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A study conducted by The University of Adelaide in Australia (2013) has found that women who suffer from urinary incontinence aged 43-65 years are more likely to be depressed than women aged 65-89 years.
Researcher Jody Avery says that younger women’s self esteem is more affected by urinary incontinence than older women who tend to be more accepting of their condition. Many aspects of younger women’s lives are impacted upon by their incontinence, including sexual relationships, family, sport and leisure activities. Not being able to go to the gym, play their favourite sport, or go for a walk without fear of being away from a toilet are real issues for women in the prime of their lives.
The study found that 20% of the incontinent population has depression and this needs to be addressed by both sufferers and their GPs. Sufferers are often too embarrassed to seek advice and will suffer in silence or told it is normal.
Attitudes towards urinary incontinence are changing as the condition can be alleviate either by pelvic floor exercises or surgical intervention. When presented with a woman experiencing urinary incontinence, healthcare professionals need to be aware of the impact this is having on her mental state and find ways to alleviate the problem.
Urinary incontinence affects about 35% of the female population, mainly women who have given birth. The number of children a woman gives birth to increases her chances of becoming incontinent. Women who develop incontinence after having a baby are 50% more likely to develop post partum depression, a condition which impacts on the mother, child, partner and other children within the family.
Research by Professor Wendy Sword from McMaster University School of Nursing (2011) found that urinary incontinence post delivery was one of the five strongest predictors of post partum depression. The type of delivery has no impact on developing depression. Discussing urinary incontinence during post natal assessments can go a long way to helping women overcome this problem which, in many cases, can be simply alleviated.
A new joint venture between the Royal College of Midwives (RCM) and the Chartered Society of Physiotherapists aims to ensure that all women receive pelvic health advice during and after giving birth. Many maternity services offer good pelvic advice but there is great variation in the information being given due to limited time and the workload of midwives.
This intervention is being driven by women’s health physiotherapists who view that there is a need for a more proactive approach to pelvic health. Many of the women referred to them for treatment with continence problems already have long term damage which could have been avoided with appropriate intervention and advice early in their pregnancy and post natally
According to Mary Steen, professor of midwifery at the University of Chester, many continence problems resolve themselves in the first few weeks after giving birth – but midwives should be checking their patient’s bowel and urinary function during antenatal checks to ensure that problems do not occur postnatally. If a woman feels that her bladder/bowel function is abnormal, she should feel comfortable to discuss this with her midwife and be referred to the appropriate medical professional.
Some of the problems that arise during pregnancy are often dismissed by healthcare professionals as normal and part of pregnancy but if it feels abnormal for the expectant mother, she should seek help. Early intervention can prevent long term problems after giving birth.
RCM director for England Jacque Gerrard acknowledges that it may be difficult to implement due to the current shortage of midwives, but the societal cost of not treating incontinence early enough costs the NHS £117 million each year – a saving which could be spent on employing more midwives. (Imamura et al 2010)
If you suffer from incontinence due to having a weak pelvic floor, it is worth investing in a set of kegel exercisers which work by training your muscles internally. If you are unsure about how to do pelvic floor exercises, ask to be referred to a womens health physiotherapist by your GP.
Squeezy app is a really useful little app you can download to prompt you to do those pelvic floor exercises. Designed by womens health physiotherapist Myra Robson it can help women with their pelvic floor muscle exercises as part of a physiotherapy programme.
Pelvic, Obstetric and Gynaecology Physiotherapy: https://pogp.csp.org.uk/
Cystitis and Overactive Bladder Foundation: www.cobfoundation.org
Chartered Society of Physiotherapy: www.csp.org.uk
British Menopause Society- thebms.org.uk
Royal College of Obstetrics and Gynaecology- www.rcog.org.uk
Squeezy : www.squeezyapp.co.uk