If you’re the kind of person who pees a little when you cough, laugh, sneeze or even hit an unexpected bump in the road, you may be one of the five million Australians and 200 million people worldwide who experience incontinence.
People can either experience urinary or faecal incontinence, although an overactive bladder or an increased urgency to urinate is most common in the older population. Having said that, expert continence physiotherapist Annabelle Citroen explains to Starts at 60 that incontinence isn’t just a condition that impacts over-60s, as many people think. In fact, 50 per cent of all cases in Australia impact people under the age of 50, meaning it’s something people develop earlier on in life and often don’t seek treatment for until it’s potentially too late.
It’s one of many myths relating to incontinence Citroen has come across in her profession.
“Probably the biggest misconception is once you have the problem, you just have to live with it,” Citroen explains. “That is becoming less so in the younger age groups. There’s definitely a misconception that it comes with being old and people just have to put up with it and live with it. We know that the large majority of incontinence issues can be managed, if not cured.”
She says people are generally unaware that so much help is available and notes that 70 per cent of people living with the condition won’t actually seek treatment or help. Instead, they hide it from their family or doctors, exclude themselves from social settings and public activities and try and manage the condition with pads – even though easier treatments are available.
“That means 70 per cent of people who have urinary leakage are actually sitting back, not seeking that advice or treatment,” Citroen explains. “That is probably partly due to not knowing it exists and partly due to them thinking it’s a condition that’s part of old age and just has to be put up with.”
The first steps for treatment are usually to speak to a health professional to assess a person’s overall bladder and bowel health. In many cases, a doctor will ensure a patient isn’t drinking too many bladder irritants including coffee, caffeine or alcohol before looking at other possible causes.
For many woman, incontinence can occur as a result of child baring, with caesareans also contributing to poorer bowel and bladder habits. A lot of women believe giving birth naturally is the only impact carrying a baby can have on continence issues, but it’s simply not the case.
Others, particularly those who experience long-term constipation, can develop incontinence problems over times because of the pressure straining can put on the bowel or bladder. In addition, weakened pelvic floor muscles caused by major operations such as prostate surgery can also cause the onset of the condition. Others experiencing asthma or respiratory problems that aren’t well-managed can develop the condition, while some medications, particularly diuretics or ones that offload fluid can cause continence issues. An increased weight can also irritate the problem further. Citroen adds menopause in women is another cause.
“Menopause usually results in a significant decline in bladder and bowel function or incontinence onset and that’s because as a result of menopause, the hormonal changes often increase the rate of decline and associated weakness,” she says.
When it comes to stress incontinence, which is what many Aussies experience when they experience leakage following a laugh, cough or sneeze, a cure actually is available. Citroen notes strengthening the pelvic floor muscle through physio can be curative for many patients and that medication is available for many others to help them better manage the condition. She suggests speaking to a GP as soon as possible when you notice something a little off.
“If there are any signs of bladder and bowel dysfunction, even a small leak with a cough or a laugh, a once-off occasion with some hay fever or a chest infection, that is a sign that there is some dysfunction and the sooner they seek help, the far more likely they are to seek cure,” she says. “The other thing that’s excellent is the Continence Foundation have a free helpline, 1800 33 00 66, that anyone can ring from anywhere in Australia and get advice over the phone there and then for help.”
She says it can be better managed in most cases and although many people use pads or nappies to prevent embarrassment, health professionals would only recommend their use when all other treatment options fail.
“For so many patients, the relief when they do seek help is so obvious. Just small things like being able to go to the theatre and not worry they’re going to leave a wet patch on the seat, or go on the bus and go for an outing to a local bingo competition or even a grandson or granddaughter’s 21st. To be able to participate in normal activities or normal living, there is help of all levels for people to remain socially engaged and not be socially withdrawn.”
To raise awareness, the Continence Foundation of Australia has launched its Life Without Leaking campaign – encouraging people to talk about their continence with the help of humour and laughing.
A National Public Toilet Map has also been launched online to help people find toilets when they’re out and about, plan their trips better and ultimately live more confidently with their condition.