Any condition involving women's gynaecological or urinary tract is often jokingly referred to as women's plumbing. But living with a leaky pelvic floor is no laughing matter for the one in four women who will suffer the condition. Angie Mezzetti reports.
'Anytime I would laugh or sneeze suddenly I'd get caught out and spring a leak," says Florie who suffered from stress incontinence after childbirth. It's a familiar story that many women will relate to after delivery when the pelvic floor muscles are stretched and out of shape, but the condition also affects women of menopausal age and older women. The problem is thought to affect one in four women at some stage and causes huge distress and embarrassment.
For Nuala it went beyond slight leaking and during menopause she would get no warning and had little or no time to get to a loo. "It got so bad that if I was going out to a restaurant or a function," she says. "I would go to the place the day before and find out where the toilet was in case I needed to go in a hurry." On one occasion she recalls she did not make it on time but fortunately had bought herself a skirt that day and was able to change.
Nurse Jane McGuinn at the urology clinic in the Coombe Women's Hospital says most women come for help when they get tired of not being able to dance at a wedding or wear a skirt and can't explain why to their family. "They get fed up wearing the black trousers and want to feel a bit more feminine." For women who encounter urinary incontinence in menopause, she says, it can seem particularly unfair. "They are free of wearing sanitary pads for the first time in years and then they find that they have to get back into pads for the urinary leaks."
The important message that needs to be put across, she believes, is that everyone can be helped and it does not matter what age you are or how bad or slight the problem is. "It is very important that the woman realises she is not alone and that her life can be made more comfortable." She says physiotherapy is very important and very effective and women can be shown techniques for bladder retraining.
Colm O'Herlihy, professor of obstetrics and gynaecology at UCD, the National Maternity Hospital and the Mater, says there are lots of possible causes for urinary and faecal incontinence.
"The first and most important course of action is to get a proper diagnosis before any course of treatment can be given." He says that for certain forms of incontinence, physiotherapy will make no difference. "The cause of the problem needs to be sorted out first and most women can be assured that they can have their symptoms cured or at least greatly improved."
Cynthia Murphy, a chartered physiotherapist in Limerick, says many women are embarrassed by the problem and are reluctant to talk about it but that the numbers are increasing. "Most clients are referred by a GP, gynaecologist or urologist. Both men and women have a pelvic floor area which is really a group of muscles that extend like a hammock from the base of your spine to the pubic bone in the front." She says that in many cases the pelvic floor can be re-educated through exercise programmes that help women to identify and locate their pelvic floor muscles.
Judith Nalty, senior physiotherapist at the NMH, says, "There is a grading system for muscles from zero to five. Zero would indicate no activity in the muscle, one would be a flicker, two a mild contraction and five would be proper functioning pelvic floor muscles. We use a biofeedback device and manual examination for assessing this muscle tone and recommend treatment with neuromuscular technology for anyone in the zero to two grading." The biofeedback/neuromuscular instrument helps women identify the specific pelvic floor muscles they need to work on. "Cones and weights are an alternative but some women may find these awkward."
The units can be rented for €64 per month with a refundable deposit and are normally referrals from physiotherapists specialising in women's health. Noel O'Dea of OPM, the company that supplies this NeuroTrac device, says the unit rewards the client with a visual signal on a screen and a tone when they target the right muscles. "The greatest demand has come about from women on maternity leave who want to get back in action and they often rent the portable units for use at home usually for about three or five weeks. When used for a quiet time every day, they will tone up the muscles and improve blood supply to the area."
Recently a new mechanical product from the US, the Kegelmaster, has been marketed here in Ireland at health fairs. While not on the list of recommended products from physios yet, several women have found it quite useful in retraining and toning pelvic floor muscles, particularly those that have become lax due to the decrease in oestrogen levels associated with menopause. One retired nurse said she picked up one in the RDS and used it herself to tone up her muscles during menopause. Using it 10 minutes a day for three days a week especially in the beginning, she says, improved the circulation to the area and toned the whole muscle area in the pelvic floor. "My sex life improved and it was really important for my femininity to get my shape and tightness back." As a health professional she would recommend it as a way of improving the whole pelvic floor area.
Another user says that at 53 she suddenly found she got a little leaky when she sneezed or laughed and that the device cleared up the problem after a few weeks of use. "I felt it improved my muscle tone especially during lovemaking and also improved the vaginal dryness which had become a problem." Another said her motivation for using it was that the thought of having surgery terrified her. Her friend had given up doing exercise because of leakage but she wanted to be able to live normally. It costs €119.95 and includes a demonstration DVD/video.
Abigail O'Donovan who distributes the Kegelmaster in Ireland says its main advantage is that it provides resistance for the pelvic floor muscles and this can be increased gradually by simple adjustments. "It has been available in the US since 1997 and is based on the exercise programme of Dr Arnold Kegel who pioneered pelvic floor exercises in the US in the 1950s."
Cynthia Murphy says that while it may be of use in some cases, it is better to get a professional diagnosis and assessment first. "For some women it may be inappropriate and even when surgery is necessary it is important that the patient does her physiotherapy exercises before and after as this will mean her recovery is better."
There are surgical solutions that can be carried out in certain cases where physiotherapy cannot completely solve the problem. MaryAnne had the day procedure called TVT (tension free vaginal tape) done this time last year and hasn't looked back. "I call it a repair job," she says, "and I can even go on the trampoline with the children now. You have to be very careful after the procedure, no driving for a week, no intercourse for a month and no heavy lifting for about six weeks."
Dr Paul Byrne says in the past surgery was quite radical and almost as severe as a hysterectomy. "Things have changed and we now have moved on from TVT to TOT [ trans obturator tape]," he says. The minimally invasive day procedure was developed in France and has been available for about seven years and is safer than TVT. "It has about an 80-85 per cent success rate and you have to allow six weeks for the tape to fix in place. Any woman considering it should be sure their family is complete."
The names of people in this article have been changed.
What can be done?
Useful contacts and websites:
Irish Society of Chartered Physiotherapists: 01 4022148 www.iscp.ie
OPM Ltd: 01 4630090
opm@indigo.ie www.opm.ie
Kegelmaster: 01 2760529
info@kegelmastereurope.com
www.kegelmaster.com