Bladder - Life without limits

An astonishing number of people let urinary incontinence limit their lifestyle and cause unnecessary embarrassment and suffering.

Bladder problems are widespread but many people are too ashamed to raise the issue with their doctor.

Many believe it is a 'normal' part of ageing or a natural consequence of childbirth. This is not so. We all need to learn about risk prevention and do pelvic floor exercise so that we don't join these statistics.

Stress incontinence (loss of urine on coughing, laughing, sneezing, exercise) can be successfully treated in a high proportion of cases through pelvic floor exercise (regular tightening and relaxation of pelvic floor muscles). Motivation and persistence is the key.

These exercises can also assist women who find they and their partners have lost sensation during sexual intercourse because of slack vaginal muscles, particularly after childbirth. Pelvic floor exercise plays an important role in enhancing the sexual fulfillment of both a woman and her partner.

It would be beneficial for all young women to be taught pelvic floor as teenagers because of the effects it has on later sexual response, the benefits it has in terms of recuperation following childbirth and minimising the likelihood of stress incontinence in later life.

The New Zealand Continence Association in association with Dr Rosie King, sex therapist, media personality and doctor, have produced a motivational audio tape teaching everything you need to know to keep the pelvic floor in top shape. (For further info. call the Continence Help Line 0800 650 659 ).

Urge incontinence is also very common and affects men and women. The key treatment is "bladder retraining" which involves learning strategies to calm the premature urge to go to the toilet. The time between visits to the toilet will eventually lengthen.

Did you know?

• Urinary incontinence is more common in women than men, with a ratio of 4:1.
• 40,000 women experience some degree of bladder leakage on a daily basis.
• Only one third seek professional help. Most think nothing can be done.
• 70-80% can become dry again or significantly improved.
• Bladder problems can seriously limit people's social life. Some won't go out for fear of an embarrassing episode.
• Bladder problems become more prevalent in men once they reach 65 years of age - an enlarged prostate and other medical conditions are the common cause.
• A study in Borneo where every female teenager is taught pelvic floor exercise in preparation for marriage showed that the incidence of urinary incontinence was 1:100 compared to 1:4 in the western world.

Types of Incontinence:

Stress Incontinence is the most common. There is a small involuntary loss of urine when you laugh, cough, sneeze or on physical exertion without the urge to go. This is often due to weak pelvic floor muscles often as the result of childbirth, chronic cough, chronic constipation or heavy physical exertion. Being overweight also doesn't help.

Urge Incontinence is the sudden strong urge to pass urine. The person is unable to reach the toilet in time. It is not uncommon to have a mixture of stress and urge incontinence.

Overflow is the leakage of urine from an over-full bladder without the urge to go. The bladder still remains full. This is common in men with an enlarged prostate.

Nocturia is when you are woken more than once a night to empty your bladder.

Nocturnal Enuresis or "bed-wetting" can occur in both children and adults. Treatment Options: Continence advisors prefer conservative treatment options that include pelvic floor exercise and bladder retraining. Surgery should only be considered after all conservative treatments have been exhausted.

Some typical cases:

A 46 year old mother of three teenagers has led a restricted social life for two years since she attended her son's theatre performance and laughed so much that she lost control of her bladder and ended up with soaked clothing. She is sure that everyone noticed. She has only recently sought help as her teenagers were insistent in her becoming more involved in their activities.

A business woman in her 30's had been unable to control her bladder since the birth of her daughter 5 months ago. Her doctor assured her it was common after childbirth and would eventually improve. She was not prepared to accept this advice and self referred to a woman's health physiotherapist. After 4 weeks on a pelvic floor exercise programme she is much improved and back at work.

An elderly man has experienced bladder leakage for 20 years. He rarely goes out. His call to the 'Continence Help Line' was the first time he had ever discussed his problem and he did so with great relief. He hand-washes under-garments everyday and has used homemade continence appliances to help him cope with his problem. He didn't realize that continence services and supplies were available.

Where to get help?

Your family GP

Continence Advisor (A nurse or women's health physiotherapist with special expertise in continence management).

Bladder Control Help Line (for information leaflets, and a list of trained health professionals in your area).

Freephone: Helpline 0800 650 659
Internet Website: www.continence.org.nz
PO Box 270, Drury 2247
Ph (09) 236-0444
Fax (09) 236-0788