health science
Bladder problems affect physical and mental well-being, costing the economy billions of dollars each year
Opinion: It’s World Continence Week, reminding us that while continence is taken for granted, incontinence is a real problem for many more people than you might imagine.
We live in an age where people share a lot about their lives, but most of us are still reluctant to talk about urinary incontinence or, if you prefer, bladder control issues.
We’ve obviously been living with it for a long time. Descriptions of incontinence can be traced back to Egyptian manuscripts from the second millennium BC, which also describe devices “for collecting urine that runs to[sic] often”.
Urinary incontinence has many causes, but affects men and women in different ways. Our team from the Pelvic Floor Research Group at the Auckland Bioengineering Institute has focused on female stress urinary incontinence (SUI), which affects up to one in three women at some stage in their lives.
Many of us have probably experienced it – those moments when you laugh, cough, jump or sneeze, strain your bladder and unexpectedly cause a leak. For many, SUI is something that affects physical and mental well-being. The direct and indirect economic costs of incontinence in New Zealand in 2009 were estimated at $2.1 billion, including lost productivity and hospital costs.
SUI is often seen as an unavoidable part of aging, heredity, or childbirth. Most often, women manage the condition with pads or “leak-proof” panties. This may be good for the sanitary napkin and underwear market, but it has also normalized a condition that is not normal. Childbirth, menopause, and aging are all risk factors for SUI, but they don’t make it inevitable.
Although urinary incontinence was described centuries ago, it wasn’t until the 1940s that American gynecologist Arnold Kegel realized the importance of the pelvic floor muscles and developed exercises, “lifting and squeezing” the pelvic floor muscles in urinary incontinence. due to muscle weakness or damage.
Numerous studies, including our own, have shown that, performed correctly and regularly, pelvic floor muscle exercises (sometimes now called Kegel exercises) can reduce urinary incontinence symptoms by 70 percent.
Pelvic floor muscle exercise during pregnancy, even when there are no symptoms of incontinence, has been shown to reduce the risk of SUI after childbirth. So it’s important to be proactive and get into the habit of integrating pelvic floor exercises into your daily life.
Even though you know that pelvic floor exercises help, convincing women to do regular and effective pelvic floor exercises can be challenging. Tensioning and lifting the right muscles is not a particularly intuitive exercise. Clinical studies have shown that 40 percent of women who do what they think are Kegel exercises don’t contract their pelvic floor muscles — they can train their abs, for example.
We at the ABI have been working with urogynaecologists and pelvic floor physiotherapists on this issue for more than a decade, exploring how to measure pelvic floor function to reduce the symptoms of SUI.
This led us to develop a device called femfit, an intravaginal device with an array of eight small pressure sensors embedded in a soft silicone that measures abdominal pressure and pelvic floor muscle pressure.
It’s been used in research projects to show that doing exercises that don’t specifically target your pelvic floor muscles, but what people think are, such as bracing or pelvic tilts, are 70 percent less effective than Kegel exercises.
Our device provides real-time guidance on effective pelvic floor exercise technique, via Bluetooth to an app on a smart device. The app then guides the user through a clinically validated exercise program. It’s a new technology designed to help women tune in to their pelvic floor muscles.
Researchers are investigating the benefits of our technology for women with gynecological cancer, endometriosis and for use during pregnancy, where the symptoms of incontinence are common and infrequently addressed.
There are often solutions for people with SUI. For some women, weight loss will likely help as well, as will avoiding chronic constipation (exercising on the toilet), which isn’t good for the pelvic floor muscles. And if you’re lifting heavy weights, keep in mind that you’re tightening your pelvic floor while lifting. Some high impact sports cause leakage, so it is recommended to do pelvic floor exercises at the same time.
Don’t be afraid or embarrassed to seek help – you don’t have to put up with it. If you suffer from SUI, your GP or physical therapist can point you in the right direction. It’s worth taking those first steps, and it’s rarely too late to reap the benefits.