Urinary incontinence remains a taboo subject, both socially and medically, even in the 21st century. It’s estimated to affect a staggering 5 million women in England and Wales, yet despite this, it is thought a third of women still suffer in silence with many women
being too embarrassed to seek help, or possibly not realising that effective treatments exist.I am going to look at what women can do for themselves, but I must stress that if you have a problem, it is critical you see your GP or practice nurse to allow it to be fully assessed.
Whilst there are a number of common disorders of the urinary
tract, this remains a complex area that needs a proper assessment to
give an accurate diagnosis and allow a discussion about possible treatments.
What are common causes of urinary incontinence?
Stress incontinence:
This is the most common cause of incontinence and accounts for
about 60% of all cases. It occurs when there is leakage on exertion,
such as coughing, sneezing or running. It is also associated with
childbirth, however nearly 5% of women who have not had children
also suffer. This compares to 7% of women who gave birth by caesarean section and 12% who gave birth vaginally.
Urge incontinence
Also known as ‘overactive bladder syndrome’ where the bladder
muscles contract before the bladder is full. This is where a person feels the need to urinate often and without much warning. If you feel
a strong need to pass urine and cannot stop yourself, this is urge
incontinence. Overactive bladder syndrome is caused by the bladder
muscle contracting before the bladder is full.
It is also possible to have a mixed picture with both stress and urge incontinence occurring together. Whilst these represent the more common causes of urinary incontinence, there are a number of others, including urinary infection, which is why it is important to have an accurate diagnosis.
How can you reduce your risk of urinary incontience?
The pelvic floor, which supports the bladder that sits above it, is made of collagen and muscle. And like all muscles in the body, when they are trained, they get stronger and when ignored they will get weaker. Pelvic floor exercises (PFE) are normally first talked about in antenatal classes, but in reality it would be best to teach them from puberty. These exercises increase both the strength and endurance of the muscles and this increases the resting tone in the area, which makes it less likely that incontinence will develop.
Pelvic floor contractions are achieved by lifting and tightening
the muscle as if to prevent the passing of wind. For women
who have been sexually active the tightening would also squeeze a
finger placed in the vagina. Up to 30% of women cannot perform a
voluntary contraction and may require specialist tuition. The
contractions need to be repeated 8 to 10 times and practiced several
times a day for life, as part of an exercise programme. Unlike other
forms of exercise though, you don't have to get changed or go anywhere special to do them!
Just like the tissues in the rest of your body, if you abuse them they are more likely to let you down. To avoid developing a problem
in the first place I would strongly recommend avoiding smoking. Not
only does the smoke reduce your collagen formation, but a chronic
cough will also put an increased strain on the pelvic floor. A diet
rich in antioxidants, particularly vitamin C, will support collagen
formation, so choose to eat a wide variety of coloured vegetables.
Just as coughing increases the pressure in the abdomen which can
result in leakage, the more weight you carry, the more pressure you
put on the pelvic floor and the more likely it is to fail. This is definitely an area where prevention is much better than cure. Avoid becoming overweight and if you are, consider losing weight.
Additional support
Finally it is important to remember that you are not alone and that this
is an extremely common problem. There are a number of very good
support groups in existence (for example
www.continence-founda-
tion.org.uk), so it might be worth looking at one in your area.
What can you do if you already suffer?
If you suffer from any form of urinary incontinence, the first course of action must be to get a diagnosis. However, whatever the form you are diagnosed with, there are several changes to your lifestyle
which may help improve your condition. These include:
Limit your fluid intake
to 1.5 litres a day. It is useful
to keep a fluid intake diary to know exactly how much you are drinking.
Lose weight
if you are overweight. This can be difficult
as you may not be able to exercise comfortably, but don’t underestimate the value of walking at least 10,000 steps each day together with a good diet.
Avoid drinking caffeinated drinks
like tea and coffee. Reduce or avoid alcohol.
Do pelvic floor exercisesIf you have stress incontinence
then pelvic floor exercises have been found to cure 65% of sufferers and offer improvement to a further 23%. Only 12% of individuals get no benefit, so this would seem to be very worthwhile trying.
Cystitis – which is inflammation of the bladder and can be caused by infections – may also lead to incontinence. This is why seeing
your GP is so important, as an infection can be simply treated. If
you suffer from recurrent bouts of cystitis the incidence can be
reduced regularly by taking cranberry juice or extracts, though
the evidence for this as a treatment is less strong (take advice before use if taking other medication).
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