Shrouded in silence: Why women struggle for years with treatable urinary conditions

For years, 70-year-old Sita followed what seemed like a quirky practice at home. She would only cook standing on an absorbent but easily washable mat. What her family members didn’t realise, however, was the immense shame and embarrassment she experienced that led to this. 

Sita was experiencing a difficulty that seemed humiliating and without resolution – urinary incontinence. Whenever she cooked any foods that used strong masala powders, she would inevitably sneeze. And immediately, her bladder would empty itself. Then she would have to scramble to change and wash her clothes and the mat before the rest of her family discovered that the embarrassing incident had occurred.

When Sita walked into the office of Dr Vijayashree Saravanan, consultant urogynaecologist at Apollo Hospitals, Chennai, she had been living like this for years, under a cloud of anxiety and shame, simply because she did not even know that her condition could be treated medically. 

A shroud of silence and stigma

While Sita’s case may sound extreme, her situation is common to a large number of patients she regularly sees, says Dr Vijayashree. There is a heavy shroud of silence that surrounds intimate aspects of women’s health such as urinary health, leaving most women ashamed and misinformed about difficulties they may be facing. Though research studies have found that nearly one in three women experience urinary problems at some stage in their lives, specialists like Dr Vijayashree never see the majority of such women.

“I see so many patients who have been struggling with problems like incontinence for five or ten years before they finally arrive in my office,” says Dr Vijayashree. In particular, older women are often told that the urinary problems they experience are simply the result of aging. Because these conditions are so common, the doctor explains, they are often seen as inevitable aspects of the aging process about which nothing can be done. 

Instead of consulting a specialist, therefore, most women find ways to adapt to urinary problems. From problematically restricting fluid intake to wearing diapers to repeatedly visiting the toilet whenever they have opportunities, women with urinary problems develop a lot of techniques to survive what are embarrassing or shameful experiences for them. 

However, says Dr Vijayashree, most such cases are eminently treatable, and women can experience a dramatic improvement in the quality of their lives with treatment and guidance from medical professionals. 

Overactive bladder and incontinence

One of the most common conditions that Dr Vijayashree sees in her practice is of women having overactive bladders. An overactive bladder occurs when the muscles controlling the bladder become overactive, contracting in periods when they should be relaxed. This leads to frequent, intense urges to urinate, even when the bladder is not completely full. 

While overactive bladder can result from urinary tract infections or certain neurological causes, often the exact cause for this condition is not known. However, this condition is more common among women living with diabetes and those who have undergone menopause, explains Dr Vijayashree. Overactive bladder can also take different forms, with some women experiencing more episodes in the daytime, while others experience them more in the night. “Nighttime overactive bladder is more common among women who experience edemas (swelling in the legs due to fluid retention),” says the doctor. Though not in all cases, overactive bladder is a common cause for urinary incontinence. 

In most cases of overactive bladder, the condition can be improved through a change in habits and behaviours, as well as the use of medication to relax the muscles controlling the bladder, explains Dr Vijayashree.

Dr Vijayashree Saravanan, Consultant Urogynaecologist at Apollo Hospitals, Chennai

Stress incontinence

Another urinary condition commonly seen among is of stress urinary incontinence. In this case, incontinence occurs when women perform actions like coughing, sneezing, lifting things or exercising. Stress urinary incontinence occurs when the muscles meant to hold the bladder closed are not strong enough because of pelvic floor weakness following childbirth or menopause. 

This condition can often cause significant disturbances to a woman’s life, as episodes of urine leakage can occur suddenly and unpredictably, explains Dr Vijayashree. In particular, stress incontinence can have a significant impact on physical health because women may become too embarrassed or ashamed to exercise. 

One of the simplest and most effective ways of treating stress incontinence is through exercises to strengthen the pelvic floor, called kegel exercises. Kegel exercises are most effective when they are learned during pregnancy, and continued as a lifelong practice, says Dr Vijayashree. However, most women do not follow through on this. 

When practiced correctly, pelvic floor exercises are one of the best methods to treat incontinence. “But they have to be practiced for an extended period of time, for at least four weeks before they start to show any effect. So, many women start doing them for a week or two and then give up saying that they are not having any effect,” Dr Vijayashree explains. 

Voiding difficulties

A third set of conditions commonly faced by women is an inability to completely void the bladder of urine. This could occur because of an underactive bladder or narrowing or blockage of the urinary tract. 

In some cases, explains Dr Vijayashree, the bladder can become underactive because of a weakening of nerves with age or because of neurological conditions like a spinal infection. In others, the bladder sags into the vagina when the vaginal walls weaken. “This is called vaginal prolapse, and can the pathway for urine flow,” she explains. Finally, the urinary tract could become narrowed or become blocked because of stones or tumours. 

Besides the pain and discomfort that come with difficulties in urinating, such conditions can also lead women to develop UTIs. “And sometimes, if the bladder is under high pressure, the urine can backflow into the kidney causing kidney problems,” explains Dr Vijayashree. 

While such conditions are treated with medication and, in some cases, surgery, the most definitive treatment for them is for women to empty their bladders using a catheter, a process called intermittent self-catheterisation. 

Most urinary conditions that women struggle with, sometimes for several years, are eminently treatable or manageable, underscores Dr Vijayashree. It is only stigma, shame, and a lack of awareness that leaves women struggling for years with conditions that can be overcome. “Women with these conditions can really be helped, and the quality of their lives can be so dramatically improved. But, still there is resistance to getting such conditions treated,” she says. 

This article has been produced by TNM Brand Studio in association with Apollo Hospitals and not by TNM Editorial.