IN other social settings, the conversation that went on between three of us journalists and our three guest speakers may be deemed embarrassing or inappropriate, to say the least.
Because there we were, five women and a clearly outnumbered man, talking - and laughing - about urinary incontinence as if we were discussing the latest entertainment news over a lunch buffet.
Urinary incontinence (or urinary leakage) is a complaint of any involuntary leakage of urine, which affects more women than men, says consultant urologist and president of the Continence Foundation Malaysia Dr Peter Ng. There may be different types but all result in a person's lack of ability to control his or her urination.
"If it is not involuntary, it is not incontinence," said Dr Ng matter-of-factly when he started the discussion with a short presentation.
"As you get older, women and men have similar urinary problems, but the only difference is the prostate gland. Men have difficulty passing water (commonly due to prostate enlargement), and women wet themselves (commonly due to weak pelvic muscles)," he explained, as his audience chuckled. And as he went through his presentation with statistics to illustrate the commonness of the condition, how it affects women, and how they cope, he got agreeable nods from women in the room.
Film/stage director and producer Low Ngai Yuen, having experienced one urinary leak too many, is the first one to respond. "I must say, at first, that I think I am totally guilty of most of the things that (Dr Ng) says," she said. "I end up wearing long jeans, especially darker jeans because you can't tell (when it's wet). I also make sure my clothes are longer, so that they make double protection."
Pointing to the comfortable sofa she was seated on, flanked by Dr Ng and motivational speaker Datin Paduka Dr Hajah Sharifah Mazlina Syed Abdul Kadir, she added, "And, I would refuse to sit on a cushion like this."
Such coping strategies are common, as women struggle to retain some control over their basic bodily function - an element very basic to their self-esteem and dignity, Dr Ng explains. Because as urine leaks catch women unawares, embarrassment, depression, and feelings of futility often ensue.
"The moment you lose control, that feeling of vulnerability and powerlessness is so overwhelming it actually takes away a lot from your quality of life."
Chances are, you might have heard of these behaviours associated with urinary incontinence. Toilet mapping, for one, is common in most cases. "No woman would ever go to a place without knowing where the toilets are," says Dr Ng.
Defensive voiding is also common. It's like being a child again, because women will try to clear their bladders before going on a long trip or into a long meeting, just in case they need to use the toilet in the middle of it.
They may reduce their water intake or give up hobbies like aerobics. Some shy away from social outings and even avoid sexual contact. Practically, people who live with urinary incontinence live in readiness, says Dr Ng. The nagging question, "When... will I wet" governs the way they lead their lives.
Their situation could be better if women were more willing to share and support each other. (That way, they wouldn't have to hide their problems.) But, while studies nationwide show about a third of women experience urinary incontinence, not many choose to reveal it, much less talk to their doctors about it. And when they do, one of Dr Ng's surveys found a lot of doctors seem to ignore the issue, thinking of it nothing more than a common condition in ageing women.
"I think... the reason I can share is because when I know my incontinence is a (medical) condition, it's okay to share. It is not embarrassing anymore," says Low. Today, as an informed woman on urinary incontinence, Low now has no problems in managing her condition with diligent practice of pelvic floor exercises. She can even joke about the occasional leak - her response to a curious stare at a wet patch on her chair would be, "Ya lah, what to do? I have a weak bladder. I've got three children, you know?"
This is precisely the kind of mindset Dr Sharifah recommends to women who experiences continence problems. To Dr Sharifah, who is the first Muslim woman to ski-sail in the Antarctic region, the power of the mind can be tapped to overcome the embarrassment and stress that comes with urinary incontinence.
"If you are stressed, and you think so much about what's bothering you, things could get worse," she says. "And the more you keep it secret, the more stressed you're going to be. Once you open up, it is no longer a secret... and you know that you have nothing to worry about anymore."
But sharing is best when taken slowly and in stages. "Talk to people who have the same experience," Dr Sharifah says. "Support systems should be from the inside - from the "in-look" to outlook.
"Start with your own friends. And if you're married, talk to your husband. That is the most important person to talk to so that he will understand your situation." Slowly, you could extend your sharing to other friends and relatives, if you wish to.
Often, after a person acknowledges the problem he or she is having, the effort to change or improve starts. And fortunately, there are many ways you can choose to manage your bladder better.
In conjunction with their Poise Up! campaign for the first World Continence Week (22 to 28 June) this year, Poise Malaysia has also launched a trilingual website (www.poise.com.my) in English, Malay, and Chinese to offer tips for women to better manage urinary incontinence.
One of the best pieces of advice Dr Ng has for women out there is - and he emphasises there is data to prove this - to learn pelvic floor exercises, often called Kegel exercises. "You can do it when you are pregnant, you can do it after you deliver your baby. You can do it all the time."
It's easy, or so it sounds. "Just bring your pelvic floor muscles in and squeeze them," he says. "I tell my patients in Kuala Lumpur, "When you come before a red light, do the exercises'." Surely, if more women in the city practice that, we can expect to have plenty of strong pelvises walking around.
First, try to stop the flow of urine while you're passing it. If you succeed, you've got the right muscles moving. Or, you could try inserting a finger into your vagina and try to squeeze the surrounding muscles. (You should be able to feel your vagina tighten and your pelvic floor move upward. As you relax your muscles you should be able to feel your pelvic floor move down to the starting position.)
Do note it may not be wise to make a habit of starting and stopping your urine stream, as doing Kegel exercises with a full bladder, or while emptying your bladder, can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection. With practice, the exercises may even give you stronger pelvic muscles that will help you achieve orgasm faster!
Nevertheless, if you're still not sure whether you are doing it right, you could ask your doctor (your family doctor, urologist, or urogynaecologist) or a physiotherapist for help.
Coping and curing
"Women have to know that 80% of urine incontinence is curable," says Dr Ng. "There's a life study that has shown 70% of patients actually avoided surgery just by doing (pelvic floor) exercises."
You could also modify your drinking habits (drink less, but enough, water) or train your bladder to urinate at reasonable intervals. Mayoclinic.com has this suggestion to help you with bladder training: you may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.
In some cases, when incontinence stems from the inability to contract pelvic floor muscles, electrical stimulation of the muscles may help. Although there are medications you can take to help you with incontinence, they do have side effects and you may need them for life. When all methods fail, you could opt for surgery.
As it takes time to see results, there are also products you can use to ease the discomfort of urine leakage as you improve. A variety of absorbent pads and protective garments can help you avoid wetting chairs and cushions, and reduce the odour coming from leaked urine too.
Could you prevent incontinence altogether? It depends on the type of incontinence and its causes.
Temporary incontinence caused by some medication, alcohol, diuretics such as caffeine, and drinking too much water can be avoided simply by avoiding those habits.
However, persistent urinary incontinence is not always preventable. As pregnancy, ageing, and surgical procedures such as a hysterectomies can also cause incontinence, the best way to decrease your risk of urinary incontinence is to maintain a healthy lifestyle (eat well and be active), practice Kegel exercises, and avoid bladder irritants.
If there is one habit we girls have to get rid of, it is the habit of holding our urine for too long. "Women's bladders are quite vulnerable," says Dr Ng. If you overstretch them, they will become floppy."
But don't be too afraid to get pregnant or age gracefully, because you can take measures to ensure your pelvic muscles stay strong throughout. After all, bringing a life into this world may be the best experience a woman can have, and ageing should be a process savoured, not endured.
As for men who experience incontinence, talking to a doctor or finding solutions to your problem is well worth the effort. Life is too short to be interrupted by leaks. -The Star/ANN
