Don’t put off getting help for incontinence. There is a wide range of good, effective treatments

Jessica Burton Urology Nurse

By Jessica Burton, BPC advanced nurse specialist in incontinence

Like many women of my age, I’ve recently taken up running. I was very interested to hear a comment made by a running friend who had taken part in a half marathon. She described a group of female runners chatting at the starting line, how one had mentioned wearing incontinence pads which prompted further discussion. Many of the other runners said they too were wearing pads and wouldn’t embark on a long run without them.

I thought this was a really interesting reflection of the speciality I work in. When I started working as a urology specialist nurse more than a decade ago, the patients I saw were often in their sixties and above. Often there were related issues, such as being overweight or other medical conditions which made treating their incontinence complex. We would always go through the treatment steps with these patients, looking at behavioural changes, pelvic floor exercises and consider surgical options if appropriate. But for some patients, treatments would be partially effective and they would move into a care plan based on managing the condition. In other words, they would have to wear incontinence pads for life.

Today, good services are resistant to care plans based on patients wearing pads for life (unless other complex medical conditions affect function). Going back to the women preparing for a running event: this is a patient cohort who are very unlikely to accept pads on a long-term basis.  One in three women over the age of 40 will have some degree of stress incontinence, which means you leak urine when you cough, sneeze or exercise. For the large majority, the cause is pregnancy, childbirth, the menopause, or a combination of these factors. Sometimes, there is an impact on the pelvic floor during childbirth but incontinence develops years later; for some, this might be triggered when you start running.

If you recognise yourself as someone who has started to wear a pad ‘just in case’ when you exercise, what should you do? We know people with incontinence are more likely to put off seeing a medical professional than those with almost any other condition. Why is this? Embarrassment is a factor for some. Equally, my discussions with patients also suggest that unlike many other conditions, people are not sure what the benefit of seeing a clinician might be. If you are leaking only a small amount of urine occasionally, you don’t need surgery and so might think – is there anything that can actually be done?

We can make a difference. If your leakage is light, you are most likely to benefit from guided pelvic floor exercises. If you remember these from your antenatal classes (and perhaps recall doing them a little haphazardly on an occasional basis), bear in mind this is different. In my field, I’ve run a biofeedback service, where we use sensors to show exactly what muscles you are using, projecting this feedback live on a computer screen as you move your muscles. We know that when women do pelvic floor exercises unguided, they often use abdominal muscles rather than the pelvic floor itself. You are given a function percentage and then participate in a 16- week programme of pelvic floor exercise before being re-tested and given a comparative percentage. This is also very helpful in establishing the smaller group of patients whose pelvic floor function is such that they are likely to need a surgical intervention to be effective (this is only 10 to 15 per cent of patients overall). We know intense, guided pelvic floor exercises (with and without biofeedback) over a 16-week period do improve symptoms for the majority of patients.

How you feel about your condition is a very important consideration. If you carry on participating in all your usual activities using a ‘just in case’ pad, you may feel no urgency to seek medical help, unless things change. If you find yourself opting out of activities because you are worried about potential embarrassment due to incontinence, it is definitely time to seek help, especially as we know people can become trapped in a cycle of inactivity (due to worries about incontinence) leading to weight gain (which exacerbates the incontinence).

There are very good, effective treatments for everyone from those with mild stress incontinence to people with a severe condition. I can carry out an initial examination and assessment and for many patients, I will be able to help with conservative treatments like pelvic floor exercises and lifestyle changes. Medication and botox can help if you have mixed incontinence (urgency as well as stress incontinence). I can provide a clear evaluation of your condition and if we know you need more than conservative management, you can see our consultant specialist Mohammed Belal who can undertake a wide range of surgical treatments, including advanced treatments not widely available elsewhere.

Certainly, don’t put off seeking help because of either embarrassment or because you imagine there is little that can be done.