Incontinence: not such a wee problem for women

There's a short clip to be found on YouTube entitled "If female incontinence ads were honest". The supplanting of the typical motivational messages of conventional advertisements for incontinence pads with brutal honesty about the reality of their use is mildly amusing, maybe especially so for those of you who have to fork out for these products and retain a sense of humour. Just allow yourself a grim smile though – a hearty chuckle may cause problems.

The market is booming for adult incontinence products, and marketers say a big reason for this is the huge spike in sales among women aged between 30 and 50. Stateside, manufacturers are even dropping their elderly spokespeople for models in their 40s, having developed more discreet products for what they see as a more physically active generation in need of protection. In fact, some estimates suggest the market for adult incontinence garments could equal that of babies' nappies within just a decade.

Estimates put the proportion of Irish women who suffer with at least some leakage at more than 50 per cent, and it is thought that at least a third of younger women are affected at some stage, typically after childbirth. As we become an increasingly overweight society, obesity is also becoming a major cause of urinary incontinence among younger women.

And yes, it’s a sexist problem; women are thought to be up to six times more likely to experience bladder leaks than men. The effect of this on quality of life should not be underestimated.

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Perhaps unsurprisingly, a recent US study published in the journal Sexual Medicine found that women with urinary incontinence were more likely to be sexually abstinent than continent women. "Women with urinary incontinence showed less sexual desire, sexual comfort, and sexual satisfaction than their counterparts, despite having a similar frequency of sexual activity," according to the researchers.

Many women will accept that some degree of leakage is normal, particularly after childbirth. For older generations, the problem simply wasn’t discussed, meaning many women suffered in silence.

Yet this taboo is slowly being broken, says physiotherapist Maeve Whelan. Whelan is a specialist chartered physiotherapist in private practice in Dublin with over 25 years' experience in treating women's health conditions, such as bladder and bowel dysfunction, pelvic organ prolapse, and overactive pelvic floor disorders. She tells Health Plus that women are finally opening up about their pelvic floor problems and learning that there are a plethora of treatment options, from lifestyle changes to surgery.

“I think women are standing for less, and that has a lot to do with there being more openness. It’s not like our grandparents’ time, when issues like this would have been kept very much to themselves. The younger generation are much more open about sexuality and body issues. Women are egging each other on not to just put up with symptoms and to go and see someone or do something about it.”

Hectic pace

Another factor is the hectic pace of modern life, and Whelan says today’s women are far too busy to tolerate the inconvenience of leaking when they laugh.

“Women don’t have time to have this problem. In addition, lots of women are really into exercise now and they don’t want this to stop them exercising. They know they need to exercise for their mental and physical health and they just aren’t willing to take it anymore.”

Pregnancy, menopause and obesity are all conditions that can lead to some form of urinary incontinence. Yet this doesn’t cover everyone – Whelan says she has helped treat girls in their teens and 20s who have been lifelong sufferers. And exercise comes into play again – ironically, some younger women are presenting with the problem due to overtraining.

“They are doing too much boot camp-type exercise, and overdoing pilates, and overdoing it to the point where their pelvic floor muscles are just far too tight and that over activity also leads to problems,” she explains.

And while an increasing number of women are aware of their pelvic floor, up to 50 per cent of women are doing the exercises incorrectly or sub-optimally, says Whelan. “The research has shown that, and this can instead be completely detrimental to the whole continence process.”

Pelvic floor training

Proper pelvic floor training can take four to six months to complete, but results will be seen much sooner than that. “We teach women what we call “the knack”, where they learn the right way to contract when they are sneezing or coughing, or lifting their child, or anything that increases intra-abdominal pressure, improvements in continence will begin to take place immediately. This has been borne out in the research.”

This means it is essential to assess a woman in order to ascertain whether she is doing the exercises (or able to do them) correctly. Whelan explains that this may necessitate an internal vaginal examination to assess the level of pelvic floor contraction. “There are grades of strength; grade 1 is that you can just about feel a flicker, 2 is that they can actually contract, but not against gravity, 3 is they can contract against gravity, 4 is that they can squeeze against gravity and resistance, while 5 is the maximum squeeze,” she outlines, adding that a programme of pelvic floor exercises is then given to women to be carried out multiple times each day.

“However, if there is nothing happening, if a woman is at grade 1 or 2, then there is no point giving them such a programme as it can be soul-destroying for the women to work hard at this with no results. At this stage they need additional help.”

That’s where electrical stimulation devices come in, Whelan says. “These can be hugely helpful for these women, where an external or internal unit can passively make the muscles contract and thus strengthen them. This will get the muscles going and they can get on with their strengthening exercises then at a later stage.”

There are two main types of urinary incontinence; stress incontinence, where abdominal pressure will cause leakage, and urge incontinence, where there is over activity of the bladder muscle itself. If pelvic floor training and/or electrical stimulation do not work for stress incontinence, then surgery may have to be considered, says Whelan. "This known as TVT [trans vaginal tape] surgery, and it acts like a sling for the urethra. It's a short procedure and many surgeons in Ireland are carrying this out successfully but obviously it is surgery, and not everyone will want to go down that route."

Effective drugs

She also advises that there are now effective drugs available for urge incontinence. “If someone has been suffering from urge incontinence, with a strong feeling of urgency of having to go to the toilet the whole time, then these medications can be life changing. We would always advise some lifestyle changes in conjunction with this, such as watching coffee and water intake. Bladder training is also key, where they learn to delay trips to the toilet by using relaxation or distraction techniques.”

Yet what if all this doesn’t work for sufferers of urge incontinence? Whelan advises that there are some “end-of-the-line” treatments that can then be employed. One of these is sacral nerve stimulation, which involves the implantation of a programmable device into the buttock. “This delivers a kind of calming effect to the bladder, and can be hugely helpful for people with incontractable bladder urge.”

Back to the booming market for female incontinence products. Surely these aren’t an ideal solution? Whelan says she believes the growth in sales is due to the number of women not willing to forgo their exercise regime. “I am seeing women coming in from their teens to their 80s and they don’t want to stop exercising, even if it is just going for a walk. In this case, the only solution may be to buy pads while they are waiting for other treatment options to kick in. I have had so many women tell me that when they’ve finished their physiotherapy, or had surgery, or taken medication, the biggest satisfaction for them is never having to walk down the supermarket aisle where the incontinence pads are ever again.”

More information is available online.