Suggest treatment for urinary incontinence

Posted on Thu, 10 Apr 2014 in Urinary and Bladder Problems
Question: Hello Dr.Sasanka, We've started CISC on 12th March along with Vesigard 7.5mg (and Nitrofurontoin 200 mg.) The bladder responded well for the first few days i.e. till 15th March. There was very little incontinence during this period and the urine output was between 200-350ml every 1-1.5 hours. However, since last few days the incontinence frequency is increased. It is usually 3-4 times continuous leakage within an hour of fluid consumption. Due to incontinence the CISC frequency has gone down too. The current urine output is 100ml in the day. The bladder is completely emptied only after 6-8 hours of stopping fluid consumption. During this period (usually between 2-7 AM ) CISC is required. The sleep pattern is impacted because of this. She can only sleep after 7AM once the bladder is empty. The normal sleep hours (while on catheter) was 2AM to 11PM. We've limited the fluid consumption to 250ml hourly and it is stopped before 4 hours (at 10PM) of bedtime (2AM). After getting up in the morning however, she consumes 300-400ml of water due to headache. There are no complaints of other side effects. Please suggest the next steps.
Answered by Dr. V. Sasanka 14 hours later
Brief Answer: Limit water intake, Continue CISC. Detailed Answer: Hi, I am actually pleasantly surprised to find that she has managed to do a very good XXXXXXX thus far.There are some practical solutions to your problems. Let us see them one by one. Water intake of 250 ml/hour is actually high under the circumstances. I doubt if she will need that much right now, unless she is really thirsty. I suggest you ask her to practice CISC more frequently, maybe even every hour during awake periods. Later once bladder capacity builds up, and incontinence is reduced, we can reduce the frequency of catheterization. We can also increase the dosage of Vesigard to 15 mg once a day, if these above measures do not work. There is a very good chance of her getting relief with Botox administration into the bladder, but we will keep this in reserve, and see if the above measures can help her stay dry. Let me know how she is progressing. Regards and best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. V. Sasanka 1 hour later
Thanks Dr. Sasanka, we'll follow the advise and keep you posted. Could you please guide us with the maximum amount of water to be taken hourly and daily ? (excluding water from other sources i.e. meals, fruits, tea.) We did not limit water intake too much for the fear of infection. Currently, the total amount per day is around 2lt.
Answered by Dr. V. Sasanka 39 minutes later
Brief Answer: 2 litres/day is fine Detailed Answer: Hi, Intake of water or other fluids of 2 litres per day is fine. Just distribute it through the day, say 100 - 150 ml an hour. I do agree that chances of infection are likely to come down significantly with more water intake, but just at present, incontinence is a real issue your wife is dealing with, and she might lose her motivation if she continues to leak. We can ask her to improve the intake once she is better and dry.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. V. Sasanka 29 minutes later
Thanks a lot again, will keep you posted.
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Dr. V. Sasanka


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