Exercises, surgery and hi-tech undies come to the aid of those with leaky bladders.
For something that affects about a third of women who’ve given birth, stress urinary incontinence flies surprisingly under the radar. Put a group of mothers with young babies in a room together and they’ll soon be sharing stories about cracked nipples and episiotomies and describing the contents of their babies’ nappies in gruesome detail. But they’re unlikely to mention that they now wet their pants when they jump on a trampoline with their children or work out at the gym, or even when they do something as unremarkable as cough or sneeze. Often it’s just a few drops of urine, but sometimes it’s a stream.
“No one says, ‘That happens to me too.’ People really, really don’t bring it up,” says Lynsey Hayward, an Auckland gynaecologist who specialises in pelvic floor dysfunction. “People feel dirty and ashamed and embarrassed, and they feel humiliated because they think they’re the only ones.”
An estimated one in three women who’ve had children will end up with some degree of stress urinary incontinence, involuntary urination during activities such as coughing, sneezing, jumping and lifting. It’s caused by damage to the pelvic muscles and to the closing mechanism of the urethra that can happen during a normal delivery, and is even more likely during a forceps delivery.
Men can also suffer stress urinary incontinence, though in smaller numbers and for different reasons, such as having an enlarged prostate.
For most women, the problem is easily solved by doing exercises to strengthen their pelvic floor, preferably in consultation with a physiotherapist. But for about 15% of those affected, exercises are not enough. Their only cure is surgery – a simple 15-minute operation to insert what is known as a retropubic sling to support the urethra.
Hayward performs about 150 retropubic sling operations a year. “It’s quite a life-transforming thing – we get a lot of hugs,” she says. Many of the women she sees have suffered in silence for years: “Life gets very small because they avoid things in case they’re going to leak.”
The economic impact can be huge too. Adult incontinence pads cost as much as $1 each and some women use 10 a day. ”If you’re living on a benefit, that’s a lot of money; a lot of the women I see can’t afford the cost of pads so they make do by using things like cut-up towels.”
Often, as well as suffering from stress incontinence, Hayward’s patients have what’s known as urge incontinence, or overactive bladder. It causes an overwhelming and uncontrollable need to urinate; sufferers often urinate frequently as well. Men also suffer from urge incontinence, which is associated with ageing and being overweight.
The first line of treatment for urge incontinence is also pelvic floor exercises, along with retraining to increase bladder capacity. Drugs can calm the bladder down, and if all else fails, a Botox injection will usually do the trick.
Incontinence surgery can be transforming, but it’s not always 100% successful. Some women still experience small amounts of leakage afterwards. Tracy Smith (not her real name) first experienced stress urinary incontinence after the birth of her second child. “I sneezed and it just went everywhere – a big morning wee that went everywhere.”
By the time she’d had baby No 3, she was using incontinence pads all the time, and she’d given up activities she’d once enjoyed, such as playing sport. She had surgery about 10 years ago and her condition improved significantly. However, she still had some leakage and continued to wear lightweight pads “just in case”.
Recently Smith discovered a new line of New Zealand-designed underwear being billed as the world’s first “sexy” answer to incontinence. ConfiTEX underwear uses hi-tech, highly absorbent sports fabric that the designers were familiar with from their involvement in alpine skiing. For Smith, the underwear provides an added level of security: “It’s fantastic.”
ConfiTEX is not designed to cope with serious cases of incontinence, but Hayward says it’s a good alternative to pads for those with milder forms of the disorder. “If I had a choice between a pad and frilly knickers, I know what I’d choose.”
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