Opinion: It’s World Continence Week, which reminds us that while continence is taken for granted, incontinence is a real problem for many more people than you may imagine.
We live in an age in which people share a lot about their lives, but most of us are still reluctant to talk about urinary incontinence or, if you prefer, bladder control problems.
We have clearly been living with it for a long time though. Descriptions of incontinence can be traced back to Egyptian manuscripts from the second millennium BC, which also detail devices “for the collection of urine that runs to[sic] often”.
Urinary incontinence has many causes but affects men and women in different ways. Our team in the Pelvic Floor Research Group at the Auckland Bioengineering Institute has focused particularly on stress urinary incontinence (SUI) in women, which affects up to one in three women at some stage of their lives.
Many of us are likely to have experienced it – those moments when you laugh, cough, jump or sneeze, putting stress on your bladder and resulting in unexpected leakage. For many, SUI is something that affects physical and mental wellbeing. The direct and indirect economic cost of incontinence in New Zealand in 2009 was estimated at $2.1 billion, including from lost productivity and hospital costs.
SUI has often been seen as an inevitable part of getting older, genetics, or of giving birth. Typically, women manage the condition with pads or ‘leak-free’ knickers. This may be good for the sanitary pad and underwear market, but has also normalised a condition that is not normal. Childbirth, menopause and ageing are all risk factors for SUI, but they don’t make it inevitable.
While urinary incontinence was described centuries ago, it was not until the 1940s that the American gynaecologist Arnold Kegel recognised the importance of the pelvic floor muscles and developed exercises, the ‘lifting and squeezing’ of the muscles of the pelvic floor for urinary incontinence caused by muscle weakness or damage.
Numerous studies, including our own, have shown that, done correctly and regularly, pelvic floor muscle exercises (sometimes now referred to as Kegel’s exercises) can reduce the symptoms of urinary incontinence by 70 percent.
Pelvic floor muscle exercise during pregnancy, even in the absence of any symptoms of incontinence, have been shown to reduce the risk of SUI after delivery. So being pro-active and getting into the habit of integrating pelvic floor exercises into your daily life is important.
Despite knowing pelvic floor exercises help, persuading women to do pelvic floor exercises regularly and effectively can be a challenge. Squeezing and lifting the right muscles is not an especially intuitive exercise. Clinical trials have shown that 40 percent of women performing what they think are Kegel exercises are not contracting their pelvic floor muscles – they might, for instance, be exercising their abdominal muscles.
We at the ABI, in collaboration with urogynaecologists and pelvic floor physiotherapists, have been working on this problem for over a decade, investigating how to measure pelvic floor function, to reduce the symptoms of SUI.
This led us to develop a device, femfit, an intravaginal device that has an array of eight tiny pressure sensors embedded in a soft silicone that measures abdominal pressure and pelvic floor muscle pressure.
It has been used in research projects to show that doing exercises that are not specifically targeting your pelvic floor muscles but which people think are, such as bracing or pelvic tilts, are 70 percent less effective than Kegel exercises.
Our device provides real-time guidance on an effective pelvic floor exercise technique, via Bluetooth to an app on a smart device. The app then guides the user through a clinically validated exercise programme. It is a novel technology designed to help women get in tune with their pelvic floor muscles.
Researchers are investigating the benefits of our technology for women with gynaecological cancer, endometriosis and for use during pregnancy, where the symptoms of incontinence are often prevalent and not often addressed.
For those suffering with SUI, there are often solutions. For some women weight loss is also likely to help, as is avoiding chronic constipation (straining on the toilet), which is not good for pelvic floor muscles. And if you lift heavy weights be mindful that you engage your pelvic floor while lifting. Some high impact sports provoke leakage, so doing concurrent pelvic floor muscle exercises would be recommended.
Do not be afraid or embarrassed to seek help – you do not have put up with it. If you suffer from SUI, your GP or physiotherapist can point you in the right direction. It is worth taking those first steps, and it is rarely too late to reap the benefits of doing so.