Dr Sharon English World Continence Week Interview
Arguably a -hidden epidemic', incontinence is in fact more prevalent than diabetes, asthma or depression and the financial burden significantly greater, with a Federal Government report in 2010 estimating a cost to the community at around $1.5 billion per year.
Incontinence affects 1 in 4 people over the age of 15 and can seriously affect quality of life.
'It's relatively low profile may, in part, be explained by sufferers' embarrassment about their condition with an estimated 70% of people not discussing the issue even with their GPs. But the good news is incontinence is very treatable and there is absolutely no reason for people to continue suffering," says the Urological Society of Australia and New Zealand's spokesperson on incontinence, Urologist Dr Sharon English.
Urologists treat all types of urinary incontinence in men, women and children including: female incontinence, including incontinence after childbirth; male incontinence related to prostate disease; neurological problems with the bladder such as occur with spinal cord injury and other conditions; pelvic organ prolapse and complications after surgery.
'While urologists are trained surgeons, not all treatments we offer for incontinence are surgically-based – for example, a urologist might, in conjunction with a GP or physio, also treat patients with bladder retraining techniques, physiotherapy and medication," says Dr English. Where those techniques aren't effective urologists can treat incontinence with surgical interventions such as slings, synthetic tapes, bulking-agents or botox injections.
There are also a few simple lifestyle changes people can make to help re-train their bladder to minimise incontinence or risk of developing it:
Reduce fluid intake: There is a lot of pressure for people to drink large amounts of fluids – up to 8 glasses or water a day. But for an older lady drinking this much fluid is probably unnecessary (unless for specific medical reasons) and will only lead to a constant need to void. Being thirsty is your body's way of telling you when you need to hydrate – there is no need to force yourself to drink more.
Reduce fluid intake before bedtime: That mid-evening cup of tea is probably a mistake. I f you have a problem getting up in the night to urinate, you are best to limit the amount of fluid you consume in the hours immediately prior to bedtime.
Manage your weight: There is evidence that suggests being overweight affects your continence by putting extra strain on your pelvic floor. So look after your diet and exercise and maintain a healthy weight.
Stop smoking: Smoking is the main cause of bladder cancer which is yet another good reason to quit.
Learn how to do pelvic floor exercises. Do these exercises at regular intervals every day. The good thing about these exercises is that you don't have to change into your gym gear – you can do them while driving or sitting at your desk and no-one will know!
'The most important message is that it is completely unnecessary for people to endure incontinence and in most cases it can be treated conservatively. We encourage people to see their GP or physio as the first port-of-call if they feel they have a problem and they will be referred to a Urologist if the problem requires specialist expertise," says Dr English.
The Urological Society of Australia and New Zealand is the peak professional body for urological surgeons in Australia and New Zealand. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.
Interview with Dr Sharon English
Question: Can you talk us through the significance of World Continence Week?
Dr Sharon English: This is an international effort to raise the awareness of incontinence both amongst health professionals and the general public.
Question: Why is incontinence a hidden epidemic?
Dr Sharon English: 1 in 4 adults in Australia and New Zealand experience urinary incontinence at least once a month. Of those that wear continence pads only a third will seek help from a health professional.
People are often too embarrassed to discuss their incontinence with their family doctors or they get the impression that the doctor thinks that they should do nothing about it. Many people think that urinary incontinence is normal, especially women that develop stress urinary incontinence after childbirth.
Question: Who does incontinence affect?
Dr Sharon English: Affects both male and females especially as people age.
Stress urinary incontinence is commoner in women after child birth then decreases as a woman ages and becomes less active. Stress urinary incontinence may occur in men after surgery on their prostate so occurs in older men.
Urge incontinence, leaking when rushing to the toilet, becomes commoner with age and occurs in both men and woman.
Question: What are the symptoms associated with incontinence?
Dr Sharon English: Stress urinary incontinence is the leakage of urine with activities such as coughing, sneezing, running, jumping and if it is more severe even just leakage with walking.
Urge incontinence occurs when someone develops a sudden feeling of busting and need to rush to the toilet, then leak on the way. This may happen just in certain circumstances such as arriving home, or getting out of bed, or hearing running water. In more severe cases it happens just at random.
Most women with stress incontinence will have both stress and to a lesser degree urge incontinence. This is known as mixed incontinence.
Question: How are these incontinence symptoms treated?
Dr Sharon English: Each type is treated differently.
Stress urinary incontinence is initially managed with teaching pelvic floor muscle exercises. If that is not effective then further evaluation by a specialist such as a urologist to consider surgery.
Urge incontinence is managed with bladder retaining and medication in the first instance. If that does not work intravesical botulinum toxin injections into the bladder may be used.
Question: How is botox used?
Dr Sharon English: Botox is used for overactive bladder if other medications and reducing caffeinated drinks does not help. It is given byperfoorming a cystoscopy, a look inside the bladder thru a telescope up the urethra, and then Botox injections are put into the bladder wall.
Question: How can incontinence be prevented in Australian females?
Dr Sharon English: Urge incontinence can be treated early by bladder retraining and fluid management. Good bladder behaviour could also be reinforced.
Stress urinary incontinence can be improved by teaching all women to do pelvic floor muscle exercises and encouraging them to continue to do them.
Question: How do we go about re-training the bladder?
Dr Sharon English: Practise sitting and waiting when the urgency hits and wait for the busting to go away before quietly moving to the toilet. Try to avoid voiding habits such as holding on until you get home then rushing straight to the toilet, or going to the toilet as soon as you get out of bed in the morning.
In some people caffeinated drinks make the symptoms worse so anyone with urgency should try cutting these out for three days to see if that makes any difference.
Question: Can you talk us through how to do pelvic floor exercises?
Dr Sharon English: Pelvic floor muscle exercises are best taught by a continence advisor of physiotherapist. To go over one now, imagine that you are about to pass wind. Tighten up the muscles around the back passage. While sitting down this should feel as if they are lifting up off the chair, hold for two then slowly relax them. Do this five times in a row.
Question: If women are concerned about their risk or symptoms; who should they speak with?
Dr Sharon English: They should speak to their GP or continence advisor. If conservative management is not effective then they can ask for a referral to a specialist such as a urologist, for further investigation.
Interview by Brooke Hunter