'It’s a global embarrassment issue, 1 in 2 women are affected' - Irish doctor on issue model Danielle Lloyd bravely highlighted
British model Danielle Lloyd received widespread praise in recent weeks when she broke her silence on how incontinence blighted her life for seven years.
The mother-of-four bravely spoke about how she first started to experience problems after the birth of her second child, when she found she was unable to control her bladder.
After her third child George was born in 2013, she started having accidents if she coughed, sneezed, exercised - or even laughed out loud.
The model recalled an incident at a trampoline park with her children when she had to shuffle them out of the play area in embarrassment because she’d had an accident.
Professor Barry O’Reilly, a consultant urogynaecologist at Cork University Maternity Hospital who assesses and treats women with pelvic floor dysfunction, says Danielle's case is common.
One in two women are affected by incontinence at some point in their lives.
But it’s an issue that’s not talked about openly, he says. He hopes to change this, and hopes to eventually help introduce pelvic floor awareness into leaving cert health programmes, to promote healthy habits for young women.
“There’s a quote that says ‘incontinence doesn’t kill you but it steals your life’. It has a significant effect on quality of life and social interaction.”
“[Women who are affected] don’t want to visit people’s houses or get into other people’s cars in case they’ll have an accident. The embarrassment of it affects their intimacy with a partner, if they have an accident during intercourse for example.”
“You might have accidents at work. Running to the loo all the time is a serious issue. It’s a global embarrassment issue.”
Incontinence can happen after pregnancy and childbirth, or as a result of lifestyle factors or genetics.
“There are two broad categories. OAB or over active bladder affects men and women; about one in three women suffer from that.”
“It can affect women at different life stages, it’s not just the elderly, it can be bed wetting at a young age, and if that’s prolonged and not dealt with girls tend to grow up to have urinary issues. In teens, we see it again if bed wetting occurred at an earlier age and wasn’t properly addressed."
"Certain lifestyle factors affect urinary issues … women get into bad bladder habits if they’re working shifts, if they’re a nurse or teacher, and they’re working all day without going to the toilet, and they develop these symptoms.”
“As women get older, childbirth has an effect, that tends to be more cause and effect, and this is stress incontinence. Stress incontinence is leakage with cough, sneeze and exercise.”
“It has significant quality of life issues."
Women with stress incontinence often avoid exercise for fear that they'll have an accident, but weight gain can exacerbate the issue as well.
"These are women who can’t exercise in case of an accident in the gym. If you’re not exercising you might put on weight and incontinence gets worse. Women will say ‘I can’t get on the trampoline with my kids, I can’t play with them."
"There are significant links with depression; and self-esteem goes significantly downhill.”
Drinking too much water, because of the misconception that it is healthy, can be detrimental for your bladder, Professor O’Reilly says. Caffeine and alcohol have a detrimental effect too.
“With the current body image consciousness, women tend to drink more water than they should. The normal pattern is going to the toilet every two to three hours and being able to sleep through the night.”
“And limiting your caffeine intake - women often don’t realise that tea has as much caffeine as coffee, coke and alcohol, and that all of these are bladder stimulants. We all know that if have a few drinks in one night for example, we tend to go to the loo more.”
“One symptom of OAB is urinary frequency which is running to the loo more than eight times a day. The norm would be six to eight times a day, and being able to sleep through the night. Women are going every 20 or 30 minutes, and that can go on through the night. It can impact on their day to day life.”
“The other symptom is urgency which is the inability to stop yourself going to the loo. Urgency is when you can’t get there on time. It’s the latch key urgency, when the key is in the door and you have to drop everything to go to the loo.”
Early intervention can help, and pelvic floor exercises, and lifestyle changes can benefit women too, Professor O’Reilly explains.
“Pelvic floor exercises should be something women do from teenage years onwards. It’s an interest for me to help introduce pelvic floor awareness into leaving cert health programmes. If we could introduce an awareness of that from an early age on, it would certainly be very helpful.”
“An awareness of toileting habits, drinking the recommended one to two litres a day, or six to eight glasses a day. If you drink in excess of that, you’ll go to the toilet more often. Going to the toilet every 30 minutes is not good.”
For overactive bladder, things like physiotherapy, lifestyle changes, and medicine to take away urgency, and bladder retraining can all help.
For stress incontinence, a new laser treatment is proving successful.
“That’s a condition that we usually offer physiotherapy for. If phsyiotherapy hasn’t worked then we offer surgery. There’s a new technique which is trans vaginal laser treatment which is an office-based procedure with no anaesthetic, no blood loss, no pain, and it’s walk-in walk-out.”
“It’s very effective. We’re seeing very good results. Most importantly, there are no complications from it.”
“You see women come into the clinic with a problem and their demeanor is really down, their confidence is really down; they wear dark clothes because of leakages. To see them six weeks afterwards, they have a new found confidence.”
Dr Suzanne O’Sullivan, also a consultant urogynaecologist, says stress incontinence is directly related to pregnancy and childbirth.
“You can have a caesarean section but that’s not going to be protective. It’s directly related to pregnancy and childbirth. Some women are more vulnerable to it in relation to genetics and connective tissue.”
“It’s common in the short term after vaginal deliveries, and after pregnancy because the connective tissue changes allowing women to carry a pregnancy and allowing the ligaments to stretch in labour. It usually will settle down. After more pregnancies it can come back or it may get worse. When menopause comes, it can come back again.”
“It’s like ageing, we can’t prevent ageing.”
“One of the problems out there is that women think ‘if only I did this’: it’s putting guilt on women. We know we can’t prevent it. Often very tall, slim women can get prolapse because there’s a genetic predisposition. It’s not people’s fault, they should not think it’s something they’ve done.”
“Other types of incontinence are associated with increasing age and are not childbirth related.
“Physiotherapy can be really important. But the ligaments that support the bladder neck onto the pubic bone can become stretched. With physiotherapy we would have up to 70pc cure rates, but it’s not effective for everyone.”
“Doing pelvic floor exercises in pregnancy can be preventative and reduce stress incontinence afterwards."
But she added: "Sometimes you can overdo the pelvic floor exercises and the muscles go into spasm with pain.”
“Antenatal and postnatal pelvic floor exercises are important. But often postnatally, the nerves in these muscles have been stretched, and people think they’re doing these exercises but they’re not. So seeing a specialised physiotherapist is important.”
Prof. Barry O’Reilly is involved with a new educational initiative called #InControl, working to empower those with OAB to stop ‘coping’ and seek help and support. For more information on incontinence and the treatments available, see here.