Gynaecologist, Dr Sonya Jessup brings this difficult topic out into the open and looks at what can be done about it.

After we grow up from toddlers to children, having full control of our bladders is something we learn to take for granted. We can run, jump, laugh and play at complete ease. As teenagers and young adults, we start experiencing sexual relationships but still the only concerns our bladders give us are the occasional urinary tract infection or the uncomfortable and inevitable wait in the queue at any large event.

Yet, somewhere along the path of life these things we take for granted frequently change to a point where for many women, bladder control is a constant daily concern with multiple visits to the bathroom at night, urgent dashes to attempt to reach a bathroom in time and frequent embarrassing leakage of urine.

How does this happen?

There are many reasons why a person’s bladder may not function normally, but in reality, for most women, there are two main events in life that trigger changes in our bladder function. The first is having babies. The second is going through the menopause.

Pre-Childbirth

The anatomical changes to a woman’s body when she is pregnant and when she delivers a baby vaginally impacts the function of the bladder and the pelvic floor.

Before childbirth, the bladder sits on a muscular hammock called the pelvic floor. When you laugh or cough, these pelvic floor muscles tighten to prevent any urine from escaping from the bladder. In a natural normal vaginal delivery, the baby’s head (which is the biggest part of the baby) needs to pass through these muscles, which involves an enormous stretching of these muscles.

In general terms, skeletal muscles are not able to stretch more than twice their normal length and yet in childbirth, they are being asked to stretch many times more than this. Now luckily the hormones produced in pregnancy appear to allow some extra degree of stretch, but for many women, this is still not enough. The pelvic floor muscles may tear off their insertion points, they may suffer multiple microfibre damage that prevents them from returning to their normal length and function or the nerves that supply these muscles may be bruised or permanently damaged during childbirth.

Post-Childbirth

After the baby is born, the body sets about trying to repair itself, and we all know that by performing pelvic floor muscle exercises, (Kegal exercises) we can increase the chance of our pelvic floors returning to normal.

However, for 1 in 5 women, their bladder function never returns to normal after having a child and they are left with incontinence issues for the rest of their lives.

Having a big baby, a long second stage of labour or an instrumental (forceps) delivery are known to increase the chances of bladder dysfunction after childbirth, but even with a normal, relatively easy vaginal delivery significant damage may occur.

What can be done?

Surely women can’t just be expected to accept incontinence for the rest of their lives?

In past centuries and decades, that is exactly what happened. Many women died after childbirth of urinary tract problems or infections and relationships fell apart due to the bladder or faecal incontinence.

More commonly, however, women just didn’t talk about their problems and accepted that they could not exercise as they had before childbirth, would excuse themselves from activities or journeys that they knew would increase the likelihood of incontinent episodes, and would avoid sexual relations due to fear of having urinary leakage.

Even today, if you look in the supermarket shelves, you will see many shelves of pads and specialised underwear to cope with daily urinary incontinence.

Surgical options

There have been many medical advances to help women with urinary incontinence.

Pelvic floor physiotherapists provide expert training feedback for women as to how to correctly perform pelvic floor exercises. Surgical options such as Burch Colposuspesions and transvaginal mesh tapes have been used to provide support to the urethra and prevent stress incontinence.

Medications have been useful for overactive bladders and urge incontinence. In the last few years, however, the mesh that has been used to treat vaginal prolapse has been withdrawn from usage in Australia and many other countries due to many cases of untreatable infection and the difficulty of removing mesh implants if a problem does occur.

The same mesh is still able to be used in Australia for transvaginal tape procedures for incontinence, but many women remain concerned about the ongoing risks should they have this procedure performed.

Non-surgical options

In the last few years, there have been a number of new technologies that have emerged to help treat incontinence –

1) Emsella Electromagnetic chair – this device uses advanced electromagnetic energy targeted on the pelvic floor muscles to deliver 11,000 contractions over a 30 minute period. That is 11,000 Kegals squeezes at a strength greater than a woman could perform herself. The treatment is not invasive and the woman can remain completely clothed.
2) Viveve – using radiofrequency thermal energy to heat up the collagen layers of the vaginal and the paraurethral tissues to create a “natural collagen sling effect” from the woman’s own body tissues, it aims to improve the structural integrity of the vagina and to support the urethra. This is a one-off treatment usually given by a gynaecologist or specially trained doctor.

For most women, there is no obvious clear way to know what the best options are for them as individuals. With many gynaecologists, urologists, physiotherapists and cosmetic physicians all offering different treatments, as a general rule, I would recommend women start by consulting a good general practitioner or a gynaecologist. The more options that the treating physician offers the better chance that the patient will receive the treatment or treatments best targeted to their specific needs.

Dr Sonya Jessup (BHB, MBChB, MReprodMed, FRANZCOG ) is a female fertility specialist, gynaecologist and parent. She currently runs her own practice in multiple locations across Sydney. She established The Elsa Clinic after recognising the need for better, non-surgical treatment options for women, in particular, those with urinary incontinence and post-pregnancy issues. She is passionate about women’s gynaecological health not only for function but for achieving personal satisfaction.