Women - Men

Stress incontinence is no laughing matter - nearly 17% of women over 18 experience it when they laugh, cough, sneeze or over-exert themselves. And there's a booming market in disposable continence products that's adding to Britain's waste mountain.

An estimated 3.8 million women in the UK suffer from stress incontinence - yet how many of us have ever discussed it? Stress incontinence is one of those 'personal' problems that women rarely talk about, even with their GP, believing that it only happens to a few women or is just an unavoidable part of getting older.

And they are wrong. Stress incontinence is frequently preventable, can be significantly improved, can often be cured and can at least be managed without embarrassment or loss of dignity.

Stress incontinence can be easily treated.

Women may find it difficult to discuss symptoms with their doctors and in many cases only mention it as a secondary complaint. Many women just put up with it, considering it as a consequence of growing older or having had babies, and they develop various ways of managing their symptoms, such as going to the toilet 'just in case', wearing panty pads, or just giving up exercise altogether.

The condition can put a lot of strain on a woman’s social and personal life ranging from feeling unable to leave home to avoiding sexual relations. Depression is also more likely to occur in women with incontinence than without.

The continence project began towards the end of 2003 leading to the launch of the briefing
No Laughing Matter (234k pdf) References (30k doc) in September 2004.

Types of incontinence

Stress incontinence can happen when you sneeze, cough or laugh.

Stress incontinence - the most common form of incontinence. The bladder leaks due to an increase in abdominal pressure, i.e. when you laugh, cough, sneeze or exercise. It is especially common after childbirth when the pelvic floor muscles have been stretched or damaged. As a result the pelvic floor is unable to contract quickly or strongly enough to prevent leakage of urine.

Urge incontinence – the involuntary loss of urine associated with a strong desire to pass urine. Apart from leakage, other symptoms may include a feeling of frequent need to pass urine. Urge incontinence is caused by inappropriate contractions of the bladder muscle. The cause of this is unknown but it is thought to be an impairment of the signalling system between the bladder and the central nervous system.

Mixed incontinence - mixed symptoms of stress and urge incontinence.

Frequency – going to the toilet more often than normal (6 to 8 times a day is normal). Frequency is another common symptom and often develops as a way of coping with stress incontinence (i.e. going to the toilet just in case). This in turn can contribute to an unstable or over-active bladder. Frequency may also indicate a urinary tract infection.

Factors
Incontinence is made worse by straining whilst going to the toilet, particularly if you are constipated. Other factors exacerbating the problem include being overweight, menopausal changes, heavy lifting and chronic coughing.

The importance of fluids
It is generally recommended to drink six to eight glasses of fluid a day. Water is the best. Caffeine acts as a diuretic and can make symptoms of frequency and urgency worse. Reduce your intake of caffeine gradually to prevent withdrawal symptoms. Do not reduce your fluid intake as a coping strategy. It can reduce your bladder capacity, increase your risk of bladder infection and make you constipated.

Physiotherapy is an excellent first-line non invasive treatment
So what can be done? Treatments vary depending on the cause of the problem. The majority of cases respond well to physical therapy. All women have slightly different problems which require individual assessment and treatment. Treatment may consist of pelvic floor exercises, bladder retraining, muscle re-education using bio-feedback or electrical stimulation. Advice will also be given on lifestyle issues such as diet, exercise and use of other aids and equipment if necessary. Bladder retraining may be necessary if there are symptoms of frequency or urgency. Normal bladder capacity is usually 400-600ml and normal frequency is approximately six to eight times per day. The bladder can be trained to hold larger volumes for longer periods of time and so help to minimise the symptoms of frequency and urgency.

Practice short quick contractions so that your muscles can react quickly.

Pelvic floor exercises
Pelvic floor exercises can dramatically reduce and often eliminate the problem altogether. To be effective the exercises must be done correctly. It is much more likely that a woman will adhere to an exercise programme if she fully understands what to do and how to do it. This is where a physiotherapist can be of help.

How to do pelvic floor exercises
The basic exercise is a ‘squeeze and lift’ - the closing and drawing up of the back and front passages. Women are often asked to imagine that they are trying to stop passing wind. It is important to do this without squeezing your buttocks or thighs together and without holding your breath. Only the muscles of the pelvic floor should be working.

First you need to establish your 'starting block' i.e. the number of contractions and repetitions you can do. Tighten the muscles as hard as you can and hold for as long as you can, up to a maximum of 10 seconds. Rest for four seconds. Repeat (tighten, hold, release) as many times as you can, up to a maximum of 10 repetitions. The starting block varies with each individual, e.g. you might be able to tighten and hold for a two second hold and four repetitions. Whatever your starting block is you should repeat this routine as often as you can throughout the day - six times is recommended. Additionally practice short quick contractions so that your muscles are able to react quickly i.e. when you laugh, cough or sneeze.

As your muscles get stronger you will find that you are able to hold for longer and increase the repetitions. Build up to 10 repetitions, holding each for 10 seconds as well as the 10 short quick contractions. You may begin to see improvements within two weeks. However it can take up to three months to strengthen the muscles. Results are directly proportional to the amount of exercise you do.

Your GP can refer you to either a specialist physiotherapist or continence advisor on the NHS. In most areas you can refer yourself directly to the local NHS continence service (see the Continence Foundation for contact details). You can also refer yourself directly to an independent specialist physiotherapist working in private practice (see the Chartered Society of Physiotherapy for contact details).