It’s good to see the subject of Continence getting into the news more recently with several articles in the newspapers over the last few weeks. The Daily Mail today features the story of businesswoman Suzy Brain England.
“Suzy always tried to remain focused in meetings — but no matter how hard she concentrated on the agenda she always had one nagging concern: was she close enough to the door, and which excuse would she give if she had to leave the room quickly. She knew the chances of her having to dash out were high; Suzy had been suffering from stress incontinence for 20 years since the birth of her son Aidan, and the condition had been getting progressively worse.
But the 53-year-old from Kirklees, Bradford, reached the end of her tether when she suffered the deeply humiliating experience of getting caught short in meetings, and wetting herself while seated around the table. But like many of the five million women affected by bladder problems, Suzy was too embarrassed to discuss this with her friends — and certainly not her GP. She recalls: ‘Like many women with bladder problems it took me a long time to ask for help. I simply put up with it and accepted that if you have had a child then you should expect to have bladder problems in due course. ‘Over time there was a gradual deterioration, but it got to the point where it became unbearable. I picked up a bad cough last year and every time I coughed I wet myself.’ Suzy is chair of a number of public bodies (she received her OBE two years ago for public service) and a member of the Trust Board at the Mid Yorkshire Hospitals NHS Trust. But her busy job made her condition even more unbearable.
‘One day I was sitting in an important meeting in front of a number of senior businessmen when I started to cough. One minute I was fine, and the next I had wet myself. I knew straight away that I was soaking wet, but that no one would notice until I stood up. It was completely humiliating. I started to dread every meeting in case I coughed or sneezed. And there was absolutely nothing I could do to stop it happening. I started to routinely wear incontinence pads .’
‘Wherever I went I had to check where the nearest toilet was just in case I had to make my excuses and flee from the room. I knew I could not continue to work like this.’
People with urge incontinence feel an urgent desire to go to the lavatory and may leak if they do not get there in time, while stress incontinence causes urine to leak when there is extra pressure, such as when laughing, coughing or exercising.
It occurs because the pelvic floor muscles supporting the bladder have weakened and cannot cope with sudden stress. It is most common in women after childbirth.
Last May, Suzy finally went to see her male GP.
‘Strangely I wasn’t embarrassed about talking to him because I went in quite determined to get it sorted. Fortunately, he recognised that I needed help immediately, too. ‘My GP gave me two options. Basically, live with it and do pelvic floor exercises , or go for secondary care and have surgery. I wanted a permanent solution, so was referred to a urinary gynaecologist who recommended having a mesh tape fitted.’
Conventional surgery for this condition usually involves inserting a large tape into the pelvis. The surgeon inserts one end into the body, through the lower abdomen, and loops this around the tube that carries urine from the bladder to outside of the body, called the urethra.
They then pull this tape up and out of the body so the tape is a U-shape — similar to a hammock — that is holding the urethra in its cradle. The tape is inserted in and out of the lower abdomen, so it leaves two external scars. However, Suzy had a newer operation, called the Bard Ajust Trans-Vaginal Tape which uses a smaller tape. She had this procedure performed in July on the NHS by surgeon Phil Assassa, from Methley Park Hospital in Leeds, who is pioneering the technique.
Using a local anaesthetic he fitted a tape under her bladder to support it if she sneezes or coughs and prevent any leakage.
The tape, which is like a ribbon of gauze with buttons on each end, is put into place using keyhole surgery; once in place it is anchored into the muscle using the buttons. There were no external stitches and no scarring.
Suzy adds: ‘I was given a local anaesthetic, so I was awake throughout and was able to cough when asked to check that the tape was tight enough. I went in for the procedure at 12pm and was home by 6.30pm.’
Mr Assassa explains that while some women can be helped following simple treatments such as pelvic floor exercises, ‘there will always be those who require help from a specialist and this will sometimes mean surgery.
‘This latest technique is an improvement on previous types of surgery as it is much less invasive — it uses a 1cm internal incision and reduces the risk of complications and pain, and most people can go back to work after three days.’
Suzy, who had the procedure in September says: ‘When I cough or sneeze now I don’t need to look for the nearest loo. It’s great. I can carry on confidently with my job and feel much more comfortable.
‘When I went for my treatment some of my female friends — mostly professional women in their mid 40s and 50s — said: “Oh tell me if it works because I will be next in the queue.”
‘It seems a lot of women are suffering in silence and they don’t know how to get help.’