Women's Health: Stress Incontinence
Urinary incontinence is a subject that many women find difficult to discuss; it can be embarrassing, uncomfortable and a nuisance. If allowed to get out of control it can impact on lifestyle, restrict physical activity, travel and social relationships. Fiona Jacobsen, Principal Physiotherapist at Physio2go St. Albans believes that it is important for a woman to both understand the causes of incontinence and be able to communicate effectively to the health care professional in describing its signs and symptoms. It is with this level of communication that a treatment programme can be planned and implemented.
A common problem
Urinary incontinence affects 3 million women in the UK across all age groups. Studies have shown that approximately 50% of all women will have occasional urinary incontinence, with as many as 10% having frequent episodes. Nearly 20% of women over 75 experience daily incontinence. It is twice as common in women as men. There are several forms of incontinence and a woman may experience one form or a combination of signs and symptoms.
Understanding is the first step
Education on the anatomy and physiology of the lower urinary tract and the pelvic floor is an essential first step in understanding the treatments available.
Incontinence is usually due to problems with the muscles that hold or release urine. There are 3 sets of muscles involved:
• The muscles in the wall of the bladder contract forcing the urine out of the bladder and into the urethra (the tube in which urine leaves the body).
• The sphincter muscle is a tight ring of muscle found at the neck of the bladder that relaxes to open the urethra and contracts to keep it closed and so stop the flow.
• The third group is the pelvic floor; this muscle group supports the uterus and the organs of the lower urinary tract.
The terminology is as follows:
Stress incontinence is the most common form of incontinence in women under 50. It is defined as an involuntary loss of urine usually during physical exertion i.e. coughing, jumping or laughing. It is usually a result of weakening of the pelvic floor muscles during pregnancy, childbirth or after the menopause. Incontinence occurs when the sphincter can’t stay closed when there’s an increased pressure in your abdomen. As a result of the increased pressure, i.e. when you sneeze, cough or laugh, the sphincter opens slightly and allows a small amount of urine to leak out. Weakness of the pelvic floor muscles is the most common cause of stress incontinence.
Urge incontinence happens when the urge to pass urine is so strong it can occur before reaching the toilet. This occurs when the bladder tells the brain it’s full (often too early) so the bladder muscle starts to contract. This condition may be called bladder instability. A common cause is cystitis (a urinary infection). An unstable bladder may be due to nerve conduction problems following a stroke, spinal cord injury, MS or with dementia.
Frequency incontinence is when you go to the toilet too often only passing small amounts of urine at a time. On average you should only go to the toilet 7x a day. If urination happens too frequently then the capacity of the bladder to retain urine decreases. If you suffer from frequency it is very useful to fill out a bladder diary, recording the amount of fluid you drink in a day and at what time, plus recording when you go to the toilet and the amount of urine you pass. It is then possible to retrain the bladder.
When should you seek help?
If you are experiencing more than the very occasional episode of incontinence then you should visit your GP. Depending upon the severity of your symptoms, the doctor may refer you to a physiotherapist, incontinence advisor or a Consultant urologist or gynaecologist. The National Institute of Health and Clinical Excellence (NICE) is a government agency which provides clinical guidelines for primary care physicians and hospital consultants for a range of medical conditions. NICE have published set guidelines for the treatment of urinary incontinence. These guidelines show a pathway of care, including specific medications that may be appropriate. The choice of therapy is based on the clinical judgement of your doctor.
Exercise and self-help
Following a full assessment, a physiotherapist will be able to provide you with an exercise program that is suitable for you. You may only need to be taught Kegels exercises (exercise for your pelvic floor). These exercises need to be performed correctly and regularly over several weeks. Most women notice an improvement after 6-8 weeks, but it may take 15-20 weeks to produce lasting pelvic muscle development.
There are a number of additional treatment options available to a specialist physiotherapist. These include biofeedback, electrical stimulation or specific exercises utilising vaginal cones.
What else can you do?
• Eat plenty of fruit, vegetables and cereals to avoid constipation.
• Drink 6-8 glasses of liquid a day.
• If you suffer from urgency then reduce your caffeine intake so cut down on tea, coffee and cola
• Walk regularly.
• If you get up more than once at night then have your last drink 3 hours before going to bed.
• Avoid heavy lifting and strenuous exertion.
• Drinking alcohol is likely to make urinary incontinence worse as it’s a diuretic and stimulates the kidneys to produce more urine.
The most important thing that you can do is to seek help. Incontinence is a women’s health issue that impacts tremendously on an individual’s quality of life. Treatment is available that is relatively inexpensive and has minimal complications; do not suffer in silence!
For further information please contact:
St. Peters St,
AL 1 3HD
Telephone: 01727 850925