Overcoming Incontinence

Read about the author Nicci Talbot

Urinary incontinence (UI) is a common problem affecting men and women of all ages but it’s still a little taboo and we get embarrassed about it. One US study found that 60% of women don’t discuss it with their doctor. There are also a lot of misconceptions – such as that it’s part of ageing and there’s nothing we can do about it. A small amount of leakage is normal during day-to-day activities but if it’s affecting your quality of life then speak to your doctor. 80% of UI can be treated so getting a diagnosis is the first step.

Here’s what the medical experts have to say:

“Urinary incontinence is a problem that affects the bladder and what happens is that the bladder fails to function in a normal way. The main role of the bladder is to store urine and then under voluntary control, that is when you are ready to go to the toilet, it should empty. However, this whole mechanism is quite intricate and requires in place support muscles. It requires an intact bladder, an intact pipe coming out of the bladder or urethra and an intact neurological system to make it work. If any of these are damaged for any reason then the bladder doesn’t work properly and you leak urine and it’s not always a condition that’s easy to predict,” says Suzy Elneil, Consultant in Urogynaecology and Reconstructive Pelvic Floor Surgery at University College Hospital, London*.

Types Of Incontinence

Stress Incontinence (SUI)

This is the most common type and happens when the neck of the bladder doesn’t support the system, typically after having a baby as the process of childbirth can damage the structures of the bladder, causing the neck to prolapse a little. The pelvic muscles gradually weaken with hormonal changes so when you cough, sneeze, exercise, have sex or laugh you may leak urine. SUI can also be caused by hysterectomy, menopause (a reduction in oestrogen), some medications, constipation, smoking, pelvic surgery and being overweight. Many women find the problem is worse in the week leading up to their period because a release of hormones can affect the pelvic floor muscles.

Urge Incontinence (UI)

This is when the bladder muscle becomes over-active so it doesn’t properly relax and open when the bladder is full. It contracts causing leakage, which can be difficult to predict. The bladder is telling the brain that it’s full before it actually is – causing it to contract suddenly. You get an urge to go to the loo and may not be able to hold the urine until you get there.

Getting a diagnosis is important to determine which type of incontinence you have, so speak to your GP and keep a bladder diary the week beforehand. This can help you to monitor any triggers such as caffeine, alcohol, too much liquid or not enough – meaning urine is too concentrated which can irritate the bladder. Your GP will take a medical history, ask about symptoms and may do a physical examination to check your pelvic organs. Further tests may be required to find out what type of incontinence it is and at this stage, he or she may refer you to a continence specialist or physiotherapist.

Treatments

In 80% of cases urinary incontinence can be treated without the need for surgery. Suzy Elneil points to research in the Netherlands which shows that teenage girls benefit from being given pelvic floor physiotherapy exercises from puberty onwards. They get used to doing them, which prevents problems later in life. In France women are offered pelvic floor sessions after childbirth to get their bodies back into good shape (presumably to produce more children…) In the UK pregnant women are usually given a leaflet by a midwife or health visitor and there might be a brief talk during an NCT lesson but you’re pretty much left to your own devices. It would be helpful to get into a PF exercise routine earlier in life to build up muscle strength and support our bodies as they change.

If your PF muscles are very weak, biofeedback (electrical stimulation e.g. a Kegel8 device) can be helpful to build strength before you do the exercises. A continence adviser or physiotherapist can advise on this.

There are medicines that can help treat UI in combination with bladder retraining. They are called Anticholinergics and they work by relaxing the over-active detrusor muscle in the bladder so that you don’t get the sudden urge to go to the loo and your bladder is able to hold more liquid.

Self Help

The pelvic floor muscles form a sling or hammock at the bottom of the pelvis to hold your organs in place (the bladder, womb and bowel). Having strong muscles can help prevent and treat incontinence as well as improving sexual sensation and orgasms. You need to be able to relax the muscles properly to have a child vaginally – and to have good orgasms! Yoga and Pilates are both excellent for strengthening the PF muscles by working on core body strength.

Identify the muscles by stopping and starting the flow of urine and wind. Try this kneeling and lying down, with and without a resistance device (such as kegel exercisers/jiggle balls or Lelo Luna Smart bead) and during sex to try and get a sense for how they feel with gravity.

Many womens’ health physiotherapist use electrical stimulation to encourage the pelvic floor muscles to work. You can now experience a similar pelvic floor workout using the MyStim range of sex toys which offer both vibratory and electrical stimulation. They even have a pelvic floor workout programme for you to use on a daily basis.

The aim is to practice lifting the muscles using longer and shorter squeezes a few times a day. Hold the squeeze for 10 seconds and relax for 10 seconds before alternating with faster squeezes. Make sure you relax the muscle fully before starting the next rep. Make it a habit – aim to do a few sets three times a day when you’re sitting, driving or in bed and you should notice a difference within 3-5 months.

If you’re struggling to maintain motivation there are private courses you can do. Pelvifix offers a tailored treatment plan that teaches you how to exercise your PF in 10 hours. Or contact the Chartered Physiotherapy in Women’s Health for referrals (www.acpwh.csp.org.uk).

Other Lifestyle Tips

• Make sure you empty your bladder properly – sit down rather than crouching over the loo.
• Bladder retraining – going to the toilet too often can make the problem worse. Practice holding out for longer over 6 weeks to help retrain your bladder to hold more liquid.
• Learn how to lift properly to avoid putting excess strain on back and pelvic floor.
• Avoid excess caffeine, alcohol and fizzy drinks, which are a diuretic making you go more often.
• Stop smoking – a 2002 study by Dallosso et al found that smokers are 1½ times more likely to have an overactive bladder due to the effect of nicotine.
• Lose weight if you need to – moderate exercise such as walking, swimming and yoga will help. Make sure your diet is high in fibre to avoid constipation and drink plenty of water – water nourishes all of your organs before being filtered to the bladder so it won’t make you rush to the loo.

Incontinence isn’t something you have to put up with in life. In most cases it can be treated without the need for surgical intervention and there’s lots of help available, so talk to your GP and get the support you need.

Squeezy app is a really useful little app you can download to prompt you to do those pelvic floor exercises. Designed by womens health physiotherapist Myra Robson it can help women with their pelvic floor muscle exercises as part of a physiotherapy programme.

Useful websites
Pelvic, Obstetric and Gynaecological Physiotherapy : www.pogp.csp.org.uk
Cystitis and Overactive Bladder Foundation: www.cobfoundation.org
Chartered Society of Physiotherapy: www.csp.org.uk
British Menopause Society- thebms.org.uk
Royal College of Obstetrics and Gynaecology- www.rcog.org.uk
Squeezy : www.squeezyapp.co.uk

If you want to know more about kegel exercise balls and how to perform exercises with them, read Jo Divine’s in-depth article.

*Quoted in Wellbeing of Women health podcasts.