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July 3, 2016

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Women’s hidden scourge

AFTER giving birth to her second child, a 35-year-old woman called Wu from Shanghai who was interviewed for this story experienced something that’s typically more common among the elderly: Involuntary, she lost urine when she coughed or laughed.

“I don’t know what’s wrong with me and why I started to leak urine,” Wu said when she finally sought medical help from a doctor last week. She was crying as she was diagnosed with incontinence, which describes involuntary loss of urine, often while coughing, laughing, walking, lifting heavy things or exercising.

Childbirth is one the most common factors for incontinence among younger women and having a second baby or more can triple the risk, local medical experts explained during the recent World Continence Week.

The week was held to improve global awareness of issues related with incontinence. In China, one out of three adult women suffers from urinary incontinence.

This year’s national theme is “Continue to feel uncomfortable, or go through OAB (Overactive Bladder) diagnosis”, aimed at encouraging more people to seek assistance and treatment.

Since mid 1990s, incontinence has become one of five leading diseases in the world. The incidence in the United States is 39 percent and 27 percent in Germany. In China, incontinence is more common than hypertension.

In Shanghai, about 35 percent of adult women are affected. Though it is common, most patients are inadequately treated and many are never diagnosed. Many also suffer from low self-esteem and try to hide their condition rather than seeking medical assistance.

Doctors said less than 10 percent of patients visit doctors due to a lack of awareness and because they feel ashamed. About two thirds of patients who do seek medical help suffer for more than two years before they finally go to hospital.

“Actually, many doctors at neighborhood health centers also don’t have proper knowledge on the disease and tell patients that incontinence comes with age. However, it is actually something that can be under well control through medication, physical rehabilitation, electric stimulation and surgery,” said Dr Wen Wei from Shanghai General Hospital’s urologic surgery department.

“Incontinence seems not such a big problem, compared with cancer and other fatal conditions like heart disease. It can impose serious mental pressure and inconvenience to the patients, who are unable to leave home for a long time and have to wear incontinence pads all the time. Many people stay at home all the time to avoid embarrassment during social activities, so it is also called social cancer.

“It is often misunderstood that urinary incontinence cannot be cured, as patients can always take precautions before it is too late. Modern technology can diagnose and treat the problem. We want to promote education and improve public awareness,” Wen said.

Incontinence is most prevalent among women older than 40 years. Generally, it is more common among female patients. Childbirth, menopause, pelvic cavity surgery, obesity and smoking are some of the main causes for incontinence.

Pregnancy and child birth are the most common and natural childbirth puts women more at risk of suffering from urinary incontinence than Caesareans.

“After all couples are now allowed to have a second baby in China, we expect to see a rise of women with incontinence,” Wen said. “The key for incontinence prevention and control is to train the pelvic floor muscle 42 days after childbirth, which is widely promoted in Western countries. That just started in some domestic hospitals last year and is not widely known by the public and medical staff.”

A 25-year-old new mother surnamed Chen said she suffered from incontinence when climbing the stairs and visited Shanghai Ren’ai Hospital.

“Due to fetal malposition, the delivery process was very long and caused vaginal lacerations which took an hour to stitch,” she said.

“Chen’s incontinence can be explained by the shift of the pelvic position plus the damages of the urethra and vagina. During pregnancy, the downward pelvic movement is mainly caused by the changes in hormonal levels and the enlarging fetal size; during delivery, overexertion often leads to urethral and vaginal lacerations,” said Dr Zhang Ziyan, a gynecologist from Shanghai Ren’ai Hospital.

Pregnancy and delivery can weaken the pelvic floor.

“Proper pelvic floor muscle training and help from medical professionals after childbirth can drop at least half of incontinence incidences,” Wen from Shanghai General Hospital said, adding that pelvic floor training was mandatory in the US. “Such compulsory training dropped women’s afterbirth incontinence by 60 percent in the US.

But there is no such regulation in China and many new mothers miss the best time for rehabilitation and incontinence prevention and control due to poor awareness and a lack of guidance from medical staff.”

Menopause also triggers incontinence among middle-aged women. A 52-year-old woman surnamed Wang said that she felt humiliated by her disorder. She was too embarrassed to seek medical advice, which only worsened her condition over time.

Dr Zhang from Ren’ai said that the disorder wasn’t unusual among middle-aged women as lower estrogen levels during menopause weakened the pelvic floors.

“The reduced tension in bladders and pelvic floors lowers human control over bladder and thus can trigger urination,” she said. Pelvic muscle training or surgery can help.

Tension-Free Vaginal (TVT) surgeries are the mainstream alternative for severely affected patients. It is a minimally non-invasive surgery and almost all patients get rid of the annoying urine leak soon after the surgery.

Simple exercises

Pelvic floor exercise, also known as Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. The exercise is the most important physical therapy for incontinence. It is can be done any where and any time and any women with incontinence or having a risk of incontinence can do the exercise.

People can contract pelvic floor muscles for three to five seconds and relax for three to five seconds. It needs to be performed 10 to 15 times every time and three to eight times every day. Such exercise should last for at least eight weeks to have an effect.


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