Incontinence. No laughing matter.

Incontinence…no laughing matter.

I’ve always been able to control my bladder for hours on end. I’m not very proud of that record, as it developed out of necessity. My sometimes fast paced job, didn’t always allow me time to run off to the loo, but after the birth of my son, boy did all of that change!

Suddenly, I found myself crossing my legs at the first sign of a cough or sneeze, or I would try not to laugh too hard for fear of wetting my pants. Which can pose a problem as my husband figures himself as quite the comedian. At that time, I thought that it was just a normal side effect of pregnancy, birth and life in general. Little did I know, these were tell-tale signs of Urinary Incontinence (UI).

Not exactly the first topic you would speak about in polite company, yet so many women (and a small percentage of men) experience those embarrassing leaks at one point in their lives. In fact, about a third of women experience symptoms, but these numbers are not set in stone, as only 25% of those affected, ACTUALLY go out and seek help. Sadly, there is even less stats available for African countries. I totally get those numbers as I was CLEARLY one of them.

So, what IS Urinary Incontinence?

UI is defined as the INVOLUNTARY leakage of urine. It may not be a devastating disorder, but the pure embarrassment, shame and general inconvenience may affect your working and social life. In some severe cases, even your sex life. The good news is that most cases are treatable…SO THERE IS HOPE!!

Most importantly, recognise your symptoms, SPEAK UP and get some assistance.

Before we can uncover why laughing, jumping and leaving the house without a pitstop may be a no-no, we need to understand what happens when we take a leak.

Check out the plumbing

The Kidneys filter waste and by-products from the blood and sends the good stuff back to the body. From the waste, it produces urine, which passes through two tubes called the Ureter. These tubes channel the urine into the bladder, which expands like a balloon as it fills up.

Below the bladder is a duct called the Urethra, which acts like a highway, funnelling urine outside of the body. The bladder can store about 500 to 700ml of urine but we tend to feel the urge to wee at about 200 to 350mls.

What stops the urine from pouring out when we walking in the mall or having coffee with friends?

There are 3 muscles keeping you from leaking: the muscles of the Urethra itself, the Internal Urethral Sphincter, found at the bladder neck and the External Urethral Sphincter, which is made up of the muscle of the pelvic floor.

When you are finally ready to go, your brain sends a couple of emails. Firstly, to the muscles of the bladder to squeeze the balloon like a turkey baster, forcing the urine down the into the urethra, and secondly to the internal sphincter to relax and let the urine pass. The External Sphincter works voluntarily, so if you are not yet at the loo, it will remain shut until you are ready to open the flood gates.

Now that you know how it all operates, here’s what can go wrong and how to correct it.

There are 4 different types of incontinence.

Functional Incontinence

This refers to people who have an underlying mental, physical or medical condition. Picture someone who had a stroke or even suffers from Dementia. They may feel the urge to wee but may not be able to get to the loo, undress or even communicate their urgency in time, due to their limitations.

Overflow Incontinence

This happens when the bladder does not empty enough. You may feel full and ready to go, but when you get to the loo, the flow is either slow and unimpressive or non-existing. The large volumes in the bladder cause small amounts of leakage to happen unexpectedly.

This usually happens when there is damage to the bladder muscles and nerves like Multiple Sclerosis or simply due to a blockage such as kidney stones.

Treatment consists of inserting a catheter into the bladder until all the urine is drained or until the blockage is removed. Usually done in a hospital, but in repeat cases some DIY self-catheterisation may be necessary.

Urge Incontinence

Also known as an overactive bladder, those who experience this type of incontinence KNOW where the loo is at all times. Even the mere sight of the toilet may trigger a need that rises from 0 to 100 in 0.2 seconds.

The urgency is brought on by random spasms on a full or empty bladder, much like squeezing on a turkey baster. Leaving you with a sudden urge to wee at frequent and inopportune times.

Treatment involves:

• Bladder diaries – documenting your bladder activity in a bladder diary to pick up any trends in your input and output frequency.
• Behavioural modification – The trends picked up in the bladder diary can be addressed according to your results, such as limiting your caffeine and fluid intake before bedtime
• Bladder retraining, like one would do with toddlers, is also necessary to allow the bladder volume to remain low.
• Percutaneous Posterior Tibial Nerve Stimulation – Administered by a trained Physiotherapist or Health care practitioner
• Prescribed medication – Anticholinergics
• Surgery – If all else fails

Stress Incontinence

This is the most common cause of incontinence in women, so at least I don’t feel alone here. In this case, the pelvic floor muscles become weak. When extra pressure is put on the bladder, like coughing, sneezing or jumping, leakage occurs.

Treatment options include

• Pelvic floor exercise
• Topical oestrogen to tone up muscles
• Pessary – inserting a ring-shaped device to support the bladder neck
• Bulking agents injected into the bladder neck for added support
• Surgical Procedures – e.g. Sacral nerve stimulation therapy, Sling Procedures (again, if all else fails)

Bottom Line

Whatever your reasons are for not seeking help, whether you think it’s normal or whether you are embarrassed to broach the subject, it’s time to realise that more people experience leaking than you think.

Start by recognising your symptoms and speak to a Health professional, so that they can tailor your treatment to your specific needs.

Who knows, maybe this could be the key to regaining your life!

Like this post if you suffer from some form of UI. Let’s see how many sisters are out there.

You’re not alone.