Women most affected as bladder weakness takes toll on Kenyans

An array of diapers on display at a supermarket. People with incontinence are finding hope on tailor-made diapers.

When Anne Kasyoki left her teaching job due to failing health in 2007, she hit a dead end. Her financial capability having taken a beating, life edged closer to worse as she hastily sought money to visit top-notch hospitals.

Having suffered from a urine leakage condition associated with shame and stigma, she returned to her rural home in Eastern Province, hoping to find a solution.

A victim of bladder weakness, otherwise referred to as incontinence, she was stung by trauma and gave up on ever regaining her normal life.

A primary norm children go through in early life is how to control their bathroom calls but in some cases, it never works out and the result is usually occasional involuntary leakage of urine or continues wetting.

According to the Health ministry’s Kenya Service Provision Assessment Survey, identification, diagnosis and management of incontinence remains dismal. It is estimated incidents of women with urinary continence will increase by 55 per cent by 2050.

The Association for Continence, the world’s largest consumer advocacy organisation dedicated to public education and awareness about the causes, prevention, diagnosis, treatments and management, says the condition remains underreported and under-diagnosed but continues to disrupt the quality of life.

For Ann, the year 2008 came with hope calling. She was introduced to purpose-made absorbents that took care of her ‘weak brakes’. She regained her esteem and resumed her teaching job.

Jemimah Owigo, 62, pulled a surprise with an almost similar story. Her condition of bladder weakness was diagnosed in September last year. After beginning to use absorbent pads, her life bid goodbye to the embarrassment caused by leaking urine.

Many more patients with bladder weaknesses tell moving and life changing stories. In Kenya, bladder weakness is a taboo topic, usually associated with shame, depression, isolation and trauma. Caused mostly by pregnancy and childbirth, obesity, nerve damage and age, the condition affects at least 6 per cent of the Kenyan population, 75 per cent of whom are women. In men, one in nine experience bladder weakness, usually in relation to prostate issues.

A report released by the Family Medical Centre, US, warns that physicians should be aware that urinary incontinence could be a side effect of the therapies they administer on patients.

The report also says physicians should consider the possibility that patients with limited mobility (arthritis, stroke) or conditions associated with chronic cough (asthma) might be suffering from incontinence but are shy to make their condition known.

Doctors say at least 40 per cent of women have experienced bladder weakness in connection to pregnancy and childbirth, while 15 per cent have regular or daily bladder weakness.

Dr Boniface Muiru, an incontinence care educator and pharmacist, says low awareness levels have raised the spectre of apathy towards victims of bladder complications. But bladder weakness, he says, is by no means unusual.

“There are several causes including pregnancy, menopause and a weakening pelvic floor muscles. The amount of leakage varies but even a few drops are enough to cause worry and discomfort,” he says.

According to the World Health Organisation (WHO), bladder control problems affect more than 200 million people worldwide and profoundly hurts the quality of life of those who too often silently suffer from its life-disrupting consequences.

Bladder weakness is not a very sexy subject. The tendency is to not talk about it because of the embarrassment. Moreover, the tendency is not to talk about it with a doctor.

There is a popular fallacy that this condition is the domain of the elderly. About 2 million people have urinary incontinence. Most of these people (90 per cent) have light incontinence, and 3 in 4 are women. Most notably, 2 in 3 of these millions are under the age of 65.

This number shows that incontinence is not just a consequence of ageing, neither is it something people should put up with.  People with bladder weakness are often made to feel powerless and out of control due to their problem.

It convinces many to have a reclusive or increasingly isolated lifestyle, which gives rise to further feelings of being a victim. Considering that women often withdraw from sex as a consequence, within a marriage this can redouble the already distressing sense of isolation.

Research has shown that 15 per cent of victims feel uncomfortable to use public transportation while 10 per cent avoid going to the cinema, theater and concerts and a similar number cannot exercise as previously.

Ten per cent do not meet with friends as before and avoid walks while 20 per cent often or always refrain from intercourse because of the problem. It often leads to complete loss of confidence.

In Kenya, one man in 10 over the age of 30 experiences incontinence problems to varying degrees. The problem increases with age. At 60, about 5 per cent of men are incontinent and at 85 roughly 25 per cent. Many suffer in silence and don’t know they can eliminate the problem or at least alleviate the effects with simple measures.

The reasons for incontinence, like the amount of cases, are very widespread. Childbirth is extremely closely related to stress incontinence (when leakages happen when coughing, sneezing, laughing, lifting, or exercising.) Other forms of incontinence are urge, overflow, mixed, functional together with neurological bladder disorders.

Approximately, two out of three women experience incontinence after childbirth, and one in three of these have the condition permanently. Hysterectomy, accidents, and the menopause are other very frequent causes, according to doctors.

But some solution is beckoning in Kenya. Mega Importers Company, a local firm associated with SCA of Sweden, has started a process towards ending the trauma associated with bladder complications by creating awareness and telling victims that there is a solution. They do outreaches in hospitals, clinics, health centres and dispensaries to raise awareness of the condition and how it can be addressed.

Mega, headed by Dr Muiru, is promoting the use of Tena Lady, a product specifically tailored to keep victims dry. It is doing business by promoting the use of the tailor-made special absorbent pads in the region through distributors in its wide network.

Besides being sold in major supermarkets, marketer Caroline Oyugi says Mega Importers also supplies the Tena Lady absorbent pads for charity. The products include male pads, leakage protection pads that work like normal underwear, leakage protection for beds and ‘AiO’ protection with belt system meant for moderate to heavy incontinence.

Tena Lady, sold under the slogan ‘for enjoying life without worrying about leakage’, Oyugi says, eliminates possibilities of odour. It is laced with an odour neutraliser.

Experts say tailor-made absorbents play an important role in boosting confidence and allowing victims lead normal lives. They can be used in combination with treatment or where treatment has not been successful.

Treatment and management options include bladder retraining and can work in up to half of cases. It aims to slowly encourage the bladder to hold larger urine volumes and reduce the number of times one needs to urinate. Pelvic floor exercises are another option for victims besides medication, weight loss, surgery and use of tension-free vaginal tape.

Experts say those with the condition must not necessarily associate it with age and that they should seek help from doctors, nurses, continence advisors or physiotherapists.