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Dr Cathy Stevenson: Incontinence - 5 October


Incontinence is the involuntary passage of urine or faeces. It is a huge problem. Almost 600,000 New Zealanders are affected by some form of urinary incontinence, and 340,000 have anal incontinence. 1 in 3 women suffer from urinary incontinence after childbirth. Incontinence causes leaking, pain, urinary tract infections, odour, skin infections, discomfort, weight gain, embarrassment, loss of self esteem, depression, and poor sex life.

Estimated costs of treating this condition in New Zealand are $142 million each year, and the estimated loss of earnings and productivity is in the billions.

However, only 1/3 of  people with incontinence problems will seek help from a health professional, and it is not a topic that most of us are comfortable talking about. It is seen as a "normal problem", and people think nothing can be done. However, 70% of women with urinary incontinence can become dry or get significant improvement with help.

What are the different types of incontinence?

Stress incontinence - more likely in younger age group - 50-60% of all sufferers; involuntary leakage of urine with exertion such as coughing, sneezing, laughing, straining, lifting or playing sport.

Urge incontinence - sudden overwhelming urge to pass urine; if unable to get to the toilet, incontinence may result.

Mixed incontinence - very common; a combination of the above.

Faecal incontinence - includes faecal urgency and difficulty with passing bowel motions (very common in women who have had a third degree tear with childbirth).

Risk factors

Gender - women are 7-8 times more likely to be affected than men
Age - higher incidence with age, but does affect young women too (especially during and after childbirth)
Pregnancy and childbirth
Still happens with caesarean deliveries, although less likely
Weight gain
Ethnicity - overall 34%, maori 47%
Constipation
Heavy lifting
Coughing
High impact exercises (including sit ups, star jumps and lifting weights too soon after baby born)

Childbirth is the biggest risk factor for pelvic floor dysfunction - which leads to urinary incontinence, pelvic pain, back pain, and sexual problems.

What is the pelvic floor? 

The pelvic floor is a group of muscles that form the floor of the pelvic outlet; they work and lift together as a group; the urethra (urine outlet), vagina and anus pass through them;
It supports the internal organs; prevents leakage of urine/faeces from the body; contributes to sexual arousal and function; assists in stabilising the spine and pelvis.
Important to act quickly to retrain these muscles after childbirth when there is any pelvic floor dysfunction, to prevent long term problems - if untreated by 3 months after the baby is born, it is more likely to become a long term problem.

More information

Speak to your family doctor - there are free continence services at most local hospitals where you can be referred for advice, treatment and follow-up.
 
www.filifit.com  - a website started by physios specialising in pelvic floor exercises; offers free pelvic floor information; DVD available to order "The Core and The Floor".

www.continence.org.nz  - NZ Continence Association - free information pamphlets on bladder and bowel control, and referral to a local continence service; Help Line 0800 650 65.


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