hot flashes appear and fibroids stop growing and slowly shrink. This helps to stop blood loss from heavy, prolonged periods. However, when the medication is stopped periods return, hot flashes disappear and fibroids that have not been removed will start growing again. These medications usually are given by needle injection in a large muscle.

Fibroids may need to be removed if they cause significant symptoms or are large enough to interfere with fertility. Growths in your uterus also may need to be removed if it is difficult for your doctor to tell whether they are fibroids or cancer. There are several options for removing fibroids:

  • Myomectomy— This means cutting the fibroids from the uterine wall. Myomectomy allows a woman to keep her entire uterus in case she wants to have children. However, because this surgery can leave the uterine wall weakened, future babies may have to be delivered by Caesarean section. Surgery to remove fibroids sometimes can be done by laparoscopy, which is surgery through several small incisions in the lower abdomen. When fibroids are too large or too abundant to perform a laparoscopic procedure, then a traditional approach through a larger incision in the lower abdomen is preferred.
  • Hysteroscopic resection — In this procedure, a viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope are used to remove fibroids growing inside the uterus. This procedure sometimes is done in combination with laparoscopy, depending on the number and location of the fibroids.
  • Uterine artery embolization — In this X-ray-guided procedure, material is injected into specific blood vessels to plug them and stop blood flow to a fibroid or fibroids. It is an option for a woman who may not be medically cleared for surgery or who does not plan to have more children, but prefers not to have her uterus removed.
  • Hysterectomy — In this procedure the uterus is removed including all fibroids within it. Though other options are available to treat or remove fibroids and the patient’s needs and goals must be fully considered, in some cases hysterectomy is the preferred treatment. This may include situations in which fibroids are too numerous, too large, or cause heavy prolonged bleeding and severe anemia. Some patients may prefer hysterectomy so they can be assured the fibroids will not grow back.

Dr.Ruchi Tandon is a Gynecologist with over 13 years of clinical experience in handling fibroids. At present, she is available at all leading South Delhi hospitals.

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Painless delivery and water birthing – the things you should know

What is Painless Delivery?

Painless delivery refers to the use of an epidural injection which is given by an anaesthesiologist trained in epidural injection for pain relief during labour. It is injected in the lower of back, and a plastic tube is placed through which drugs are released around the spinal cord. It is mostly injected only once when you are in active labour which means you are having at least three contractions in 10 minutes.

Epidural doesn’t always provide 100% pain relief, but it substantially reduces pain and sensations in the lower half of the body, especially below umbilicus. In early labour, pain can be managed using natural methods like warm showers, massages, and exercises.

Is it safe to take Epidural?

According to the doctors, epidurals are safe for the mother and baby, and it also provides relief from exhaustion and irritability. It helps women to relax and refocus on labour, but like any medical intervention, it can also cause unwanted side effects.

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Why should you avoid an Epidural?

Epidural has a numbing effect. You will not be able to walk around and be confined to your bed.

  • Your labour may be longer.
  • You may have difficulty urinating and need a catheter.
  • You may experience nausea and dizziness.
  • You may be at higher risk for a forceps or vacuum delivery.
  • It can fail to relieve the pain.

What are the Pros and Cons of Painless Delivery?
Pros

  • It helps a woman cope better with post-partum depression or exhaustion.
  • It relaxes the vaginal muscles and provides space for the baby to descend.
  • It decreases the blood pressure of the mother which is good because in natural labour, the mother has high BP and there are risks of the pressure reaching dangerously high levels and ending in a stroke.
  • It prevents damage that would otherwise occur to the pelvic muscles during a normal delivery.
    Cons
  • It can fail completely to relieve the pain sensation and can be cumbersome.
  • It could cause a backache, dizziness or shivering.
  • A decrease in the mother’s blood pressure can lead to a slowing down of heartbeat rate in the baby.
  • There is a risk of experiencing severe headaches because of the fluid of the spine leaking.
  • In some cases, there are chances of irretrievable damage to the nerves.In some studies, it was suggested that babies born in a painless delivery procedure could be a little slow and may face breastfeeding problems.

Should you choose a Painless Delivery?

It is suggested to a pregnant woman to prepare for normal delivery by building their stamina, practicing labour exercises and breathing techniques and selecting a birth partner. You can cope well with labour pain without an epidural with the right support.

Water delivery

Water birth is childbirth that occurs in water. Proponents believe water birth results in a more relaxed, less painful experience  Critics argue that the safety of water birth has not been scientifically proven and that a wide range of adverse neonatal outcomes have been documented, including increased mother or child infections and the possibility of infant drowning. A 2018 Cochrane database of water immersion in the first stages of labor found evidence of fewer epidural and few side effects but insufficient information regarding giving birth

A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labor. A 2018 Cochrane review found that immersion during the first stage of childbirth reduces the use of epidurals, however there is no clear evidence on the benefits of water immersion for the second stage of labor or full water birth. There is no evidence of increased adverse effects for immersion during the first or second stages of labor. There is not strong evidence that a water birth reduces tearing or perineal trauma.

Water birth may offer perineal support for a birthing mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.

Dr.Ruchi Tandon, is a trained obstetrician and Gynecologist, with over 13 years experience in painless deliveries. She is available at leading South Delhi hospitals like Max Smart superspeciality hospital, Apollo hospitals for pregnancy management.

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Why choose Dr.Ruchi Tandon as your Gynecologist?

Let’s answer a more honest question first,

What should you look for in your Gynecologist?

Trust and comfort.

Once you have shortlisted a few doctors you would like to meet, schedule an appointment with them to help you decide which one to stick with.

Over the course of your nine months, you will form a bond with your gynecologist. Even if the relationship ends with the delivery, most mums remember the doctor who helped deliver their baby with fondness. You need to be able to trust your gynecologist to take the right decisions for you at short notice during birth and to give you the necessary information and advice to have a healthy pregnancy and baby.

This trust might grow as you progress in your pregnancy but you can already decide a lot in your first meeting. When you go for your first appointment, ask yourself the following questions:

  1. Does the gynecologist answer your questions willingly?
  2. Is she friendly and responsive?
  3. Do you feel comfortable asking her personal medical questions?
  4. Does she seem up-to-date in her knowledge?
  5. Is she listening to your concerns and answering accordingly?
  6. Is she gentle during her check up?
  7. Does she seem to care about your comfort?

If you don’t feel comfortable with this doctor at your first meeting, try another one.

Many women prefer female gynecologists. But keep an open mind: you may also find a male gynecologist who is understanding and helpful. Make your decision after you’ve had a chance to speak with several doctors.

There is a reason that a woman’s intuition is so revered, it is often right! So do your research, check background information and the practicalities of consulting a particular doctor, but in the end trust your gut.

Often family members have a common gynecologist because it is easier to see someone known, tried and tested than to look for a new doctor. Do not feel bad about wanting someone else if for some reason you are not comfortable with the gynecologists that your other family members have been happy with. It is about your health and your body so you have to be satisfied.

Difference Between a Gynecologist and Obstetrician

Technically, obstetricians and gynecologists are two separate specialties. Gynecologists are doctors or physicians who have specialized in women’s reproductive care. Obstetricians are the one delivering babies and providing pregnancy care. Now the two fields are largely interwoven and that is why in India, we have about 90% doctors who are a hybrid of the two, nicknamed as “ob-gyns” who would both take care of reproductive health problems while also delivering babies.
Happy pregnancy and happy womanhood!

Key points in helping you decide your Gynecologist

  1. Reference:You cannot visit every doctor in town to pick the right one for you. So you do the next best thing. Ask people! Ask family, friends, colleagues, your partner’s colleagues and neighbors for recommendations. Remember that you might not share your personality with these advisers, so what worked for them might not work for you. However, this step will definitely help you to narrow down your list. Or even create a list, if you have not already done so. You can also look online for feedback – but as usual, take them all with a pinch of salt.
  2. Reputation:Look for the doctor’s credentials. Start from the hospitals that the doctor has been with, and do take into consideration the educational degrees. More often than not, it is difficult for laymen to understand any acronym beyond MBBS and MD that follows the doctor’s name. However, once you have shortlisted the doctors, you could use credentials and number of years of experience as a selection criteria
  3. Specialization:Find out if your gynecologist is also an obstetrician (see the end of this article for details). If not, you would need an obstetrician at the time of your delivery. Also depending on your pregnancy, you might want to pick a gynecologist who is specialized in high-risk pregnancies. This option should be explored if you have an underlying medical problem, have had miscarriages before or if you are having multiples. For example, if you have been a patient of blood pressure or epilepsy, you will need to consider whether your doctor has handled patients with such conditions. In this reference, you will need to consider the hospital’s credibility as well
  4. Availability: How easy is to get an appointment with the doctor? What is the waiting period like? Unfortunately, better the doctor is, more busy he/she would be. In most cases, with good advanced planning, you can block the doctor’s calendar for your monthly check-ups. That said, here are few things you need to clarify:
  • Will the doctor be available on phone or SMS to answer your non-emergency queries?
  • How long do you need to wait to get a non-routine appointment?
  • How does he/she deal with emergency calls? How soon will he/she be able to meet or attend you?
  1. Time Spent: This is sometimes the most important criteria, especially for first-time parents-to-be. You need a gynecologist who is not rushing from one appointment to other without pausing. You need someone who is relaxed no matter how many more patients are waiting after you. You need someone patient enough to answer all your questions, no matter how minor it might sound

Dr.Ruchi Tandon, is a Gynecologist practicing in South Delhi for the last 13 years, she is available at leading hospitals including Max Smart super speciality hospital, saket, Apollo Spectra , kailash colony, Apollo cradle Royale , Nehru place , Delhi. She is well versed in the various subspecialties of Obstetrics and Gynecology. Trained laparoscopic surgeon and Cosmetic Gynecologist makes her an ideal choice. Her humbleness and approachable nature make her patient-friendly.

She is versed in cases of fibroids, pregnancy management, PCOD, endometriosis, menopause management, ovarian cyst, abnormal bleeding, recurrent UTI and PID.

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Heavy period – how to manage it?

What is menorrhagia?

Menorrhagia is a heavy or prolonged menstrual bleeding. Many women have this type of abnormal uterine bleeding. It can be related to a number of conditions including problems with the uterus, hormone problems, or other rare conditions. While heavy bleeding can make it tough to take part in normal daily life at times, there are treatments to help.

What causes menorrhagia?

During your menstrual cycle, if an egg is not fertilized, the uterine lining breaks down, and bleeds. The egg and the uterine lining are then shed during your period.

Hormone problems or conditions that affect the uterus can result in heavy bleeding. Other diseases or bleeding disorders can also cause it.

Hormone problems include:

  • Imbalance of estrogen and progesterone or other hormones

Problems with the uterus include:

  • Fibroids (non cancerous)
  • Cancer
  • Pregnancy problems (such as a miscarriage or ectopic pregnancy)
  • Use of an intrauterine device (IUD)

Other conditions such as thyroid, kidney or liver disease, cancer or bleeding disorders can also cause heavy bleeding.

What are the symptoms of menorrhagia?

If you have to change your pad or tampon every 1 to 2 hours because it is soaked, or bleed longer than 7 days, see your doctor. Spotting or bleeding between periods is also a sign of a problem.

The symptoms of menorrhagia may look like other conditions or medical problems. Always consult your healthcare provider for a diagnosis.

How is menorrhagia diagnosed?

Your healthcare provider will ask you about your medical history and about your periods. You will also have a physical exam including a pelvic exam. You may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t already done so.

  • Blood tests. These check for anemia and test how fast your blood clots.
  • Pap test. For this test, cells are collected from the cervix and examined. It’s used to check for cancerous changes, infection, or inflammation.
  • Ultrasound. Using sound waves and a computer, your healthcare provider can check for fibroids or other problems inside the uterus.
  • Biopsy. Examining a tissue sample from the uterine lining can help your healthcare provider find cancer or other abnormal tissue.

Other tests include:

  • Hysteroscopy. Using a viewing instrument inserted through the vagina, your healthcare provider can see the cervix and the inside of the uterus.
  • Dilation and curettage (D&C).This procedure involves scraping and then examining the uterine cavity.

Treatment

Treatment of menorrhagia depends on the individual case.

Drug therapy includes:

  • Iron supplements to treat anemia
  • Tranexamic acid, or Lysteda, taken at the time of bleeding to help reduce blood loss
  • Oral contraceptives to regulate the menstrual cycle and decrease bleeding duration and quantity
  • Oral progesterone to treat hormonal imbalance and reduce bleeding
  • Hormonal IUD to thin the lining of the uterus, reducing bleeding and cramping

In women who have a bleeding disorder, such as von Willebrand’s disease or mild hemophilia, Desmopressin nasal spray, or Stimate can boost the levels of blood-clotting proteins.

Nonsteroidal anti-inflammatories, such as ibuprofen, or Advil, can be used to treat dysmenorrhea, or painful menstrual cramps, and they can help reduce blood loss. However, NSAIDS can also increase the risk of bleeding.

Surgical interventions

A number of surgical procedures are available to treat or relieve the symptoms of menorrhagia.

  • Dilation and curettage (D&C) is a surgical procedure for scraping the lining of the uterus
  • Uterine artery embolization treats fibroids, a cause of menorrhagia, by blocking arteries that feed them
  • Hysteroscopy involves inserting a camera into the uterus to evaluate the lining, assisting in the removal of fibroids, polyps, and the uterine lining.
  • Focused ultrasound ablation uses ultrasonic waves to kill fibroid tissue.
  • Myomectomy is a surgical intervention to remove uterine fibroids through several small abdominal incisions, an open abdominal incision, or through the vagina.
  • Endometrial ablation permanently destroys the lining of the uterus.
  • Endometrial resection uses an electrosurgical wire loop to remove the uterine lining.
  • Hysterectomy removes the uterus and cervix, and, sometimes, the ovaries.

The choice of intervention will take into account the cause and extent of the condition, the age and health of the patient, and their personal preference and expectations.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi and Greater Kailash.

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PCOS in your 30’s, how it can affect you?

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work.

The 3 main features of PCOS are:

  • Irregular periods – which means your ovaries do not regularly release eggs (anovulation)
  • excess androgen – high levels of “male” hormones in your body, which may cause physical signs such as excess facial or body hair
  • polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)

If you have at least 2 of these features, you may be diagnosed with PCOS.

What are polycystic ovaries?

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. 

The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.

It’s difficult to know exactly how many women have PCOS, but it’s thought to be very common, affecting about 1 in every 5 women in the UK.

More than half of these women do not have any symptoms.

Symptoms of polycystic ovary syndrome (PCOS)

If you have symptoms of PCOS, they’ll usually become apparent during your late teens or early 20s.

They can include:

  • irregular periods or absent periods
  • difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
  • The excessive hair growth or hirsutism – usually on the face, chest, back or buttocks
  • weight gain
  • thinning hair and hair loss from the head
  • oily skin or acne

PCOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is unknown, but it often runs in families.

It’s related to abnormal hormone levels in the body, including high levels of insulin.

Insulin is a hormone that controls sugar levels in the body.

Many women with PCOS are resistant to the action of insulin in their bodies and produce higher levels of insulin to overcome this.

This contributes to the increased production and activity of hormones like testosterone.

Being overweight or obese also increases the amount of insulin your body produces.

What causes it?

Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.

Genes, insulin resistance, and inflammation have all been linked to excess androgen production.

Genes

Studies show that PCOS runs in families.

It’s likely that many genes — not just one — contribute to the condition.

Insulin resistance

Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly.

Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy.

When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.

Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 Diabetes.

Inflammation

Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.

How PCOS affects your body

Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.

Infertility

To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.

Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high BP, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and they increase the risk for heart disease, diabetes, stroke.

Sleep apnea

This condition causes repeated pauses in breathing during the night, which interrupts sleep.

Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.

Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.

A thickened uterine lining can increase your risk for endometrial cancer. 

Depression

Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety.

Dr.Ruch Tandon, the Gynecologist, specializes in PCOS and is available at leading hospitals in South Delhi

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Urinary leakage in women, why does it happen?

What is stress incontinence?

Stress incontinence is the inability to control your urge to urinate in certain circumstances. It’s a serious and embarrassing disorder and can lead to social isolation. Any pressure placed on the abdomen and bladder can lead to the involuntary loss of urine.

It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. It refers to excessive pressure on the bladder and not emotional stress.

An overactive bladder is a separate condition. In some cases, both overactive bladder and stress incontinence can occur, which is called mixed incontinence. Your Gynecologist can do tests to determine which is causing your incontinence.

Anatomy of the bladder

Your bladder is supported by a varied system of muscles:

  • The sphincter encircles the urethra, the tube that carries urine outside of your body.
  • The detrusor is the muscle of the bladder wall, which allows it to expand.
  • The pelvic floor muscles help support the bladder and the urethra.

To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When your sphincter and pelvic muscles are weak, it’s more difficult to contract these muscles and the result is called as stress incontinence.

Stress incontinence symptoms

The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. This can happen while you are:

  • laughing
  • sneezing
  • coughing
  • jumping
  • exercising
  • doing heavy lifting
  • engaging in sexual intercourse

Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage. Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity, and the same activities that cause leakage for you may not affect another person with stress incontinence.

Who suffers from stress incontinence?

Women are twice as likely as men to suffer from involuntary leakage. The most common causes of stress incontinence among women are pregnancy and childbirth, especially having multiple vaginal deliveries. During pregnancy and childbirth, the sphincter and pelvic muscles stretch out and are weakened.

Older age and conditions that cause a chronic cough can also cause stress incontinence. This condition can also be a side effect of pelvic surgery.

Some women only suffer from stress incontinence during the week before they get their period. Various studies explain that estrogen drops during this phase of the menstrual cycle, which can weaken the urethra. This is not common though.

Other risk factors for stress incontinence include:

  • smoking due to chronic cough
  • any other condition associated with chronic cough
  • excessive caffeine and alcohol use
  • obesity
  • constipation
  • long-term participation in high-impact activities

Treatment

Your Gynecologist may recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you’ll also receive treatment for the condition.

Behavior therapies

Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:

  • Pelvic floor muscle exercises. Called Kegel exercises, these movements strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.

A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.

  • Fluid consumption.Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don’t limit what you drink so much that you become dehydrated.

Your Gynecologist may also suggest that you avoid caffeinated and alcoholic beverages because it’s believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you’ll have to decide whether these changes are worth the improvement in leakage.

  • Healthy lifestyle changes.Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
  • Bladder training.Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Medications

There are various approved medications to specifically treat stress incontinence.The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence.

Devices

Certain devices designed for women may help control stress incontinence, including:

  • Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).

This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.

Surgeries

Laparoscopic bladder neck repair, Kelly’s repair, sling operations,  burch colposuspensipn, TVT tape colposuspensipn are some of the surgical options.

Recently transvaginal RF LASER treatment is giving good results in stress and mixed incontinence.

Dr.Ruchi Tandon is a Gynecologist with 13 years experience in all cases of urinary leakage and urinary incontinence. She is practicing in leading hospitals in South Delhi.