Guest post: Stress incontinence - 'Fallen fanjos are a feminist issue'
Did you know that one in three women aged 35-55 wet themselves? Stress incontinence is very common, and yet we're often too embarrassed to talk about it. Physiotherapist Elaine Miller (AKA gussiegrips) is determined to remove the taboo and encourage all women to do their pelvic floor exercises. In this guest post, she explains why it matters.
Posted on: Wed 21-May-14 10:55:17
(259 comments )
Doorstep piddling wasn't unusual for me - you know how you're okay right up until you get the key in your lock? Well, my poor neighbour caught me as I was wresting small kids and shopping with a post-coffee-bladder. She chatted away as I tried to disguise that I was bursting (standing on your tip toes works by the way, for a time).
Our relationship was mostly based on exchanging gardening tips and accepting parcels for each other. So, washing her down the driveway in a giant tsunami of my steaming piss was a bit, y'know, socially awkward.
And I had no excuse. I knew exactly what pelvic floor exercises were, how to do them, and why I should bother because <hangs head in shame> I'm a physiotherapist.
No excuse, but, there was a good reason – I was awfully tired. I lived with hundreds of tiny kids who were always trying to maim themselves, and each other, in ever-more inventive ways. I could barely remember my children's names, let alone remember to clench my nether regions.
But the great Dribbly Doorstep Disaster was the motivation I needed.
"Make it a habit" is the advice, so, I did them every time I shouted at my kids' (effective), every time I craved a glass of wine (remarkably effective) and every single time I thought an evil thought about my husband (dry in three months).
Here's the sciencey bit:
One in three women aged 35-55 wet themselves, and, about 50% of women over 55.
70-80% of stress incontinence can be cured with pelvic floor exercises within four months.
Read that again. At least a THIRD of your peers use pads, and MOST of them can be cured.
The exercises are cheap to teach, free to do and don't have any side effects. Unless you count toe curling, panting, blaspheming orgasms as a side effect (ask me how I know).
And it bloody MATTERS. Incontinence quietly disempowers women by interfering with every single thing they do, and yet, few complain. It matters because wetting yourself in the front row of Zumba, means you are unlikely to go back to Zumba (again, erm, ask me how I know), and we know that diseases of inactivity kill people. It matters because being "a bit leaky" is a big deal that can have a huge impact on your long-term well-being.
It bloody MATTERS. Incontinence quietly disempowers women by interfering with every single thing they do, and yet, few complain. It matters because wetting yourself in the front row of Zumba, means you are unlikely to go back to Zumba (ask me how I know), and we know that diseases of inactivity kill people.
We silence ourselves. It’s as if we are so ashamed of having less bladder control than our toddler that we'd rather continue to suffer in silence than seek help. I suggest we try being angry and vocal instead, because that’s how taboos change.
Even more silent are the one in ten people who leak poo, or the 50% of women over the age of 50 who have vaginal prolapses. Some wait until they are practically dragging their cervix behind them before seeking help.
It's common to be a bit disengaged with your "down below" because, well, you can't see it. We know that many women find the exercises difficult to do correctly, and that energetic eyebrow wiggling is not an effective alternative.
So, set the scene: You're in a tiny lift with your boss, your MIL and someone you've got a massive crush on. Imagine you can feel a fart brewing. A really nasty one. You know that bum-ole squeezing you do to hold in the mortifying toot? That's you working your pelvic floor. Hold it for a count of 10. When you let go you should feel a "drop" down into your pants. Or you could do 10 quick flicks and relaxes in a row - try doing them in time to the beat of music.
The important thing is to keep breathing and to relax your muscles in between the exercises. Do these three times a day, every day for four months, and then, once a day, every day, until you die. If you get pain, stop and take your bits to a GP or pelvic physio.
And, I'll even remind you via twitter - when I tweet, you twitch your twinkle. Midwives and physios are collaborating with #squeezeandlift. If you see it, do it!
Basic lifestyle changes – like reducing caffeine, citrus and alcohol (so, at least cut out the 'slice' from your rum and coke), controlling hayfever or asthma coughs and (even small amounts of) weight loss can make a huge difference to the amount of leaking you experience.
As with all things, the best place to start is with good information – there are brilliant blogs out there, like Evidently Cochrane, and lots of useful stuff from the CSP and the Bladder and Bowel Foundation. Or, you could even watch me, on a really bad hair day, doing stand-up comedy about pelvic floors.
The bottom line is that any leaking at all is abnormal. It is not an inevitable consequence of ageing or parenthood, and you don't need to put up with it.
Watch Elaine's alter ego Gussie Grips take the Edinburgh Festival by storm over on the Mumsnet YouTube channel - and don't forget to subscribe - lots more brilliant videos coming very soon.
By Elaine Miller
Hi all your ladies I am 65 yrs old with two adult children, both were quite large children and my first was a forceps delivery. I now find myself with a quite bad continence problem. I did see my GP who referred me to a specialist pysio, but after six months of doing PF exercises I did not have any improvement so I stopped going. I have tried electronic stimulators but they seemed to make me worse, I continue to do manual PF exercises but do not seem to get any better and wear a pad most days. have any of you had the vaginal tape repair and how did it work for you, answers appreciated please many thanks
Message deleted by MNHQ. Here's a link to our Talk Guidelines.
Message deleted by MNHQ. Here's a link to our Talk Guidelines.
I realise that I may be too late to this discussion?
I was wondering if you had come across urinary incontinence caused by adhesions/ soft tissue issues (rather than pelvic floor weakness). A few people (e.g. cranio-sacral osteopath) have mentioned this to me, so I am keen to canvas other thoughts on this.
It's, I am familiar with the article, and I respect Kathryn bowman. But, I disagree with many of her assertions. The sacrum simply doesn,t move as she says. The pelvis is a fixed structure, there,s a few mms of movement at best. And, the pf is a dynamic structure that rises nod falls as you breathe and move. I do agree with her saying keels aren't,t the whole answer, but, neither are squats. Indeed, if you have a prolapse and start doing deep squats you,re risking worsening the prolapse. Any one size fits all approach is going to be flawed. There is no substitution for assessment, and that goes for my rumblings too! So, yep, she,s got some good points, but I,d caution against squatting and doing nothing else. Training is specific, if you want a pf that coordinates itself and resists the forces you subject it to, well, squatting isn,t going to mimic that at all. Sorry for the typos, a, away from computer and on bloke,s stupid I pad.
And follow up post to link above...
Interesting blog post for you Gussie - to me makes perfect sense but I am not a physio.
Basically says that pelvic floor issues are a function of poor posture and tucking pelvis (caused by high heels/tight muscles etc) and that to fix maintain PF we should do squats and not kegels (as doing kegels weakens PF)
I would be really interested to hear your take on this article/post.
Gussiegrips, I'm not sure of the specifics of when they will pay. Just that when I called they asked if it was pregnancy related and when I said yes (as I was referred at my post natal 6 week check) they refused to pay as my policy doesn't cover pregnancy or related issues. Seems a bit Horst sighted to me....
Synchronised Squishing it is.
Do come and say "hi" if you come along. I'm always a wee bit surprised that there are real people behind the screen, gives mea wee warm and fuzzy.
Yup, I'll be there! Boggles at audience participation - synchronised squishing?
Sorry, it's all, I didnt' answer your question.
Pelvic floor problems have probably been around since bipedal walking came into vogue. Gravity just doesn't suit our pelvises, and, mammals who walk on 4 legs get prolapse related to pregnancy/birth, but, not just having the whole shebang fall out.
Mary O'Dwyer calls it your "pelvic flaw". it's just not very well designed.
it's all good question.
The truthful answer is, we dont' know. There's not enough research looking at the incidence here as compared with the developing world, or, here before the reduction in physical activity with the increase in labour saving gadgets.
Certainly, obesity is a major cause of stress incontinence. And, so, it's a reasonable assumption that people in developing worlds have less incontinence. They are more likely to have lower BMI, to be physically active, to move more and to squat to sit. But, they also have less maternity care - so, you know, have to put up with things like this:
freedom from fistula youtube
freedom from fistula website
Which is why this stuff matters. It's awful for a woman in the West to live with incontinence - but, I'd not swap for a woman in the Developing World's chances.
The people who run these charities are saints. FFF is a UK based charity, there's a number around. The Hamlin Foundation has a Nobel Nominee at the helm. Saints.
Helen I did not know that. So, they'll pay if it's post-op but not to prevent surgery?
Curious, I'll ask about that.
Little Miss I am!
Just a short run, am needing to develop some "audience participation" (no show and tell, it'll be written feedback that I read out. No one likes being picked on, particularly in a show about wetting yourself!)
2-12 August, 1940 daily, venue 430, The George Next Door, 9 George IV Bridge, free non-ticketed, part of the Free Fringe so it'll be in their fliers - missed the Big Book.
You goannie come along?
Hope so, it's a bit embarrassing being on your own during the Fringe. Or at least, so I hear...arf.
So have women always had this issue or is it a modern thing brought on by not squatting and sitting for long periods?
How do the stats compare with eg developing countries?
It would help if private healthcare providers would support female physio. I have just been referred but BUPA won't pay as it's pregnancy related. So 3 months (or more) of waiting to be seen by the NHS. And yet if you sprain your knee whilst ski-ing, your healthcare will pay.
Is GussieGrips doing the Fringe again this year? I missed last year and couldn't see you in this year's programme...?
I totally missed your post, Janela, am sorry.
Delighted your symptoms are improving, and yep, TALK about it!
Here's a thing published today on Evidently Cochrane, erm, by me. Cochrane Review's usually quite a sober organisation, so, I'm delighted to have been allowed to have a wee go. It's about the evidence behind what the advice is, and, there's not much evidence. Funny that.
Posted this in the wrong place so have moved it...
I'm not trying to make fun of stress incontinence. Far from it. I've sneaked in at the dead of night and peed in people's gardens, gone behind a car in a garage, and had to sneak in parks. If I haven't been able to find somewhere to go in time, I've wet myself. I've had to wash down my garden path many times.
There was the unforgettable time when I was waiting for the loo in a shopping centre. I knew I would be OK because I had found a ladies as soon as I knew I needed to. I was the only one waiting when a woman came in with a small girl and asked if her daughter (I assume) could go first because she was about to wet herself. I had to refuse her because by then I was desperate myself and knew I couldn't hold on any more, and (to my shame) pushed past the little girl who started to run when a cubicle became empty. I made it to the loo in time, the little girl didn't. I'll never forget the way her mother looked at me when I came out and washed my hands. The loo attendant who was clearing up her wee told me I should be ashamed of myself. I was sorry, but actually I don't think I had to explain myself, they knew nothing about me or any possible health problems which meant I couldn't wait either.
So that's my confession I had as much bladder control as a toddler and I am in my 50s. No kids but overweight which doesn't help.
I found the article on your site a couple of weeks ago and realized that I hadn't been doing my pelvic floor exercises properly so nothing changed. I stopped having cafetiere coffee for breakfast, in fact have cut out caffeine as much as I can.
Two weeks on and I haven't had an accident in over a week. Perhaps the warm weather helps too.
So one in two women over 55 wet themselves? I was ashamed of this and it's hard to talk to friends about this. But now I've found this site I'm not shy...
If you can see anything, best get it checked out. There's nothing online or from the library that's ever going to be better than having someone who knows what they are doing having a keek.
High impact martial arts - well, like anything, if you are trained and have a good pf and good technique, no problem. If your technique's a bit off, then your intra-ab pressure will spike and that'll be a potential problem.
But, if you're not leaking, then there's less likely to be a problem.
Sports aren't off topic at all! Yep, gymnasts have a higher incidence than other sports. Elite gmnasts tend to be naturally super-bendy people which will increase their risk, add to htat lots of training and high impact, well, that's why about 70% of them pee themselves.
Hardly any seek help, either.
And, occaisionally, one's in the Olympics, doing an amazing floor routine, and there's a bunch of journos with their super-fast cameras perfectly placed to capture the arc of urine leaving her body mid flick-flack. Makes the press, but, only in a way to mock this elite athlete. The real story is how many of them wet themselves. (waves to any journalists reading the thread...)
Anyhoo, as far as you go, yes, do your exercises, and yes, take your bulging bits to a medic and get a referral. Your prolapse sounds similar to mine, and it's not a bother. As long as I do my exercises, keep my bowels in good order and contract my pelvic floor before I lift anything heavy.
Just saw some links on another thread and mine is def looking like the grade 2 image. What does this mean in terms of GP? Worth going or just do exercises at home? Also, erm, very high impact martial arts, likely to be ok to continue with if not leaking?
Btw on the other thread, it said gymnasts have the worst pf. Is that really because they are hypermobile rather than because of the nature of the sport? (Sorry, off topic)
Squatting can increase your intra-abdominal pressure if your posture's poor, Desert. So, if you are in a deep squat and not used to it, you'll wobble about a bit and hold your breath. that's going to put pressure on your pf, and, can lead to congestion of your varices.
Now, doing pf exercises can help vulva varicose veins, it's a bit like using a muscle pump to shift the extra blood - same as doing ankle exercises on an aeroplane to reduce ankle swelling. Well, not the SAME, obviously, but, you know what I mean.
Guess what I'm going to suggest? Take your bits to your GP and ask for a referral, best rule out whether there's a prolapse and see whether you have weak muscles.
Prolapse isn't always a dreadful condition. Got one myself. Doesn't bother me a bit, as long as I look after it.
Gussy, would more exercises help with the fact that I can't squat down for more than a minute or two without feeling huge pressure on what I suppose is my pelvic floor? am not sure if this is because of pelvic varicose veins, which I know I have, or weak pf muscles (or is in fact normal and I was lucky when it didn't happen back in the mists of antiquity), but is very uncomfortable
DaVinci - absolutely. Really important that women who are pregnant get advice and information about pelvic floors.
There's some evidence that a strong pf can reduce the second stage of labour, and the exercises certainly help manage the post-delivery ouchi-ness. Even helps shrink the piles.
Here's a link to the collaborative work just released by the CSP/RCM:has a nice video link on there
Holey that's an interesting point. Kari Bo (clever research type) comments about how odd it is that women have to navigate three specialities for what is going on in her undercarriage - so, a urologist for the bladder stuff, a gynaecologist for the vagina stuff and a colo-rectal dude for the bum stuff. And, none of them really specialise in the pelvic floor.
So, yep, it's great to get more than one opinion, but, not great to have your care delayed whilst they figure it out.
Hope you get sorted soon.
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