One in three women will suffer urinary leakage at some stage in their life,” says Maeve Whelan, a chartered physiotherapist who specialises in the area of women’s health and continence.

Based at Milltown Physiotherapy Clinic in Dublin, Maeve believes stress incontinence is under-reported and that this is because women have been reluctant to come forward in the past, due to embarrassment.

“Many women live with it, and it could be years after their families are grown – when they’ve just had enough of the whole thing – that they seek help,” she says.

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She has come across young mothers who can’t play with their children because of urinary leakage. “It’s one thing that brings tears to a woman’s eyes: not being able to run around and kick a ball with their children. She’d love to be playing with her child, but because of the stress incontinence she can’t.”

A recent Irish Tirim report showed that it takes six to seven years for women to present with the problem, she says.

But who exactly is affected? “Women who’ve had babies are most commonly affected by this, but many young women who’ve never had children will suffer from stress incontinence also.

“Women involved in athletics are particularly prone, with the highest prevalence in sporting groups among trampolinists. In all, 80% of elite trampolinists and 28% of all athletes, including runners, have pelvic floor leakage. Women playing golf would be the least affected,” says Maeve.

So what causes the problem in each group?

Childbirth can mean the possibility of internal structural damage for the mother. “A big baby, a long second-stage of labour and a forceps delivery can make stress incontinence more likely. This is because the baby’s head may disrupt the urethral structures on the way down the birth canal,” she explains.

This kind of damage can lead to bruising and complete loss of (urinary) control in the first couple of weeks after the baby is born. “While it usually settles down, it can settle into more minor incontinence from then on,” says Maeve.

But how does jumping on a trampoline make a woman leak urine? Maeve Whelan explains that it has to do with balance and timing: “Our pelvic floor muscles are affected by our whole musculo-skeletal system, through our lumbar spine, hips and pelvic floor. Every time you land on the trampoline, your pelvic floor has to contract to keep everything in place. The bounce generates a lot of intra-abdominal pressure, and if your muscles are weak, you’ll leak.

“Think of a ship in dry dock: the organs (bladder, uterus and bowel) keep going down and the support (the muscles or, in this analogy, the water) is not there to counteract that force. The neck of the bladder then opens.”

PELVIC FLOOR PAIN CAN ALSO OCCUR

Over-activity and tension in the pelvic floor muscles often co-exists with pelvic floor pain, Maeve says.

“That can manifest itself with intercourse pain also, and sometimes women will present with that. Irritable bladder (urgency and frequency, as in wanting to pass urine suddenly or needing to go very often) can be an issue, as well as stress incontinence.”

While surgery can help in very serious cases, seeing a physiotherapist to learn pelvic floor exercises properly can sort the problem for 70% to 80% of women. “You don’t have to be referred by a GP. You can simply make an appointment at your chosen physio clinic,” she says.

TREATMENT

What exactly does treatment with a chartered physiotherapist involve?

An assessment is done first, which includes a full medical history being taken, followed by an explanation of anatomy relative to the woman’s condition. Consent for an internal examination is requested.

“This examination is important, because it tells us whether the muscles are working at all or whether they are overactive and not releasing. We would also know then whether there is structural damage or pain and tension,” explains Maeve.

Women are “fabulous” about this, she says and, while some admit to “being awful about these kinds of examinations”, most are curious themselves to know where their muscles are at, after the anatomy talk.

“It’s about reassuring them and explaining why it’s necessary to know what their situation is before teaching them specific abdominal release and pelvic floor release exercises that will help,” she says.

It’s about teaching the women how to contract their pelvic floor correctly. “Up to 50% of women contract it the wrong way. The whole deep and posterior part of the pelvic floor – and not just the vagina and urethra – has to be contracted. Doing the release-and-contract exercises three times a day is advised.”

LIFT ANALOGY IS GOOD

Thinking of a lift can be useful in relation to the exercises, she adds. “Getting the muscles to come in to the neck of the bladder is key with all of this. Thinking of going up and down from floor to floor on a lift while you are squeezing and releasing your muscles can be good, but it has to be done properly.

“If women are not releasing properly, they need to get down to the ‘basement’, but sometimes if you get them to squeeze higher and higher (as if going from floor to floor in a lift) they’ll stop bringing in their gluteal muscles (a group of three muscles that make up the buttocks) and start breath holding and pulling in their tummy too tight. Learning the right strategy is important,” she stresses.

GADGETS CAN HELP

There are also many gadgets that can help with pelvic floor re-training. Pericoach or Elvie are two examples.

These include “biofeedback” units that are inserted into the vagina and give readings of how well you are squeezing and releasing your muscles.

“There is even Bluetooth to your phone, you can see on your handset how well you are squeezing and releasing,” Maeve says.

“That can go onto your computer to give a print out that your physiotherapist can see. It’s great motivation for many women to do the exercises when they can see the improvement.”

There are also external machines worn like shorts – for instance, the Inov – for women who don’t like the internal machines.”

Women’s sex lives can also be helped by doing pelvic floor exercises. “For someone whose problem is pelvic-floor weakness and lack of enjoyment or control during intercourse, there are products that can help too and give them more confidence around enjoying intercourse.

“They get over the embarrassment, and doing the exercises improves the leakage problem and the woman’s sex life, so it is really empowering.”

It takes six months of doing the prescribed exercises to experience real improvement related to stress incontinence, she says. After that it would be a case of doing to exercises once a day for maintenance.

SURGERY

For women who don’t want to do the exercises yet have a serious problem with leakage, surgery can be an option. A urodynamic test is done first in the hospital to determine the type and extent of leakage the person has.

“This kind of operation is very much for a structural problem, about supporting the urethra. If a woman doesn’t want to do the exercises and is in a bad way, then if surgery will help her then I’d say absolutely.

“Exercises, however, if she could do them, could help her avoid surgery and stop the leakage as well as improve her control of prolapse, control of her bowels and her control of sexual function, so she is getting control in all those departments.” CL

find out more

Visit the website of the Irish Association of Chartered Physiotherapists at www.iacp.ie. Find out more on www.oab.ie and www.befreefromoab.ie

Note: Some general hospitals have uro-dynamics clinics that your GP may be able to refer you to, where you will learn exercises to help.

ONLINE COUNSELLING SERVICE FOR THE IRISH ABROAD LAUNCHED

Cabhru, a free, new type of support service for the Irish abroad has been launched. Helplink Support Services (Helplink.ie) has joined forces with the Department of Foreign Affairs and the GAA to launch this new service.

Cabhru (meaning “help” or “support” in Irish) is a free online counselling service available seven days’ a week.

Initially, the service will be available to Irish citizens in Australia during their evening times. Each client can avail of up to six free sessions.

The service is being promoted by agencies in Australia to encourage people to avail of these free counselling appointments.

There are plans to extend the Cabhru service to other countries in the future.

See www.helplink.ie/cabhru/ for more information.

Hash tag #helpfromhome when referring to Cabhru on social media.

The idea came from Helplink’s counsellors, who saw clients continue their regular counselling appointments when they went abroad because of Helplink’s online counselling service.

“We found, in research, that emigrants were very unlikely to make use of counselling services in their adopted country of residence,” say Lochlann Scott, founder of Helplink.

“The research also illustrated that some of those who did attempt to engage in mental health services abroad reported barriers, including encounters with culturally unaware counsellors which made the counselling process more difficult.”

Helplink.ie is a national, non-profit organisation that provides mental health and other services for free or at low costs.