Incontinence - an issue for one in three women

Does jumping on a trampoline, coughing, or sneezing make you a wee bit nervous? What about the feeling of urgency when the shower starts running, or you put the key in the door after a long day? If these moments sound familiar, you are certainly not alone.

An estimated one in three women experience urine leakage and one in five live with faecal incontinence. Sadly, these figures are believed to be underestimated.

Many women will know the signs of stress urinary incontinence (SUI), an involuntary leakage that occurs when laughing or coughing. Urge urinary incontinence (UUI), on the other hand, is the sudden and strong need to urinate or the loss of control on the way to the bathroom. It may occur in conjunction with an overactive bladder. Mixed incontinence is the combination of both stress and urge incontinence, commonly experienced by women around the time of perimenopause and those who have had stress incontinence after childbirth.

The good news is there are plenty of options available to help treat incontinence, says Niamh Clerkin, our pelvic health physiotherapist. A referral to a specialist in this field opens the door to a range of options that are tailored to you and your condition. When she first meets with a patient, Niamh takes the time to get a full medical history, complete a vaginal examination of the pelvic floor muscles, and review other potential factors, such as hormonal influences. She asks questions about fluid intake; when and how often the incontinence occurs; the quantity (is it a drop, a tablespoon or is a change of clothing required?); and any noticeable triggers, for example, does it occur at the sound of running water? Niamh also asks patients to provide quality of life information and a bladder diary to gain more insight.

As a full picture begins to emerge, Niamh puts a treatment plan in place. The first line of treatment, which is best practice in accordance with international guidelines, is developing individualised pelvic floor muscle training programmes.

This is particularly important in mid-life, post-menopausal women as the pelvic floor can thin, stiffen and become more sensitive.

“It is essential that women learn the correct technique and they work with a professional,” says Niamh. 
 

Niamh Clerkin

“The latest research indicates that women who do pelvic floor muscle training feel 30 to 50 per cent drier and more than half of women say their symptoms improve by 80 per cent. Studies are also starting to show that urethral sphincter training plays a much larger role than previously thought, so this is something else worth considering.”

Increasingly, more continence devices are appearing on the market, including various pessary options, vaginal weights and cones, good underwear products, and innovative technology, such as the NHS-developed Squeezy app.

When it comes to managing faecal incontinence, Niamh says it is important to remember that this is a sign or symptom, not a diagnosis. Fear and embarrassment mean this has been a widely underreported condition, and those living with symptoms who are aged over 55 have often been experiencing issues for some time.

Again, when seeing patients, Niamh will take a good medical history and ask them to complete a bowel diary. From there, physiotherapy can assist with muscle re-education, expulsion and sensory training, breathing, and postural changes. Other options may include sacral nerve stimulation, TENS, balloon training, and biofeedback. In both urinary and faecal incontinence, regularly practising pelvic floor contractions will help to strengthen the pelvic floor muscles.

There is plenty that can be done to treat and manage incontinence and the aim is always for self-management. Incontinence can be a huge hurdle for people, so Niamh encourages patients to stay active and live full lives.

"When working alongside someone, I am always thinking, How can I help this person to be doing what they want to be doing in life?"

Prolapse more common than you might think

Studies show that up to 40 per cent of women who have had children will experience some form of prolapse in their lifetime.

The condition is more likely when women are older; have a high BMI; have been pregnant particularly with vaginal and instrumental delivery; have been straining during constipation; have been lifting heavy weights - recreationally or with their job; have a connective tissue disorder, or there is a family history of prolapse.

Pelvic organs are usually suspended by an incredible collection of muscles and ligaments that support the whole area, says Oxford Women’s Health urogynaecologist Dr Fiona Bach.

However, when they are stretched or placed under pressure, they can weaken causing prolapse to occur. Pelvic organ prolapse can involve the bladder, bowel, uterus/cervix, or vault (in previous hysterectomy), or a combination of these. Symptoms vary and depend on which organ is affected. Symptoms of pelvic organ prolapse often include feeling a vaginal bulge which can be coupled with a feeling of pressure or heaviness in the abdomen or back.

From a urinary point of view, patients may report a weak or prolonged stream leading to incomplete emptying; the need to change position to fully empty; urinary incontinence, urgency and frequency.

Bowel symptoms include a feeling of needing to strain; incomplete emptying; or incontinence. Other symptoms include pain and a lack of sensation during sex, and it can also affect body image and the desire to be sexually active.

The damage associated with bladder and bowel prolapse often happens during a vaginal birth delivery when everything is forced to stretch. After menopause, when estrogen levels decline and tissues are weakened, this damage can become more problematic.

While some women will experience very few or no symptoms at all, for others pelvic organ prolapse can significantly affect their quality of life. 
 

Dr Fiona Bach

When treating patients presenting with pelvic organ prolapse, Dr Bach always takes a patient-centred approach. “I’m a firm believer in providing all the suitable options to patients to allow them to plan their care,” she says.

While many women will require no treatment for prolapse, some may find physiotherapy-approved pelvic floor exercises and the use of pessaries can make a big difference to their lives. If these measures are not working, or there are any other problems, an operation may be required. The perineal body – located between the vagina and the anus – can also be rebuilt in patients who have had an episiotomy or a first or second degree tear during childbirth that hasn’t healed well, leaving the feeling of openness in the vagina.

Dr Bach says there are many different vaginal and abdominal surgery procedures available that can be matched to the patient’s condition and preferences. Factors that are considered include, not only the person’s history and symptoms, but whether they are sexually active, if they have finished their family, their quality of life, and their general health.

Following the operation, patients can expect to spend one to three nights in hospital and may experience some vaginal bleeding and discharge.

For the next six weeks, recovering patients will need to take time off work and place nothing in the vagina, including tampons. While they are taking it easy for four to six weeks, they can lift the kettle to make a cup of tea, but shouldn’t do anything that puts strain on the pelvic area.
 

Welcome to Sarah and Samanthi

General Practitioners Dr Sarah Robson and Dr Samanthi Rambadagalla have recently joined us to work part-time in our menopause clinic.

Dr Robson’s special clinical interests include menopause, perimenopause, and contraception. After completing her MBChB, she worked as a junior doctor in Hawke’s Bay and Christchurch. Dr Robson also undertook medical research in London.

Her GP training was completed in Christchurch, and she is a Fellow of the Royal College of General Practitioners and a member of the Australasian Menopause Society. When she is not at Oxford Women’s Health, she enjoys working in women’s and children’s health as a GP associate.

Dr Rambadagalla has a special clinical interest in women’s health, lifestyle, and preventative medicine. Soon after completing her Bachelor of Medicine and Bachelor of Surgery (MBBS) in 2000, she moved to New Zealand and went on to become a Fellow of the Royal New Zealand College of General Practitioners (FRNZCGP).

Dr Rambadagalla has worked as a General Practitioner for more than 15 years and is thoroughly enjoying her menopause GP clinics at Oxford Women’s Health where she can focus on her special interests. She is trained to insert Mirena® and Intrauterine Contraceptive Devices (IUCD), and to perform pipelle biopsies.
 

Dr Sarah Robson

Dr Samanthi Rambadagalla

If you would like to make an appointment to see Dr Robson or Dr Rambadagalla, call us on 03 379 0555.
 

Menopause GP now available in Queenstown

General Practitioner Dr Rachel Copland is now based at our satellite menopause clinic in the Queenstown Centre of Medical Excellence.

With dual fellowships from the Royal New Zealand College of General Practitioners and the Australasian Society of Lifestyle Medicine, Dr Copland has broad experience in all areas of General Practice and is looking forward to meeting with new and existing patients.

Her interest in lifestyle medicine enables her to take a comprehensive and holistic view of the hormonal challenges that women face throughout their lives. She enjoys educating, empowering, and supporting her patients to improve their health and wellbeing.
 

Dr Rachel Copland

Dr Copland is a member of the Australasian Menopause Society and keeps up-to-date with the latest research and guidance on supporting women through the menopause transition and beyond.