Author: ControlYourChoice

A new year is a perfect opportunity to leave behind bad habits in an attempt to change our ways and better ourselves in the forthcoming year. Many think of it as a time to start focusing on improving health and wellbeing, with getting fit, mindful eating and alcohol abstinence being three of the most common resolutions. However, many tend to neglect other aspects of their health and put off seeking help and advice for treatable conditions, especially those that are often considered ‘embarrassing’ or ‘taboo’. In particular, sensitive conditions such as stress urinary incontinence (SUI).

 

What are the causes of stress incontinence?

 

Some women suffer from bladder weakness when exercising– meaning that it can have an impact on your new fitness routine – but can also occur when coughing, sneezing or running. The condition affects women of all ages, but factors such as age, weight, pelvic floor disorders and childbirth can put you at greater risk of experiencing it.

 

How common is stress incontinence?

 

Stress incontinence affects a third of women at some point during their lifetime. Despite the condition being so common, many women prefer to suffer in silence rather than look for help to treat the symptoms. In fact, a survey of more than 2,000 women commissioned as part of the ‘Control Your Choice’ campaign found that over a third (39%) of the women questioned said they had waited up to 6 months before eventually seeking treatment, while a shocking 12% admitted to leaving it for up to 5 years or more¹.

 

What stops women from seeking stress incontinence treatment?

 

• Many find their weak bladder simply too embarrassing to discuss, whether they are talking about it with their friends, partners or mums. Some even struggle to raise the issue with their GP. Indeed, according to the same survey, two thirds (67%) of women under 45 would be embarrassed about discussing stress incontinence. This is one of the reasons for why women live with the condition long-term and delay seeking treatment.

 

• There is a lack of knowledge amongst women about the different stress incontinence treatment options available. The survey found that 77% of women think that there needs to be an increase in awareness and understanding about the treatment options for stress urinary incontinence amongst women in general. The lack of knowledge and information leads to women simply just “padding up” and “putting up” with their weak bladder because they’re unaware of alternative solutions which can alleviate the symptoms. The so-called benefits of incontinence products have recently been heavily promoted and glamourised by manufacturers, although in 2019 this led to a complaint from the Royal College of Nursing (RCN) to the Advertising Standards Authority. The RCN explained one of the reasons for their concerns was because the adverts wrongly tried to normalise stress incontinence. The other reason being that the adverts failed to provide advice about the treatment options available for the condition.

 

• Last year the press was dominated by debates about tension-free vaginal tape (TVT), also known as mesh, and whether it should continue to be used to treat stress incontinence. Concerns were raised following nationwide media reports sharing stories from women who experienced severe pain and devastating side effects following the procedure. Worryingly, the Control Your Choice survey also found that almost half of those questioned (38%) said that the recent concerns with mesh being covered extensively in the media would deter them from seeking any advice from a health professional about alternative stress incontinence treatment options.

 

Three ways women can avoid a ‘wet’ 2020:

 

1. Pelvic floor exercises can help improve the symptoms of stress incontinence in most women – as long as they are done consistently and correctly. But they can sometimes be difficult to do properly, especially if the muscles have become weakened over time. Exercise aides and apps can also be used to help improve your technique. Another option is visiting a specialist physiotherapist who will guide you through exercises and offer advice and techniques on how to strengthen the pelvic floor muscles.

 

2. Speaking to a healthcare professional about stress incontinence treatment options available can help clear up any confusion or concerns women may have. At first, a GP is likely to suggest trying physiotherapy for 3 months to help strengthen the pelvic floor muscles. However, if physio doesn’t work for you, your GP will be able to talk through alternative weak bladder treatment options – most of which are widely available on the NHS. Your GP may suggest a treatment called bladder neck bulking, which uses water-based gels, such as Bulkamid®, to help to close the bladder neck and prevent leaks. The procedure is minimally invasive and takes around 15 minutes and, in some cases, can be carried out under local anaesthetic. It involves injecting a water-based gel into 3 or 4 locations just below the bladder neck, creating a “cushion effect” to help prevent urine leaking. Research from a randomised control trial of over 200 women published last year in the Journal of Urology found that 92% of patients were cured or improved after being treated with Bulkamid®².

 

3. Some women will still opt for wearing incontinence pads daily as a way to deal with any unexpected ‘leaks’. But experts continue to warn that this shouldn’t be seen as a long-term solution, coupled with growing anxiety about the impact incontinence pads have on the environment. Such pads and pants are not easily disposed of, taking hundreds of years to decompose in landfill sites. Indeed, another survey conducted by Control Your Choice in 2019, found that nearly two thirds (66%) of women were concerned about the environmental impact of incontinence pads³. But if you do choose to wear incontinence pads or pants, do make sure that you’re always prepared and carry spares!

 

References

1 Fieldwork for the survey commissioned by Contura International, took place 1st – 4th December 2017, among 2,000 women, aged 18+

2 “TVT surgery versus Bulkamid injection for primary stress urinary incontinence: a randomized clinical trial” Authors: Anna-Maija Itkonen Freitas, Maarit Mentula, Päivi RahkolaSoisalo, Sari Tulokas, Tomi S. Mikkola : J Urol in press

3 Fieldwork for the survey commissioned by Contura International, took place 21st – 27th August 2019, among 2,001 women, aged 18+

The Office Christmas party, with copious amounts of drinking and dancing, has all the ingredients for festive fun. However, for some women it is often a recipe for disaster in terms of embarrassing leaks and awkward moments amongst colleagues.

 

To avoid potential leaks, many women who live with stress urinary incontinence on a daily basis will resort to incontinence products such as pads or pant. There are now now widely marketed as a discreet and desirable staple of any woman’s wardrobe.

 

Despite the phenomenal growth of this sector – predicted to be worth almost £15 billion by 2026¹ – a new survey² commissioned by ‘Control Your Choice’, has shown that almost three quarters of women (72%) said they ‘felt embarrassed about wearing incontinence products’. Of these, 29% said it led to a fear of going out.  Furthermore, almost a third (31%) of women are ‘depressed by the thought of having to wear incontinence products for decades.’

 

60% of all those questioned said they were concerned about the environmental impact of incontinence pads. Incontinence pads are not easily disposed of and end up in land fill sites, taking hundreds of years to decompose.

 

The past two years has seen an unprecedented level of campaigning and debate, highlighting the devastating effects on some women following treatment using vaginal mesh or TVT-tape for conditions such as prolapse or for stress incontinence. Whilst official inquiries continue, the UK has seen a temporary suspension in the use of these procedures.

 

In response, the past six months, has seen a huge push by the manufacturers of incontinence products encouraging women to turn to ‘pads and pants’ as a solution to their SUI. A strategy that has also led to complaint from the Royal College of Nursing to the advertising watchdog.

 

Leading experts are now calling for women to see past the recent headlines and, rather than suffering in silence, encouraging them to speak to a healthcare professional about their problem as a priority. Effective alternatives to mesh – and incontinence products – are available and women need to discuss the best available treatment options for them. Learn more about available treatment options here.

 

Nicola Dean, Consultant Obstetrician and Gynaecologist, based at York Hospital, is now supporting the ‘Control Your Choice’, campaign warning that whilst the ‘uncertainty’ continues, women are too confused and scared to seek advice and are allowing their weak bladder to impact on their quality of life.

 

Ms. Dean also warns that although stress incontinence is common, it is not ‘normal’ – a myth perpetuated by the manufacturers – and that women should be encouraged to ask for professional help and not just ‘put up with pads’.

 

The new survey also reports that 41% of UK women have used an incontinence product to help contain their weak bladder. And, when asked what activities might prompt them to wear an incontinence pad, around one quarter (24%) women would think about using such a product if they were going out socially or on a date.

 

Nicola Dean, recommends that women consider a treatment known as ‘bladder neck bulking’ to treat their stress incontinence. “Since 2017, we’ve seen a significant drop – 79% – in women coming forward for treatments for incontinence. As a healthcare professional, committed to helping women regain their confidence following a diagnosis of stress urinary incontinence, it worries me that a growing number of women are seemingly avoiding asking for expert help, through fear or misinformation and missing out on the opportunity to explore other successful treatments options.”

 

“Whether a woman is referred for physiotherapy, pelvic floor exercises, pilates or a procedure, in my opinion no patient should ever simply be sent away and told just to put up with pads.”

 

Indeed, NICE Guidelines³ advise that “absorbent containment products should be used only as an interim coping strategy while more definitive treatment is awaited.”

 

Across the industry, it is widely believed by medical experts that overall, procedures carried out for stress incontinence in the UK have dropped from 16,000 annually (2010) to 6,000 (2018), with the start of the decline starting unsurprisingly in 2014 when the international mesh story first broke, then saw a sudden and steady decrease from 2016 onwards (when the scale of the issue reached the UK media).

 

Stress incontinence affects an estimated 30% of women worldwide. Two thirds of women suffering are undiagnosed. It can occur at any stage of life, with risk factors including pelvic problems from pregnancy, childbirth, obesity, menopause and ageing. Learn more about the condition here.

 

Yet, despite its prevalence and impact on the quality of life, the Control Your Choice campaign has also shown that well over a third of women (39%) say they’d waited up to six months before eventually seeking treatment. A staggering 12% left it for up to five years or more.⁴

 

Vicki Williams, 45, is mum to a teenage son and works as an Operating Department Practitioner at York Hospital, where she was treated by Nicola Dean for her weak bladder issues in October 2017.

 

She says; “There really is no need to put up with this problem. Female stress incontinence is extremely common and incontinence pads are really not the only solution – not to mention their negative impact on the planet. I had bladder neck bulking treatment carried out under local anaesthetic, which consisted of three Bukamid injections into the neck of the bladder and took around 15 mins.

 

“At the time I’d recently started competing regularly in weightlifting and I found I was leaking a lot at the gym and increasingly in my daily life, so I wanted something done about it. And, I’ve never looked back. In fact, I was able to go home shortly after the procedure and I was back at the gym that evening and achieved a ‘Personal Best’ in dead lifting, without any bladder incontinence.”

 

Bulking agents are a minimally invasive (meaning no cutting of the patient’s tissue or skin), safe and effective treatment for stress urinary incontinence which have been used for over 10 years.

 

The current market leader Bulkamid®(a water-based gel that helps the bladder neck to close when needed to help prevent bladder leaks) has an 80% success rate  when used as a first line treatment and to date has successfully treated over 60,000 women.

 

Vicki concludes; “I hope that by becoming such an advocate of this type of treatment and being prepared to share my experience, more women like me will speak to their GP to discuss what options are open to them too. It is all about their decision, their choice.”

 

References:

¹ Rapid Growth Predicted for Incontinence Devices Market, Incontinence UK, July 2019

² An online survey was conducted by Atomik Research among 2,001 women aged 18+. The research fieldwork took place between the 21st and the 27th of August 2019. Atomik Research is an independent creative market research agency that employs MRS-certified researchers and abides to MRS code.

³ https://www.nice.org.uk/guidance/ng123/chapter/Recommendations#absorbent-containment-products-urinals-and-toileting-aids (Urinary incontinence and pelvic organ prolapse in women: management; NICE guideline [NG123] Published date: April 2019 Last updated: June 2019)

⁴ Fieldwork for the survey commissioned by Contura International, took place 1st – 4th December 2017, among 2,000 women, aged 18+

A treatment that is routinely offered to women on the NHS has come under the spotlight this month with the findings of an exciting new study published in the acclaimed Journal of Urology.

 

The research is the ‘first study of its kind’ to challenge previous doubts over the efficacy of a minimally invasive treatment for SUI, known as bladder neck bulking.

 

The much anticipated study – a randomised control trial (RCT) of over 200 women assessed across a period of 12 months – showed that when followed up in a rigorous, study setting, complications with mid-urethral sling surgery using tension-free vaginal tape (TVT, also known as ‘mesh’) appear higher than previously thought (“common”) compared to treatment using a so-called “bulking agent” (a water-based gel). Learn more about treatment options here.

 

The landmark study showed that whilst TVT-slings showed a better overall ‘satisfaction’ in outcome than bladder bulking, all serious complications were associated with TVT, whereas there were NONE for Bulkamid® (the current market leader).

 

92% of patients were cured or improved with Bulkamid®, the highest ever figure recorded in published data.

 

Over the past 2 years there has been an unprecedented level of campaigning and debate, highlighting the devastating adverse effects on some women following treatment using TVT-slings for conditions such as prolapse or SUI.

 

Whilst official inquiries continue, the UK has seen a temporary suspension in the use of these sling procedures.

 

As such, there has also been a huge push by the manufacturers of incontinence products encouraging women to turn to ‘pads and pants’ as a solution to their SUI – a strategy that has also led to complaint from the Royal College of Nursing to the advertising watchdog for trying to “normalise” the condition.

 

A new national opinion poll of 2,000 women commissioned just last month on behalf of ‘Control Your Choice’, revealed that almost three quarters of women (72%) said they ‘felt embarrassed about wearing incontinence products’. Of these, 29% said it led to a fear of going out. 60% of all those questioned said they were concerned by about the environmental impact of incontinence pads.

 

Yet, despite the scale of SUI (the condition affects an estimated 30% of women worldwide) and the obvious effects on a woman’s quality of life, it is now widely believed by medical experts across the industry that procedures carried out for SUI in the UK have dropped from 16,000 annually (2010) to 6,000 (2018), with the decline starting in 2014 when the international mesh story first broke, then “dropping off a cliff” in 2016 (when the scale of the issue reached the UK media).

 

Consultant Obstetrician and Gynaecologist, Nicola Dean, says;

 

She says; “This new research underlines the fact that women do have a choice and they must be encouraged to use that choice. For some, specialist physiotherapy and guided pelvic floor exercises will make the world of difference. However, when these conservative therapies fail, women should not simply be faced with the prospect of pads. This paper supports our own practice here in our department that bladder bulking can be offered as a safe, first line procedure for primary SUI treatment due to the high satisfaction of patients and low complications associated with Bulkamid.”

 

Jenny (53) from St Albans was treated with Bulkamid® earlier this year following almost a decade of suffering from embarrassing, and at times debilitating, condition.
She told Control You Choice that the results have been “life changing”.

 

“I was very fortunate that my GP referred me to a local Consultant Gynaecologist who immediately suggested I would be eligible for bladder bulking treatment. It was all done so quickly – in fact, I was back home, post-surgery, later that same day. Within a couple of days, I’d returned to my day-to-day activities, including lifting boxes in the school kitchen where I work – but without any leaks! The whole experience has been incredible, and my husband says I’m a new woman!

 

Following the awesome spectacle of Glastonbury 2019, the festival season is well underway and it is expected that an estimated four million people will be attending an outdoor music event in the UK, this year¹. If, like 30% women, you suffer from stress urinary incontinence (SUI) the thought of spending a weekend in a field enjoying live music can be daunting. Many will be hesitant to attend out of fear that they may ‘leak’ due to the pressure caused by certain activities and the limited access to toilets.

 

SUI is a common condition that occurs when certain physical movements or activities, such as sneezing, coughing, running, dancing or heavy lifting puts pressure on the bladder. The condition can leave many women feeling embarrassed, leading them to isolate themselves from exercise and social activities, particularly during the summer as the condition can be harder to disguise as the weather gets warmer.

 

Mr. Steve Foley, Consultant Urologist at the Royal Berkshire NHS Trust (Reading) discusses four top tips every woman suffering with SUI should take on board as part of their pre-festival preparation this summer:

 

Keep hydrated – Most people who suffer from the condition will think that limiting their fluid intake will lessen the need “to go”, but ultimately there’s a very real danger this will leave you dehydrated (particularly if we see the same temperatures as we did at Glastonbury this year) This is not only dangerous in the warmer weather, but the dehydration concentrates your urine, irritating the sensitive lining of your bladder and making you feel like you need to ‘rush to the loo’ more often. Without sounding like a killjoy for your festival fun, alcohol and caffeine consumption should really be kept to a minimum as both can make you feel like you need to go more often – which isn’t ideal when you’re in the front row at the main stage!

 

Think of the impact – This year, Glastonbury goers were advised to ditch the single-use plastic and opt for more sustainable options, with organisers asking attendees to swap their tents, wipes and bottles for reusable alternatives.

 

Research² has shown that around 9 out of 10 women living with SUI are likely to simply “put up with” the condition, rather than seeking treatment and advice, with many using pads as a way to ‘treat’ their ‘leak’, without considering the environmental impact when it comes to disposing of them – especially if other festivals take after Glastonbury with the use of compost toilets which do not always offer sanitary waste disposal bins.

 

Washable pads/pants offer an alternative for those willing to ‘manage’ SUI whilst being conscious of their environmental impact, but there are more long-term alternatives available such as bladder bulking, which is a minimally invasive option offered widely across the NHS and with a quick recovery time. Bulking agents, such as Bulkamid®, are a water-based gel that helps the bladder neck to close when needed to help prevent bladder leaks and has an 80% success rate when used as a first-line treatment.

 

If you’re looking for an environmentally friendly, longer-lasting solution, do make sure you speak to your GP about the treatment options available.

 

Familiarise yourself with locations – Depending on the size of the festival, access to toilets may be limited, as some sites are spread across over 1,000 acres! If you’ve already planned which artists you are going to see, you should also consider looking into the nearest toilets for each stage, and familiarise yourself with them, that way you can schedule in regular toilet breaks to minimise the risk of embarrassing leaks.

 

Pack light – Summer allows you to wear light, loose-fitting clothes, which can not only keep you cool in the warmer temperatures, but they also dry quickly, which can be beneficial in case you have a leak. Dark, loose-fitting clothing such as smock dresses and tunics, can be a great way to hide visible signs of leaks but can also hide pads. Be aware that tighter and lighter coloured clothing such as skinny jeans can reveal a lot, especially if you’re not properly prepared to deal with possible leaks and the visibility of pads.

 

#ControlYourChoice

 

References
1. https://www.ukmusic.org/assets/general/Live_Music.pdf
2. Fieldwork for the survey took place 1st – 4th December 2017, among 2,000 women, aged 18+

On the 10th anniversary of World Continence Week 2019 (17-23 June) we take a look back over the past 12 months and the growing awareness of bladder neck bulking as an effective, first line treatment for stress urinary incontinence (SUI).

 

The issue of SUI and recommended treatments for the condition continues to be debated and discussed, with regular reviews and articles on a range of conservative interventions from physio, and pelvic floor trainers to the popular minimally invasive, urethral bulking and more invasive treatments that require surgery.

 

The fitness and running community continued to support and promote the efficacy of the treatment (particularly for “fit, forty-something females”) and in November, the popular lifestyle magazine, Women’s Running featured patient case studies that had been treated with urethral bulking agents (Bulkamid), alongside expert opinion from Consultant Urologist, Mr Steve Foley.

 

Speaking in the special feature, Natalie said, “I started running when I hit 40 but soon noticed that I was suffering from SUI. It was a bit uncomfortable and embarrassing, so I went to see my GP who referred me to a consultant. He talked me through all the options, after which we both agreed I should have a bladder neck bulking procedure. The treatment took around 15 minutes and I was back home later that day. Since my treatment I haven’t experienced another leak and I’d go as far to say it’s changed my life – certainly my life as a keen runner!”

 

Global perspective

 

One of the highlights of the past year was the much-anticipated International Masterclass presenting evidence on Urethral Bulking as well as surgical interventions for the treatment of SUI.

 

Chaired by Mr Ash Monga (Consultant Urogynaecologist, University Hospital Southampton NHS Foundation Trust) the topical and varied day-long agenda introduced issues such as an overview of the “US experience” on the treatment of SUI, reviews of randomised controlled trials and the importance of shared decision making when considering treatment options for SUI.

 

One of the key presentations was led by Ms Tamsin Greenwell (Consultant Urologist and Clinical Lead for the Female, Functional and Restorative (FFR) Urology Unit, UCLH – and former Chair of BAUS) and Contura’s Chief Scientific Officer, Dr Ieva Ankorina-Stark, discussing the safety and efficacy profile of Bulkamid®.

 

NICE Guidelines – what happened next…

 

Just days after this successful, international event, the new NICE Guidelines for Urinary Incontinence in Women were published. The much-anticipated review continued to list bulking agents as a recommended treatment for SUI.

 

This lead to an article in the Daily Mail, researched and written by leading health writer, Lois Rogers, investigating the safe alternatives to mesh implants. The coverage featured a first-hand account from another Bulkamid® ‘success story’, 58-year old Debbie Dowd.

 

She told us; “18 months on and I haven’t suffered with stress urinary incontinence since. I could cry with relief! I’ve been on walking and climbing holidays and have developed a real sense of adventure and a taste for travel with my husband. The treatment has totally changed my life and I would recommend it to any other woman suffering the same issues. I can relax and play with my grandchildren, aged 1 to 10 and have no worries now about scooping up the little ones!

 

So, as World Continence Week 2019 continues to generate a talking point around urinary incontinence and helps to tackle the taboo, our Control Your Choice campaign looks forward to another 12 months of educating and informing women and encouraging them to take positive steps to cure their SUI.

 

A survey, commissioned by the Control your Choice campaign*, revealed that four in ten women had admitted they avoid certain activities for fear of accidental bladder leakage. These activities included trampolining with their children, an activity that is increasing in popularity with young families. With the May Bank Holiday and half term week upon us, many mums (and grandmas) may find themselves worrying about the impact of running around after their young children and letting leaks get in the way of a fun family day out.

 

So, here are some top tips for springing into action this Half Term and making sure you’re not a slave to your SUI!

 

1. Locate accessible toilets and take regular breaks –Whether you are heading to the park for the day, visiting a museum or embarking on a long car journey, then make sure you know where the nearest toilets are located. Knowing that you’ll be able to stop for toilet breaks as and when needed can help avoid embarrassing leaks and reduce stress about SUI.

 

A nationwide information campaign has been launched by #ControlyourChoice, hitting washrooms at motorway services and rail stations from May half term through to September, signposting ladies to the latest advice and information about treatment options for SUI.

 

2. Avoid activities that put too much pressure on your bladder – Many activities aimed at children such as trampoline parks, soft play areas and family fun runs, can put extra pressure on your bladder, resulting in occasional but embarrassing leaks. It is important to remember that these are really special times with your young family, and you don’t want to miss out on making memories with them and so for many women this is the trigger for them to seek professional help from a GP or Physiotherapist. However, if you are really worried and don’t want to miss out on all the holiday fun then be prepared and do ensure you carry a spare pair of pants and pads with you.

 

3. Speak to your GP about treatment options – Bulking agents are a minimally invasive treatment (which means no cutting of the patient’s tissue or skin) and are a safe and effective option which has been used for over 10 years across the NHS. Bulkamid® is a water-based gel that helps the bladder neck to close when needed to help prevent bladder leaks and has an 80% success rate when used as a first line treatment. Many patients tell their consultants they’re surprised by how quickly they are able to return to their normal routines following bladder bulking treatment and see an instant end to leaks when partaking in exercise, sneezing or even bouncing up and down on a trampoline with their kids.

 

4. Stay hydrated – Most women with SUI instinctively try drinking less to prevent the need to go to the toilet. However, dehydration concentrates your urine, irritating the sensitive lining of your bladder and making you feel like you need to ‘go’ more often, and alcohol and fizzy drinks can worsen the problem. Don’t cut down on the amount of fluid you drink in an attempt to avoid unwanted accidents, as you will be leaving yourself open to the dangers of dehydration and after a long day out with the family, this can be dangerous, triggering other health complications such as migraines and dizziness.

 

Don’t forget – You can stay hydrated with foods as well as fluids; watermelon, cucumbers, radishes and peppers are spring staples packed with water that gives your bladder a break.

 

5. Skip the stress – 60% of women* in the UK have admitted to experiencing an embarrassing leak when they sneeze and with high pollen levels already being reported this spring, it is important to be prepared. Make sure you pack extra pants, pads and if necessary, antihistamines but most importantly speak to your GP and find out how you can prevent SUI and make sure you are not putting a damper on the family Easter holiday.

 

* Fieldwork for the survey took place 1st – 4th December 2017, among 2,000 women, aged 18+

 

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