Thursday 19 April 2018

Dr Ciara Kelly on the silent suffering of urinary incontinence

Urinary incontinence in women is more common than hayfever - why aren't we talking about it?

Up to a third of younger women have had issues with urinary incontinence
Up to a third of younger women have had issues with urinary incontinence

Ciara Kelly

One of the best things about having a health column, is getting to shine a light on stuff that I know from my day job happens to lots of people, but doesn't get aired much in the public domain.

One such thing is urinary incontinence, and specifically this week I'm talking about female urinary incontinence. It's not a sexy subject but up to a third of younger women have had issues with it and over half of Irish adult women overall suffer from some degree of it. And here's the thing: they don't talk about it - to anyone.

They don't talk about it, which means they never seek help for it. So these women, are attempting to manage the condition themselves - as they think it's some kind of normal side-effect of ageing that they have to put up with - using pads and planning their wardrobe and their day around it. Dark clothes and trying always to be near a toilet, have become a way of life for many women. And it doesn't have to be that way.

There's two kinds of urinary incontinence (the involuntary leakage of urine). Stress incontinence occurs accidentally when you laugh or sneeze or cough or run and jump or dance. Urge incontinence occurs when you know you need to go to the toilet but you simply can't make it - it can happen literally in the bathroom, beside the toilet. There's also mixed incontinence where some people have a bit of both.

Stress incontinence is caused by a weak pelvic floor and is hugely common in women, particularly after child birth - although it's a myth that women don't get it unless they've had children, as many do. And it's the condition I'm going to focus on, as it seems to be the one that women just accept as their lot in life. They often give up exercise as a result, as they feel their pelvic floors simply can't cope with jogging or Zumba.

'Pelvic floor exercises' are often glibly prescribed by doctors - but they're quite hard to do (you clench and hold the muscles that you would need to use to stop yourself from weeing - but not while doing a wee) and need to be done ridiculously often, to have any effect and even then it's still only a marginal benefit at best. So pelvic floor neuromuscular stimulation is what's really needed. On the continent, women are routinely prescribed a neuromuscular stimulator, for use on their pelvic floors, after childbirth - not so here. We're expected to put up and shut up about this issue.

But you can access the use of a stimulator here. You can buy one. You can get use of one through a physio. Or there's an Irish company that provides a rental option - which is not a bad idea, as studies show that use for eight to twelve weeks, provides long-term, lasting benefit in the majority of cases. And before you freak out, it's non-invasive! No vaginal probes, just a wrap-around gadget that passes a current across your pelvic floor, effectively contracting it, in a way you simply can't with clenching alone!

If that isn't enough to sort you out, there are also tablets available for both stress and urge IC. And if all else fails, there is, of course surgery. However, most Irish women never use a neuromuscular stimulator. They simply hide or ignore the problem putting up with it until it gets so bad, they choose surgery in desperation.

In one recent study, Irish women with urinary incontinence said they were embarrassed and ashamed by the condition. The majority of them said their social lives were affected by it and a third of them said their sex lives were affected. Most of them appeared to think there was nothing that could be done. Long past time to challenge that idea.


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