What can be done to treat urinary incontinence?

While it may seem embarrassing, urinary incontinence is a common and predominantly treatable problem affecting around 34% of women in Aotearoa. It’s nothing to feel ashamed of – it happens as a result of the amazing feats conducted by our pelvic muscles, or as a natural part of ageing.

Urinary incontinence usually comes down to a damaged or weakened pelvic floor. Acting like a diaphragm in the pelvis, the pelvic floor muscles hold the pelvic organs in place. When the muscles begin to slip or sag, the organs can move further down the pelvis, known as prolapsing, which causes urine to leak.

Childbirth is a common reason for these muscles to become damaged. Menopause is also a culprit, due to reduced oestrogen levels causing a thinning of the urethra lining. And as we know from observing our external muscles, as we age muscles lose tension and begin to atrophy.

No matter what age or stage you are at, if you are experiencing incontinence at any level, it is important to get checked out

Steps to treatment

Your doctor will initially refer you to a specialist for a physical assessment. This is to rule out any gynaecological problems or prolapses. If this is all clear, you will then be referred to a pelvic floor physiotherapist, who will help to rebuild weakened muscles through gentle, targeted exercises.

If there is evidence of a prolapse, there are two options depending on the severity. In most cases, a prolapsed bladder can be amended using a pessary, which is a ring shaped device that can be used to lift the bladder back into place. The pessary works by pressing against the wall of the vagina and urethra to decrease leakage and support the uterus, bladder and rectum.

For some women, the weakening of these muscles can cause a prolapse of the uterus or the vaginal walls, which requires surgery. The use of surgical mesh for such surgeries is currently on hold, but there are other mesh-free procedures available to treat these problems.

Every prolapse is different but for many, a pessary is one option for addressing urinary incontinence.

Types of bladder control issues

Your doctor may ask some questions about the symptoms and sensations associated with your incontinence. This will help them determine whether you are expecting stress, urge, overflow or functional incontinence, or a combination of any of these four types. If you are otherwise healthy, it’s likely to be stress incontinence.

Stress incontinence. This is when leakage occurs from pressure on the bladder, such as during laughing, lifting or running. This is mostly experienced by middle aged women or those who are nearing or experiencing menopause.

Urge incontinence. This type of incontinence is when you need to urinate but cannot make it to the bathroom in time. It is often suffered by those who have diabetes, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease or stroke victims.

Overflow incontinence. A type of incontinence that occurs when you can’t empty your bladder completely. This may be due to a lack of sensation around needing to urinate due to a spinal injury. For men, it can be due to an enlarged prostate, which blocks the urethra. 

Functional incontinence. This is the name for incontinence that is caused by severe conditions, often associated with disability, disease or old age, that prevent you from making it to the bathroom. Sufferers of this type of incontinence may benefit from urinating on a schedule, with assistance, or may require pads or barrier products to absorb leakage.

Health based reasons for urinary leakage

It can also be helpful to talk to your doctor about your lifestyle, as sometimes bladder control problems can be solved or reduced through weight loss, a change in diet, or by reducing high impact activities. Some medications and herbal supplements can also affect your bladder, so ensure you are open about anything you take regularly. 

A persistent cough, urinary infection or severe constipation can also cause bladder weakness, as can such diseases as diabetes or nerve disorders. In these cases, good healthcare management may lessen urinary issues. 

Let it all out

Keeping quiet and staying home is not a sustainable solution. If these problems are impacting your lifestyle – or even if they are just mildly annoying, please don’t hesitate to book an appointment to discuss them with your doctor.

And remember – prevention is the best cure. All women should work on their pelvic floor muscles at all stages of life. Seeing a pelvic floor physiotherapist can help to ensure you’re doing these exercises well, so make an appointment if you feel this might benefit you now or in the future.