Urinary incontinence

Urinary incontinence is when you pass or leak urine without control. It may be constant, occasional, heavy or light. There are many different causes of incontinence. It can lead to a lack of confidence, feelings of helplessness, can destroy self-esteem and even become an overwhelming force controlling the lives of women. In order understand the problem, we need to know how the urinary system operates, and the muscles involved in bladder control.

How the bladder works

We have two kidneys that produce urine. They send the urine down a tube (the ureter) to the bladder, which keeps the urine until full when we have an urge to pass urine (to micturate). When we want to pass urine we relax the muscle holding the bladder neck in place (urethral sphincter) and contract the bladder to empty the urine through the urethra (tube to the outside). For the bladder to work properly the sensors that tell us the bladder is empty or full must work properly, the sphincter that holds the urine in must work properly, and the nerves that communicate with the brain and spinal cord must work properly.

Female reproductive organs

When the bladder leaks

When you leak urine when you do not expect or want to, the circumstances surrounding the leak will often gives us a clue as to why. For instance if you leak urine when you laugh, run or cough it is likely that you are suffering from a weak bladder neck (the stress of moving causes you to leak – stress incontinence). On the other hand if you have an urge to pass urine but leak before you get to the toilet, it is likely that the nerve signals are sending you the wrong signals, making you rush when you don’t have to (urgency).

If you suffer from incontinence do go and speak to your doctor and seek help. You may find it embarrassing to talk about your problem, but remember it is such a common problem and so much can be done to help you.

Vaginal discharge

It can be quite normal for a woman to have a discharge. It is usually clear, white or slightly yellow. It should not be offensive or irritating. The amount of discharge can vary and often increases after a woman has had a baby.

The vagina, just like the skin and bowel, has lots of friendly bugs (bacteria) that help us everyday of our lives. If the environment in the vagina changes (e.g. sex, change in diet, long periods sitting down, pregnancy, menopause, taking hormones) the friendly yeast or bacteria can overgrow and become a nuisance. If a discharge becomes foul smelling, discoloured or irritating it is usually simply an overgrowth of the friendly yeast or bacteria that normally live in the vagina in very small amounts. So while the discharge naturally causes concern, it is usually nothing to worry about. Your doctor can take a swab and treat with a local cream or tablet.

A breast lump

Breast tenderness is a common complaint amongst women, especially during their fertile years. Fortunately the majority of women with breast tenderness have no underlying pathology, e.g. cancer and the changes reflect changes in the body brought about by hormone and other changes in the menstrual cycle, or indeed pregnancy. Similarly a tender breast lump is often a cyst or a benign fibroadenoma. A painless lump is always a cause for concern If you experience any breast changes which cause you concern we can have you investigated promptly and arrange any treatment if required.

Weight and skin changes

Diet and Exercise – the key to maintaining your desired weight.

Nothing terrifies a woman more than the feeling she cannot control her weight. The fact that a woman’s weight often fluctuates through her menstrual cycle can also lead to a feeling of uncertainty as to what foods and habits are causing actual ‘fat’ weight gain as opposed to a temporary ‘fluid’ weight gain. Also muscle is heavier than fat so a lot of exercise can result in a better looking, healthier woman whose weight remains the same. Some women are able to control their weight more easily than others and of course a small percentage of teenagers become disturbingly and unhealthily anorectic because of fears over their appearance.

There are some basic rules which no amount of slimming books and tablets can get away from. Your weight (assuming your body is working normally) reflects the number of calories you eat over the amount of activity and exercise you undertake. Foods do vary in their nutritional value, their calorie count and the level of fullness they provide, which is the key to eating to control or lose weight.

If you try to lose weight by being hungry you will usually end up gaining pounds in the long run (the yo-yo effect), as you scare your body into starvation mode. We are programmed to store fat as in ancient times we did not always get to eat every day. If you starve your body to lose weight and then eat again, your body will immediately store fat in readiness for the next time you starve again. So for instance who skip breakfast are 400% more likely to be overweight, as they train their bodies to store fat.

Exercise

Exercise does not have to be going to a gym every day, but it does involve being active on a daily basis. This can mean some house cleaning, swimming or a good hour or two gardening, or perhaps wearing trainers and walking home briskly from the train station or office rather than taking a bus. Exercise is important for two reasons: you burn calories and if you are active your body handles food differently, preparing some of the food eaten today for the anticipated activity the following day.

Diet

It is vital that you do not scare your body by starving, but it is not essential to be ‘stuffed’ with food every time you eat. As a simple rule the ‘meat (including other sources of protein such as eggs, cheese, lentils) fruit and vegetable’ approach provides you with all the nutrients you need for everyday life. Protein (usually contains some fat: we need some for its nutritional needs) tends to fill us up for longer, which is the basic principle surrounding ‘low carb’ diet. While fruit and vegetables (and other sources of complex carbohydrates e.g. whole grain foods and non processed ‘carbs’) are dreaded ‘carbohydrates’ most are good complex carbohydrates, which means they are absorbed more slowly (a good thing unless you are undergoing exercise) than ‘bad’ carbs, such as pure sugar and processed/fast foods.

Low glycaemic index foods (complex carbs) are another way of looking at good and bad carbs. For instance an apple is healthy but apple juice is only good for you in small amounts, as it is processed with most of the fibre removed. A ‘smoothie’ with no additives, just fruit and its fibre, is better that pure juice. Oats (broken down more slowly) are generally better than wheat (interestingly wheat and dairy are the most commonly causes of food ‘allergy’ or unpleasant side effects such as bloating or insomnia).

So it is important to eat when you are hungry but avoid too many carbs or processed or ‘fast’ foods, in particular processed or high energy carbs, unless you are very physically active. Porridge, a smoothie, omelette are good examples of breakfast foods that will get you off to a good start to the day. A salad with as much protein (but no bread) as you need to feel full for lunch, while in the evening meat (or other protein) and vegetables (only use potatoes, rice and wheat products in proportion to how physically active you are: not very active then avoid or use sparingly), with fruit for dessert. Good chocolate (high cocoa and lower sugar content) has lots of health benefits but do not overdo it! Wine has ‘empty’ calories so should not be avoided but remembered when looking at the overall amount of calories in the meal. Up to 2 units a day has a lot health benefits but too much alcohol can damage your liver and have unpleasant side effects.

At the end of each week/month it is also important to have had a little of everything you like, otherwise you will give up and go back to bad ways!