1 in 3 women and 1 in 8 men in Australia live with urinary incontinence. Urinary incontinence is more common than diabetes, hypertension breast and prostate cancer yet it is a problem that is rarely mentioned.
Most imagine that incontinence is something experienced only by the elderly but you may be surprised to learn that many women in their 30s, 40s and 50s are suffering from incontinence.
Types of Incontinence
There are two main types of incontinence, stress incontinence which is the leakage of urine with coughing, sneezing and exercise, and urge incontinence which is the sudden and uncontrollable desire to pass urine that cannot be suppressed.
Risk factors for stress incontinence include having had children, chronic cough, obesity smoking and ageing. For men, prostate surgery is a common cause of stress incontinence. Urge incontinence often has no known cause but may be worsened by caffeine, some medications and obesity.
In some cases, urge incontinence is triggered by a particular situation e.g putting the key in the front door or the sound of running water, some find their symptoms worsened by cold weather or stressful situations. The sudden onset of urinary urgency or frequency may be caused by a urinary tract infection, in this case, a visit to the GP has advised.
Consequences of Incontinence
The consequences of incontinence are far-reaching, for many the problem is kept as a lonely and humiliating secret not even shared with a partner or family. The financial burden associated with the purchasing of protective pads can be crippling.
In Australia, the total cost per person with incontinence is about $9000 per year when the need for residential care is calculated. The fear of leakage can mean a trip to the shopping mall becomes a military exercise with all toilets mapped out, a car trip or holiday for someone with urgency and urge incontinence, may be seen as impossible, what will I do if I need to go and there is no toilet? I can’t go to that social function, what if I have an accident? Life becomes smaller, anxiety levels increase.
For those with stress leakage they miss out on kicking a football around with their children, they may leak making love and so avoid intimacy for fear of humiliation. The constant wearing of a pad can make the skin sore and is uncomfortable, black becomes the go-to colour as it is less likely to show ‘that accident’. Listen to the stories of two women with incontinence, their only regret was they didn’t seek help sooner.
Heremia was 54, for the last 20 years she had coped with severe stress incontinence. She used 6-8 pads per day. Her leakage was so bad she found it impossible to work; the financial burden of continence products meant she had to choose between pads or electricity. She avoided social occasions with family for fear of leakage, she was worried about smelling of urine.
She couldn’t contemplate a relationship. Heremia finally sought help and underwent a 15-minute operation to have a mid-urethral sling that cured her incontinence. She is now pad free and working as a school bus driver, only now has she told her family.
70% of women with stress incontinence will be improved or cured with the help of pelvic floor exercises. For others, a simple mid-urethral sling operation will result in an 80-90% cure rate. Janet is 76 and has urge incontinence. Following the menopause Janet noticed that she had some mild symptoms of urgency, one day that urgency resulted in leakage, she was appalled and distressed.
Gradually the urgency worsened to the point where Janet was not just losing a couple of drops at a time but enough to soak a pad and leak urine down her legs She developed a habit of ‘just in case’ voiding, stopped drinking before going out and couldn’t contemplate travel, she became trapped by the need to be near a toilet. With a combination of bladder retraining with a physiotherapist and medication Janet’s symptoms were brought under control. She feels she has her life back.
Urge incontinence can be a little trickier to treat than stress incontinence but with a combination of physiotherapy the use of drug therapies, oestrogen cream or Botox injections into the bladder, it can be cured or very manageable.
For those with some ongoing leakage, pads are an option but NZ company Confitex have also produced excellent and elegant absorbable underwear (for men and women) that can just be thrown in the wash! The good news is that urinary incontinence is usually a very treatable condition and one which your family doctor should be very comfortable to talk to you about. Life is precious and should be enjoyed. If you have incontinence, be brave go and see your family doctor for help and advice.