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Gynaecology, Pregnancy Professor Jason Abbott Associate
Being a woman and/or having had a baby increases your risk of urinary incontinence. About 1 in every 5 Australians has an issue with bladder or bowel control and it is not just women who suffer with this problem….

You know that feeling, that moment when you need to cross your legs before you sneeze, or having to make sure you know where every bathroom is in the shopping centre.  Loss of bladder function is termed urinary incontinence and it affects over 1 in 3 women and just over 1 in 10 men.  Often, the symptoms are mild with about 70% of sufferers not seeking any advice.  There are different kinds of bladder incontinence and different kinds of treatment and if you suffer with this problem, then maybe you should ask your health care professional as something can often be done about it.

For leakage from the bladder, there are 2 main types.  These are designated by the termsstress incontinence where you have bladder leakage when you cough, sneeze, run, jump or laugh – that is when you put physical stress on the bladder by pressurising the abdomen.  The second main type isoveractive bladder where you have a need to go very often, may experience urgency (like a very strong need to use your bladder when you get your key in the front door), leak before you get to the toilet and have to get up at night (the technical name is nocturia) to use your bladder at least twice, sometimes more.

Urinary incontinence or bladder leakage may occur for other reasons (such as the bladder neck muscle being weak or there being a nerve related issue) and it is possible to have more than one type of bladder issue at the same time leading to incontinence.  A detailed history and some simple tests are often used to help define what the issues are for any individual woman, although sometimes this is incomplete and more information is needed and further, more detailed and less pleasant tests are required.  One such test is called urodynamics and measures pressures in the bladder and in the abdomen and provides very useful information when things aren’t quite so clear.  When used as needed it provides excellent information on the causes of urinary incontinence and may help to direct treatment appropriately.

One of the main reasons that women are affected more by incontinence than men is that they have a short urethra (the pipe that leads from the bladder to the outside world) and their pelvic floor muscles are often stressed and stretched more than men’s because of child carrying and delivery.  The pelvic floor muscles are a thin group of muscles that sling across the bottom part of the pelvis and are involved in the control of bladder, bowel and sexual functions.  Having weak or damaged pelvic floor muscles is a risk factor for both bladder and bowel incontinence and having a proper assessment of these muscles (usually with a pelvic floor physiotherapist) can help to understand how strong they are and working with a women’s health physiotherapist may help improve the symptoms of incontinence.

In fact there is no downside to pelvic floor physiotherapy, since many types of incontinence may be reduced or even prevented by having a good strong pelvic floor.  Exercises need to be taught and focused, since studies have shown that many women who think they are using their pelvic floor muscles are in fact not correctly contracting and may be doing more harm than good.  Think of it as personal training for your pelvic floor.  Understanding how the bladder works and how the muscles may help your situation is often the first port of call in this situation.

For women who are post-menopausal, the loss of oestrogen production from the ovaries is also an issue for the pelvic floor and replacing the oestrogen with a topical cream or pessary (other forms of HRT are not adequate for this purpose) may further assist blood flow to the muscles, strengthen the bladder, aid in strengthening the muscles and laying down new collagen (the ‘strength fibres’ in muscle).  For women who can use oestrogen, this is a further simple method to aid in function of the pelvic floor and help reduce incontinence.

For certain types of incontinence such as overactive bladder, there may be a nerve problem that contributes to the bladder leakage.  This is termed detrusor instability and means that the bladder is irritable and contracts when there is only low volumes of urine within the bladder.   This leads to frequency, urgency and leakage when it is not expected or wanted.   Bladder infections should be excluded as these may be a contributor to this problem.  If physiotherapy and oestrogen don’t work, then sometimes medications that settle this bladder overactivity can help.   These may not be suitable for all women and you should consult with your Alana doctor to see if these are suitable for you.  Common side effects of many of these medications include dry mouth and dry eyes as they work by relaxing the bladder muscle and can also cause relaxation of the muscles that control the tear ducts and salivary glands and these don’t produce as much secretions and lead to these symptoms.  Again, you should speak with your doctor if these occur.

For women with stress incontinence, there may be damage to the supporting ligaments that hold the bladder neck in place.  These stretched or damaged ligaments may then lead to the bladder neck moving down and out from the pelvis and this leads to incontinence.  Any activity that increases the pressure in the abdomen may increase bladder leakage.  If simple treatments don’t work here, then other options may include a device (called a pessary) to support the bladder neck or a surgical procedure that aims to replace the ligaments and again support the bladder neck.  This is a common and simple procedure with low (but not no) risk and usually only requires an overnight stay when done on its own.  Not all women are suitable for this procedure and your doctor will direct if this is appropriate care for you.

Bowel Incontinence

Bowel incontinence is less common than bladder incontinence but may still affect about 1 in every 10 women.  It is one of the three major contributors to being admitted to an aged care facility in Australia.  Injury to the anal muscle at the time of a vaginal delivery is a contributing factor to this problem in women, but is not the only cause.  Assessment of this problem may require additional tests such as an ultrasound of the anal muscle and the involvement of a colo-rectal surgeon.  Care is specialised and there is a strong role for the physiotherapist to improve muscular strength, however, other treatments may also be needed.  If you suffer with bowel incontinence, then do seek advice from your doctor who can direct you to the most appropriate care.