We take continence for granted until we don’t have it any more.
Many people don’t even know what we mean by the word ‘continence’. I was reminded of this the other day when I went into a restaurant and I asked could we hire their restaurant for a meeting for the Continence Foundation of Australia – the peak body for continence promotion – and the waitress wrote down the word Continents. When I corrected her spelling she had no idea what the word Continence meant.
What does it mean?
It means confidence with laughing at the Melbourne Comedy Festival.
It means exercising with gay abandon with your children.
It means you aren’t really thinking about where is the next toilet, therefore freedom to enjoy your holiday, travel on public transport, hike in open fields with no trees (to hide behind).
So when you don’t enjoy ‘continence’ you are suffering with urinary or faecal INcontinence- a leakage of urine, faeces or gas.
Continence is expected by the age of 2 or 3 and if you don’t achieve it, your parents get judged.
There are no formal instructions given, yet it is way more complicated than putting together an Ikea wardrobe.
And when you lose continence after a baby, you are sometimes told by your doctor, you are too young to do so and it’s all because you didn’t pay attention at the birth classes when they mentioned pelvic floor exercises.
But when you are a woman and post-menopausal the same health professional may almost write you off because there is an expectation that it is a ‘given’ that you will leak now you are old.
So what are some hints to achieve continence?
If it’s sudden and out of the blue – think infection. See your doctor for a micro-urine because all bladder infections don’t necessarily present with burning, pain or a feeling of passing razor blades.
If it’s immediately after childbirth, take it seriously and be assessed by a pelvic health physiotherapist to see what might be the cause. It may well be that learning about those pelvic floor muscles may in fact get you dry.
But do seek help – don’t just hope it will get better with time, even though there may be some improvement as swelling decreases, as nerves start to do their thing after the tractioning or compression they may have received at the vaginal birth. There can be urethral sphincter damage (Intrinsic Sphincter Deficiency ISD); there can be smooth muscle (the detrusor) irritation making it seem like the bladder is the boss not your brain (the overactive bladder OAB); it may be that the vagina (the labia) seems to be trapping the urine causing an annoying dribble post void (called a post micturition dribble); it can be due to constipation – who’d have thought?
The pelvic health physio is going to teach you to be a detective – what does your bladder hold? Normal is 350-500mls per void (wee). So she will ask you to do a 48 hour bladder diary and check out volumes, triggers to void, what you drink in (type of fluid and volume), episodes of leakage, frequency during the day and night and assess how you need to respond to the findings.
She* will give you lots of education about what is normal and what goes wrong and reassure you that leaking urine is common (30% of women in their lifetime will suffer urinary leakage) but never normal and may even tell you she got into her job because she has had it also.
A pelvic health physio should help you feel unburdened once you have fessed up to your secret. You should feel lighter for seeking help and more hopeful that this isn’t the future forever. And once you have commenced your new strategies you should feel renewed vigor in your step and reinvigorated to go back to exercise, to playing with your grandchildren and laughing out loud with confidence!
The saddest thing is that as you read this, in many doctors’ surgeries around the world there will be many women (and men) too embarrassed to mention their problem to their doctor and their doctor is too time-poor to ask them “How is your continence?”
Well at least after this blog you will know if your doctor asks you, he is not enquiring after any large land masses!
If you have any continence issues we have five delightful pelvic health physios who can help you; Megan, Jane, Alexandra, Martine and myself, Sue. Give my caring and discreet secretaries a ring on (07) 38489601 if you are in Brisbane or check out the APA Find a Physio site or the CFA Helpline 1800 33 00 66 and they have a list of Pelvic Health Physios to help you around Australia.
*My pelvic health physio is a she in my blog but there are he(s) that can be pelvic health physios also.