What is urinary incontinence?
Urinary incontinence is defined as bothersome urinary leakage causing a social or hygiene problem. It is a common condition that, although rarely life threatening, is embarrassing and distressing, and may severely affect your quality of life.
Incontinence may be quite mild: the occasional leaking of small amounts of urine that does not cause embarrassment and would therefore not be considered a problem. Or it can be very severe and may lead to people constantly having to wear pads to stay dry, avoiding normal activities such as sport or worrying about people noticing the smell of urine.
The causes of incontinence are very varied, and some are easily corrected – just as constipation can be easily cured with a better diet or a urinary infection with antibiotics. Others may require surgery or long-term medication.
This book is written to help you learn about incontinence and how it may be treated. It is not designed to replace a consultation with your doctor but hopefully will help you understand the broader facts around the problem. It will also look at other urinary disorders such as recurrent cystitis and bladder pain, because not all women with bladder problems leak.
Who is affected?
Urinary incontinence is most commonly found in women who have had children but it can also affect children, men and women without children.
Urinary incontinence is estimated to affect around 2.5–3 million women in Britain; this translates to 50 patients per GP in the UK. However, this figure is probably an underestimate, because there may be many women too embarrassed actually to admit that they have a problem. Some studies suggest that up to 30 per cent of women may be affected after pregnancy and childbirth.
Symptoms
As well as leakage, there are a range of other symptoms of incontinence and bladder problems. You may have to pass urine more often than usual, which is known as frequency, and it may be painful or difficult to do so (dysuria).
You may have a sudden and uncontrollable desire to pass urine. This is called urgency and can lead to leakage if you don’t reach a toilet in time. These are all common symptoms of cystitis, an inflammation of the bladder.
You may have to get up in the night more often than normal to pass urine, which is known as nocturia, or you may have difficulties in emptying your bladder (voiding problems). You may have the sensation of wanting to pass urine but being unable to do so on demand, or you may suffer from hesitancy, which is a period of delay before you begin to pass urine.
Why are people so reluctant to seek help?
Currently, the average time before a woman seeks medical help for incontinence is five years. She may be embarrassed by the problem, or may feel that it is ‘to be expected’ after having children and think that nothing could be done anyway. Or she may learn to ‘manage’ the problem, for example, by emptying her bladder frequently to prevent there being enough urine in it to leak.
But you should be reassured that there is a great deal of help available, from your GP, specialist incontinence clinics and local continence advisers who work in the community. Treatment options are very wide and range from simple changes in lifestyle to surgery. Some improvement in symptoms is possible for almost everyone with incontinence. Help can also be given in managing the symptoms more effectively.
Case history: Sarah
Sarah Hunt is a 36 year old who has had problems with leaking urine when she coughs. Her problems started after the birth of her second child when she was 30. At first she noticed slight leakage when she attended her aerobics class which meant that she had to stop doing step exercises. Over the next three years the problem increased, so she stopped going to the gym altogether.
She eventually went to her GP for help when her problem became so bad that she leaked in public after picking her daughter up. When she saw her GP, she was having to wear sanitary towels whenever she went out, and her friends made a standing joke about her always using the toilet before going out.
Sarah was referred to her local hospital where she underwent urodynamics, which showed that she had urodynamic stress incontinence. At this time Sarah was unsure about whether she wanted more children so she was referred to a physiotherapist who taught her pelvic floor exercises. After four months of these exercises, she is now able to control her problem. When she goes to the gym she wears a large vaginal tampon which stops her leaking during aerobics.
Case history: Dorothy
Dorothy Evans is a 65-year-old woman who went to see her GP because she was always going to the toilet. She was well known in most of the local shops because she often used their toilet when out shopping. She found that if she didn’t void frequently she felt that she would leak and, on occasions, did leak before she found a toilet.
Her GP sent her to a continence adviser for a supply of incontinence pads. However, her continence adviser recommended that she be assessed at her local hospital. The urodynamic tests showed that she had urodynamic detrusor overactivity.
Dorothy started taking an anticholinergic medication (a medication that blocks the action of the nerves on the bladder muscle) and bladder drill was started. She can now manage to shop without using the toilet. She no longer carries changes of underwear in case she leaks.
KEY POINTS
- Incontinence is a common problem
- It leads to a range of symptoms
- Women are often reluctant to seek help
- There is a great deal of help available
