Incontinence, also known as bladder or bowel ‘leakage’ is probably more common than you think. One in three women who have had a baby, and up to 10% of women who haven’t, have bladder incontinence, while many women also experience bowel incontinence at some point in their life.
Incontinence, often a symptom of pelvic floor changes, is something many women think they simply have to put up with. However, a few lifestyle changes and medical treatment, if needed, can greatly improve the condition – and a woman’s life.
We talk to Dr Payam Nikpoor, Jean Hailes urogynaecologist (a doctor who specialises in the diagnosis, management and treatment of pelvic floor disorders in women), about what you can do.
The female pelvis is home to the bladder, the uterus, the cervix, the vagina, the anus and the rectum.
These organs are supported by the pelvic floor, which is a ‘sling’ of muscles and connective tissues.
The pelvic floor has three main jobs – to contain the pelvic organs, to provide continence (bowel and bladder), and sexual function.
There are two main forms of incontinence – urinary (wee or pee) and faecal (poo, or stools) – and women can have one, or both. Sometimes a woman can experience ‘flatus incontinence’ and have trouble controlling her flatulence (breaking wind or farting).
Urinary incontinence can become increasingly common as we age. But although 50% of cases occur in women aged over 70, it can also affect younger women.
Dr Nikpoor says that up to 20% or 30% of women aged 18-45 might also experience the condition, yet it was still widely thought that incontinence only affected older people.
“It is also a [condition] of the young,” he said. “We need to create greater awareness about it.”
There are different types of urinary incontinence. Some women may leak urine when they sneeze, laugh, cough, have sex, or exert themselves in some way. This is known as ‘stress urinary incontinence’.
In other instances, women may leak urine because they feel a great urgency but can’t get to the toilet in time. This is known as ‘urge urinary incontinence’. This often occurs with needing to go to the toilet frequently and getting up several times at night to empty the bladder.
The symptoms of both are bothersome and can, says Dr Nikpoor, affect the quality of a woman’s life.
Dr Payam Nikpoor, Jean Hailes urogynaecologist
Bowel incontinence is common, but also greatly under-reported because women can find it embarrassing to talk about. Flatus incontinence is also largely unreported. “It is not uncommon in young women after childbirth, especially in those who have had instrumental [forceps or vacuum extraction] deliveries, prolonged labour, large tears, or large babies,” explains Dr Nikpoor.
Leakage of faeces can be caused by bowel surgery, radiotherapy or rectal prolapse. However, diarrhoea is the commonest cause. Dr Nikpoor says that a condition known as ‘third’ or ‘fourth’ degree tears – where women have suffered damage to the anal muscle during childbirth – also puts these women at risk of faecal incontinence.
A diet rich in fibre, drinking 6- 8 cups of fluids daily (mainly water), and a healthy lifestyle are important for bowel and bladder function.
Dr Nikpoor believes it is also critical to adopt good toilet habits, including the correct positioning on the toilet. You should lean forward slightly, rest your elbows on your knees slightly above the level of your hips, relax and let your stomach out. This helps to relax the pelvic floor muscles.
He suggests you should wait until you feel the urge to go, but don’t wait too long. When you ignore the urge to go, you can get a sluggish bowel. If you sit on the toilet for too long, you can get into the habit of straining – one of the worst things for pelvic floor muscles.
At any point when a woman feels things are not quite right in her body, or she experiences symptoms that affect her daily, personal or social life, it’s time to consult a doctor.
“I always start with conservative management and lifestyle modifications,” says Dr Nikpoor. “If you are not active enough, regular exercise helps to treat constipation. Diet is very important, as is hydration. A doctor might also review the medications a patient is taking to see if it is contributing to the problem.”
The doctor might also suggest fibre supplements (in moderation to avoid side effects) or the use of laxatives. Dr Nikpoor believes it is also a good idea to see a pelvic floor physiotherapist.
To manage urinary incontinence, Dr Nikpoor suggests limiting your alcohol intake and avoiding caffeinated drinks like tea and coffee, as these stimulate the bladder and bowel.
He also believes that women who smoke should be encouraged to quit, as the chemicals in cigarettes can not only irritate the bladder, but the smoke can cause coughing that can lead to leakage. For women who are overweight, he says weight loss has also been shown to help reduce urinary incontinence.
Dr Nikpoor also suggests that women who experience urinary incontinence should be taught correct pelvic floor exercises by a pelvic floor physiotherapist. Women with overactive bladder symptoms would also benefit from these exercises, in addition to bladder training. They will establish better coordinated and stronger pelvic floor muscles that are able to work well and release well.
“It is true that these conditions – urinary and faecal incontinence – are very common,” says Dr Nikpoor. “They can affect the quality of life for women of all ages, but they can be greatly improved by [changes] in lifestyle.
“Doing small things can make a big difference.”
Dr Payam Nikpoor, Jean Hailes urogynaecologist
For more information on bladder and bowel health, visit https://www.jeanhailes.org.au/health-a-z/bladder-bowel
or listen to the Jean Hailes podcast, ‘How to exercise the pelvic floor muscles’. Find it here.
You can also visit the Continence Foundation of Australia’s website at https://www.continence.org.au/
