It isn’t unusual to experience Stress Incontinence and Urge Incontinence together. This is know as Mixed Incontinence, and can happen because the causes of Stress Incontinence and Urge Incontinence are very different.
We’ve just added a new video to our “About Incontinence” website page. The video talks through incontinence and bladder issues and talks about the common types and what causes them including Stress Incontinence, Urge Incontinence, Overflow (or Drip), Mixed Incontinence, Reflex Incontinence and Faecal Incontinence.
The video can also be seen below.
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.”
Women with gestational diabetes mellitus (GDM) are at increased risk of postpartum urinary incontinence, including stress, urge, and mixed type, according to Taiwanese investigators. And the problems may persist for at least two years after delivery, a finding that goes against the common belief that genitourinary problems subside soon after delivery.
The study also found that quality of life is often compromised in these women, Dr Chi-Mu Chuang from Taipei Veterans General Hospital and National Yang-Ming University said.
“Women with GDM should be provided with timely consultation and support once urinary incontinence occurs,” Dr Chuang and colleagues advise in a report online in the British obstetrics journal BJOG.
The impact of GDM on postpartum urinary incontinence was studied in 6,653 pregnant women who delivered a single term infant between 2002 and 2007 at a single hospital in Taiwan. A total of 580 of the women had GDM.
At six weeks postpartum, the percentage of women with urinary incontinence was higher in the GDM group than the non-GDM group: stress urinary incontinence, 11.9% vs 5.6%; urge urinary incontinence, 4.4% vs 1.6%; mixed urinary incontinence, 2.7% vs 0.3%.
After adjusting for multiple confounding factors, GDM was a significant independent risk factor for all types of urinary incontinence, with odds ratios of 1.97 for stress urinary incontinence, 3.11 for urge incontinence and 2.73 for the mixed type.
The authors say, “Compared with women without GDM, women with GDM tended to exhibit more severe symptoms of stress incontinence for up to two years postpartum, whereas for urge or mixed incontinence, more severe symptoms were found only at six months postpartum.”
Quality of life was “generally poorer” among women with GDM, the researchers say. In particular, based on the Incontinence Impact Questionnaire 7, women with GDM who required insulin had a higher likelihood of functional impairment than women with GDM who required conservative treatment only or women without GDM (p<0.05, by the chi-square test for trend).
In their paper, Dr Chuang and colleagues say the “epidemiological value” of the study lies in the establishment of a positive relationship between GDM and urinary incontinence, “in addition to the established positive relationships between diabetes mellitus and urinary incontinence, and between gestation/delivery and urinary incontinence.”
“This finding,” they say, “suggests that diabetes and gestation/delivery may have additive or synergistic effects on postpartum urinary incontinence. However, the underlying biological pathway was not investigated in the current research, and merits further in-depth study.”