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Chapter 1: What is the main issue regarding incontinence among women in Ireland?
Urinary incontinence affects a large number of women in Ireland, yet it is rarely discussed openly. Rather than addressing the issue, it seems many women are suffering in silence instead of seeking medical help.
To help us break the stigma, bust the myths around bladder control and share some simple but life-changing tips, I'm joined in studio by Dr Orla Conlon, Consultant Gynaecologist in Marble Arch Health. Orla, good morning to you. Thanks for coming in.
Thank you, David.
Chapter 2: Why do many women suffer in silence about incontinence?
Thanks for having me.
Just as an indication of how many people are affected, you recently posted a TikTok video about incontinence and how it's affecting women and it got a huge reaction. What did you say in that post and why did you think it was important to speak about the subject in social media?
Well, I suppose when you think about it, two thirds of women have incontinence in Ireland at least. And it may even be higher than that. Really? But it's a case of let's talk about it. And one patient on that day actually said to me, look, I have to wear a nappy to go for a walk. And my heart just sank, even though we see patients with it all the time. It was her message to me.
And I thought, hold on a minute here. This is ridiculous. This is crazy. Women are putting up with this. So can you imagine putting your nappy on before you go anywhere or go for a walk as a woman? And so that's why I thought it was really, really important. And the response I got was just unreal. So many women are talking about it.
And I think there's so, you know, people out there are thinking, well, actually, that is me or I have to like load myself up with pads. And, you know, we can't live like this.
Yeah. And the fact that it got such a response, I think it got 300,000 views or something for that post-log, would suggest that there are a lot of women receptive to that message.
Yes, absolutely.
Can you explain exactly what we're talking about? What is incontinence and how is it defined?
Yes, well, incontinence basically is meaning not being dry, not being continent. And there's lots, there's a few different types. Now, what I'm going to concentrate on today is urinary incontinence. But believe it or not, a lot of women also suffer in silence. Fecal incontinence, where that is where you actually lost control of your bowel and you would stain and soil yourself.
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Chapter 3: What are the different types of incontinence discussed?
So there's no real contraindications. You know, it doesn't mean if you have a history of breast cancer that you can't use it. It's a little pastry or cream or a gel that we put into the vagina. Now, I say to patients, it's like putting the jigsaw puzzle together. That in itself is not going to solve anything.
But actually, one of my ladies yesterday in surgery, she said, you know what, since I started my HRT, I'm not getting up at night to go to the toilet. So even systemic HRT can be even better for the bladder. So just the lining of the bladder is also very similar to the lining of the vagina and it has lost of oestrogen receptors. So HRT is fantastic. Even that's one part of the jigsaw.
A simple thing as well, like putting a tampon in, basically a little bit of support underneath the urethra. So say, for example, so the urethra is the neck of the womb or the neck of the bladder. Sorry, I talk about wombs a lot too. And I could talk about this all day, as you can see.
But so a little tampon can be very useful, not when you're having your period, but it just gives that little bit of support if you were going for a walk so that when you cough or sneeze or walk, you know, it helps support the urethra. Pelvic floor physio is the first part of the story.
And in Ireland here, there are an amazing group of experts, of physiotherapists who specialise in the pelvic floor. And I mean, a lot of the time you don't need anything more than that, but that can be life changing. But then we also have to make sure there's nothing pressing down from above.
Yeah, because you mentioned fibroids and all the rest of it, which need to be checked out, obviously.
And then a lot of women have incontinence and have a prolapse. So there are other different devices, vaginal ring pessaries. There's little other devices, continence devices that you can pop into the vagina. again, to support the uterus, to support the prolapse and to support the bladder. One other big thing is avoiding constipation.
So if you're really constipated, which a lot of women are and they're pushing down, you know, that's putting more pressure on the bladder. And then other things like going to the loo.
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Chapter 4: What causes urinary stress incontinence and how is it defined?
Most women... We call it the sandwich generation. You're running after kids. You're also looking after older parents. You're trying to bring, you know, keep down a job. You're running out to the toilet and some of the time your kids in the bathroom with you. So women have to relax into the toilet, take more time.
We call it double voiding, but basically it means that when you go to the loo, you take a little break, you stand up, you sit back down, you lean forward, you lean back. And that way you get another little tinkle, as I say, that if you completely empty your bladder better, then you're less likely to feel an urge to go again. So a lot of women aren't very good at emptying their bladder.
And then, of course, there's surgical options. Now, there's some more major surgical options and some more minor procedures. There is a little injection that you can get into the neck of the bladder and that just closes over the neck a little bit enough to support the bladder.
And then also for an overactive bladder, we use botulinum toxin, also known as Botox, but we use it in a lot of the cosmetic industry, but it's used in lots and lots of things in medicine. And that basically stops the contraction of the bladder as well as surgery.
So there are lots of options and obviously you'd explore a lot of them before you'd go down the surgery route. We have loads of texts in. Oh, brilliant. And I just try and get through them. One text says, what about the Emcella chair? I've used it and found it great and I think it worked for me.
Well, again, I would say to women, if you find something that works, to be honest, I would like to see a little bit more research in that, that it's evidence based. But a lot of patients would say that it does work. But I think it works. But you have to keep doing it.
OK. Another one. How successful is the bulk amid procedure for incontinence? And is it usual to have this treatment repeated?
Yes. So that's a little injection that I'm talking about. It's Bulkimid. It can be very successful, but it's a minor procedure. But we have to have realistic expectations because if you have really, really severe incontinence, it's not going to work. It's more to do with the mild to moderate. And that's the big message here.
Whether you're postnatal, whether you're young, young women, this is when you need to get start, you know, looking at fixing this problem. And so then the bulk of it will be much more successful than having to have a major operation.
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