Julie Goodyear talks about continence issues
Julie Goodyear has been causing havoc in the Celebrity Big Brother house.
“I sneeze, I pee,” she announced to fellow housemates, flicking away any embarrassment at suffering from urinary incontinence as if it were ash at the end of her trademark cigarette holder. In doing so she highlighted the millions of Britons who have poor bladder control.
It is estimated 14 million people in the UK have urinary incontinence and although it can occur at any time of life problems are most likely in middle age. One in five women over the age of 40 experience problems although men can also be affected, particularly if they have undergone prostate surgery.
However, as Julie, 70, has shown, there is no need to suffer in silence and there are many ways to deal with the problem.
Professor Linda Cardozo, an expert in urogynaecology at King’s College Hospital in London, says: “There is not one solution for everyone but there is help for absolutely everybody.”
There are four types of incontinence: stress, which causes leaks when you cough, sneeze or laugh; urgency, which is characterised by a sudden compelling need to pass urine; mixed, which is a combination of the two; and overflow, which occurs when the bladder overfills but there is no corresponding urge to urinate.
Childbirth increases the risk of problems. A Norwegian study published in the New England Journal Of Medicine found 10 per cent of childless women experience problems compared to 16 per cent of those who had children via caesarean and 21 per cent who had a vaginal delivery.
Other factors include loss of muscle tone as we age, obesity and lifestyle. Smokers like Julie are more likely to suffer because of their chronic cough. Constipation can also increase pressure on the bladder. White wine, champagne and caffeine-based drinks are the most irritating for the bladder but the fashion for downing copious amounts of water doesn’t help either.“Women often drink far more than they ought to. There is absolutely no need to drink all that sippy mineral water,” Professor Cardozo says.
“In a temperate climate the fluid intake recommended by renal physicians is 24mls per kilogram of body weight. For the average woman that would equate to 1,200 to 1,500mls a day.”
Diet versions of popular carbonated drinks are also more likely to cause problems than standard sugary ones. “The diet drinks are better for teeth and weight but they are not better for your bladder,” Professor Cardozo says.
Some forms of exercise are bad news. “Trampolining is about the worst, 70 per cent of women will leak when they are on a trampoline.” High-impact aerobics and weight training can also cause leaks but exercises to strengthen the pelvic floor, the sling of muscles which holds the bladder in place, will help reduce symptoms if you do them regularly. Professor Cardozo says pelvic toning devices may help, if only to identify the right muscles to flex and relax.
If in doubt ask your GP for a referral to a member of the Association of Chartered Physiotherapists in Women’s Health or search their website for a local one.
Incontinence specialists can offer distraction techniques such as sitting on the edge of a hard chair and other tips to minimise the risk of accidents.
If the problem is more troublesome you may be prescribed antimuscarinic drugs that suppress involuntary bladder contractions. A new class of drug which regulates nerve signals to the bladder will be available within a year or two.
Botox and other forms of botulinum A toxins are another option: injected into the wall of the bladder they can prevent for up to a year the muscle spasms which trigger leaks.
Surgical solutions involve slings to support the bladder, procedures to lift the neck of the bladder or placing a tape under the urethra which blocks urine if the pelvic floor drops. “It works like a hosepipe when kinked,” Professor Cardozo explains.
“The most important thing to remember is there is help available. Urinary incontinence is no longer such a taboo because there are so many high profile people who have now admitted to having problems.”
Some information to help solve incontinence worries
Urinary incontinence is more common than reported. Regrettably, many people suffer in silence and restrict their daily activities. Yet incontinence is often easily managed and treated, indeed, experts have shown that nearly 80% of people with poor bladder control can be cured or improve.
Bladder control is a problem for women and men, and some young people. Experts estimate that four out of five incontinence patients are women — especially those who have had pregnancies or who are elderly.
Urine leakage is the symptom of a medical problem. Diabetes, strokes or Parkinson’s can damage nerves. A bladder infection or irritation (like a kidney stone) can scar the urethra (the tube that moves urine from the bladder). Childbirth can weaken muscles, stretch tendons, or damage nerves. Drugs like diuretics can increase bladder activity. It can be hard to get to a toilet if severe arthritis slows walking, or if medication makes a person confused or sleepy. Lower estrogen during menopause can weaken the vaginal canal.
There are several types of incontinence. Stress incontinence occurs when pressure on the bladder causes a loss of control and leakage. This often occurs when a person sneezes, laughs, falls, runs, exercises or lifts a heavy object. Urge incontinence is different; the bladder becomes overactive, perhaps from a spasm. The sudden urge to go makes a person rush to the toilet. Overflow incontinence can occur when the bladder will not empty and urine builds. Something might prevent the bladder from emptying, such as constipation, an enlarged prostate, or scar tissue.
Pelvic surgery and trauma can affect the nerves, muscles, and structure of the pelvic area.
For women, the trauma of childbirth and carrying a baby can reduce support of pelvic organs, affect the bladder, and injure nerves. After a pregnancy, weak muscles can also cause the bladder or uterus to drop out of place and bulge into the vaginal canal or press down on the rectum.
For men, especially older men, an enlarged prostate or prostate surgery can weaken muscles or cause nerve damage. The surgeon might widen a passage for urine or use techniques to shrink an enlarged prostate gland. Men can need surgery for prostate cancer. At times, surgery results in complications such as impotence or incontinence
There are many urological tests that can help specialists learn the specific problem or problems causing leakage. Urodynamics tests are helpful to see how efficiently a bladder fills and empties.
However, don’t assume that incontinence is a problem that you must just accept.
Don’t be embarrassed to get help. Specialists (urologists for men and women, or urogynecologists for women) can do tests to pinpoint medical problems. Finfing the right solution depends on identifying the real problem.
Don’t be afraid to be honest with your doctor or nurse, give a complete history so they have all the information to make a correct diagnosis. Don’t be surpised to be asked for a physical examination and to provide a urine sample.
Look for habits that you can change to manage leakage. Some people improve by avoiding caffeine, alcohol and certain drugs, and by limiting fluids at night before bedtime. A diet of fruits, vegetables and whole grains can reduce constipation. Drink enough fluids in the daytime to avoid urinary tract infections and constipation.
If you weigh too much, lose weight. A large belly puts pressure on the pelvic muscles. Excess weight can cause both stress and urge incontinence.
For urge incontinence, create a regular schedule to empty your bladder, starting at every two hours. Over time, you can increase the time between trips to the bathroom. This schedule can retrain your bladder to control urges.
Regardless of your age or sex, force yourself to do Pelvic Floor (Kegel) exercises. They can strengthen muscles to support the bladder and control leakage. Don’t just blame old age or being out of shape for your poor bladder control.
If you are a young woman, start doing Kegel exercises before getting pregnant. Strong pelvic muscles will serve you throughout your life and could make the effects of childbirth less difficult.
If a treatment does not work well for you, don’t be afraid to ask for another option and remember that there are many ways to manage incontinence alongside incontinence pads and incontinence pants.
Pelvic Floor Exercises Prevent Incontinence
A 12-week exercise program, including pelvic floor muscle training (other wise known as Pelvic Floor Exercises), during pregnancy can help prevent and treat urinary incontinence in late pregnancy, according to research published online July 17 in BJOG: An International Journal of Obstetrics and Gynaecology.
Signe N. Stafne, P.T., of the Norwegian University of Science and Technology in Trondheim, and colleagues conducted a randomized controlled trial involving 855 pregnant women who were randomly allocated to either an intervention comprising a 12-week once-weekly physical therapist-led group exercise session, including PFMT, conducted between weeks 20 and 36 of gestation, or regular antenatal care.
The researchers found that 11 percent of women in the intervention group reported any weekly urinary incontinence, compared to 19 percent of controls (P = 0.004). Three percent of women in the intervention group reported fecal incontinence compared with 5 percent of controls, but the difference did not reach statistical significance (P = 0.18).
“The results from the present trial indicate that pregnant women should do pelvic floor muscle training to prevent and treat urinary incontinence in late pregnancy. Thorough instruction in correct pelvic floor muscle contraction and pelvic floor muscle training is important, and specific pelvic floor muscle exercises should be included in exercise classes for pregnant women,” the authors write. “Any possible long-term effects on urinary incontinence and the preventive effect of pelvic floor muscle training on anal incontinence should be explored further.”
Some statistics about incontinence
- Two-thirds of individuals who experience loss of bladder control symptoms do not use any treatment or product to manage their incontinence. 1
- Urinary Incontinence affects 200 million people worldwide. 1
- About 17% of women and 16% men over 18 years old have overactive bladder (OAB) and an estimated 12.2 million adults have urge incontinence. 1
- One in four women over the age of 18 experience episodes of leaking urine involuntarily. 1
- On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s). 1
- Stress urinary incontinence, the most prevalent form of incontinence among women, affects an estimated 15 million adult women in the U.S. 1
- Urinary Incontinence is twice as common in women as in men.2
- Pregnancy, childbirth, and menopause are major reasons of the increased prevalence of incontinence in women as compared to men. 1
- Between the ages of 18 and 44, approximately 24% of women experience incontinence.3
- For women over age 60, approximately 23% deal with incontinence.3
Sources
1 National Association for Incontinence, Facts and Statistics, http://www.nafc.org/index.php?page=facts-statistics
2 WomensHealth.gov, Urinary incontinence fact sheet, http://womenshealth.gov/publications/ourpublications/fact-sheet/urinary-incontinence.cfm
3 American Medical Systems, Urinary incontinence, http://www.americanmedicalsystems.com/womens_conditions_detail_objectname_womens_urin_incont.html
Caesareans no guarantee against incontinence
Post-partum urinary incontinence is less common in women who have a caesarean delivery but it is still a persistent problem for one in seven women a recent study has shown.
A prospective study of more than 1500 nulliparous women found that persistent urinary incontinence was experienced by 25% of all women up to 18 months after giving birth.
Rates of urinary incontinence among women who had a caesarean were about 40% those of women who had a spontaneous vaginal birth, but persistent incontinence was still seen in 16% of women after a caesarean, according to the findings published in the British Journal of Obstetrics and Gynaecology this month.
Urinary Incontinence under reported in Young Women
Normally urinary incontinence is considered a problem of middle-aged and older women, especially those who’ve had a baby. But a study out today suggests even young women who’ve never been pregnant could suffer from the problem.
A new report published in Annals of Internal Medicine from Australian researchers is apparently the first study to look at the rate of urinary incontinence in the younger population. The study recruited healthy young women aged 16 to 30 on university campuses and at health clinics. The researchers asked the women to complete questionnaires about urinary incontinence during routine activities or sports, psychological well-being, physical activity, and health. They ended up with usable questionnaires from just over 1,000 women whose average age was 22.
About one in eight of the young women reported they’d experienced urinary incontinence.
Unlike previous studies, the researchers found no association between urinary incontinence and age, body mass index, physical activity, or past urinary tract infections. They say that could be due to the fact that the women in their study were relatively young, physically active and, for the most part, of normal body weight.
Women who had been sexually active but did not report use of oral contraceptives were more likely to report urinary incontinence than women with no history of sexual activity.
Urinary incontinence was also associated with lower psychological well-being. In previous research, “younger women have been shown to be subject to greater distress and restriction in activities from urinary incontinence than older women,” the scientists wrote.
Researcher Susan Davis, PhD, chair of women’s health in the Monash University department of medicine at the Alfred Hospital in Melbourne, says she and her collaborators had suspected that some women might be predisposed to incontinence without being pregnant. The study shows that this is apparently the case however it doesn’t establish clear reasons for this.
Possible reasons for the link between being sexually active and having urinary incontinence include the effects of intercourse and altered bacteria in the urogenital tract, according to the researchers.
Although other studies suggest urinary incontinence runs in families, this has yet to be backed up by solid genetic evidence.
Some answers to common questions about Incontinence
Do women have incontinence more often than men?
Unfortunately for women, yes. Urinary incontinence often occurs because of problems or weaknesses in muscles, support mechanisms and nerves that help to hold or release urine. Pregnancy and delivery, body changes associated with menopause and the way a woman’s female urinary tract is structured are among factors that contribute to twice as many women having incontinence problems. What’s important to know is that you don’t have to live your life wearing pads or being embarrassed by leakage. Incontinence is treatable at all ages.
Do symptoms differ for women?
The most common type of Urinary Incontinence for women is stress incontinence where coughing, laughing, sneezing, or other movements put pressure on the weakened bladder structure or surrounding muscles, resulting in urine leaks. With urge incontinence, women suddenly feel an uncontrollable urge to urinate and leak without control. Something as simple as hearing the sound of running water may be enough to prompt the release of urine. Mixed incontinence, a combination of stress and urge incontinence, also occurs much more frequently in women.
How is incontinence treated?
Significant progress has been made in treating incontinence effectively. Make an appointment with your Healthcare professional for an exam that will identify what type of incontinence you have. The doctor also will determine if you have underlying medical conditions that can cause incontinence.
Common medical reasons include pelvic growths, blockages and vaginal or bladder prolapses. Some medications also can contribute to the problem, so bring a list of all meds you take when you go to your appointment.
Depending on the type and extent of your problem, you may be referred for a course of treatment. This may include behavioral therapies such as fluid management, pelvic floor strengthening, bladder retraining, bulking agent injections, biofeedback or nerve stimulation (neuromodulation).
Finding the right combination for your needs may take some time and you will need to work with your Healthcare Professional to determine a treatment that works best for you. Sometimes surgery may be necessary; for instance, the bladder or urethra may have moved out of its normal position following childbirth.
What can I do to lessen my symptoms?
Some women find success by restricting certain liquids, such as coffee, tea, and alcohol. Severe constipation can worsen symptoms so try to keep your bowel movements regular. While absorbent undergarments such as adult diapers make the problem less visible, it’s important to use appropriate skincare products at the same time to avoid skin irritation and sores.
Save money with bulk savers on Ladies Washable Pants
We’ve now added bulk saver discounts for our ranges of Ladies Washable Incontinence Pants. Prices start from just £6.49 per pack for the Ladies Cotton Brief, a saving of 24% over the recommended price. These are available in Extra Small, Small, Medium, Large, Extra Large, XX Large and 3XL sizes.
The more absorbent Ladies Cotton Brief Plus, are available from £6.99 per pack when you buy 10 packs. This represents a massive 30% saving over the recommended price. These are available in Extra Small, Small, Medium, Large, Extra Large and XX Large sizes, plus the Bariatric sizes 3XL, 4XL and 5XL which go up to a 60″ waist. All our Ladies washable incontinence pants are 100% Cotton for extra comfort and made in the United Kingdom.
Three out of 10 people experience incontinence
Three out of 10 people experience some form of incontinence, but you don’t hear much about it.
Many people need to urinate more frequently as they age and there isn’t a formula for determining when urinary symptoms merit treatment, the rule of thumb is that when they interfere with a person’s quality of life, it’s time to seek help.
As women age, they lose estrogen while muscles in the bladder and urethra weaken, however chronic conditions like diabetes, congestive heart failure, Parkinson’s disease and stroke also can affect bladder. Calcium deposits in the kidneys or bladder also can prevent it from emptying completely, leading to sudden urges to urinate or leakage.
Incontinence isn’t just a problem for older people and those who have other health problems, though. Serious runners may experience some leakage because the rhythmic pounding of exercise takes a toll on their pelvic floor muscles. Some young women also develop incontinence during and after pregnancy. The uterus sits above the bladder and the weight of the baby presses on the bladder, so that between one-third and one-half of pregnant women experience some incontinence, the symptoms don’t always go away after the birth, because the weight of a baby strains the muscles of the pelvic floor, she said.
Incontinence can also run in families, different ethnic groups tend to have different problems.
Despite the fact that incontinence is common, many women are embarrassed to talk about it or assume it’s a normal part of aging. Many doctors either don’t think to ask about it or don’t have the time to work with patients on what’s causing the problem.
Most people can improve their symptoms, though. About 50% of people with incontinence improve after behaviour modification and 46 to 78% may be helped by taking medication without behavioural changes. When the two tactics are combined, 93% of people improve, surgery and nerve stimulation remain as as alternatives if these don’t prove effective.
One of the first steps is for people to keep a “bladder diary” of what is eaten and drank, when they urinate normally and any leaks. With that information, people can be helped to modify their habits and train their bladder to urinate at the right time.
Caffeine and alcohol are diuretics and can worsen bladder control problems. Spicy food, citrus fruits, excessive consumption of milk or calcium supplements and artificial sweeteners also can irritate the bladder.
The idea is to help people improve their quality of life, instead of giving them rules they may not follow. For example, instead instead of drinking several cups of coffee in a morning, rather than give up coffee altogether it’s easier to reduce the amount of coffee drank, switch to decaffeinated coffee, alternate between coffee and water throughout the day or sip the coffee, so that it doesn’t flood the bladder.
Some people also benefit from pelvic floor exercises that strengthen the muscles around their bladder. Many women develop incontinence during menopause, but these exercises can help women recovering from childbirth and importantly prevent incontinence for those who want to have children in the future.
Physiotherapist goes where men fear and dread
David Young is unusual in that he has specialised in an area that isn’t talked about often – male incontinence. Mr Young, 51, of West Pennant Hills, USA has worked as a physiotherapist for the past 30 years and set up his own practice in 1988.
Mr Young said he enjoyed making a difference since many men avoided seeking help from health professionals and few people worked in the field.
“It’s not a happy topic but when blokes pee on their pants they don’t like it, and if you can help them it means they can be out and more social. It helps them with self-esteem,” he said.
He said the challenges included keeping abreast of latest developments in the field and completing at least 20 hours of learning a year.
Mr Young said key attributes a physiotherapist needed included a deeply inquiring mind, a commitment to developing skills and being able to work with people who are under huge amounts of stress.
Mr Young’s practice, Pennant Hills Physiotherapy Centre, focuses on male and female incontinence, muscle and joint problems, knee and neck pain, sprained ankles and on elderly people, including running exercise programs in the local community centre.