Toilet mapping’ and ‘latchkey urgency’ are phrases you’re probably going to hear more about as women increasingly seek help for an embarrassing problem which affects large numbers of them — leaking urine.
There are women who know the location of every public toilet in their local town or city, says Barry O’Reilly, consultant obstetrician and gynaecologist at Cork University Maternity Hospital and the Bon Secours Hospital.
Because more than one in three mothers-to-be in Ireland report leaking urine in early pregnancy, while half of all new mums say they ‘leak’ for up to three months after giving birth.
It plays havoc with their sex lives and restricts their ability to exercise or even enjoy some fun with their small children, even leaving them fearful even to laugh or sneeze.
That’s according to a study underway by researchers from Trinity College Dublin, who are looking into all aspects of maternal health for first-time mothers.
The MAMMI (Maternal Health And Maternal Morbidity In Ireland) study is following more than 2,600 women through their pregnancy and for one year after birth, recording their experiences.
Women were traditionally deeply reluctant to discuss the problem — but that’s changing, believes Dr O’Reilly.
A year ago, he and other experts addressed an information night at a Cork City venue on the issue of urinary and stress incontinence.
The speakers expected about 40 women to turn up — instead they got an audience of more than 200.
Dr O’Reilly, who founded the Continence Foundation of Ireland ( www.continence.ie ) a decade ago to highlight the issue, provide information, develop a strategy to deal with the problem, and carry out research, says urinary continence is a “huge quality-of-life issue” for affected women.
The Continence Foundation recently published the findings of a study into more than 1,000 first-time mothers — it showed that about 40% of women had experienced bladder problems of some kind prior to pregnancy, and that these problems worsened following childbirth.
There are two main issues, says Dr O’Reilly — one of which is the overactive bladder that has women constantly running to the loo.
“They experience a sense of urgency, and they will have an accident if they don’t make it to the loo on time.
“Such women will know every public loo in Cork City if they are going out,” says Dr O’Reilly, explaining that this has been dubbed ‘toilet mapping’.
“They are so worried about it that it takes over their life.”
Affected women can be prone to ‘latchkey urgency’, which, he explains, “is about coming home and putting your key in the lock and then dropping everything and running to the loo”.
Such women may also have to rise several times during the night to visit the toilet.
“The quality of life issues include lack of self-esteem, missing work because they are embarrassed, avoiding social functions or visiting people — for fear they may have an accident on someone’s couch,” says Dr O’Reilly.
It can result in serious lifestyle changes, warns Shirley McQuade, medical director of the Dublin Well Woman Centre.
“The estimate is that at least one in five women over the age of 40, if not more, can develop urinary incontinence issues over time,” says Dr McQuade.
“It can change your lifestyle and make you more isolated if you’re not going out and meeting other people in walking groups or in the gym — a lot of women avoid social contact which can cause depression.”
Managing the problem includes lifestyle modification — being aware, for example that caffeine is a potent stimulant to the bladder and only using decaf, restricting intake of liquids to one and a half litres daily and trying to train the bladder by trying to ‘hold on’ for longer before running to the loo.
Dr McQuade urges women to seek medical treatment.
“A lot of women are embarrassed to talk to the doctor about this problem, but there are lots of good way to treat it and improve or even eliminate it through a range of different exercises,” she says.
“Bladder retraining and pelvic flow exercises are successful in the vast majority or about 80% of cases.
“Get yourself checked out and ensure there is nothing medically wrong like a urinary tract infection. This problem is very common and there are lots of ways of dealing with it.”
Urinary incontinence has an “insidious” way of affecting life, warns Michele Pippet, psychotherapist and counsellor with the Well Woman centre in Dublin.
“It impacts on daily activities,” she says, explaining that while some women experience minimal leakage, others can have a severe problem which can make them reluctant to participate in everything from exercise to social life and which may cause anxiety, isolation, and low mood.
“It can impact on your confidence and your social interaction,” says Ms Pippet.
For those who do not find relief as a result of physiotherapy and pelvic floor exercises, medication can also be prescribed and is reasonably effective, say the experts.
However, where medication doesn’t work, says Dr O’Reilly, doctors may inject Botox into the bladder to paralyse the muscles.
“The bladder is a muscular bag and injecting Botox into the bladder relaxes the muscles and soothes the irritable contractions of the bladder — it lasts for up to six months.”
Another type of urinary incontinence is stress urinary incontinence, where women ‘leak’ as a result of coughing sneezing, laughing, jumping, or exercising.
“This is a problem that most women who have had babies would be familiar with — it’s caused by a looseness of the pelvic floor muscles,” says Dr O’Reilly.
The problem intensifies with exercise, so women may stop exercising. This can result in weight gain which not only exacerbates the problem but can cause depression, as well as lack of self-esteem and embarrassment.
Social isolation can also result from non-interaction with friends and family — some women may not even feel able to play with their children.
Sling surgery can tackle the problem — the technique involves inserting a sling or hammock-like support for the bladder.
“That has been a fantastic revolution in the treatment of stress incontinence but it is done under anaesthetic and requires an overnight stay in hospital,” says Dr O’Reilly.
However, he believes a recently developed method — trans vaginal laser therapy — will revolutionise the treatment of stress incontinence.
Dr O’Reilly offers the procedure, which is office-based and requires the patient to lie on a couch while a laser probe, an erbium laser, is inserted into the vagina.
“Basically it heats up the walls of the vagina,” says Dr O’Reilly. “The walls contain collagen. Heating allows the collagen to re-form and new blood is attracted to the area.” This strengthens the support structure around the bladder.
“It’s painless, currently requires two applications of 20 minutes each and so far has proved 90% efficacy a year after treatment,” he says. The treatment is ideal for women who are between babies, and experiencing severe leakages.
“Generally we would reserve the sling surgery until a woman’s family is complete and the youngest is mobile,” he says.
Women are increasingly willing to discuss the problem and seek treatment.
“Women are discussing the issue with their friends more and more, whereas previously it was not something that you would talk about.”
n A comprehensive overview on how to identify the pelvic muscles, pelvic floor exercise and bladder re-training such exercises is available on the Well Woman centre at www.wellwomancentre.ie
In 2012 Eileen* started to experience ‘leakage’ during outings with a group of women from her regular aerobics class.
“It came out of the blue,” she says.
“There was no reason for it, but generally after I had been walking for about half an hour or more it would happen.”
The women in the group were extremely fast walkers, she recalls, and eventually she noticed that the leakage only seemed to occur when she was with them.
“I found that when I was keeping up with them it would happen.”
Embarrassed, she let it go for nearly two years, but eventually sought medical advice in 2014.
The GP recommended that she have a scan, which came back negative.
“Once I found that there was nothing wrong, I didn’t see any point in taking it further,” says Dublin woman.
She simply stopped walking with the group in September 2014 she experienced no further trouble.
She now walks alone, and at her own pace, every day and never drinks coffee before going out anywhere because she finds she experiences a sense of urgency.
“However I still wear pads every day, just in case. Once you have had one accident, you will never again take a chance.”
*Name has been changed