Sally Jenkins* always thought that incontinence was a problem of the elderly.
That is until she started suffering from urinary incontinence after childbirth, around the age of 40. An active working mother of one, Jenkins’ day-to-day life was soon consumed by the concern of having a washroom close by. “My work involves long meetings, and I would often worry about whether the meeting would end in time for me to get to a bathroom,” she says. “Then I dreaded the walk back to the office when a laugh or sneeze might bring about disastrous consequences!”
Mount Sinai Hospital’s Division of Urogynaecology, led by Dr. Harold Drutz, provides care to more than 5,000 women a year with similar pelvic problems as Jenkins, as well as the associated fear and anxiety. “Pelvic floor problems are issues with a woman’s bladder, genital tract, bowel or even prolapse, a condition where internal organs fall down,” says Dr. Drutz, a urogynaecologist at Mount Sinai since 1976 and Professor and Head of the Division of Urogynaecology at the University of Toronto. Dr. Drutz and his team, Drs. Danny Lovatsis, May Alarab and William Easton, have dedicated their teaching, research and care to helping women with pelvic problems find comfort and relief beyond surgical methods.
The two most common causes of pelvic floor problems are vaginal delivery and aging. Dr. Drutz says labour can result in a number of issues, including urinary/fecal incontinence, retention — when the patient has difficulty emptying the bladder — or prolapse. Urinary incontinence can occur when sneezing, laughing, lifting something heavy, or during intercourse. According to Dr. Drutz, 30 per cent of women who experience urinary incontinence, also experience some degree of fecal incontinence.
“Socially, this is a very embarrassing issue, but it’s highly prevalent,” explains Dr. Drutz. He says research shows that as they age, between 30 to 50 per cent of women will experience pelvic conditions. In fact, among women, urinary incontinence has become the most common cause of admission into long-term-care centres.
Dr. Drutz notes that women of any age can face pelvic floor issues. “The average age of patients we see at Mount Sinai is women in their fifties, but pelvic problems are not confined to only these women. We see patients ranging from their teens all the way up to 100 years old,” says Dr. Drutz. The Mount Sinai Urogynaecology Department also runs a clinic at the Baycrest Centre for Geriatric Care, where 85 per cent of the patients are female.
“The big difference today is that women are living longer,” says Dr. Drutz. “A hundred years ago, the average life expectancy for a female in Canada was only 45 years, so all these post-menopausal issues were not as significant to health care, but today, the average woman lives into her eighties.”
There are a number of factors that increase the likelihood of pelvic problems. Weight, caffeine and alcohol consumption as well as dietary factors can all aggravate pelvic issues and hinder the healing process. A poor diet can result in constipation and contribute to further problems. For overweight patients, Dr. Drutz’s first suggestion is to lose weight.
The good news is there are a number of non-invasive treatments for pelvic problems that don’t involve surgery. “Pelvic floor exercises really do help strengthen the muscles of the pelvic floor and help cure pelvic problems; plus, there are many drugs available to help with overactive bladders causing incontinence,” says Dr. Drutz.
Women can also take comfort in the fact that the majority of pelvic problems can be addressed with some simple lifestyle changes. For example, since caffeine is a bladder irritant, reducing the consumption of coffee and other caffeinated beverages can help alleviate pelvic problems.
Jenkins, an avid runner, says she tried everything she could to resume her active lifestyle. Her 10-kilometre running career was cut short when she discovered there was no product on the market that would hold 10-kilometres worth of leaked urine. However, through the treatment and support Jenkins’ is receiving from Dr. Drutz and his staff, she is working towards running again soon. “Dr. Drutz and his team are fabulous. They reassured me, first, that I am not alone and second, that I do not have to live with this. Dr. Drutz moved cautiously through alternatives starting with Kegel exercises, medication and finally when all else failed – surgery,” says Jenkins.
Dr. Drutz uses surgery as a last resort, especially if the patient plans to have children. “We rarely operate on patients until they have finished their child bearing,” he explains.
Dr. Drutz believes the future of women who suffer from pelvic floor disorders is looking much brighter. He is involved in research on the genetics of pelvic floor prolapse, with Dr. May Alarab, the newest addition to the Urogynaecology team at Mount Sinai. “We know that women with certain connective tissue disorders such as Marfan’s Disease or Elos Danalos Syndrome, have a higher incidence of pelvic floor problems,” says Dr. Drutz. “We have been looking at the vaginal tissue in pre-menopausal women. There may be genes that we can identify so that eventually, we will be able to do simple tests to see if they are more at risk of pelvic floor problems.”
* Sally Jenkins is a pseudonym.