Urinary incontinence:  busting the myths
Kirsten is 47 and has trouble holding on when she needs to go to the toilet. Often she gets to the front door and is searching for her keys when she suddenly has an overwhelming urge to urinate. Before she can get the key in the door she has leaked a bit and needs to drop everything and run to the toilet as soon as she gets inside. Kirsten is embarrassed by her problem and doesn’t know what to do about it.
Sound familiar? Kirsten is just one of more than three million Australians who experience urinary incontinence. Unfortunately most people don’t realise that incontinence can be improved and even cured if they can just build up the courage to talk to someone about it.
Types of urinary incontinence
The most common types of urinary incontinence are:
Urge incontinence
This is bladder leakage that occurs with a strong desire to go to the toilet but being unable to make it in time. It is associated with frequency, needing to pass urine more often than normal and nocturnia (needing to wake at night to go to the toilet).
Stress incontinence
This is when urine leaks with exertion or effort, such as coughing, laughing, sneezing or running. Many women have a combination of urge and stress incontinence. It is also not uncommon for women to have unwanted leakage from the bowel.
What is normal?
According to the Continence Foundation of Australia, a normal bladder:
- Empties 4-8 times each day (every 3-4 hours)
- Can hold up to 400-600ml of urine (the sensation of needing to empty occurs at 200-300ml)
- May wake you up once at night to pass urine and twice if you are older (over 65)
- Tells you when it is full, but gives you enough time to find a toilet
- Empties completely each time you pass urine
- Does not leak urine
What causes incontinence?
Jean Hailes physiotherapist Janetta Webb says it’s a common misconception that incontinence is something only experienced later in life. “Urinary incontinence can happen to anyone, young or old,’ she says. “It’s especially common during menopause and during or after pregnancy.”
Women who have chronic respiratory illnesses, do repetitive heavy lifting (such as gym work), are constipated and strain to empty, or are overweight, also increase their risk of developing incontinence. Some other medical conditions such as diabetes and low back pain can also contribute.
Some common incontinence myths
| Incontinence is a normal part of ageing
WRONG. Incontinence can happen to anyone at any age and is not normal. |
| Leakage is NOT incontinence
WRONG. Many women don’t think that ‘leaking’ is incontinence, but it is and can be improved or cured. |
| It’s bad to ‘hold on’… you’ll get a bladder infection
WRONG. When it’s full the bladder will allow you enough time to hold on and find a toilet. It’s normal for the bladder to act as a reservoir to store urine, so holding on is not a bad thing and will not cause infection. |
Ways to improve continence
The good news, according to Janetta, is that in most cases urinary incontinence can be improved and even cured. “Incontinence needs to be properly managed by a health practitioner with training in this area. Talk to your GP – it’s a common area of concern,” she says. “You may need to see a continence physiotherapist, continence nurse or a specialist doctor. There are also continence clinics in many public hospitals and regional centres.”
Pelvic floor exercises
According to Janetta, regular exercises to strengthen your pelvic floor muscles can reduce the risk of incontinence and help to treat it. “Pelvic floor exercises need to be regular and done the right way to be effective,” she says. “Results won’t happen overnight, so keep doing them. If it’s not helping seek advice as you may not be doing them correctly.” Janetta advises that pelvic floor exercises are not always the best form of treatment for incontinence, so it’s important to seek help if a problem persists.
Bladder retraining
Bladder retraining improves your bladder capacity so that it can hold more urine. It’s useful for women who have frequency or urge incontinence. Your continence physiotherapist or nurse can help you retrain your bladder.
Hormone therapy
Urinary incontinence can worsen after menopause because of a lack of oestrogen. Oestrogen treatments such as hormone therapy, particularly local vaginal oestrogen cream, can be helpful. Surgery There are a variety of surgical procedures that may be helpful if your incontinence is not improving through other methods. Your health practitioner may refer you to a specialist if surgery is an option.
Medications
Medication may on occasion be prescribed to treat incontinence. This would follow an assessment by a medical specialist and can be extremely helpful.
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Don't just put up with incontinence – do something about it! |
How to do pelvic floor exercises |
- Start by lying down or sitting comfortably in a chair. Tighten the muscles around the anus, vagina and urethra all at once and try to lift them up inside.
- Try to hold this while you slowly count to five, then let go.
- Rest while you count to five, then try again.
- If you can’t feel anything happening at all you may need help from a physiotherapist to learn how to work your muscles effectively.
- If you can hold for a little longer, do so. Gradually build up until you can hold for 10 counts and rest for 10 in between.
- Do as many as you can up to 10, then rest for a minute or two.
- Now do some really strong squeezes – as strong as you can, then let go. Do as many of these as you can, up to about 10.
- Do the above routine several times a day.
- Remember, don’t bear down, hold your breath or squeeze buttocks or legs together.
- Don’t practise stopping the flow of urine mid-stream as an exercise. This can send incorrect messages to your bladder and stop it from emptying completely.
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Continence aids
Continence pads can help you to lead a normal life feeling dry and comfortable. It is, however, still important to work on improving your continence as much as possible.
Talking to your health practitioner
Many women are too embarrassed to talk to their doctor about urinary incontinence or are confused by what incontinence actually is. Jean Hailes Foundation GP Sue Reddish says it’s important for women to tell their doctor about all their symptoms, no matter how embarrassing or trivial they may find them. “So many women of all ages experience incontinence from a variety of causes, so you are not alone. Your GP can offer you treatment options and ways to help you manage,” she says.
Lifestyle tips to help manage and improve incontinence
- Aim to drink 6-8 cups of fluid a day unless otherwise advised by your health practitioner
- Cut down on caffeine, fizzy drinks and alcohol as they may stimulate the bladder
- Maintain an ideal body weight – keep fit
- Don’t smoke – chronic coughing can cause stress incontinence
- Eat fibre-rich foods – constipation can affect both bladder and bowel function
- Don’t go to the toilet ‘just in case’ – only go when you need to
- Seek treatment for urinary tract infections
- Sit down on the toilet and take your time
Resources
For further information on women and continence issues, including a fact sheet and booklets, Incontinence: the hidden epidemic and Women’s Waterworks, please log on to www.jeanhailes.org.au or freecall 1800 151 441.
Continence Foundation of Australia www.continence.org.au
National Continence Helpline 1800 33 00 66
Bladder & Bowel Website www.bladderbowel.gov.au
National Public Toilet Map www.toiletmap.gov.au
© 2007 The Jean Hailes Foundation for Women’s Health
Apart from fair dealing for the purposes of private study, research, criticism or review, as permitted under copyright legislation, no part may be reproduced or reused for any commercial purposes.
Content updated November 29, 2007
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