Valerie Gommon Midwife’s Blog

Stress Incontinence

Posted on: March 8, 2009

I was delighted to read Ulrika Jonnson’s article in today’s Daily Mail about Stress Incontinence.  How brave of this woman to admit something that most of us keep secret, Ulrika will have helped thousands of women with the public admission of her problem.  www.dailymail.co.uk/health/article-1160211/Ulrika-reveals-embarrassing-health-secret-TV-presenter-breaks-secret-taboo-incontinence-affects-millions-women.html

Stress incontinence is a large problem affecting 1:4 (or maybe even 1:3) women at some stage in their lives.

Urinary incontinence can be broken down into “frequency” (often associated with infection), “urgency” (usually caused by nerve pathway damage), “overflow” (when the bladder is atonic and has lost the ability to empty correctly) and “stress”.

Stress incontinence occurs when the intra-abdominal pressure rises abruptly when under stress, (e.g. coughing, laughing, sneezing).  Urine loss is likely to be small in volume, however it is not unknown for the stress to act as a “trigger” causing a complete void (perhaps when suffering from mixed “urge” and “stress” incontinence).

There are various theories and several predisposing factors to stress incontinence, these include the ageing process, denervation during childbirth, multiple pregnancy, multiparity, large babies, obesity, chronic cough, intra-abdominal mass (e.g. fibroids/tumour) and constipation.

Many women manage the problem day-to-day basis with the use of panty liners and by doing pelvic-floor exercises, but in many cases it can be treated, so speak to your GP about it or contact your local continence clinic – you can contact many of these clinics directly for a consultation www.bladderandbowelfoundation. org/continence-clinic-directory –  more than 70 per cent of cases can be helped, so it is very important to overcome your inhibitions and ask for help!  www.continence-foundation.org.uk is another really useful site.

Pelvic Floor Exercises

The first-line treatment for stress incontience is to do Pelvic Floor Exercises.  The muscles are in the bottom of the pelvis and form a sling that supports your pelvic organs (bladder, uterus and bowel) and are a vital part in preventing bladder and bowel incontinence. They also play a part in sexual function and are important during pregnancy and childbirth.

It is important to make sure that you are using the right group of muscles and contracting them in the right way. It helps to be lying down or sitting forward when you first try to do the exercises and you need to breathe normally.

Imagine that you are trying to stop yourself passing urine and at the same time trying to stop yourself passing wind. The muscles should feel as though they ‘lift and squeeze’ at the same time. The buttock and thigh muscles should remain relaxed but a gentle tightening in the lower part of your tummy muscles is quite normal.

You should try to do your pelvic-floor exercises at least three times a day. Most women aim for ten long squeezes followed by ten short squeezes. It can take three to five months before you notice an improvement.

Tighten pelvic-floor muscles and hold for several seconds and then relax for the same length of time. Repeat until muscles feel tired.

Tighten your pelvic-floor muscles for a second and then relax. Repeat until muscles feel tired.

One of the best booklets I have come across is “Fit for Motherhood” produced by the Association of Chartered Physiotherapists in Women’s Health www.acpwh.org.uk/docs/FitforMotherhood.pdf

There are also devices that can be bought to help you, for example www.tenscare.co.uk/index.php?action=products&product=75 or vaginal weights www.aquaflexvaginalweights.com however I really do encourage you to pluck up the courage and speak to your midwife or doctor first and ask for a referral to a physiotherapist.

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