Elise Elliott, Herald Sun
The Continence Foundation of Australia’s Laugh Without Leaking campaign kicked off on World Laughter Day last month, with Helen Magee, Beth Wilson, Thelma Saville and Susie Lewis having a good belly laugh. Picture: Sarah Matray
DO you leak when you laugh? It’s kind of an odd, personal question. The thing is, the answer is “yes” for 5 million Australians. That’s right, one in four Australians suffer incontinence. Eighty per cent of them are women. But the topic is still taboo.
The stigma of incontinence prevents people talking about it and taking action, leaving them to suffer in silence.
But one outspoken incontinence sufferer won’t be silenced.
Female stand-up comedian Bev Killick uses humour to remove any shame about the condition in her shows. She’s now been crowned the Queen of Continence Comedy.
“Nothing’s off-limits, so if there’s something happening in my life, I’ll talk about it,” Killick says. “I’ve had problems with incontinence all my life.
“I’ve always had a really weak bladder, even as a child. Especially if I laugh — I really let go.
“I used to have to have a note at school, saying that I was allowed to go to the toilet whenever I wanted.”
The shy child is now the voice and face of the Continence Foundation of Australia’s Laugh Without Leaking campaign. Its aim is to use humour to get people talking about their bladder, bowel and pelvic floor problems.
“If you try and keep it secret, it becomes an even bigger problem. Humour is a great way to break down those barriers and show people they’re not alone and they can do something about it,” Killick says.
So what is incontinence? Often referred to as poor bladder control, it is the involuntary loss of urine, ranging from minor leaks to complete loss of bladder function.
“Nine years ago, I realised something was wrong. I would hit a golf ball and whoosh,” orthopaedic nurse and grandmother Melinda McDonald says. “At work, I felt very insecure because I had to go to the bathroom every hour to make sure I was OK.
“When travelling, my incontinence became the entire focus; I was always searching for the next toilet.
“I had three big babies, so I knew my pelvic floor was not what it should be. I hadn’t looked after it. And back in the old days of nursing, we did a lot of heavy lifting. We moved patients around, which certainly didn’t help.”
It’s time to clarify this condition. First, incontinence should not be dismissed as a usual part of getting older or after having a baby.
“It’s not normal and can have a seriously negative impact on daily life for millions of women, men and even children,” Continence Foundation of Australia chief executive Rowan Cockerell says.
“This silent epidemic is costing the Australian economy a staggering $67 billion each year, including the burden of disease, health costs, work productivity losses, carer and continence aid costs.”
We now know incontinence is very common.
“In fact, incontinence and prolapse are the most common reason women will require an operation in their lifetime,” says Professor Peter Dwyer, head of the UroGynaecology Department at the Mercy Hospital for Women, Melbourne.
What many people don’t realise is it’s not just an “old person’s disease”. Many young mums suffer as a consequence of childbirth.
There’s a high chance then that your best friend, mother, sister, wife or daughter will suffer this debilitating and restrictive condition, but men and children can suffer, too.
Incontinence has a huge impact on sufferers’ quality of life.
Professor Barry O’Reilly, consultant obstetrician/gynaecologist and subspecialist in urogynaecology, says sufferers map out their life according to where the next toilet is located.
“These women can’t play with their children or, heaven forbid, go on the trampoline. They can’t exercise for the constant fear of wetting themselves,” says O’Reilly, a world leader in this field who recently visited from Ireland for the UroGynaecological Society of Australasia’s annual meeting.
“Because of this, they tend to put on more weight, which affects them further. They won’t travel. They don’t visit friends. It affects their sexual and personal relationships. It has a negative impact on self-esteem and confidence and has significant links to depression and anxiety in the future.”
THERE are two main types of incontinence. Stress incontinence (SI) is leakage caused by physical exertion like coughing, sneezing, lifting, exercising and laughing.
It is usually related to pelvic floor damage. One of the biggest causes of SI is childbirth — in particular, vaginal births.
Urinary urge incontinence (UUI) is leakage linked to an overactive bladder and can be caused by damage to muscles or the nervous system.
This is often called “latch key urgency”, where women will race home, drop their bags on the floor and run to the toilet.
“That is part of an overactive bladder, which is also connected with frequency, which is running to the loo too often,” O’Reilly, a former University of Melbourne senior lecturer, says.
“The normal number of times a woman should go to the toilet is six to eight times a day and one to two times at night. Women with severe incontinence get the urge every 20 minutes and four to five times at night, so it is a significant issue.”
Here is the good news.
“The important thing to realise is incontinence is a common condition that can be cured. You don’t have to put up with it for years and years,” Dwyer says.
Different types of incontinence require different treatments.
“An overactive bladder is addressed with lifestyle interventions, like restricting fluid intake and medication,” O’Reilly says. “Stress incontinence is completely different. It is more a damage problem to the pelvic floor. Initially physiotherapy, exercise and weight loss can help.”
Indeed the first line of treatment is the more conservative Kegel exercises to strengthen the pelvic floor. Women should be doing these regardless. A friend once told me she does them every time she is stuck at a red traffic light.
Up until recently, the next option was surgical. Yet, even some of these procedures have been shrouded in controversy, further eroding patients’ confidence.
Late last year the Therapeutic Goods Administration banned some trans-vaginal mesh products for prolapse, and single incision mini slings for stress urinary incontinence.
This followed a class action involving 700 Australian women. Many victims claim they were left with serious side-effects, including chronic pain and infection, after being fitted with the implants.
Women with severe incontinence get the urge every 20 minutes and four to five times at night. Photo: iStock.
A Senate Community Affairs References Committee recently investigated the risks and impacts of trans-vaginal mesh implants. It made many recommendations that aim to improve the regulation process of the procedure.
O’Reilly claims some underqualified doctors were performing these operations without the correct training.
“These operations should only be performed on women with stress incontinence,” he says. “If you did it on someone who had an overactive bladder, that patient would
be so much worse off.
“The problem is you have the wrong doctors, performing the wrong operation on the wrong patients. It put us in a very difficult position because it created a lot of distrust just when we were beginning to get over the taboo factor of incontinence.”
Another treatment touted by some practitioners is trans-vaginal laser therapy, with claims it’s a non-invasive, walk-in, walk-out procedure that carries minimal risk, bleeding or infection, and requires neither anaesthetic nor sutures.
How it works is a special small attachment is inserted into the vagina and treats what’s called the urethral tissue (the outlet to the bladder) with quick laser pulses. The light emitted creates a kind of thermal effect that stimulates and encourages new collagen and elastin.
O’Reilly has been using the device for 2½ years in Ireland.
“So what trans-vaginal laser therapy does is strengthen the area and mimic the sling device we would have inserted in the past,” O’Reilly says. “Anecdotally, I am seeing great benefits.
“It is suitable for women who are between pregnancies, who have young children, who don’t have time to take time off work, and who are worried about mesh implants.”
Some specialists, like Dwyer, remain cautious about the procedure, saying some cases of incontinence — such as bladder overactivity and urinary retention — will be made worse by this treatment.
“It is tempting to get on to things before they have been fully assessed,” Dwyer says. “I think we need to see more data before we rush in.
“We don’t want to doom ourselves to repeat mistakes of the past by introducing new technology before it has been shown to be safe or effective.
“Laser treatments should be in supervised trials, approved and supervised by hospital ethics committees, where patients are independently monitored. Only then can we assess its effectiveness, safety for patients and cost in comparison to well-researched treatments, such as the mid urethral sling, which is the day procedure operation accepted as the gold standard around the world.
“Once we have this information, we will know how and when to use this new technology.”
The Continence Foundation of Australia remains wary about the use of lasers for incontinence.
“There are lots of treatments women can try to control bladder leakage, both surgical and non-surgical, such as strengthening pelvic floor muscles,” Cockerell says. “At this time, trans-vaginal laser treatment is not well researched as an effective treatment for urinary incontinence. Women need to be guided by their treating health professional as to what are suitable options for their particular case.”
Grandmother Melinda McDonald says laser treatment for incontinence has transformed her life.
But McDonald says laser treatment improved her condition.
“I saw my general practitioner and she said I was a candidate for laser. She told me I was young and fit. I told myself I had nothing to lose,” McDonald says.
“A few months after the treatment, I could play 18 holes of golf and not have to worry about protective underwear.
“I came home to my husband and said, ‘I had a great day — today I did not wet myself’.”
Dr Else de Wit, a general practitioner specialising in women’s health, performed the IncontiLase procedure on McDonald using the Fotona laser — one of many different options — out of Albury clinic Delete Medical Laser Treatment.
De Wit recommends two treatments for incontinence and sometimes three for prolapse.
“Because it is a truly minimally invasive, quick procedure many of my patients come in their lunch hour — 95 per cent of them get an improvement., 65 to 70 per cent of them claim incontinence stops altogether,” de Wit says.
“I have lost count of the times people have told me it has changed their life. All of a sudden they can do the things they have been wanting to do but have been unable to.”
O’Reilly, who uses the laser, concedes the procedure requires some caution at this stage.
“Because laser is a new, innovative therapy we need to learn from lessons from the past,” he says. “The procedure needs to be done by reputable, well-trained doctors on the right patients.”
The thing is, incontinence will not get better on its own. And it will never be cured if it remains a hidden, secretive and embarrassing topic.
“Most of these problems can be better managed, better treated and in many cases fixed without surgery,” Killick says. “If having a laugh gets people asking for help for their leaks, then I believe comedy really can lead us to a cure.”
World Continence Week runs from Monday to next Sunday. National Continence Helpline 1800 330 066 or continence.org.au