Don’t suffer alone — there ARE treatments that make a difference
WOMEN who’ve had children are a third more at risk of incontinence than women who haven’t, thanks to the impact this can have on the pelvic floor — a hammock of muscles that runs from the pubic bone at the front, to the spine, which supports the bladder, bowel and womb as well as the spine.
‘Just being pregnant puts the pelvic floor and the connected ligaments under a lot of strain — carrying a baby is like carrying around a bowling ball,’ says specialist urologist Jeremy Ockrim.
‘If the pelvic floor is strong it can make up for the stretching of the ligaments and take some of the strain but if it’s weak, then the neck of the bladder is not well-supported and it will leak urine under pressure, what we call stress incontinence.’
Laughing, coughing or even lifting something heavy can lead to leaking. Stress incontinence can often be accompanied by urge incontinence — a sudden desire to go — as the bladder suddenly spasms.
Risk factors for incontinence include having a big baby (over 8.8lb), forceps delivery and a prolonged labour, especially an extended second stage of labour when the baby’s head is deep in the pelvis, adds Tim Hillard, a consultant obstetrician and gynaecologist at Poole Hospital, and spokesperson for the Royal College of Obstetricians and Gynaecologists.
Incontinence can occur immediately after childbirth or during pregnancy itself — in other women it develops over time, especially around the menopause when the drop in oestrogen can further weaken tissues.
‘A weak pelvic floor also raises the risk of falls with age — if you’re incontinent you’re several times more likely to have a hip fracture, which can be potentially very serious for an elderly person,’ says Mr Ockrim. ‘It happens because you are rushing to the toilet, or are distressed after wetness.’
Pelvic floor exercises (see left) can be beneficial even after problems begin. Losing weight to help take pressure off the pelvic floor may also help, as can avoiding caffeine. ‘It’s a bladder stimulant, as is alcohol,’ explains Mr Ockrim.
The longer you leave it before getting help, the more likely you are to have a weaker pelvic floor, says specialist physiotherapist Myra Robson. ‘The menopause can affect muscle function, so some women may benefit from using oestrogen gel.’
If these measures don’t help then medication, duloxetine, can improve the muscle tone. It works only for as long as you take it and it can cause sideeffects such as nausea.
More invasive options include bladder bulking, where a filler or bulking agent is injected to bulk up the neck of the bladder so urine can’t leak out.
Vicki Williams, 44, a mother of one from York, had the treatment last October, after first developing problems when she started going to the gym four years ago.
‘As so as I had done a warm up — I would leak a bit and feel the need to go to the loo,’ says Vicki, an operating department practitioner at York hospital who is married to John, a warehouse manager (the couple have a 13-year-old son).
The treatment took about an hour. ‘I just had a local anaesthetic to numb the area before the injections. I haven’t had to think about sneezing or laughing since.’
However the effects can reduce over time leading to the need for more injections.
Surgical options include inserting a plastic mesh to help hold the urethra in place — but as Good Health has highlighted, in some women the mesh can disintegrate, leading to crippling side-effects and its use is currently under review.
Another option is colposuspension which involves surgically lifting the vagina. ‘Essentially it puts the anatomy back to where it should be,’ says Mr Ockrim.
This is specialist surgery; sideeffects include repeated urinary tract infections.