3.3 million Canadians suffer from incontinence (1).  Many do not know what it is or only know what they heard from friends, family or TV. Incontinence is the involuntary loss of urine, meaning you peed when you did not want to. There are different circumstances under which this can occur; sneezing, coughing, laughing or you simply could not hold it. However, the purpose of this article is to explore some of the common beliefs women do have about urinary incontinence (UI) and provide clarification.

 

So what do we believe we know? A study in 1999 was done to find out. They asked women about their beliefs and perceptions of UI and found 3 main common beliefs (2).

 

  1. UI is something old women have
  2. Having babies gives you and/or increases the risk of getting UI
  3. UI will resolve on its own

 

Firstly, UI can be experience by anyone of any age. A study from Australia showed 12.8% of women aged 18-22 had UI compared to 36.1% of 45-49 and 35% of 70-74 (2). In 2003, the Canadian Urinary Bladder Survey found 16% of females between the ages 18-40 have some form of UI (3). A large study of 34,815 women out of Norway found 10% had UI between 20-24, 14% 25-29, 18% 30-34, 21% 35-39, 24% 40-44, 28% 45-49 and 30% 50-54 years old (4). Although the percentage of women experiencing UI does increase with age, younger women experience it too.

 

So what… regardless of age, UI is a sign of muscular dysfunction and should be assessed by a pelvic health professional.

 

Secondly, although childbirth is a risk factor, it is not the only factor that can cause UI. Some other risk factors include obesity, surgery, strenuous work or exercise, constipation, straining with bowel movements, chronic coughing and older age (5). In fact, athletic women whom never had children are experiencing UI in surprisingly large numbers. One study of 156 US State University athletes found that 28% reported at least one episode of UI, 42% experienced UI during daily activities and the sport with the most reported cases of UI was gymnastics at 67%. The average age of these athletes was 19 (6).

 

Another study of former US Olympians found during competition, 4.5% of swimmers had UI and 35% of women in gymnastics/track and field had UI. When they stopped competing 50% of swimmers had problems and 41% of women in gymnastics/track and field had UI (7).

 

So what… whether you have children or not, are active or not, UI is not normal and should be assessed by a pelvic health professional.

 

Thirdly, generally speaking UI does not go away on its own. In the study of former Olympians, those women leaking during competition continued to leak when they stopped. Another study of post partum women noted that if symptoms of UI did not resolve by 3 months postpartum there was a high risk that those women would continue to have UI symptoms 5 years later (8) (9). In postpartum women it is difficult to predict who will resolve and who will not. In France every woman has coverage to attend pelvic floor physiotherapy postpartum that is paid by the government. France takes a proactive approach to help women postpartum in hopes of resolving symptoms quickly and reducing the risk of future pelvic floor problems.

 

So what…If you have leakage don’t wait weeks, months, years to seek help. Get assessed postpartum and be proactive by seeing a pelvic health professional during pregnancy to be prepared for postpartum.

 

UI is not a life threatening condition so media and healthcare providers minimize/ignore the problem, but it can have major impacts on women’s lives. Women will often stop participating in health and fitness activities to manage symptoms leading to a sedentary lifestyle. We know that not exercising has other health risks such as cardiovascular disease, obesity, mental health, etc. Emotionally it can be stressful as women are embarrassed, angry, frustrated and can feel isolated. The reality is that only 1/3 of women actually seek help for UI.

 

So what… 2/3 of women are NOT seeking help, perhaps because they don’t think UI can be helped or don’t know there is treatment available.

 

UI also has a financial burden. Did you know that the annual financial cost of UI in the US is approximately $11.2 billion in the community and $5.2 billion spent in nursing homes (5). The Canadian Continence Foundation estimates that UI costs $10,000 annually per resident with UI in long-term care plus an additional $1400-2400 is spent by the resident on incontinence supplies (3). What about outside of nursing homes?

 

I did some of my own research. I looked at the price of Poise pads at Walmart, the super thin (24 in a pack) were $5.86 + tax. For simple math, you purchase a pack a month from the age of 25 to 65. That ends up costing you $79.46 a year for 40 years is $3178.46, if you only leak occasionally. The Poise ultra absorbency is $24.24 + tax (45 pads). The cost over 40 years at one pack per month is $13,147.77. Physiotherapy treatment sessions average between $500-600 to teach you everything you need to know and in most cases is covered by insurance.

 

So what… Wouldn’t it be great to have better control over your bladder and save money?

 

Madelaine Golec - ECO Physiotherapy in mississauga

 

 

 

 

 

 

By: Madelaine Golec PT, Pelvic Health Physiotherapist

 

References

  1. Canadian Continence Foundation, accessed n Feb 4, 2017 from http://www.canadiancontinence.ca/EN/what-is-urinary-incontinence.php
  2. Chiarelli, Pauline and Jill Cockburn. 1999. The development of a physiotherapy continence promotion program using customer feedback. Australian Journal of Physiotherapy v. 45: 111-119.
  3. The Canadian Continence Foundation. 2014.  Incontinence: The Canadian Perspective. Accessed on Feb 1, 2017 from http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf
  4. Hannestad et al. 2000. A community based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT Study. Jorunal of Clinical Epidemiology 53: 1150-1157.
  5. Bø, Kari. 2004. Urinary Incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 34(7): 451-464.
  6. Nygaard et al. 1994. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol 84: 183-187.
  7. Nygaard, IE. Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female Olympians. Obstet Gynecol 90: 718-722.
  8. Dumoulin et al. 2010. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil 91: 1059-1063.
  9. Thyssen et al. 2002. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J 13: 15-17.
What we believe about incontinence is not always true