Urinary incontinence is a common condition, with research suggesting that around 13 per cent of UK women are affected to some extent. One of the most important known risk factors for female incontinence is childbirth, with a significant proportion of women relying on incontinence supplies during pregnancy, immediately after giving birth and, in some cases, for months or even years to come. Here, we take a closer look at the problem, possible reasons for the links between pregnancy, childbirth and incontinence, and ways in which women can manage their condition. 90
Incontinence during pregnancy
The extra weight that is placed on the bladder during pregnancy typically causes women to urinate more often than usual. However, some also experience urinary incontinence and depend on products such as Tena Pants Super. The reasons for this are not yet fully understood; it may be that the weight of pregnancy causes incontinence, or that hormonal fluctuations contribute to the problem. In most cases, the incontinence resolves itself soon after giving birth, although some women continue to experience problems.
Risk factors for persistent incontinence
A number of factors relating to pregnancy and childbirth can increase the risk of ongoing female incontinence. Pregnancy itself is a known risk factor for urinary incontinence, with research indicating that women who develop stress incontinence during pregnancy or in the first six weeks after their baby’s birth are more likely to still be experiencing problems five years later.
There is evidence to suggest that a vaginal birth – as opposed to having a caesarean section – may be associated with an increased risk of stress incontinence, although studies have produced conflicting results. For instance, a recent investigation published in the obstetrics journal BJOG by British scientists found that women who delivered exclusively by caesarean section were only slightly less likely to have urinary incontinence than those who only had vaginal births. In fact, 40 per cent of caesarean-only patients who took part in the ProLong Study still reported urinary incontinence.
Other pregnancy-related factors that may increase the risk of incontinence include giving birth to a high number of children and having babies with a higher-than-average birth weight.
Treatment and management
Women are usually advised to do pelvic floor exercises to strengthen the muscles that control urination and reduce the risk of stress incontinence. In order to exercise the muscles, women should pretend they are trying to stop the flow of urine, holding this squeeze for about ten seconds. This should be repeated for three or four sets of ten contractions each day in order to strengthen the pelvic floor musculature. Results will not be seen immediately, but women should start to notice the benefits within a few weeks.
Women who are still experiencing bladder problems several weeks after giving birth should speak to their doctor, as they may require treatment. This may include medication, such as the anti-depressant duloxetine, which is thought to interfere with chemicals involved in the transmission of nerve impulses to the muscles around the urethra so that they contract more strongly.
In certain cases, doctors may recommend surgery to tighten or support the muscles around the urethra. Surgery usually has a high rate of success, but it usually not considered until other treatment options, including pelvic floor exercises, lifestyle changes and medication, have failed to provide relief.
Women with pregnancy-related incontinence have a range of products to choose from to help manage their condition on a day-to-day basis. Products include disposable incontinence pads, such as Cottons Comforts Pantyliners and Cottons Comforts Light, and washable products such as Ladies Cotton Briefs with extra absorbent built-in pads. Selecting the right incontinence supplies can greatly improve women’s quality of life and enable them to get out and about without fear of embarrassment.
Scientists in the US are conducting a study to see whether a new approach may benefit men undergoing prostate cancer surgery.
Around 37,000 men are affected by prostate cancer each year in the UK and many require surgery to remove the gland.
Figures suggest that as many as one in five men who undergo radical prostatectomy to remove their prostate gland subsequently experience minor long-term urinary incontinence,
while a further five per cent have more serious problems.
Surgeons at the Indiana University (IU) School of Medicine believe that a biodegradable ‘sling’ may help to prevent this outcome and reduce the chances of male incontinence after prostate cancer surgery.
They are conducting the first study to test the approach, which provides support to the bladder neck and urethra after the prostate gland has been removed.
Around 80 patients are taking part in the study at the IU Health University Hospital and the IU Health North Hospital.
Half of patients had a ‘sling’ inserted during their robotic prostate surgery, while the remaining 50 per cent received standard care and no sling.
Participants are now being followed for a period of time to see whether or not they develop lasting urinary problems.
If found to be effective, the technique’s use could become widespread to help reduce the risk of incontinence in men with prostate cancer.
Dr Chandru Sundaram, professor of urology at the Indiana University School of Medicine, explained: “The most important concerns for patients coming in for a prostate removal are twofold: incontinence and erectile function.”
The expert added that the sling concept itself is not new, but that this is the first time it has been used to reduce the risk of male incontinence following prostate cancer surgery.
Women who are overweight when they give birth appear to be at greater risk of developing ongoing stress urinary incontinence than those with a lower body mass index (BMI), a study has found.
A significant proportion of women develop incontinence either during their pregnancy, immediately after giving birth, or several years later.
There are several reasons for this, including damage to the nerves that control the bladder during pregnancy and childbirth, and the movement of the urethra and bladder to accommodate the growing baby.
These problems can lead to stress incontinence, in which the pelvic floor muscles become too weak to prevent urination, causing leakage when the woman’s bladder comes under pressure, such as when they cough, sneeze or laugh.
Scientists at Donostia Hospital in Guipuzcoa, Spain, set out to investigate factors that may increase the risk of persistent stress urinary incontinence during the first two years after giving birth.
They recruited 272 women, all of whom were pregnant for the first time, between April and October 2007.
Of these, 26 women (9.5 per cent) were still affected by stress urinary incontinence two years after giving birth.
In the majority of cases, the stress incontinence was slight or moderate and women reported that the impact on their quality of life was small.
When the scientists looked for possible risk factors, they found that the only one associated with an increased risk of persistent stress urinary incontinence was BMI.
Publishing their findings in the International Journal of Gynaecology and Obstetrics, the study authors concluded: “Higher BMI in pregnant women at term was an independent risk factor for the persistence of stress urinary incontinence from pregnancy to two years post-partum.”
Men who undergo surgery for prostate cancer at a late age appear to have an elevated risk of post-surgical complications, such as male incontinence, compared with their younger counterparts, a new study has found.
Prostate surgery is already known to increase the risk of urinary incontinence, as the nerves surrounding the gland can be damaged during the procedure.
For this reason, many men choose not to have surgery unless their tumour is growing aggressively.
Scientists in the US and Germany, recently conducted a study which discovered that the risk of incontinence and other complications may be greater among surgical patients who are over the age of 75.
The researchers analysed data on 115,554 patients, all of whom underwent a surgical procedure called open radical prostatectomy between 1998 and 2007.
Of these, 2,109 (1.8 per cent) were 75 years of age or older.
Publishing their findings in the journal BJU International, the study authors revealed that over-75s were more likely to need blood transfusions and were more likely to experience post-surgical complications.
Seventeen per cent of older men experiencing complications following their operation, compared with just 12 per cent of younger men.
The researchers concluded that adverse outcomes were “more often recorded in the elderly”.
Lead researcher Dr Quoc-Dien Trinh, a urologist at Henry Ford Hospital in Detroit, was interviewed by Reuters news agency about the team’s findings.
He told the news agency that the higher rate of complications among older study participants was unsurprising.
The expert also noted that treating early-stage prostate tumours can do more harm than good, as men can be put at increased risk of male incontinence when their tumour might have been slow-growing and non-life-threatening.
Dr Trinh told Reuters: “Radical prostatectomy in men aged 75 or older should be an exceptional event.
“They should at least seek the care of an expert surgeon/institution, especially when we know that they are at higher risk of complications than their younger counterparts.”
Bladder weakness and male incontinence affect more men in the UK than people realise, an expert has claimed.
Many people regard urinary incontinence as a predominantly female condition, because it is often associated with a history of childbirth.
However, Zoe Brimfield, brand manager for Tena Men incontinence pads, revealed that male incontinence and bladder weakness is more common than people think, with one in nine men in the UK experiencing the condition to some extent.
“That’s around 3.6 million men – enough to fill the stadium at Twickenham 44 times over and Lord’s Cricket Ground 128 times over,” she pointed out.
Ms Brimfield noted that bladder weakness can seriously affect a man’s quality of life, leading them to feel isolated and embarrassed about their condition.
But she revealed: “Tena Men pads specifically designed for male bladder weakness can help men feel fresher, more comfortable and ultimately more confident.”
Prostate cancer is the most common cancer among men in the UK, affecting around 37,000 men every year. Approximately one in ten men will develop prostate cancer at some point during their lifetime, with the majority of cases occurring in men over the age of 75. The good news is that the majority of patients live for at least five years after their diagnosis and many do not even need treatment if their tumour is growing slowly. Treatment for those with faster growing tumours can also be effective. However, some men experience complications such as urinary incontinence after receiving treatment, which can have a negative impact on their quality of life.
What is the prostate?
The prostate is a walnut-sized gland located beneath the bladder in men. It surrounds the urethra – the tube through which urine and semen pass – and is responsible for producing some of the fluid in semen. The prostate often gets bigger as men get older – a condition known as prostate enlargement that affects around one-third of men over the age of 50. Another condition that can affect men is prostatitis, which occurs when the tissues of the gland become inflamed, causing pelvic and testicular pain. The third main condition that can affect the gland is prostate cancer, which is discussed below.
Prostate cancer – signs and symptoms
Prostate cancer accounts for one in four cancer diagnoses in England and Wales, according to NHS figures. The causes of the disease are largely unknown, but older men, those with a family history of the disease and men of black African and Caribbean descent are known to be more at risk.
Men should ensure they are aware of the possible symptoms of prostate cancer, as early diagnosis can have a significant impact on the effectiveness of treatment. According to Cancer Research UK, symptoms include an urgent need to urinate; difficulty in passing urine; and frequent visits to the toilet, particularly at night. Occasionally men may also experience pain when passing urine or blood in their urine or semen. All of these symptoms can also be symptoms of an enlarged, non-cancerous prostate, but men should visit their GP for tests.
Treatments for prostate cancer
The most appropriate treatment will depend on whether or not the cancer has spread from the prostate gland to other parts of the body. Some men opt to have radiotherapy, while others may be eligible for surgery to remove the gland. The different treatment options have both advantages and disadvantages and each patient’s choice of treatment will usually take the possible side-effects into account. For instance, radiotherapy can cause bowel and urinary problems, tiredness, skin irritation, sexual problems and infertility, while surgery – known as radical prostatectomy – can also cause urinary incontinence and other side-effects.
Urinary incontinence following prostate cancer treatment
Urinary problems are unfortunately not uncommon after treatment for prostate cancer. Many men experience urinary incontinence and the need to pass urine regularly at night after undergoing radiotherapy or surgery. This male incontinence is often temporary and can be managed effectively using incontinence supplies until the problem resolves itself. However, about 20 per cent of men who undergo radical prostatectomy to remove their prostate gland experience minor long-term urinary incontinence, while five per cent have more serious long-term male incontinence.
Managing male incontinence
Incontinence can greatly affect an individual’s quality of life, causing embarrassment, a reluctance to socialise and even depression. However, there are many products that can reduce the condition’s impact on a day-to-day basis and help men to maintain an active and sociable lifestyle.
For instance, Men’s Pull-up Incontinence Pants, such as Lil Pants Maxi, can be worn just like normal underwear, while those with light to moderate male incontinence may prefer to use Tena Men incontinence pads, which can be used with their own underwear. Items can also be purchased to protect bedding against night-time leakage, such as a PVC Washable Mattress Cover.
Men may also benefit from maintaining a healthy weight and performing pelvic floor treatments to strengthen the muscles in their pelvic floor, while certain medications can increase bladder capacity and reduce urinary leakage.
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Female incontinence is a common side-effect of pelvic organ prolapse surgery, but new research suggests that the fitting of a device called a midurethral sling could help to reduce this risk.
The sling – also known as tension-free vaginal tape (TVT) – consists of a thin strip of mesh which is placed under the mid-urethra and becomes incorporated into the body tissue, replacing the weakened ligament under the tube that leads from the bladder.
Its aim is to support the urethra so that the patient does not experience stress incontinence, in which urine leaks when a woman strains, such as when she coughs, sneezes or laughs.
Researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development have now carried out a study to see whether the procedure is effective at preventing incontinence in women undergoing prolapse surgery.
The scientists followed more than 300 women who underwent pelvic organ prolapse surgery, none of whom had stress urinary incontinence prior to having the procedure.
Half of the women were fitted with a mid-urethral sling, while the others were not.
Participants were examined three months and 12 months after undergoing surgery to see whether they were experiencing female incontinence.
The researchers found that 49.4 per cent of women who did not receive a sling during surgery complained of urinary incontinence at three months, compared with just 23.6 per cent of women who were given preventative treatment.
A similar trend was seen one year after surgery, when 43 per cent of the control group and only 27.3 per cent of sling patients needed incontinence pads, such as Tena Comfort Mini Plus or Lil Form Classic Super.
Lead researcher Dr John Wei concluded: “Our findings suggest that preventative treatment for urinary incontinence during pelvic organ prolapse surgery decreases the incidence of bothersome urinary incontinence symptoms.”
Urinary incontinence is a common complaint among women, with NHS figures suggesting that around 13 per cent of women in the UK are affected to some extent.
Now, a new study by scientists at Taipei University Hospital in Taiwan has revealed that the problem may be even more prevalent in women who have suffered a traumatic brain injury.
This type of injury is caused by a trauma to the head, such as during a road traffic accident, assault or fall, and may vary in severity from short-term amnesia to coma or long-term amnesia.
Official figures show that around 700,000 people attend A&E departments in England and Wales with head injuries each year, around ten per cent of which are moderate or severe.
In the latest study, researchers at the Taipei University Hospital looked at data on 20,342 women, all of whom sustained a traumatic brain injury between 2001 and 2007.
They compared these data with records of 61,026 participants who did not have a history of brain injury.
The researchers found that 1.03 per cent of women with traumatic brain injury were diagnosed with urinary incontinence during the year after their injury, compared with just 0.49 per cent of women in the control group.
Once possible risk factors had been taken into account, the researchers concluded that the degree of increased risk was still about the same for women who had sustained a brain injury.
Presenting their findings at the annual meeting of the International Continence Society, which took place in Glasgow between August 29th and September 2nd, the study authors concluded that brain injury sufferers appeared to have an increased risk of incontinence.
They said: “Our results suggest that an increased risk of urinary incontinence exists at the first year follow-up in patients with a traumatic brain injury diagnosis.”
The US Food and Drug Administration (FDA) has approved Botox as a treatment for a particular type of urinary incontinence that affects some people with neurologic conditions, such as spinal cord injury and multiple sclerosis.
These patients are prone to overactive bladder, as they may experience uninhibited bladder contractions.
However, research shows that injections of Botox into the bladder can help to increase its storage capacity and ease incontinence.
“Urinary incontinence associated with neurologic conditions can be difficult to manage,” said FDA spokesman George Benson.
“Botox offers another treatment option for these patients.”
Dr Victor Nitti, vice-chairman of the urology department at New York University’s Langone Medical Centre, said that urinary incontinence is often considered a “taboo” subject.
He revealed: “Studies have shown that many patients are undiagnosed and under-treated because they are too embarrassed to talk to their doctor about their symptoms.”