Let's talk about incontinence!
Yes that’s right... It may not be perceived as the most glamourous subject and sadly many choose to suffer in silence due to the stigma attached to bladder leakage. However, we do need to speak about it – loud and clear. In the UK today there are around six million people who experience symptoms of incontinence. Do a quick Google search on the subject and you will find an array of companies selling incontinence products. As amazing as it is that these products are available for those who really are in need and as a short term solution, it also poses the risk of people thinking that incontinence is “just something one has to live with and accept”, without actually being proactive in taking steps to become continent.
Incontinence may be very common, however it is NOT normal, meaning it’s is NOT something you have to live with. The symptoms can often be treated, either with professional help or on your own by doing a combination of specific Pelvic floor exercises and by implementing lifestyle changes.
Although the incidence of incontinence and bladder weakness does increase with age, surveys show that 6% of women aged 15-44 have the condition so it is far more common, than one might think.
Urinary incontinence is often considered a female problem, but this is only partly true. Although in younger age groups, more women than men do experience this condition, the differences are equalized around the age of 70, so in later life, almost as many men as women suffer from incontinence. However, we should not view as part of normal aging- it is never too late to seek help.
There are two main types of urinary incontinence – Stress Incontinence and Urge Incontinence.
Stress incontinence: Leaking of urine with coughing, sneezing, sex, or impact exercise, like running and jumping. This is related to damaged and/or weak pelvic floor muscles, and is common in younger women who have given birth vaginally.
Urge incontinence: Sudden and unpredictable overwhelming urge to urinate, with leaking of small to large amounts of urine. This sometimes also goes along with needing to go often that can occur day and night. It is more common in people who are overweight, or have diabetes or other neurological issues such as dementia or stroke. The problem is thought to be due to spasms of the bladder. A lot of things can aggravate symptoms, such as caffeine, diuretics (“water pills” used for high blood pressure), drinking too much fluid, and bladder infections.
The most common form of incontinence, called “mixed”, has symptoms of both of these categories. But the kind of incontinence really doesn’t matter. What people need to know is that there are solutions.
So what are the ways of treating incontinence?
First of all, you need to be assessed thoroughly by your health professional to understand the cause of your problem. In the case of this being done by a Pelvic floor Physio, they may observe your breathing, posture and how your muscles are functioning. You will be asked about your lifestyle choices such as hydration, nutrition, exercise and stress levels.
Specific Pelvic floor exercises (often prescribed by a Pelvic health professional) are in many cases the simplest and best way to start with, often leading to good results. These should be done in conjunction with implementing the necessary adaptions to your lifestyle. The importance of treating the patient with an holistic view is something we learned about in the last 25 years — before then, most doctors believed that most stress incontinence required surgery.
Your health professional may also ask you to keep a “bladder diary,” in which you record two days and nights of activity.
Finally, were there events that triggered it? Laughing? Coughing? Sex? Drinking coffee? This can help with diagnosis and treatment, especially for people who have to go frequently during the day or have to get up several times a night to urinate (a problem called nocturia).
For otherwise healthy people, the next step is to look at your lifestyle choices. If you are overweight, losing weight is essential. Stop smoking (for this and many other reasons). Limit your caffeine. If you have trouble with nocturia, avoid drinking liquids after 7 p.m. If constipation is a problem, treat it.
Another treatment method is behavioural therapy, which means a combination of two techniques, bladder and pelvic muscle exercises and bladder training. Strengthening or down training the muscles of your pelvic floor (these are called Kegel exercises, often recommended to pregnant women).
For those with urge problems, the strategy is slightly different. Bladder training involves going on a regular schedule and learning how to retrain the central nervous system to control strong urges (“mind over bladder”).
Instead of running to the bathroom as quickly as possible, be still. Do pelvic muscle exercises and focus on feeling the urgency to wane (like a decreasing wave). Hopefully the urgency will lessen so you can get to the bathroom in time.
By Karin Goldschmidt