Most women know if they have urinary incontinence, they don’t just suspect it, although some women may confuse urinary incontinence with vaginal discharge or perspiration. If they are concerned that they are leaking urine and that it is wetting or staining their underwear or that they have had to resort to the use of pantiliners or pads, then they should either use a self-help guide, which can be downloaded from the internet, or they should seek advice from their GP or the local continence advisory service [Editor’s note: These services primarily exist in the UK or Australia. If you’re in the US, a doctor should be your go-to.] If the urinary leakage only occurs whilst exercising, then it may be worth trying a continence tampon; several types are available on the internet.
What lifestyle factors can contribute to UI? Do you recommend avoiding them?
Many lifestyle factors contribute to urinary incontinence, especially excessive fluid intake, overweight and obesity, heavy lifting, high-impact exercise, constipation, and chronic cough. Lifestyle changes can significantly improve urinary incontinence, so women should be advised to drink approximately a liter and half in 24 hours [about 50.7 ounces] (to include all of their fluids) and they should avoid caffeine-containing drinks such as tea, coffee, and chocolate. They should also avoid artificial sweeteners such as aspartame, which is in many low-calorie foods, and white and fizzy wines such as prosecco and champagne, which have a worse impact on lower urinary tract symptoms than other types of alcohol. Women who are overweight should be advised to try to lose weight, and if exercising is difficult because of their incontinence, then Weight Watchers or Slimming World may be able to help. Heavy lifting should be avoided whenever possible and high-impact aerobics or marathon running should be replaced by swimming or cycling. Those with constipation should be advised to improve their diet or take a laxative or suppository from time to time, and a chronic cough can be helped by treatment of asthma and other chest conditions or smoking cessation.
What demographic trends have you seen over the past few years or decades regarding who experiences UI and how they treat it?
Women of all ages suffer from urinary incontinence. The change that occurs over the years is the type of incontinence. Stress urinary incontinence, i.e. incontinence from coughing, sneezing, or effort or exercise, peaks in prevalence at the time of menopause and then declines again in later years as women become less active or have had the problem treated. Overactive bladder symptoms of urgency, urgency incontinence, frequency and nocturia increase gradually with increasing age. Other less common causes of urinary incontinence can occur at any age and need to be excluded prior to treatment of the more common conditions.
How can a woman determine what the best treatment options will be for her? Is it mostly trial-and-error?
Conservative therapy is readily available. Pelvic floor exercises are best taught by a women’s health physiotherapist, but if this is not available then information can be downloaded from the internet, or smartphone apps are available to help. Bladder retraining can be undertaken by voiding by the clock rather than desire and increasing the intervals to increase bladder capacity and reduce overactive bladder symptoms.
Where would you like to see the public conversation turn with regards to UI?
Over the last two decades, public awareness of urinary incontinence and what can be done to improve it have improved immensely. It is now possible to find information from many different sources including women’s magazines, social media, and the internet, so no woman should have to feel that she is ignorant or does not know what her management options are. However, if incontinence is more severe and therapy could be required, then women should access this from their GP. If they require further investigation or surgery, this should be undertaken in a specialist unit, and the GP will need to refer women to secondary or tertiary care.
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