Incontinence happens often as a result of childbirth but is still a taboo subject and women suffer in silence. This article looks at the 2 main types of incontinence and talks about treatments (and hope) that's available. Incontinence can make you lose your confidence - it causes anxiety and embarrassment. In extreme cases women hide themselves from the world and stop going out. Some need extra sets of clothes - underwear or skirts and trousers - and pads in case they wet themselves. Do you know where every public toilet is when you're out? - perhaps you don't like to visit unfamiliar places. Nearly 25% of women affected say that it has changed their quality of life for the worse. A third say their sleep is disturbed and nearly another third are upset by their leakage because it affects their relationships.
If this sounds like you, then now you know you're not alone. It's thought that the problem is common but hugely under-diagnosed. Experts think that up to a quarter of women over 40 suffer incontinence at some time in their lives, but of course it can affect women of all ages.
In women, the pelvic floor muscles stretch backwards, like a hammock, from the pubic bone to the spine. The bowel, vagina and urethra (tube leading away from the bladder to the outside) pass through it.
Controlling when and where you choose to have a pee is done by the brain via the spinal cord. The bladder is a muscular ‘bag' and messages to and from the brain prevent it squeezing while it's filling until there is a toilet available.
When you cough, sneeze, exercise or laugh the abdomen presses down on the bladder. Normally this sends an instant message to the brain and the pelvic floor muscles tighten up so there's no leakage.
Do you leak when you laugh, jump, cough or sneeze? Is it usually a small amount and normally there is no sensation that you need to go immediately before hand? And if leakage occurs during sex it's usually during penetration?
The reason for the problem is that the pelvic floor has become slack, overstretched by childbirth (a vaginal delivery rather than a Caesarean), gynae operations or obesity. If they're out of shape then they can't work properly.
Treating stress incontinence
Conventional treatments used to be pretty limited. Women were simply told to do strengthening exercises for the pelvic floor muscles and while this is successful, it takes some months. To improve the effectiveness of the exercises you can use a specially designed cone, put into the vagina, and by squeezing it and gradually increasing the weight the muscles get stronger. If you do this sort of pelvic floor workout for four months you'll get the greatest improvement, so it takes a bit of dedication to see it through.
Medical treatments have a lot of side effects and are really only good for mild stress incontinence. However a new drug, duloxetine hydrochloride means that there is potential relief for more severe stress incontinence problems. It seems to work faster than other drug remedies - on average two weeks to a month to see an improvement.
Women using it say they have a much better quality of life.
The other option is surgery to fix things in severe cases.
Urge incontinence and dealing with it
In urge incontinence there is a strong need to pass urine - thus the ‘urge' - which is accompanied by leakage. The leak is usually bigger than the one you get with stress incontinence.
There are two types. An ‘oversensitive' bladder means that it can't fill properly. An infection (cystitis) might cause this, or any other irritation of the bladder, including things like emotion or small particles in the urine.
In an ‘unstable' bladder, the bladder muscle squeezes at the wrong time. That causes the strong urge to rush to the bahroom, often more than 6 or 7 times a day, and leakage occurs. For a woman with an unstable bladder orgasm can cause leakage as well.
Your doctor will probably ask you to keep a diary for a few days, recording how often and how much urine you're passing and then get you to try to increase the time between each trip to the loo. This aims to re-train the bladder.
There are drug treatments - oxybutinin or tolerodine - which can be effective in stopping the bladder spasms, and again surgery is used in the most severe cases.
Pelvic floor exercises for women with stress incontinence
- Sit with the legs apart and close the front and back passages as if ‘zipping' them up inside.
- Hold for the count of 4 and then relax slowly.
- Repeat 4 times each hour.
- Consider doing these after passing urine.
You can increase the exercises after 3 months by:
- When going to the pass water (when there is not a strong sensation to go) pass the first part of the stream,
- repeat steps 1 and 2 above - close the front passage and count to 4 then release
To test the success of the exercises, try jumping up and down gently when the bladder is nearly full (as above). If there is no leakage the exercises have been successful, otherwise continue for another 3 months.
Women with incontinence often assume that their problem has come about because of childbirth and ageing and just accept it. Perhaps if you worry that you will be prodded and poked this might put you off getting help. It seems that less than 9% see their doctors about it and then only after many years. A quarter put off getting help for more than 5 years.
You should be aware that you can ask to see a female doctor if there is one in your medical centre. New treatments mean that you don't just have to suffer in silence and while no one is denying that it's embarrassing, your doctor is a trained professional and has definitely heard worse.
As one woman put it "I hate this problem for the loneliness it brings. Life is too short not to get help and get the most out of living."