Urinary incontinence can lower self-confidence, causing depression and social isolation, and costs the government’s health service millions. And the problem affects one fifth of women over 40, as well as a small number of men. So should you rely on gadgets sold via TV or go to a specialist? And is there any lasting cure for this embarrassing but common problem?
Earlier this year, the QVC shopping channel experimentally launched a new product for sale, intended for people with stress urinary incontinence. The producers of this satellite channel – better known for selling trendy jewelry and kitchen gadgets – were amazed at the reaction: in the eighth minute of the 12-minute ad block, callers bought all 150 iTouch Sure devices for £ 65 each. All the helpless presenter could do for the remaining four minutes was filling airtime, while frustrated customers headed to the Amazon online store, where about 800 of the same products were sold the next day.
It confirms what has long been suspected – regardless of the effectiveness of the battery-powered iTouch – and it is too early to consider any product on the market as effective – patients desperately need help. ITouch delivers it in the form of a discrete electrical stimulation system that exercises the pelvic floor muscles.
A disturbing report published in September by the Royal College of Physicians (RCP) suggests that thousands of women rely on over-the-counter remedies for stress urinary incontinence, such as iTouch and vaginal cones (small weights placed in the vagina to strengthen pelvic floor muscles) because professional medical care is neither effective nor available. The RCP report describes millions of people in the UK with bowel or bladder problems who are destined to suffer for the rest of their lives from the lack or inadequate quality of diagnosis and treatment – due to insufficient training and poor organization. Research shows that urinary incontinence can lower self-confidence, causing depression and social isolation, and costs the NHS millions of pounds. Indeed, stress urinary incontinence occurs in a fifth of women in their 40s and a small number of men.
Should you therefore rely on the gadgets sold via television, or should you go to a specialist? And is there any lasting cure for this embarrassing but common problem?
This problem is understood by Kate Partridge, 56, a South London administrator. For over a decade, she has tried various gadgets such as vaginal cones and pelvic floor exercises, suffering from bothersome urine leakage that began after a hysterectomy for ovarian cancer at the age of 40.
“I initially attributed the leak to the surgery,” says Kate, who lives with her husband Richard, a teacher. “But things were getting worse, I soon knew it would happen as I walked down the stairs, or when I coughed or sneezed or laughed.” I felt that I was turning into a foul old lady.
Even though she married Richard eight years ago, she didn’t tell him or any of her friends about her problem because it was taboo. But 10 years after the surgery, it turned out that he refused to leave the house for fear of a leak: – One time I had a cough and I knew I just couldn’t risk going to dinner.
It’s time to take action. “I confided in my GP, who explained that it is a very common condition, caused by weakness in the pelvic floor muscles that do not squeeze my bladder neck,” says Kate. Fortunately, she found out that stress urinary incontinence isn’t something you just have to deal with – there are effective treatments.
While many women find it difficult to discuss the issue with their GP, this is the best first step, says Jane Dixon, a physical therapist at Fitzwilliam Hospital in Peterborough. This way you can get a referral to a specialist. “Most women develop this type of incontinence first during pregnancy – hormones and extra weight put pressure on the pelvic floor [the muscles that support the intestines, bladder and uterus like a hammock], and it can damage more during childbirth, she explains. Surgery, menopause, and aging can also increase your risk.
The first step is to learn to tone your pelvic floor muscles and make this exercise a daily habit as obvious as brushing your teeth. The problem is that retracting the pelvic floor is not normal tightening, which is why many women do it wrong. As Jane explains, the pelvic muscles are complicated and pulling in the abdomen is not enough.
He suggests a way to be successful: Imagine you are a dog, carrying your tail between your legs (forward and up) until the tip of it tickles your nose. And if that’s too weird, imagine a cable car being pulled up a hill with a rope. Some physical therapists (including Jane) currently use ultrasound, which allows patients to see how their muscles are working on the screen. Men, he says, can also benefit from pelvic floor exercises, especially after prostate surgery.
Regular pelvic floor exercises, which should be continued for the rest of their lives, improve for approximately six out of 10 patients within three to six months. But for some – Kate Partridge among them – exercise is simply not enough. – I also tried various muscle stimulating gadgets, but they turned out to be humiliating and embarrassing. Then I was prescribed a drug called duloxetine, which I had been taking for a year. He helped a little and finally gave me the confidence to confide in my husband and friends.
Duloxetine is an antidepressant drug, but has been approved by the National Institute for Health and Clinical Excellence (NICE) as an aid to stress urinary incontinence, although, as one large review shows, it does not completely cure and has side effects such as nausea.
Richard Montague, a urology consultant at the private Spire Manchester Hospital, points out that losing weight can help overweight or obese women as extra weight puts pressure on the pelvic floor. When it comes to pelvic floor exercises, she is concerned that many women may find it difficult to persevere.
“For the exercise to be effective, women need to exercise 8 to 10 times in a session, three times a day for at least three months,” he says. – And then you have to continue – or the problem will come back. No wonder women quit.
So if exercise is too hard and medications can cause side effects, maybe gadgets are the solution? Both experts are open to the news, but warn that devices like the iTouch are useful for correctly identifying pelvic floor muscles rather than tightening them. Most of these have not been tried in clinical trials (although there is some evidence that weighted vaginal cones can help). “I would never say don’t use them, and I’m glad to help anyone who has them see if they can be used better,” adds Jane Dixon.
Surgery to support or raise the bladder, says Mr. Montague, is 85 to 90 percent effective. Various types of surgery are available, including a relatively new technique – Tension Free Vaginal Tape (TVT) placement. The method consists in inserting a polypropylene tape under the pelvic floor which acts as a sling. It only takes 30 minutes and the recovery period is shorter than with traditional surgery. However, NICE recommends that the procedure be performed only by specialist surgeons, as there is some risk of complications.
Kate Partridge underwent surgery on TVT in 2007. “It gave me immediate relief,” she says. – I regained my freedom. I feel younger and more alive.
More advice from www.bladderandbowelfoundation.org