The Silent Struggle: The Ongoing Challenges in Women’s Urological Health

To explore these issues and help women get the help they need, we recently spoke with urology expert Mr Jeremy Ockrim. He sheds light on the most pressing problems and provides insights into potential solutions.

Stigma and Taboo

Political profiling plays a significant role in healthcare, influencing funding, research priorities, and public awareness. Conditions like cancer have a substantial political profile, leading to well-defined treatment guidelines, targets for patient care, and widespread media coverage. This high profile means robust advocacy and significant resources allocated for research and treatment.

Women’s urological issues lack such attention.

“Stigma and social taboos surrounding urological health issues prevent many women from seeking help,” Jeremy Ockrim observes. “Conditions like incontinence and prolapse are often seen as embarrassing, leading to social isolation and depression.

“One of the biggest challenges is the general lack of awareness and guidance surrounding urological health issues in women,” Mr Ockrim points out. “Many treatments are not yet widely recognised in general practice due to a lack of knowledge and guidance. The absence of governmental and media focus on women’s health issues, compared to diseases like Alzheimer’s or cancer, exacerbates this problem,” he adds.

There is clearly a critical need for patient champions, marketing campaigns, and government targets to build awareness and ensure effective treatment.

This pervasive stigma affects not only patients but also doctors, who may not be fully aware of the treatment options available. This in turn means that both patients and general practitioners frequently lack knowledge about available treatments, contributing to underdiagnosis and undertreatment. And so people don’t come forward to seek treatment.”

For instance, a survey conducted by the British Journal of General Practice found that over 60% of women with incontinence delayed seeking help for more than a year, and 50% of general practitioners felt they lacked sufficient knowledge to manage these conditions effectively. In a separate study, the National Association for Continence reported that: “Studies on why women do not seek treatment for incontinence have identified potential reasons, such as embarrassment, viewing it as a normal part of ageing, feeling that they can cope on their own, and having low expectations of benefit from treatment.”

This highlights the urgent need for increased education and awareness to break down these stigmas and ensure women receive the care they need.

Conditions

Menopause

Menopause significantly impacts women’s urological health. The decline in oestrogen levels can lead to a range of issues, including vaginal atrophy, cystitis symptoms and recurrent urinary infections, sexual dysfunction, and prolapse. These symptoms are called genitourinary syndrome of menopause (GSM).

“Despite recent media attention, thanks in part to advocates like Davina McCall, there is still a significant gap in awareness and understanding.”

In 2021, McCall released a groundbreaking Channel 4 documentary, “Davina McCall: Sex, Myths and the Menopause,” which played a pivotal role in changing the conversation about menopause in the UK. The documentary addressed common misconceptions and challenged the lack of menopause training among healthcare providers. This program was widely acclaimed and helped to shine a light on the real issues women face during menopause, including the benefits and risks of hormone replacement therapy (HRT)​

Read: Your guide to the menopause

Prolapse

Approximately 40% of women over the age of 50 experience some form of prolapse, making it a significant health concern.

Jeremy Ockrim explains that prolapse – a condition where pelvic organs descend into the vaginal canal – is another condition that lacks the political and media attention it deserves. Unlike cancer, which has well-defined treatment protocols and targets, prolapse suffers from a lack of guidelines and awareness. However, this condition can be well treated by a combination of pelvic floor training (physiotherapy), pessary inserts and if necessary a number of different surgical procedures.

Incontinence

This condition is particularly prevalent among women, with around 7 million women experiencing urinary incontinence.

“Incontinence remains a major challenge because it’s so often accompanied by social stigma and embarrassment,” Mr Ockrim points out. “Many women suffer in silence, unaware of the treatments available. Incontinence can severely impact quality of life, leading to isolation and depression. Raising awareness and providing clear guidance on treatment options are essential steps toward improving outcomes for women suffering from this condition.”

READ: Urinary incontinence: 5 ways you may be making your symptoms worse

Other urological conditions that women suffer from

Women in the UK suffer from a variety of urological conditions, each with significant prevalence rates. The statistics below highlight the widespread nature of urological conditions among women in the UK, underscoring the need for better awareness, treatment options, and support systems.

• Urinary incontinence: 7 million women in the UK
• Pelvic organ prolapse: 40% of women over 50
• Urinary tract infections (UTIs): Up to 60% lifetime prevalence among women. READ: How to Prevent UTI: Causes, symptoms, treatment
• Overactive bladder (OAB): 12-17% of women, particularly over 40
• Interstitial cystitis (IC/BPS): 3-6% of women
• Faecal incontinence: 10-15% of women
• Urethral syndrome: Common but unspecified prevalence
• Urinary fistulae (leak) following urogynaecology surgery is rare but has a huge impact on patients affected.

READ: A Guide to Common Urological Conditions

Latest treatments

Recent advancements in the treatment of women’s urological health conditions have introduced several innovative options, offering new hope and improved outcomes.

Vaginal hormones

“Infections are a common and recurrent issue for many women,” Mr Ockrim explains. The latest advancements in treatment involve the use of vaginal hormones, DHEA applications and ospemifine, which have shown promise in reducing the frequency and severity of UTIs and improving sexual health”. Despite their effectiveness, there is also a lot of stigma associated with hormone treatment, particularly around concerns related to breast and uterine cancer. However, vaginal hormones have minimal systemic absorption, making them safe for a wide range of women, including those with a history of cancer.”

Bulking injections, autologous slings, colposuspension and minimally invasive surgery for incontinence and prolapse

Mesh implants have been suspended in the UK since 2020 due to the increasing awareness of complications that can occur in a small number of women. Mr Ockrim explains that ‘specialist mesh centres and surgeons are now designated to treat women who have had complications of mesh implants’

As such, the number of women coming forward for treatment of incontinence has substantially decreased.

However, there are excellent alternatives available, many of which can be offered via minimally invasive techniques. Mr Ockrim explains the importance of being referred to specialists who can offer all techniques and mesh removal if appropriate so that women can have a full assessment, informed discussions of the pros and cons of all the options and follow a joint decision-making process to decide the best option for them as individuals.

Treatments for overactive bladder

Overactive bladder affects up to a third of women as they age. For many years the only options have been drug therapies with modest efficacy, and side effect profiles that have increasingly been recognised as important issues for patient choice

More advanced treatments are now possible including

• Botulinum toxin injections
  • Botulinum toxin (Botox) injections have been used to treat overactive bladder by relaxing the bladder muscles. Recent studies have confirmed its effectiveness in reducing urinary urgency and frequency.
• Percutaneous tibial nerve stimulation
  • is electroacupuncture along the tibial nerve (at the ankle) which is a minimally invasive technique for alleviating some symptoms
• Sacral Neuromodulation therapy
  • Neuromodulation involves electrical stimulation of nerves to improve bladder function, particularly for patients with overactive bladder or women with voiding difficulties

Moving forward

To address these challenges, Jeremy Ockrim recommends a multifaceted approach. “Increasing awareness through patient-led campaigns, improving education for healthcare providers, and advocating for governmental support are essential steps,” he says. With 50% of the population experiencing menopause, incontinence and prolapse it is essential to shine a spotlight on these issues. By doing so, we can ensure that women receive the attention, treatment, and support they need to maintain their urological health.”

8 ways to improve healthcare access and quality for women with urological issues

1. Develop comprehensive national guidelines
   Establish clear, evidence-based national guidelines for the diagnosis and treatment of women’s urological conditions. This should include setting targets for timely diagnosis and treatment, similar to those for cancer care.
2. Increase funding for research
   Allocate more resources to research focused on women’s urological health. This should include funding for clinical trials, development of new treatments, and studies on the long-term impact of urological conditions.
3. Enhance GP training and education
   Integrate comprehensive training on women’s urological health into medical education and ongoing professional development for GPs. This will improve diagnosis and treatment rates at the primary care level.
4. Launch public awareness campaigns
   Implement national public awareness campaigns to reduce stigma and increase awareness about urological health issues. Campaigns should focus on educating women about the symptoms and encouraging them to seek medical advice.
5. Improve access to specialist care
   Increase the number of specialists in urological health and ensure equitable access to care across all regions. This could involve telemedicine services to reach underserved areas.
6. Create support networks and resources
   Establish support networks for women with urological conditions, providing resources such as patient education materials, self-care tools, and access to support groups.
7. Government and healthcare collaboration
   Encourage collaboration between government bodies, healthcare providers, and patient advocacy groups to develop and implement policies that prioritise women’s urological health.
8. Regular policy reviews and updates
   Conduct regular reviews of existing policies and make necessary updates based on the latest research and clinical guidelines. This ensures that policies remain relevant and effective in addressing current challenges.

Find out more about urology at King Edward VII’s Hospital