Swansea psychologists give confidence boost to women seeking help for incontinence

Psychologists at Swansea University have been working with Swansea’s Singleton Hospital to develop therapy that is helping to give women the confidence to seek help for incontinence.

Phil ReedThe therapy is detailed in a new paper co-authored by psychologists including Swansea University’s Professor Phil Reed (pictured) and Dr Lisa A Osborne, a research psychologist specialising in Women’s Health Physiotherapy at Singleton Hospital.   .

Professor Phil Reed said: “Incontinence is a significant issue affecting around 25% of women in the UK, and up to 50-60% of those who have experienced childbirth or who are over 60.

“Though common, the problem is rarely discussed, but can be debilitating, as well as being associated with NHS costs estimated at £1.8bn per year.” 

Women’s Health Physiotherapy can provide effective and safe treatment for a relatively low public cost.  However, research based at Swansea’s Singleton Hospital and Swansea University has shown that physiotherapy outcomes can be affected by patients’ mental states – not surprisingly, many women experiencing continence problems are anxious and depressed. 

Professor Reed said: “The recommended first-line treatment for incontinence is pelvic floor muscle training (PFMT), which is effective, acceptable to patients, and cost-effective.  However, PFMT outcomes are mediated by the patient’s depression, anxiety, motivation, and health values.

“Without recognising these psychological aspects of the patient, and helping patients to overcome these as barriers to treatment, getting the patient to engage with her treatment may be very difficult.

“Our research shows that supporting women psychologically during pelvic floor muscle training makes them more likely to attend for treatment, stay for the full course of treatment, and improves their continence.” 

The new paper entitled “Randomized control trial of a values-based motivational interview support to promote attendance at pelvic floor muscle training physiotherapy treatment” examined whether provision of motivational interview support for moderately depressed and/or anxious patients would improve attendance at PFMT group sessions.

In total, 67 female patients who were referred for PFMT were screened for signs of depression and anxiety, and 31 were identified as having moderate levels of both conditions. 

The average age of the women was 50 years and they suffered from a variety of pelvic floor problems, such as bladder and/or bowel dysfunctions, and prolapse. 

The participants were randomly divided into two groups: one group received PFMT treatment as usual and the second group received PFMT plus motivational support. The patients then received one session of outpatient physiotherapy treatment each month for six months. 

Those in the PFMT plus motivational support group received three, thirty-minute group sessions of psychological support after PFMT sessions two, three, and four, which involved focusing on their motivation and health values.

Professor Reed said: “We found that significantly more patients (approximately twice as many) in the group receiving motivational support completed the course, compared to those receiving just physiotherapy.

“These results suggest that psychological support during PFMT may help some patients by enhancing their motivation to attend sessions and their treatment compliance.” 

Professor Reed concluded: “Incontinence has a profound influence on the wellbeing and quality of life of its sufferers, and addressing the issue is vital. Working closely with Singleton Hospital, which is conducting extensive work on the topic and has a specialist multi-disciplinary team to help women with incontinence, we hope to continue researching and developing ways to tackle this very common problem.” 

The Swansea University team will shortly launch a website detailing the research and hopes that World Continence Week this month will help to promote awareness of this issue.

Swansea University is a partner in the HealthWise Wales initiative, a confidential research study that will help the NHS in Wales plan for the future.  If you are over 16 and live in Wales, we need your help. Whether you’re young or old, fit or unwell, by registering online you will be asked to answer simple questions about your health and lifestyle every six months. This is your opportunity to be part of shaping the health and well being of future generations in Wales.  This project is led by Cardiff University, in partnership with Swansea University and funded by the Welsh Government.