Royal Alexandra Hospital Foundation

As an artist, teacher and mother of two teenagers, Marilyn Porter (not her real name), 49, manages a busy life in Edmonton. She also manages a condition not uncommon to her peer group – urinary incontinence.

“I’ll be working in my office. I’ll feel the need to go and run for the bathroom, but I won’t make it,” she says. “I probably pee my pants on a daily basis.” It’s been an issue for Marilyn since childhood. She consulted doctors, but they could find no physical cause. Marilyn was embarrassed that her body was betraying her and was too humiliated to talk about it.   

Then, about 20 years ago, something shifted. She and a friend were giggling during a visit, her bladder let go and she wet her pants. “There was no way she could not see what had happened, so I came clean. She told me her sister did that all the time.” 

“It was at that point that I lost the shame around it,” says Marilyn. “I learned I was not alone and that it was not my fault. It was such a turning point.” Today, she wears maxi-pads, voids whenever she can – up to 20 times a day – and makes sure she is close to a bathroom at all times.  

Women like Marilyn are the kinds of patients Dr. Jane Schulz sees in her position as divisional director of urogynecology at the Lois Hole Hospital for Women. 

“We get peed on every day,” she says. But she is nonplussed. “Body fluids do not faze us in any way. We want to see what is going on so we can help people.” Schulz is not only frank and funny, she is also setting the bar high and leading opinions in treating urinary incontinence. She says it’s a common problem that doesn’t commonly get talked about.

"Urinary incontinence can make you an embarrassed wreck but it’s highly treatable. Schulz and her surgical colleagues are in the operating room four days a week to help women stem the flow."

Dr. Jane Schulz

Schulz and her team at the Lois Hole Hospital for Women are creating new best practices that have the attention of other clinical centres, and she says that acknowledging the universality of the problem is the first step. 

It happens frequently in women over 60 due to age and menopausal changes, and urinary incontinence is estimated to impact one in four women over her lifetime. It can occur in elite athletes and in women who are pregnant or have had children. 

Many athletes have low body mass index, which is associated with lower estrogen levels and weaker connective tissues. Add in high impact activities like jumping or running, which put extreme pressure on the pelvic floor, and you are at risk for dribbling. Schultz estimates up to 70 per cent of high-level athletes like Olympic gymnasts and weight lifters will have unwanted leakage during their training or competitive activities. 

During pregnancy, women can leak due to hormonal changes and pelvic organ prolapse “Fifty per cent of women who have had children will have prolapse, where the bladder drops and pushes against the vagina, or herniates through the vaginal wall,” says Schulz. After pregnancy, damage to the nerves or tissues of the urethral sphincter can result in unexpected peeing.

Other professions are not immune. Construction workers, farmers and health care personnel are vulnerable due to the pressure on the bladder from the lifting and bending associated with their work. “Women who cough frequently – those with chronic obstructive pulmonary disease (COPD) or asthma, for example – are at increased risk, too,” Shultz says.   

Women who are incontinent may also have urinary frequency – constantly running to the bathroom or having trouble getting there on time, feeling the urge to go when water is running, having difficulties completely emptying the bladder and/or getting up many times in the night. The disrupted sleep, if pervasive, can result in anxiety or depression. Approximately 25 per cent of women experience mental health problems as a result of the stress of incontinence.

“But not everyone is bothered by urinary incontinence,” says Schulz. “If the leakage is a just a spritz, you might just wear a light sanitary pad and call it a day.” But if you are active, for example, you spend time on the golf course or on the tennis courts, and the leakage is significant, it could be bothersome. “Jumping on the trampoline with your kids and wetting your pants,” says Schulz, “that is a huge issue.” For some women, urinary incontinence makes them feel like a wreck – socially, hygienically and mentally. “The good news is it’s highly treatable,” says Schulz.

The first line of attack is to discuss the situation with your family doctor, who may make suggestions or refer you to an expert like Schulz. (This is not as obvious as it sounds; due to the stigma of this condition, many women have not told their spouses about this let alone their primary health care professionals.) 

At the Lois Hole Hospital for Women there’s a multidisciplinary team consisting of surgeons, nurses, urologists, a family doctor, pharmacist, physiotherapist and a dietician – nurses will take a history and do a physical exam. They will suggest you avoid bladder irritants like alcohol, caffeine, citrus, tomato and aspartame. “They’ll will ask you to keep a bladder diary to record how often you go for a pee,” Schulz says, “and note how much you are peeing and what you are drinking.”

Next up is help with urge suppression to increase the time between voiding; Kegel exercises, for example, strengthen the pelvic floor and help contain urine in 60 per cent of cases. Vaginal estrogen – taken twice a week and typically by cream or suppository – helps temper an overactive bladder. If necessary, you can get a ring-like device called a pessary inserted that will lift the pelvic organs – the uterus, bladder and rectum – back into a supportive place.

DID YOU KNOW

A Kegel is the conscious contraction of muscles that support pelvic organs. If you imagine you’re sitting on a wooden bench next to the Queen of England and you feel the urge to pass gas, and you resist by squeezing THAT muscle. If you can do that, you are probably doing a pretty good Kegel right now! Healthy women can benefit from doing Kegels as a preventative measure.

If your condition is more complex or these conservative management efforts don’t do the trick, there is always surgery – bladder slings, prolapse repairs, hysterectomies or vaginal vault suspensions. Schulz and her surgical colleagues are in the operating room four days a week to help women stem the flow.

And research is ongoing. Some of the most promising leads involve exploring more effective bulking agents to inject into the bladder neck and developing more resilient graft materials for pelvic floor repairs.

For now, the message is clear: women do not have to suffer in silence. “This is a very common condition,” says Schulz. “There are lots of treatment and resource options. You do not have to live with this.”