Esmeralda Schukala’s story is one of pain, fear and embarrassment.
Since she was a little girl, this 58-year-old woman from Gauteng has been suffering from stress incontinence – a condition that causes involuntary loss of urine, usually when she coughs, laughs, sneezes or does any other activity that places stress on the abdomen.
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“It’s really a terrible thing from which to suffer,” admits Esmeralda. Apart from the chronic pain and discomfort in the bladder, it also interferes with her quality of life on a mental, social and even sexual level.
“It really affects every part of my life,” she says. “I was always anxious about it, worrying that someone might see or smell something. I didn’t want to go out of the house and I even shied away from intimate situations because I was afraid (there would be an accident). Mentally it affected me so badly that it actually changes your personality. I was very anti-social, irritable and tired.”
Esmeralda notes that she never felt “fresh”. As she could never empty out her bladder completely, urine leaked onto her clothes. She even had to change her clothes every few hours so nobody would notice an embarrassing stain or smell.
A lifetime of surgery
In search of a solution to this inconvenient condition, Esmeralda has been in and out of the operating theatre all her life.
Over the years she’s undergone five operations to relieve the incontinence: some to stretch the opening of the urethra (the tube that transports urine from the bladder to the urinary opening), others to lift the bladder, and some to lift the weight of other organs from the bladder.
The latest operation, which was done just last month, involved the insertion of a trans-vaginal tape (TVT) that restores the normal position of the urethra by placing a "sling" or mesh tape beneath it.
“I feel like a new person,” says Esmeralda. Within two weeks she was already benefiting from the operation. “I can go out for three to four hours before I need to go to the loo,” she says. “I’m not frightened anymore. I’m back on the social scene, I can go shopping or visit the gym, and I’ve even been horse riding.”
Why does it happen?
Urinary incontinence, which affects 8% of females and 3% of males, occurs for a variety of reasons.
Women are more prone to the condition, because the female urethra is short and the continence mechanism is not as well developed as in the male. Multiple childbirths stretch and weaken the support of the bladder and urethra, and menopause sometimes weakens the vagina and urethra, which impairs the “closing” function of the urethra.
Other factors that may contribute to urinary incontinence include:
prostatic hyperplasia;
trauma, surgery or radiation to the pelvis;
tuberculosis of the urinary tract;
stroke;
dementia; and
spinal cord injury.
Types of urinary incontinence
There are four different types of urinary incontinence:
1. Stress incontinence, which occurs when urine leaks from the bladder when you cough, laugh, sneeze or do any other activity that places stress on the abdomen.
2. Urge incontinence – the leakage of urine associated with a great urgency or desire to urinate, which cannot be suppressed. For example, it kicks in when (even if you’ve been fine up until that moment) you get close to a toilet and suddenly find you can’t make it all the way.
3. Overflow incontinence happens when someone has difficulty passing urine, which causes the bladder to be permanently full. As the kidneys continue to produce urine, the excess spills out through the urethra – almost like a dam that’s overflowing.
4. Total incontinence is the continuous leakage of all the urine. It’s most often caused by an abnormal communication between the bladder and the vagina (called vesicovaginal fistula).
What’s the solution?
Fortunately, there’s a lot that can be done.
“For decades, thousands of women have quietly dealt with what they believed to be incurable ailments, but they don’t have to be silent anymore,” says Lizelle Grindell from the Biofeedback Clinic at the Sunninghill Netcare Hospital in Johannesburg.
Various tests, as well as surgical and non-surgical treatment options, are available.
The Biofeedback Clinic specialises in pelvic muscle rehabilitation, assisted by biofeedback and behavioural therapies.
“These treatments are very effective for a variety of bowel and bladder disorders and chronic pain syndromes,” says Grindell. Studies have shown that pelvic muscle exercises, relaxation training, electric stimulation and bladder training are effective in 85% of patients, she claims.
The first, and probably the most difficult step, is to acknowledge the condition and to speak to your GP about it – this is essential in seeking referral to a specialist centre.
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