This Women’s Health Week (WHW), the Continence Foundation of Australia has formed a community partnership with Jean Hailes and are focusing on pelvic floor muscle health across a woman’s lifespan. This targets three important groups including teens and young women, pregnancy and post-partum and menopause and the years beyond.
Urinary incontinence (UI) is the most common pelvic floor issue affecting women across their lifespan and its prevalence increases with age. Whilst stress urinary incontinence (SUI) is predominant in younger women, overactive bladder (OAB) syndrome, also known as urinary urgency incontinence and a combination of the two is more common in older women, and the prevalence increases with each decade.
It is a common human trait not to think too much about our health until we experience issues. Young women in their late teens to early twenties are usually not too concerned about their pelvic floor muscle health, often thinking that incontinence is an older woman’s issue and not something they need to be worried about. However, one in eight young women experiences bladder leakage (incontinence).
Although this can occur in any young woman, female athletes are particularly susceptible. Urinary incontinence, of which SUI is the most common, has a prevalence rate of 25.9% in young female athletes across different sports, with the highest prevalence rate of 75.6%. found in volleyball players.
An Australian study, published in 2018, found that 30 percent of female netballers experience urinary incontinence while playing one of Australian women’s most popular team sports. Published by women’s health continence physiotherapist, Naomi Gill, the study found that one third of all netball players, and half of those who have had children, experience urine leakage during training or playing the game.
The association between UI and high-impact physical activity is due to increased intra-abdominal pressure building up to a level that exceeds intra-urethral pressure. The good news is that pelvic floor muscle training (PFM) is considered as the first line of therapy among young female athletes.
It is known that urinary incontinence in young people is both under-diagnosed and under-reported. Many young women may not address the problem or seek specialist help due to embarrassment and lack of knowledge. They may also reduce or withdraw from physical activity due to fear of developing pelvic floor issues.
Go Against the Flow (GATF) is a primary health prevention campaign to raise awareness amongst young women. GATF was started with one main goal — to let young women know about incontinence; that it does happen, but it doesn’t have to. The research and co-design strategy involves the ongoing input of Swinburne University students, and is all about education, awareness, support, and sisterhood. It’s about empowering young women to build a community where they can talk about ‘below the belt’ issues, starting with incontinence.
Like many women’s issues, there is something that can be done to treat incontinence and GAFT is a website where young women can receive important information and support. The key message of GATF is that incontinence is both preventable and treatable and that it is not something a woman of any age should feel is a normal and irreversible part of her life.
GAFT was created specifically for adolescent and young women as a primary prevention initiative with a long-term vision to curb the incidence of 1 in 3 women with incontinence and pelvic health issues later in life.
Pregnancy and Post-Partum
The message is now loud and clear that women need to be thinking about the importance of their pelvic floor muscle health before they even conceive a baby! Evidence and the experience of healthcare professionals tells us that preparing the pelvic floor before and during pregnancy can reduce the likelihood of birth trauma injury and improve a woman’s postnatal recovery.
During pregnancy the body releases hormones that soften muscles, including the pelvic floor muscles. Along with the extra weight of a growing baby, this can weaken the pelvic floor and the organs it supports. Correctly doing pelvic floor exercises before, during and after pregnancy may help to reduce the chance of experiencing incontinence after birth.
During a vaginal delivery, the vagina stretches, and the supporting tissue and pelvic floor can tear. Women who give birth to larger babies, have a longer labour or difficult delivery are more likely to have bladder or bowel problems. Birth injuries such as pelvic organ prolapse (POP), and obstetric anal sphincter injury (OASI), also referred to as third- and fourth-degree tears, are likely to result in bladder and or bowel control issues.
Some women notice leakage (urine or stool) during pregnancy or after birth. It can take time for the pelvic floor and muscles to recover after birth, and every person is different. Most women notice their bladder and bowel concerns improve in the first six months after birth, but others may experience ongoing symptoms and require professional care and support.
It is not uncommon following birth for women to experience a shift in the attention of healthcare professionals from them to the care and well-being of the baby. Whilst this is a necessary focus, the care and well-being of the new mother in the immediate postpartum period is also vital, particularly if there has been significant birth trauma and/or injury. This requires informed and competent care, potential referral, and a high level of support. Otherwise, women may face embarrassment, stigma, and shame, particularly if their injury is followed by either urinary or fecal incontinence.
It is vital for women to have access to a supportive group where they can talk to women who have similar experiences and share information and strategies. This can help women to better comprehend their experience and incorporate it into the story of their life journey.
Much like we recommend preparing for pregnancy and childbirth, women also need to ideally consider their pelvic floor muscle health prior to menopause. Many women are ill-prepared for and poorly informed about the changes and symptoms they may experience during perimenopause and menopause. This can lead them to feel bewildered, scared, alone and ashamed.
Knowledge provides women with empowerment and often relief when they can attribute a cause to their symptoms, particularly loss of libido and greater susceptibility to urinary tract infections which may often benefit from quite simple interventions.
The narrative around menopause is rarely positive, but this too is fortunately changing thanks to the information and communication boom that has seen the revolution of numerous podcasts tackling topics previously considered to be taboo, and the pioneering women and healthcare professionals who are making the changes that women want to see. Talking openly helps to reduce stigma and shame.
How does menopause impact bladder and bowel health?
During the menopausal transition, oestrogen levels decline dramatically, which may lead to a thinning and weakness in the tissues of the pelvic floor and bladder, which normally depend on a regular and healthy supply. Vaginal dryness, due to reduced oestrogen, can also affect the tissues of the urethra. As such, many women notice changes to their bladder and bowel health, including:
Reduced Bladder Capacity
As women age, the bladder can start to hold less and not empty as well. As the bladder fills with urine, this loss of bladder flexibility and volume may cause you to go to the toilet more often. Combined with weaker pelvic floor muscles, this makes it much more difficult to hold on or put off going to the toilet.
A Weaker Pelvic Floor
An inevitable consequence of the aging process is loss of muscle mass due to oestrogen and collagen deficiency, and the pelvic floor muscles may become thinner and weaker. This can lead to urinary or fecal incontinence as we use our pelvic floor muscles to help control our bladder and bowel, urine leakage with coughing and sneezing, or urgency and frequency.
Given the abundance of oestrogen receptors in the urogenital tract, it is not surprising that natural reduction of endogenous estrogen can cause or potentiate pelvic floor muscle issues and recurrent urinary tract infections (UTIs).
Oestrogen helps maintain the surface moisture of the vagina and urethra. With less oestrogen in the body, the vagina and urethra (bladder tube) can become drier. This can be painful and irritating, especially with sexual intercourse, increasing the risk of urinary tract infections (UTIs) and incontinence.
Some factors, particularly childbirth and a weaker pelvic floor, mean pelvic organ prolapse (POP) is more likely to occur after menopause. POP occurs when one of the pelvic organs sags and may bulge or protrude into the vagina. There are different types of POP, and it is important to have any prolapse properly assessed. Common symptoms of POP are the feeling of a lump in the vagina, vaginal heaviness or pressure, difficulty emptying the bladder or bowel and lower back pain. This can cause embarrassment, anxiety, fear of going out and avoidance of exercise and social situations.
Symptoms from Childbirth
Some women may experience damage to their anal sphincter during childbirth, but the symptoms might not be obvious until later in life. Fecal incontinence due to this damage most commonly starts in perimenopause when hormonal changes may lead to the development of symptoms.
Recurrent Urinary Tract Infections and Dyspareunia
Microbial changes in the vagina associated with menopause include increased vaginal pH as a result of reduced oestrogen levels, which leads to a decrease in the usual Lactobacillus dominant vaginal flora seen in premenopausal women. This increases the potential for pathogenic microbes like E. coli and Enterococcus, most commonly associated with UTIs, to populate in the vagina.
There are many treatment options available for menopause and incontinence, and women don’t have to just put up with the symptoms and inconvenience. For incontinence, these may include pelvic floor muscle training, bladder training, vaginal oestrogen cream or an oestrogen pessary, lifestyle changes and surgery. For more information and to speak confidentially with a Nurse Continence Specialist, call the National Continence Helpline on 1800 33 00 66 or go to continence.org.au.
Meet Our Contributing Author — Nicola Reid
Nicola Reid (B.A.Comm;ND;HD;MPH), is the Media and Health Content Writer for the Continence Foundation of Australia, where she writes and edits Bridge, the Foundation’s quarterly magazine. She is a highly skilled educator, medical writer, and communicator, with considerable experience in developing and presenting seminars, webinars, and lectures to healthcare professionals both nationally and internationally. With a background in journalism and public relations, research and natural medicine, Nicola has been involved in writing and editing scientific and educational materials in the healthcare industry and has a widely recognized ability to translate complex scientific concepts across all levels of education. Nicola is passionate about health and wellness and sharing her knowledge and insight to improve well-being and quality of life for all.