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Incontinence after childbirth: why prevention is better than cure

Posted: 05/10/2017

Last month was Urology Awareness Month, but the fight to break the silence around issues relating to urology affecting both men and women of all ages continues.

A recent article in The Guardian dealt with an issue that is starting to get more exposure – bladder incontinence due to weak pelvic floor muscles.

Weak pelvic floors

Women who have given birth often experience trouble with incontinence due to the fact that their muscles are damaged during labour. There has been criticism by a number of mothers in the UK who feel that exercises to strengthen pelvic floor muscles are only given brief lip service after they have had a baby. They feel that the exercises are not explained in detail and that information is not given on why they are important or how to engage the pelvic floor muscles. Arguably, earlier steps taken to rebuild these muscles can help to avoids the development of longer term problems which lead to urinary tract infections (UTIs). For more information on UTIs, please see our earlier article here.

At Penningtons Manches, we have seen many cases where women have been referred for surgical procedures such as transvaginal tape surgery in order to treat incontinence issues which could have been dealt with much more conservatively at an earlier stage.

Electrical stimulation

The French healthcare system evidences the benefits of a preventative approach to treatment, and its strategy for dealing with this delicate topic was the subject of another recent article in The Guardian in which the author Gillian Harvey explained that, despite having four vaginal births, an episiotomy and a natural twin labour, she does not have any problems with her pelvic floor muscles. She attributes this to the fact that, after giving birth each time, she was referred to a French physiotherapist for 20 sessions of ‘pelvic floor re-education’. This involves doing exercises while a device inside the vagina measures the strength of contractions and stimulates the muscles through electrical pulses (in the manner of a Slendertone).

These treatments have been well received and while electrical stimulation can be prescribed by the NHS, referrals to ‘special continence centres’ are not routine. An estimated 50% of women do not seek treatment in the UK, and it would seem that the stigma surrounding this issue does not help. Clearly there are many benefits to breaking the silence on this commonly experienced problem.

Emma Beeson, an associate in the clinical negligence team who deals with a number of urogynaecological cases and represents women who have had surgery for incontinence problems, comments: “A number of my clients tell me that after they gave birth, all they remember about pelvic floor exercises was a quick reminder from the midwife to do them and occasionally they were given a leaflet. Many of them were never shown how to do the exercises and they have suffered for years with problems of incontinence which progressively became worse as the muscles weakened further. Some of them end up resorting to surgery as a means of treating their incontinence.

“The information about steps taken in France to tackle the issue of weak pelvic floor muscles soon after childbirth is really interesting. It causes me to question whether more should be done in the NHS to promote a ‘preventative approach’ to medicine rather than a reactive one. Women who experience persistent incontinence and later resort to incontinence surgery, such as the use of a transvaginal tape, will surely cost the NHS far more money as a result of the surgery they undergo and the complications that may follow this than physiotherapy after birth. There is also a great deal of discussion in the media at the moment about controversial incontinence surgery such as the use of transvaginal tapes and vaginal mesh. Perhaps the need to undergo such surgery could be avoided if all women in the UK, like women in France, were prescribed supervised pelvic floor physiotherapy after giving birth.”

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