A staggering number of women suffer in silence from urinary incontinence, according to a report. And yet, just one in four with symptoms seek medical help, despite the fact that numerous treatment options are available today.

Megan Ogilvie

Vancouver Sun
December 2, 2006
Weekend Review

TORONTO - Hilda Dube can pinpoint the exact moment she decided to do something about her urinary incontinence.

It was a Saturday night in 2002, during a family gathering at Georgian Bay, where more than 100 family members had assembled around a glowing campfire to tell jokes.

When it was her turn to make the family laugh, Dube, who had drunk a glass of wine to steel her nerves, stood up in front of the group to act out her joke.

It was an enormous success.

"Everybody was in stitches," recalls Dube, a 50-year-old registered nurse who works at McMaster University Medical Centre. "I was laughing so hard that I saturated my pants. I kept going -- I was brave to keep going -- but at that moment, I thought, 'That's it, I'm not putting up with this any more.'"

She consulted Richard Kalbfleisch, an urogynecologist at Hamilton Health Sciences, an organization of health care facilities in Hamilton, who confirmed that Dube had stress urinary incontinence, and laid out several treatment options, including surgery.

But Dube didn't want a big surgical procedure and other methods, such as Kegel exercises to strengthen her pelvic floor muscles, hadn't worked. "I did 200 to 300 of them a day," she says. "But it was unreliable… I was wearing a pad every day."

So she decided to wait a few years until a less invasive option became available.

When it arrived in 2004, Dube arranged to have Kalbfleisch perform the new procedure that used a novel version of a tension-free vaginal tape, a product called TVT, to support her urethra. Since then, a newer version, the TVT Secur, has been launched in North America. In August, Kalbfleisch became the first in Canada to treat stress urinary incontinence using the TVT Secur.

For two years now, Dube says, "I can cough, laugh, jog, run, do aerobics, dance, play tennis, sneeze, lift, enjoy wine, have sex.

"I can go for a weekend getaway without the extra nuisances of pads or extra underwear. I have no more leaks or gushes. It's just fantastic. My whole quality of life has really improved."

Stress urinary incontinence, or SUI, is leakage of urine brought on by exertion, says Sender Herschorn, professor and chair of the division of urology at the University of Toronto and an attending urologist at Sunnybrook Health Sciences Centre and Women's College Hospital.

Exertion, which can include anything from coughing, sneezing or laughing to bending, straining or climbing stairs, puts pressure inside the abdomen and on the bladder, he says.

Urine leaks out of the urethra when its support mechanism or sphincter control mechanism don't work properly.

People who are obese, who have excessive coughing or who do a lot of heavy lifting are more prone to SUI, says Herschorn, because these activities put extra pressure on the urethra. But the main risk factor is labour and childbirth, which weakens the pelvic floor muscles and other urethra support mechanisms. This also explains why women are much more likely than men to get SUI.

Dube, who had two long labours, says she started suffering from SUI immediately after she gave birth to her second child. She was only 33.

"My family doctor thought I was much too young to have [SUI]," she says. "Then he said there was nothing I could do about it, that it was major surgery [to fix it] and that I should wait until I was older. He discouraged me."

Urinary incontinence can affect up to two-thirds of all women, and yet only one in four women with symptoms seek help for their problem, says an article in a recent Canadian Medical Association Journal.

That a staggering number of women suffer in silence does not surprise Herschorn. He says urinary incontinence, from dripping to gushing, is a hidden epidemic in women. A combination of myth and perception stop women from seeking treatment.

Studies have shown that people who have SUI think it's a normal part of aging and that there is no treatment, says Herschorn. Many women are also embarrassed by it and keep their condition hidden.

"It's easier to wear pads or diapers than to complain about it," he says. "But it does impact a person's quality of life."

Urinary incontinence can also affect a woman's health.

Complications include urinary retention and chronic lower urinary tract infection, which can, if left untreated, lead to kidney damage.

There is ample evidence to show that many thousands of women in Canada have SUI. According to Kalbfleisch, SUI affects approximately one-quarter of women between the ages of 18 and 44 and about 40 per cent of women over the age of age 45. A 2001 survey by Mount Sinai Hospital found that 15 per cent of young women who had not yet given birth had SUI. In a third study, the Women's Health Council and York University found that 40 per cent of 1,365 women surveyed had some form of SUI, but less than one third of those women consulted a physician.

Herschorn is adamant that women do not have to suffer from urine drips, leaks or gushes, especially since less invasive treatment options are now available.

The TVT, first developed in the 1990s, is the least invasive surgical intervention for SUI. The tape system is generally made of a synthetic mesh that is inserted under the urethra to support and stabilize it during exertion, which stops urine from leaking.

Treatment with the TVT Secur can be done as outpatient surgery, usually under local anesthetic, and only requires several small incisions in the vagina. It's reported to cause less pain, with the woman usually able to return to work and normal activity after 48 hours.

The goal of the eight-page review article in the Nov. 7 issue of the Canadian Medical Association Journal is to inform family doctors about female urinary incontinence and to heighten awareness of the condition.

Most Ontario hospitals have a cap on the number of procedures they can perform to treat SUI. In British Columbia, however, women can pay for treatment -- a TVT Secur device costs around $600 -- at private surgical centres.