Marathon runnners warned about potential incontinence risks
Marathon runners may be preoccupied with shin splints, chafing and blisters on race day, but they should also consider bladder health, a U.S. researcher says.
“The added stress on the body that comes with running a marathon can cause urinary stress incontinence problems during the race or down the road,” Dr. Melinda Abernethy of the Loyola University Chicago Stritch School of Medicine, said in a statement. “People who already suffer from incontinence also are at risk for bladder-control issues while running.”
Stress incontinence – the loss of urine from physical activity such as coughing, sneezing and running — is the most common form of urinary incontinence, and affects women more often than men.
Researchers at the Loyola University Health System plan to survey Chicago area runners to study the relationship between long-distance running and pelvic floor disorders, Abernethy said. Until more is known, Abernethy recommends runners monitor their fluid intake and go to the toilet at least every few hours during a marathon.
“Putting off going to the bathroom during the race is not healthy for your bladder,” Abernethy said. “Runners also should avoid diuretics, such as coffee or tea, before the race, because this can stimulate the bladder and cause you to visit the bathroom more frequently.”
Abernethy added pelvic floor exercises such as kegels, may help runners prevent urine leakage during the race.
Revolutionary procedure for Incontinence shows promising results
Carolyn Upton, an exercise enthusiast first noticed that she had stress incontinence in her mid-forties.
“Running, jumping jacks. All those things were really terrible for me,” she said. She was one of 64 women picked for a first of its kind study. Urologist Kenneth Peters is testing a non-surgical procedure to help and possibly cure stress urinary incontinence. Patients undergo a leg biopsy to remove muscle for cultivation.
“We would take a little piece of muscle,” said Peters. Cells from that muscle were isolated. Then, grown in the lab and separated into different doses. “Ten million, 50 million, 100 million or 200 million cells.”
The cells are injected to help regenerate muscles that control the bladder. Six months later the initial results seem promising.
“The majority of patients had at least 50-percent reduction in their incontinence. Depending on the dose, anywhere from 20-50 percent of patients become completely dry,” said Peters. It appears the higher the dose the better the outcomes. Carolyn says her problem is about 80-percent better since the procedure.
“It really does change your life,” she said. A larger clinical trial in the works and could happen within the next year.
New research suggest surgical operations to correct urinary incontinence in women are socially viable
Urinary incontinence in women affects 15% of women of adult age, but only one in four requests health assistance and when the disorder is serious. In his PhD thesis, Manuel Montesino Semper, Head of the urology section of the Virgen del Camino Hospital in Pamplona, analysed the financial cost which would be required for surgical operations to be carried out under the local public health service in order to combat the problem. “When costs include the enhancement in the quality of life of the patients” he explained, “one comes to the conclusion that, from a perspective of the economics of health standards, such operations are cost-effective or, stated in another way, they are socially profitable, given that, with relatively low costs, benefits in the quality of life for the patients are obtained”.
Urinary incontinence is the involuntary loss of urine. In the case of adult women it means an important deterioration in their quality of life and a challenge for the urologist and gynaecologist who have to attend to them. According to doctor Montesino, “this problem, at times hidden and even taboo, gives rise to important financial costs for the health services and for the patients themselves, besides the intangible costs involved in the personal insecurity and anxiety that can arise”.
The research undertaken by Doctor Montesino Semper showed that surgical operations for urinary incontinence are effective and provide a clear enhancement in the quality of life of the women affected. “In patients who have been operated on, improvements are manifest in aspects involving anxiety and depression, with mobility and undertaking everyday activities, family activities or free time ones, as well as household chores”, pointed out the author of the research.
Apart from the financial cost this type of surgical operation involves, this thesis also evaluated the enhancement in the quality of life of the women undergoing surgery and, finally, the two parameters were linked. “The conclusion is, from the perspective of the economics of health standards, such operations are cost-effective or, stated in another way, they are “socially profitable”, given that, with relatively low costs, benefits in the quality of life for the patients are obtained”.
The costs computed for this PhD thesis included the health care from the first medical check-up carried out after one year after the operation, the sum coming to 1,250 euros per patient. Most operations are outpatient ones, without any need for patients to spend the night in hospital. Moreover, the operation is relatively simple, being carried out with local anaesthetic.
The research analysed the results from 69 patients through a questionnaire, one specific to urinary incontinence and the other about general health, both internationally recognised and validated.
Factors such as being younger and the type of urinary incontinence (associated only with physical effort, without urgency) are associated with better results in surgical operation, while overweight and obesity are associated with poorer results.
New video about Incontinence types and causes
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 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.”
Research Shows Urinary Incontinence Affects Work Life
Work is stressful. But when the added strain of a medical condition keeps you from performing your best, the workday can be even more worrisome.
Stress incontinence is a medical condition caused when the muscles and nerves that hold or release urine fail to function properly. This results in an involuntary loss of small to significant amounts of urine during movement (for example, coughing, exercising or lifting).
Women are much more likely than men to experience urinary incontinence. In fact, incontinence can cause monthly on-the-job, performance-related issues for more than one-third of women in the work-force. According to a study by the University of Michigan, women who indicated that incontinence had a negative effect on their work stated their ability to complete tasks without interruption (34%) and their self-confidence (28%) were affected significantly (see chart).
Negative impact of incontinence on work performance
| Aspect of work | Percent |
| Ability to complete tasks without interruption | 34% |
| Performance of physical activities | 29% |
| Self-confidence | 28% |
| Ability to concentrate | 19% |
Stress incontinence can be embarrassing to the people it afflicts. It can also create feelings of powerlessness. Employers can help by ensuring appropriate access to toilets (this means allowing employees reasonable use of toilets, especially if they have a medical condition) and that these comply with relevant regulations and standards.
Employees with urinary incontinence should have a candid discussion with their manager about their condition. This will help assure he or she understands that frequent trips to the restroom are medically necessary and not performance related.
There are ways to relieve the embarrassment caused by stress incontinence. Several treatments: lifestyle, behavioural and surgical are available, and your doctor or urologist should be able to recommend the ones best for you.
Lifestyle
Use absorbent incontinence pads or incontinence pants. Limit physical activity as much as possible to prevent pressure on the bladder. Also take frequent bathroom breaks.
Your physician will ask you to record the times and frequency of bathroom breaks to determine a pattern. A schedule will be developed so you gain control over your voiding and can extend the time between scheduled trips to the restroom.
Pelvic Floor (Kegel) exercises
Pelvic Floor exercises strengthen the muscles of the pelvic floor. If done correctly, women could see marked improvement with incontinence in about eight to 12 weeks.
Remember, you’re not alone. Millions of people the world over have daily, severe incontinence, and many more are diagnosed with mild to moderate urinary incontinency. The condition is more prevalent in women due to childbearing, with a 30% report rate for women ages 15 to 64. Men are less affected, about 15%, but the rates are rising as more men undergo prostate surgery. The best news is that it is treatable. If you or someone you know is affected by incontinence, talk with a medical professional about treatments.
Gestational diabetes raises risk of long-term urinary incontinence
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.”
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.
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.
Even celebrities aren’t immune from Stress Incontinence
You know the old expression, “I laughed so hard that I…?” Many people can relate to the expression but in reality nobody talks much about stress incontinence in polite society. Howeve, if you do experience stress incontinence (or are caring for someone who does), you probably can’t help thinking about it, and can’t help hoping it doesn’t strike at an inopportune moment. It doesn’t get more inopportune than while you’re performing onstage before an audience of hundreds, as recently happened to singer Marie Osmond.
The 52-year-old let out a noticeable puddle during the farewell night of the Donny & Marie Cruise, which transports fans from Fort Lauderdale in Florida to the Bahama after an audience member’s question had both her and her brother, Donny, laughing hysterically.
Osmond was, as usual, performing with her brother, former pop star Donny Osmond of the Osmond Brothers. We don’t know what made her laugh so hard, but Marie erupted into such a fit of laughter that couldn’t control herself. .
Osmond wasn’t ashamed. Instead, she exclaimed, “I just peed my pants!” and wiped the stage where her little accident took place.
Leaking when you laugh or sneeze isn’t normal, of course. But it’s common, laughter is one of the top 10 bladder triggers. Among the causes for urinary incontinence in older women is a history of childbirth. (Osmond’s a mom of eight, although five, including her late son, Michael, were adopted.) Menopause is another risk factor.
How did the singer react to her mortifying “oops” moment? She went on with the show! At least at first, she tried to “slyly” mop the accident with her top, but as it became obvious what had happened, someone brought out a towel — and her brother doubled over with laughter before consoling her.
Although embarrassed, Marie reportedly laughed, too: “She ‘embraced it,” said Donny. “It’s so important to be yourself.”
Using appropriate Incontinence Products and regularly doing Pelvic Floor Exercises are positive steps you can take managing to manage Stress Incontinence.