Home and dry
Bladder-control problems are surprisingly common - and help is at hand, writes Sylvia Thompson
Bladder-control problems are estimated to affect nearly half a million people over the age of 40 in Ireland, two in five of all women and one in four of all men. Sufferers also tend to live with their symptoms for an average of six years before seeking medical help. "When your bladder function impacts on your day-to-day activities, you know you have a bladder-control problem," says Tom Creagh, consultant urologist at Beaumont Hospital, in Dublin, and a member of the advisory panel of Tirim - Irish for dry - the bladder-control information service.
The panel is a multidisciplinary team of specialists representing gynaecology, urology, physiotherapy, general practice and continence promotion. Since it was set up, in 1999, Tirim has received almost 20,000 calls for help and information on bladder-control problems.
Stress incontinence is the better known of the two most common bladder problems. You know you suffer from stress incontinence if you experience leakages from your bladder when you cough, sneeze, laugh or run. Stress incontinence is caused by weakened pelvic-floor muscles and mainly becomes a problem for women during pregnancy and following childbirth. Men who have had radical surgery for prostate cancer can also suffer from the condition.
"A large study carried out in London found that up to 30 per cent of women suffer from stress incontinence from about 20 weeks onwards in their pregnancy," says Dr Declan Keane, master of the National Maternity Hospital, on Holles Street in Dublin. A urogynaecologist - a specialist in urology problems associated with pregnancy and childbirth - he is another member of the Tirim team.
The main causes of post-natal stress incontinence, he says, are having a baby that weighs more than eight pounds and 13 ounces, having a long second, or pushing, stage of labour and having an epidural - which in itself tends to increase the second stage.
"It's difficult to tease out which factor is the most significant, but the longer the foetal head is sitting on the perineum, the higher the risk of stress incontinence," says Keane. "Episiotomies were once thought to protect the urethral sphincter, but now it is known that episiotomies neither protect nor increase the risk of stress incontinence."
Post-natal incontinence is less common among those who have Caesarean sections.
Hormonal factors also play a part. Progesterone relaxes muscle and can therefore worsen stress incontinence, which is why many women find the problem increases in the days before their period,when progesterone levels are increasing. Low levels of oestrogen also reduce ligament and muscle strength, which is why hormone-replacement therapy can reduce stress incontinence for post-menopausal women.
The physiotherapy departments of maternity hospitals run treatment programmes for stress incontinence. They sometimes use on-screen feedback about muscle activity (biofeedback) to help retrain the pelvic-floor muscles. "We tell women about the condition in the antenatal and post-natal classes and that it is not something to be put up with and viewed as a natural part of childbirth. It can be treated, and if you treat it earlier, results are better," says Jill Andrews, a physiotherapist at the National Maternity Hospital. Surgery is required in severe cases.
Urge incontinence, or overactive bladder, is the other common bladder-control problem. The symptoms include needing to go to the toilet more than eight times in 24 hours and having a sudden and overwhelming urge to go to the toilet, which sometimes results in a wetting accident. It affects men and women equally.
"Research has found that bladder overactivity can have the same impact on your life as depression. However, there is a 90 per cent success rate of treatment with medication, biofeedback and physiotherapy," says Creagh. Drugs used to treat bladder overactivity help to calm the bladder muscle, allowing the bladder to fill to a more normal level before prompting a desire to urinate.
Tirim Talk, a newsletter on bladder- control problems, is available free by calling the Tirim helpline (1850-476476) or by writing to Tirim Information Service, PO Box 6235, Dublin 17; see also www.continence-foundation.org.uk and www.pelvicfloor.co.uk