Urinary Incontinence: Turning a blind-eye

You’ve heard of it before. You may have even experienced it before. That time your friend told a hilarious story while out to dinner, during your jog, or last winter when you had that really bad cough. Maybe it just happened once and you figured it was no big deal, or maybe it has been progressively worsening over the past 5 years and you either figure there is nothing to be done about it, or are too embarrassed to admit that you….wet your pants.

Urinary Incontinence is defined as any involuntary loss of urine. There three types: stress, urge and mixed. Stress incontinence is the accidental loss of urine during any type of activity that causes an increase in intra-abdominal pressure (coughing, sneezing, laughing, jumping, running). Urge incontinence is the symptom of intense urgency to urinate, sometimes accompanied by a loss of urine. Finally, mixed is the presence of both stress and urge incontinence.

The pelvic region consists of a complex system of bones, muscles, nerves and connective tissue to maintain 6 basic functions:

1. Support of the pelvic organs;

2. Sphincteric in response to increases in intra-abdominal pressure;

3. inhibitory effect on bladder;

4. provides rectal support during defecation;

5. contributes to sexual arousal and performance;

6. acts as a part of your “core” muscles (Lieblech et al., 2013, pg 1).

Continence is maintained in this region through a combination of muscular, connective tissue and neural support. Urinary incontinence results when this mechanism is disrupted. This is usually a result of muscular weakness from overuse or underuse of these muscles, repetitive stress from an increase in intra-abdominal pressure (chronic coughing, obesity, high-impact physical activity), or trauma to the soft tissue or nerves (childbirth or pelvic surgery).

Urinary Incontinence affects many women today. In teenage girls, it is estimated that 15% have stress incontinence (Alnaif & Drutz 2011), 85% of trampolinists (Nygaard 1994) and 55% of women over the age of 65 (Herschorn et al 2003). The World Health Organization states that this condition is a widespread, global disease and is one of the only medical taboos remaining amongst people today (WHO 1998). The discrepancies between the prevalence of people suffering from urinary incontinence and the prevalence of people who report this condition is surprising. According to the Canadian Continence Foundation, only 25% of people with incontinence seek professional help (2009, pg4). Many men and women are hesitant to admit this condition to their health care practitioners, let alone their families or friends. The main reason? Embarrassment. As a result, this medical condition progresses far beyond what it should.

The presence of urinary incontinence has a significant impact on a person’s life. Social repercussions including embarrassment, depression and social isolation; as well as the financial effects (loss of time at work, cost of absorbent pads) and physical health (high impact activities can worsen urinary incontinence symptoms and deter people from being physically active).

So what exactly causes this condition? The main cause is trauma to the pelvic region. This can include childbirth or pelvic surgery. However, other factors can play a large role. For example, genetics and lifestyle factors: obesity, smoking, diet and hormonal changes associated with aging.

For such a debilitating condition, the fix is quite simple. Urinary Incontinence is essentially a result of poor muscular control with a combination of dietary, hormonal and mechanical factors.

It is important to keep healthy down there; so, to have your pelvic floor function and bladder and bowel habits assessed, visit your pelvic floor physiotherapist!

 

References:

Canadian Continence Foundation, Impacts of incontinence in Canada – a briefing document from the Canadian Continence Foundation, May 2009.

Lieblich, P., Thompson, S., Wilson, P. Continence and Pelvic Floor Re-education in the Female Patient – Terminology, May 2013.

Alnaif B & Drutz HP, The prevalence of urinary incontinence in Canadian secondary school teenage girls, Int Urogyn J Pelv Floor Dysfunct 2001; 12(2): 134-7.

Herschorn S et al., Canadian urinary bladder survey: population-based study of symptoms and incontinence, Neurourol & Urodyn 2003; 22(Pt 5).

Nygaard I et al., Urinary incontinence in elite nulliparous athletes, Obstet Gynecol 1994; 84(2): 183.

The World Health Organization, World Health Organization calls first international consultation on incontinence – a press release from the World Health Organization, July 1, 1998.

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