MumsnetGuestPosts (MNHQ) Wed 21-May-14 10:55:17

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.

Elaine Miller

Gusset Grippers

Posted on: Wed 21-May-14 10:55:16

(255 comments )

Lead photo

One in three women aged 35-55 wet themselves

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

Twitter: @GussieGrips

MrsRTea Wed 21-May-14 11:59:36

Anyone watching the stand-up comedy gig linked above - make sure you do your exercises first...or you may find you are pmsling. grin

Callani Wed 21-May-14 12:05:44

It's not just about doing exercises though, is it? It's about the medical establishment no longer expecting women to "just get on with a little bit of prolapse" and about doctors actually having time and sympathy for women suffering with life-limiting side effects of giving birth.

If 80% of men went through an operation that had a 33% of making them incontinent then the issue would be addressed - the same should be true for women.

BertieBotts Wed 21-May-14 12:29:53

I asked this on twitter, but, how important is the breathing thing really? Because I just noticed that I don't breathe while I do my PF exercises and now I'm wondering if that means I'm doing them wrong confused

mercibucket Wed 21-May-14 13:02:09

i have one of those machine thingies - are they better? i find them more effective (except you cant take it everywhere wink)

confuddledDOTcom Wed 21-May-14 13:26:13

There's a school of thought now that's saying it's not enough on it's own. Does anyone know about it and have any thoughts?

coffeehouse Wed 21-May-14 13:30:15

After three dc's and 3 traumatic births I only needed to see a loo and I would tiddle. I used to flood uncontrollably if I ran or jumped - Now jogging and exercising with no issues..I have my life back

Lots of googling led me to Ben Wah Balls / geisha balls - They work brilliantly. There are lots of versions, mostly marketed as sex toys..Some have a pull cord thing, but the best ones I have are small glass and are pretty heavy, but I built up to those. I started with fairly large attached together duo balls.

The whole time you wear them you are grabbing for dear life to stop them falling out, (I only wore around the house whilst cleaning to start) cue very strong p/f and vaginal muscles - wahey!

If caught of guard by a sneeze, I might let a tiny drop go, but for the most part I am dry! It has been a massive improvement..

cardamomginger Wed 21-May-14 13:34:11

So why can't HCPs be absolutely honest about the risks to our pelvic floors, other pelvic organs, and continence when we are pregnant, and let us make a fully informed choice (without having to argue, without having to see yet another HCP who will try to change our minds, without it having to occur to us to do the research ourselves) whether we want ELCS or VB? And when discussing the risks of CS why can't they SEPARATE the risks of EMCS and ELCS in an otherwise fit and well woman?

I'm fed up with the argument of cost. The costs of repairing the damage far outweigh the costs of ELCS (there was a statistic on the St Mary's website, which I can't find at present, that said that something like 1.5% of the entire NHS budget goes on treating women's incontinence). Not to mention the economic impact of time spent out of the workforce when receiving treatment, and the longer term economic impact of either not being able to have another child, or feeling that the risks are too great. That's an extra tax payer the country isn't getting.

Can you tell I am still angry, bitter and twisted?!

GotMyGoat Wed 21-May-14 14:25:49

Cardamomginger - unfortunately having a CS does not mean that your pelvic floor will be damaged. Pregnancy itself causes the pelvic floor to stretch and weaken, although a VB doesn't help matters of course! I wonder if lots of women who have had a CS either by choice or by emergency/medical need are walking away thinking that they don't have to do their exercises?

Lovecat Wed 21-May-14 14:57:13

I had an ECS and was left with extreme stress incontinence, to the point where I needed an op to tighten my bladder. Now as long as I do my exerises I'm fine, but if I let it slide... it's not as simple as saying I'll have a CS and avoid the problem - DD was heavy and overdue and took 36 hours bouncing around in labour to decide she wasn't coming out - that in addition to normal pregnancy wear and tear was what did for me!

fromparistoberlin73 Wed 21-May-14 15:07:51

cardoman, the fact is its very common and has been I guess since women were created!!! we cant all have ELCS, and more importantly its not massively. I was OK after DC1, and yet after DC2- well I might as well but bloody tena lady shares

cardamomginger Wed 21-May-14 15:47:16

Gotmygoat I know ELCS is not a cast iron (pun intended) guarantee that your pelvic floor will remain intact. But certainly incontinence through tearing (whether it is pelvic floor muscles or urethral/anal sphincters) would be avoided. And prolapse/incontinence caused by extended pushing would also be avoided.

Giving the full pros and cons of ELCS vs VB, that would include the fact that pelvic floor damage may still occur despite ELCS, would enable women to make a more fully informed decision about what is best for them. In some cases, where there is already a degree of stress incontinence, early ELCS may be indicated, i.e. before the baby has started to descend. As for pregnancy causing pelvic floor damage, my uro-gynae surgeon says that it is this descent of the baby that risks permanently knackering the pelvic floor muscles, rather than pregnancy per se.

fromparis not everyone will choose ELCS. Other countries are far more open about VB vs ELCS and give women far more of a choice (Australia and, would you believe it, Iran!). Yet women in these countries still choose to give birth vaginally. It's just not the case that if we were all offered ELCS we would take it.

stoptalkingmoredoing Wed 21-May-14 16:09:16

I think all ladies over a certain age, especially those who have had a pregnancy, should have their PF assessed by a PF physio.

I've got stress incontinence after the birth of my large back to back DD with 3rd degree tear. It is exacerbated by hormones, so when progesterone is high and oestrogen low (after ovulation and before my period) I can just start to dribble for no apparent reason.

I have tried numerous methods, but still had the frustration of the leakage. I went to see a gp in my practice who was female (after I had peed myself walking home) and she immediately sent me to be examined.

I had to do a log of fluid in and fluid out and answer some questions on a questionnaire. These were then analysed by a PF Physio / incontinence nurse (I'm not quite sure to be honest), she also checked my 'skill' at doing my PF exercises.

I was pleased to find out that I was doing them correctly, but she also found that my right hand side was much weaker than my left hand side. She also confirmed with me that I would always have some level of weakness before my period. Which I was pleased about because when I initially talked with the practice nurse when my DD was about 1 yr old, she dismissed me in a school ma'amish way and just told me I can't be doing the exercises properly and I should 'read this leaflet' and do them more regularly.

From seeing the physio / incontinence nurse she told me instead of doing blocks of 10 long holds, I should do block of 8 maximum, but instead of doing 3 blocks of 10, do 4 blocks of 8 max., but if I felt as though I was struggling to get a good lift just to stop. Likewise to do a maximum of 10 quick lifts. I should do this 4 times a day. This was to account for the weaker RH side.

She also told me I was a prime candidate for the mesh lift, which after seeing the surgeon I decided to hold off to see how I get on with the new way of doing the exercises.

Sorry for the ramble. The gist is, is it shouldn't just be something we have to cope with and just to 'read the leaflet'.

Lovecat Wed 21-May-14 16:17:00

stoptalking I'm really glad you posted that, although I'm normally ok on a day to day basis, in the week before my period all bets are off! I too was spoken to by the CONSULTANT as if I was a looney when I was assessed for the mesh (which works brilliantly as long as I stay under 10 stone - excess weight puts too much pressure on the bladder).

Now I'm entering menopause it's the only reliable way I know I'm due on!!

stoptalkingmoredoing Wed 21-May-14 16:23:36

lovecat, yes, it's my notification of when I'm due also! I've got PCOS and I think I'm perimenopausal, so irregularish on a 5 to 8 week-ish cycle.

I've decided to delay the mesh band op just yet because I'm not yet 40 and the results from a 2nd fitting is not a good as the results from the first fitting.

I've also found the caffeine is a very bad trigger for me.

It has taken me 5 years for somebody to believe that I can do the exercises properly and it's not me being incompetent and lazy. FFS, I've tried traditional PF exercises, TENS stimulation, The Burrell method and still I get the dribbles for no apparent reason before my period is due. Straight after my period and just before ovulation I can jump on a trampoline whilst feeling as though I needed a poo, and not a drop would come out. Before my period is due, just starting to walk can cause me to leak as though an eye dropper is slowly emptying my bladder.

Gussie, I think I luffs you - just watched your Fringe show grin. I'm on the idiotPhone so won't go into my feminist take on this just now. Except to say that incontinence is absobloodylutely a feminist issue.

TheOldestCat Wed 21-May-14 16:40:41

Good work, Gussie!

I saw a genito-urinary physio after two very long labours led to a rectal prolapse (quite delightful). The physio was really helpful and things got much better, although not until 18 months after having DS, when I stopped breastfeeding (she said the hormones slowed down the healing?).

Think I may still need an op, but things are so so so much better than they were.

The waiting room of said physio was full of women in their 60s and 70s. One lady told me she'd had problems since having children in her 20s but her GP had dismissed her out of hand. sad

So well done Gussie and co!

alikat724 Wed 21-May-14 17:03:22

Thank you Gussie, and all other posters. I struggle enormously with this issue (only just 40, only one DD although a rather gruesome forceps delivery followed by an infected episiotomoy), and after wreaking further havoc on my PF with training and running a Marathon a month back, I am about 2 weeks into my concerted 3 x a day efforts to get dry. Am already feeling results, and take great inspiration from all those who have managed it. Coffeehouse, am definitely going to look into duo balls!

However, may I add my 2p worth to the C-section discussion - I do not think this is the way forward. I think we need to remember that vaginal birth has enormous health benefits for our DCs immune and respiratory systems and C-section should only be considered for extenuating medical reasons. And it is MAJOR SURGERY, with it's own set of risks and side effects.

Varya Wed 21-May-14 17:25:18

I gave up tea and coffee, just had water and the odd glass of wine, so after twins by natural birth, I have very little trouble with unexpected results from sneezing or coughing.

cardamomginger Wed 21-May-14 17:32:32

alikat - glad you are making progress. I'm not saying that ELCS should be the default position. Rather than I believe the default position should be full and frank disclosure of the risks and benefits of each method of delivery, honest discussion and the woman being allowed to make her own decision.

As for the health benefits of VB, you can go at least some way to reproducing these in ELCS by taking a very generous swab inside the vagina and then wiping this all over the newly delivered baby.

Yes, ELCS is major surgery, but so is pelvic floor repair surgery. The impact on both physical and mental health of prolapse, bad tears and incontinence should not be underestimated.

Peepee22 Wed 21-May-14 17:36:02

Loved your write up. I found that doing pelvic floor exercises alone didn't work and would recommend everyone having at least one good training session with a women's health physiotherapist.
A very good book to get is by Mary O'Dwyer one of the worlds leading physiotherapists. Hold It Sister you can buy it in any bookstore. Worth getting as it gives you good pelvic excercises and reasons why, it also shares insights of pelvic organ prolapse which sadly I have also but am managing it well. So easy to read and use as a reference book.

gussiegrips Wed 21-May-14 18:10:50

Thanks for the encouraging responses, folks! Thought I'd answer some stuff, so pleased to see a discussion going.

Callani - absoblardylutely. There is a remarkable discrepancy between the amount of money and time medicine has invested in sorting out problems between women's and men's genitals.

Most shocking to me is that it wasn't until 1994 that a scientist stuck some women in an MRI scanner to see what the clitoris is all about. 1994. <shakes head>

The scientist who did the work was, unsurprisingly, a woman.

gussiegrips Wed 21-May-14 18:15:01

Bertie breathing really matters. Like, in general terms, obviously, it's to be recommended, but, your pf doesn't work as well with breath holding.

Imagine your pf as a trampoline at the bottom of your pelvis. It's not a fixed, solid bit of anatomy - the whole thing moves with a piston action with your diaphragm. So, if you hold your breath that mechanism can be disrupted - and can contribute to spasm in your pelvic floor.

Here's a link to Julie Wiebe's explanation - she's smashing:https://www.juliewiebept.com/video/the-diaphragm-pelvic-floor-piston-demo/

gussiegrips Wed 21-May-14 18:18:38

merci - there's a heap of gadgets available. Some are great, some are guff.

There's no evidence to show that using a machine is better than just doing your exercises, but, there is a suggestion that women who spend £30 (and beyond) on a bit of kit are more likely to keep working on their exercises for the necessary 3-4 months. Get your money's worth and all that.

I think that if you are going to spend money on it, the BEST thing you can buy is an assessment from a women's health physio. But, I'm biased.

gussiegrips Wed 21-May-14 18:21:11

confuddled there's certainly a range of conditions which cause incontinence, and, not all of them will respond to simple exercises.

However, the evidence is really clear that clenching your bits fast and clenching your bits slow, (whilst breathing and allowing them to relax in between) x3 day for 3-4 months cures 70%+ of stress incontinence.

That's better stats than the medication or surgery get.

gussiegrips Wed 21-May-14 18:23:18

coffee delighted to hear it. Glad they worked for you!

(as an aside, be careful of the tinkly ben wa balls. It's possible they can be heard as you wander round the supermarket, causing small children to ask "why is that lady chiming?"

gussiegrips Wed 21-May-14 18:28:43

Cardamon good points, but, I'm with Goat and Paris.

There is a greater risk to your pf if you have a vaginal birth than CS.

You are x3 more likely to be incontinent by the time your baby is 21 if it was delivered vaginally than if you have a CS.

But, CS risk includes damage to your bladder during surgery and complications from having a catheter.

And, most of the stress comes from the 9months of lugging the bump around. Though, obviously, birth injury can cause devastating damage to a pelvic floor, and significant tears can cause long-term problems.

You are right, we need to talk about all of this more.

gussiegrips Wed 21-May-14 18:31:45

lovecat - yep, if you forget it'll come back.

Blardy gravity.

Every day - do them when you brush your teeth.

chrysanthemumtea Wed 21-May-14 18:49:53

Funnily enough I saw Physio today about this as have leaks whenever I have an (asthma) cough. Started my exercises this pm. Cannot hold for ten yet. Is that normal? And find v hard to relax and breathe at same time.

NormHonal Wed 21-May-14 19:04:18

Thank you gussie we really need to talk about this more - the more women I talk to post-DCs about this, the more of us will readily admit it's a problem.

And if more of us will admit it's a problem, then hopefully more of us will seek help too.

I am very angry, with hindsight, at the asthma nurse and GPs who allowed me to cough my way through two pregnancies without inhalers because I "didn't need" them, only to reinstate my inhalers more recently when I insisted. This was after seeing a specialist Physio for a prolapse - she was appalled that this had happened.

I'm not saying I would have been unscathed after two pregnancies, but the Physio thinks I would have been better.

For the want of a few inhalers, I might now need surgery. There needs to be more education of both pregnant mothers (and partners) and health care professionals.

gussiegrips Wed 21-May-14 19:29:24

stoptalking <nodding> Good for you. Yep, there is no substitute for a proper assessment with specific treatment.

Certainly better than a leaflet in a bag of freebies on a postnatal ward. Sigh.

gussiegrips Wed 21-May-14 19:30:39

PacificDogwood <blush> mwa.

gussiegrips Wed 21-May-14 19:33:08

oldestCat yep, breastfeeding changes your hormones and they can have a very real effect on your symptoms - like lovecat and stoptalking mentioned.

Rectal prolapse? Ouch. Glad it's better.

gussiegrips Wed 21-May-14 19:36:53

alikat runners and piddling go hand in hand. That's good that you're noticing a difference, keep going with the exercises.

Strategies for runners - pee before you go, keep distances short, avoid hard surfaces, don't get dehydrated and there's a suggestion that internal support can help. Some runners use lubricated tampons, but, better still is something like a pessary - I'll just check about advertising rules before I put the links to suppliers up.

gussiegrips Wed 21-May-14 19:38:45

Varya yep, caffeine can be a problem for people with irritable bladders. Shedloads of the stuff in chocolate too, how annoying used to quite like to dunk a bit of dairymilk in a cuppa

gussiegrips Wed 21-May-14 19:40:48

peepee Mary O'Dwyer's book is excellent. She coined the clever phrase "the pelvic flaw" because the anatomy just isn't very good.

Wish I'd thought of it.

CrispyFB Wed 21-May-14 19:43:20

I used a Mooncup to run the London Marathon with barely a drop.. if I didn't wear it I'd fill a heavy duty Tena Lady over a 5K or less. And that's AFTER going to the bathroom immediately before running. Where does it all come from? confused

Not a permanent solution obviously though!

gussiegrips Wed 21-May-14 19:50:09

chrysanthemum uncontrolled cough is a problem because coughing raises your intra-abdominal pressure, which pushes down on your bladder. If your muscles are too weak or too slow to resist the force then you'll leak.

So, firstly, get the cough under control - your medication's being reviewed by the nurse, right?

And, second, #doyerblardyexercises. Yes, if your wee muscles are weak it'll take a bit of effort to get up to the magic "hold for 10". So, if your start point is "hold for 3" then see if it improves over the next few weeks so you're maybe at "hold for 5" and keep going. If you can't change it, even though you are diligently doing your exercises, then, ask for a referral to a women's health physio.

Relaxing and breathing's tricky. Try it in lying, side lying and on your tummy - sometimes a change of position helps. If you can't "get it" then get a handmirror and an uninterrupted 15 minutes. Have a look, you'll see your perineum lift when you contract, and drop down when you relax. Watch it as you breathe, you'll see it move, and sometimes that can be enough to get the hang of it. If not, get a referral.

I don't have a video to link to that, you'll be glad to hear, but, I DO have one about breathing and relaxing by Jane Appleyard: using a pebble to work your pelvic floor

gussiegrips Wed 21-May-14 19:55:13

Nodding with Norm.

It's a good point, the stats say it's 1:3 at the school gate, but, if you get them talking, MOST women of that age understand they don't belong on a trampoline.

And, I'm cross on your behalf about the coughing. Continence is a common problem in people with respiratory illnesses - but, the specialised staff often don't have much training about it, or are reluctant to ask for fear of causing offence.

Changing all that is on my "to do" list.

gussiegrips Wed 21-May-14 19:58:55

crispy yep, a mooncup will help. Just wodges everything up where it belongs, really.

When you run there is x3 your bodyweight impacting on your pelvic floor with every single step.

So, if you weigh 10 stones, that's 30stones of pressure on your wee muscles with every step.

Running is really hard on your pelvic floor. You can do stuff to help, but, certainly, if you've got any sort of prolapse, well, you don't need to be a urogynaecologist to figure out what is going to happen to it.

SwimmimgMonkey Wed 21-May-14 20:44:49

Has anyone heard of the Wholewoman approach by an American nurse called Christine Kent? I won't put the link here in case that's not allowed but it's easily googleable.

Her exercises are not about squeezing your pelvic floor but about changing your posture and realising that your pelvic floor really isn't a floor at all. It's not supposed to take the weight of your pelvic organs (which can lead to prolapse), rather your pubic bone is.

It's our terrible modern posture that has done the damage. A couple of years ago I was ready to have surgery but today I manage my prolapse quite happily with these exercises. I know they work because if I don't do them for a few days there's trouble.

I know I'm sounding like a bit of a saleswoman but the exercises really do work!

mercibucket Wed 21-May-14 20:51:14

blush

is trampolining bad? it always makes me 'clench' properly so i thought of it as good

usuallydormant Wed 21-May-14 20:54:04

I gave birth in France and both times as standard was given 10 sessions with a midwife for pelvic floor exercises, where I would spend 30 min doing different pelvic floor exercises. The second one was using a kind of probe whereby I would squeeze to follow a line on a computer programme and I could see the progress on a monitor. A kind of pelvic floor x box....you'd even have to get a certain score to pass.

Anyway, this is provided free as part of your post partum to do, which I thought was amazing. The midwife was passionate about the importance of it and told me as soon as my daughter hit puberty I should get her to get into the habit of doing one every time she lifts something or sneezes, that it should be an ingrained habit for all women. I'm not sure what the French figures for stress incontinence are, but it certainly seemed to be taken pretty seriously.

Ponkypink Wed 21-May-14 21:17:10

Thing is, there's not much use saying 'if it's painful, see your GP', because some of us have and they say 'oh well, you're probably depressed and lots of people have this and it doesn't cause any problems and we can't see anything so go away', effectively. I suppose they might take severe incontinence seriously, but pain they are not too bothered by- it seems to be considered something women should have to put up with. I think it would be better to train GPs than tell women to see them when mostly they will not help.

Doyouthinktheysaurus Wed 21-May-14 21:46:19

I think there needs to be more acknowledgement of the role forceps deliveries play in vaginal injuries. I know it is an emergency situation but I was given no advice before or after about the impact on my vagina.

Since my forceps delivery 11 years ago I have suffered a prolapsed womb which was removed due to unrelated health problems, then a vault prolapse post hysterectomy and I still have a rectocele which I refused surgery for a few years back. I just couldn't face further surgery after the vault repair didn't fix my problems and it's become something I live with.

Until I discovered MN a few years back I had no idea prolapses were such a widespread issue. I always thought of it as an older persons problemhmm Even my mum won't mention my prolapse problems directly, she talks in euphemisms!

3mum Wed 21-May-14 22:00:03

DoYouThink I absolutely agree. My first (of three) was a ventouse delivery and my pelvic floor has been buggered ever since. He was basically dragged out because the monitor showed foetal distress. If i had known then what I know now I would have insisted on an emergency caesarian. SO many things inc horse riding, running, abdominal crunches, rowing etc are now off the menu. He's 16 now so it's not going to get better. It's clear only an op will fix it but it's also clear the op has a fairly high failure rate.

hoboken Wed 21-May-14 22:19:39

Yeah and it all magically cures itself at the age of 56...

gussiegrips Wed 21-May-14 22:27:16

Swimming that's an interesting site. I agree with some, but, not all, of what she says - though, for sure, posture is really important. <stops slumping over laptop>

bodo2 Wed 21-May-14 22:33:58

I'm actually seeing my gynae this week 7 months after the birth of my 3rd. The physio I previously saw has said that I have nerve damage which prevents me from being able to do any PF exercises. Where does that leave me? I really want to avoid surgery if possible. I'm in my early 30s. Will using a machine to electrically stimulate the muscles work to strengthen them instead of doing the exercises myself?

gussiegrips Wed 21-May-14 22:35:31

merci well, trampolining in itself isn't bad...unless you are drunk. Best avoided after too much fizz.

There is a belief that fit women have strong pelvic floors because of their training, no matter what their sport of choice is. However, repeated impact forces are known to damage these muscles.

A study found that 80% of elite trampolinists wet themselves and used pads - but, assessment showed they had strong pelvic floors.

Like swimming said - it can be complicated.

In general terms - #doyerblardyexercises is good practice.

gussiegrips Wed 21-May-14 22:38:31

usually yep.

What I'd give to get hold of the curriculum...if we educated our young people on this stuff as teenagers then, perhaps they'd be in a better state when they hit middle age.

That's boys and girls. Menfolks have pelvic floors too!

"Bof!" <shrug>

gussiegrips Wed 21-May-14 22:54:51

Ponky good point, well put.

The problem with health advice on a forum is that it's generalised. There are a number of pelvic problems which are associated with pain - and, the only safe way to approach that is to advise people to follow it up.

Part of the problem is that the NICE guidelines are, to my mind, unhelpful.

For instance, the one for prolapse recommends that women with "symptomatic" prolapses are referred on to a specialist. There isn't any mention of what to do with asymptomatic prolapses.

I have a real problem with that. For a start, many prolapses can be successfully managed with lifestyle, diet and exercises - but, if no one tells you that you've got one (for instance, when you have a smear test), how to avoid constipation and why that matters, which activities can make it worse, how to correctly perform pelvic floor exercises and when to realise you need help - well, then we are surely consigning women to live with a progressive condition which causes pain, misery, difficulty with peeing/pooing and sex, and limits their activities.

I am in no way suggesting that GPs or practice nurses are anything other than fantastic. But, the thing about this stuff is that it takes TIME to teach. And, discussing such intimate problems can be tricky - it's very difficult to explore that effectively in a 5 minute appointment.

But, you know, the consequence of the way the NICE guidelines are written is that the implication is that "it's only a vagina. Doesn't really matter. Surgery can fix that"

Makes. Me. Cross.

So, yep, your story is not a new one to me. That's why I'd like to make women angry enough to refuse to accept these experiences where they have felt dismissed.

80% of all incontinence can be improved - so, even people with significant health issues can be treated. You don't have to put up with it.

gussiegrips Wed 21-May-14 23:04:55

Doyou yep. I'm sorry you had that experience, that's been a really rough ride.

You make a really valuable point...anonymous online sites are practically the ONLY place women talk about this stuff. This bemuses me, there's a whole psychology PhD in why that might be.

Prolapse is the "wimmin's ishoos" whispered about why your grandmother was in hospital, why your colleague is off sick, why your auntie had taken to her bed.

These conditions can be hugely disabling, and there is good evidence that G1 and G2 prolapses can be managed conservatively.

But, if we don't talk about it, well, how do we learn that sort of thing?

Periods were embarrassing 30 years ago. Not now. I'm very hopeful that these issues could be deconstructed too. Starting here, with this website, the raggedy threads and these conversations!

gussiegrips Wed 21-May-14 23:11:35

3mum yep. Someone told me she thought her undercarriage was considered "canon fodder" during a difficult delivery.

That's shocking, and I really can't imagine that a man's todger would be treated in the same way.

Have you had an assessment from a physio or nurse? Silicone pessaries can be really effective for some prolapses, not so good for rectoceles mind.

gussiegrips Wed 21-May-14 23:12:55

Hoboken - haven't seen that study...

gussiegrips Wed 21-May-14 23:22:19

Bodo birth injuries can be really brutal.

Nerve damage can occur for all sorts of reasons. Nerves can heal, but, frustratingly slowly.

You're right, electrical stimulation can help strengthen a muscle where it is either too weak to initiate a contraction, or there is another reason which prevents it contracting.

It looks like a plastic tampon. It's a strange sensation, but, not uncomfortable. Certainly, not as erotic as it might sound!

You can get simple units home with you - but, don't despair, there are some really talented therapists out there. Try to think of it like a whiplash - might be sore, stuck and broken, but, after a bit of work and effort, swan like again.

gussiegrips Wed 21-May-14 23:23:29

(disclaimer - I'm not sure what a swan's pelvic floor is like)

ancientbuchanan Wed 21-May-14 23:30:57

This is a fascinating thread aNd every hospital and clinic should have an equivalent or link to it! I am so glad to learn the desperate door stop, the pre period premonition isn't just me. I also specialised in Bookshop Bladder. There's something about being in a place where I want to relax and focus that has an immediate impact. Why, Gussie? I need to train my mind as well as my pf...

gussiegrips Wed 21-May-14 23:54:17

Oooh, ancient Bookshop Bladder, l love that!

When you are potty training a child you teach them to associate a potty with the sensation of "needing to go". They learn to sit and relax and pee in the potty, and not, for instance, on the settee.

We have a lot of learned behaviours around toileting. So, you go "just incase" because that's what you were taught as a child. You pee yourself on your doorstep because your bladder knows it's nearly (but, sadly, not quite) at the loo.

And, presumably, Ancient, you have a Waterstones Widdle? <sorry, it's an affliction>

Anyhoo, that sort of problem responds very well to a bladder diary. You fill it out for three days or so, and you'll see a pattern of when and where you pee. Worth showing it to someone who can give you advice, but, failing that, I'll link the B+BF's one.

So, if you pee too often (more than x5-8/day, or x1 at night) then you'd aim to distract yourself for a minute or two and go from peeing every 20mins to peeing every 22 minutes until you could last the 2-4 hours you should be able to (from first feeling the urge to pee to being absolutely bursting) (I know it's ages) (and, the normal)

Here's a bladder diary, there's loads online. www.bladderandbowelfoundation.org/bladder/bladder-problems/bladder-diary.asp

cardamomginger Wed 21-May-14 23:56:43

Just to reiterate (again!) that I am not suggesting that ELCS is a panacea for all birth-related ills. What I am suggesting is that the pros and cons of ELCS and VB should be discussed truthfully with pregnant women and that the risks of ELCS should not be conflated with those of EMCS in these discussions. Currently they are not. I am also suggesting that women should be allowed to make a fully informed choice, having weighed up the risks and advantages of each.

Yes, ELCS is not without risk. But neither is surgical repair, which may also involve surgery near the bladder, and may also necessitate a catheter (either suprapubic or urethral).

I think it is brilliant that we are (finally!) becoming more open about discussing these issues - the causes, the symptoms and how we can treat them.

I think another point to make re physio, is that even if physio cannot cure incontinence or a prolapse, it can be extremely helpful in the run up to surgery, helping to get as much muscle function as possible. And it is absolutely vital after surgery to rebuild strength, get the muscles recruiting properly, help with nerve damage, release any post-surgery spasm, and help ease scar tissue.

gussiegrips Thu 22-May-14 00:04:47

You're right to repeat that, Cardamom, I did see what you were saying, but, I was a bit clumsy in my response.

I'd be interested in knowing what conversations people had about continence, birth injury and outcomes when considering birth options.

There's a great collaboration between physios and midwives now - #squeezeandlift but, lots of work to do.

And, yes, yes, yes to pre-and post-op physio!

gussiegrips Thu 22-May-14 00:07:22

Actually, that's a point - there's some great collaboration going on between other professions too.

There's an excellent group on facebook that's for professionals - so, if you're a fit-pro, nurse, medic, physio, dietician, or whatever and would like to join then PM me.

It's like having a conference in your in-box. Perfect for pelvic geeks.

MrsRTea Thu 22-May-14 00:12:15

Thanks for that bladder diary link. The "just in case" habit is a real bummer, it makes it counter-intuitive to say "I'll see how long I can go without emptying my bladder, and then work on making it longer".

cardamomginger Thu 22-May-14 00:17:20

Thanks for the offer, but I'm not an HCP. 3.8 years of medical treatment including 3 major operations, and 2 minor ones, all manner of hideous tests and shedloads of physio has left me with rather more knowledge about the subject than I would care to have grin!

One other thing that I think often gets overlooked is pelvic floor spasm. Certain women, e.g. those with hypermobility, can be prone to this and have a degree of it anyway. But after a traumatic birth (whether or not actual injury was sustained) or after surgery, it can be a real problem. The bugger of it is, that it is often confused with a weak pelvic floor - the muscles are so contracted that they cannot contract any further, PFEs are not possible, everyone concludes that the woman has a weak pelvic floor and she gets sent off to do more exercises which is the last thing she should be doing! When spasm goes along with a damaged and weakened pelvic floor, it can be particularly tricky to sort out. But this is more something that HCPs need to be aware of and to consider as a possibility (it's quite easy to diagnose with a thorough internal examination, if you ask the right questions and know what you are looking for). Although if patients are also aware of it, then they know it's something to ask about, which is no bad thing.

gussiegrips Thu 22-May-14 00:44:09

Pelvic floor spasm really needs 1:1 treatment to sort out.

You're right, the symptoms can be almost exactly like weakness - but, painful sex or difficulty peeing/pooing are more indicative of a spasm (dysfunction) than a bog standard weakness.

Of course, it's common for people to have a mixed picture, particularly if there's been surgery, injury or anxiety.

It also responds to treatment, but, it's worth repeating - #doyerblardyexercises is not going to help.

Treatment's teaching you how to let go, and once the muscles are relaxed then you can start strengthening.

I hope your problems get sorted soon. It's a wearing cycle to be in.

Cariad007 Thu 22-May-14 02:00:19

Gussie, recently I read somewhere that if you're squeezing your back passage then you aren't doing your PFEs correctly. Is this right? I've always thought that a bit of a bum squeeze is what you need to do!

GarlicMayonnaise Thu 22-May-14 02:27:10

Another vote of thanks to stoptalking for confirming that hormones make a difference! It's ridiculous that I've been making this observation for years, to all kinds of doctors, and had no response whatever.

Aside from the hormones and some scarring from an ovary operation, I have fucking anxiety incontinence. Various bits of me spasm due to anxiety, especially when I'm tired. A bit of wobbly balance, breathlessness and heart irregularity can be more easily glossed over than a sudden gush of pee. Always reassuring when you're anxious hmm

50%??!! (I'm over 55.) At least I feel less of a freak now! It is shocking that it's so rarely discussed, and even more so that medics are dismissive. You're right, it's a feminist issue.

<dusts off Aquaflex kit>

nooka Thu 22-May-14 06:18:52

I've a slightly different pee problem, in that I don't seem to be able to quite empty my bladder any more, and find that a few drops always come out after I get up, however long I sit and however much I jiggle. I don't have any issues otherwise really but I would really like to sort this one out. Is it likely to be related to my pelvic floor? I had both my children by c-section with virtually no labour, and dd is 13 now whereas this problem is fairly recent. I'm 43 and no signs of menopause yet, not very fit, a bit overweight and generally leading a bit of a lax lifestyle but no major vices.

gussiegrips Thu 22-May-14 09:24:29

Cariad - I get quite worked up about that sort of thing. This isn't rocket science, and "you're doing them wrong" just stops women from trying!

Having said that, we know a lot of women do them incorrectly - here's how to know if you're doing them right.

There's a heap of muscles down there, the anatomy is complicated - but, really, they all do the same thing and that's lift.

If you are working the muscles at the back then you will also be working the ones at the front. Similarly, if you contract your deep, postural muscles or the hip ones that pull your leg in - then you get an "overflow" contraction of your pelvic floor. That can be used to strengthen very weak muscles to the point where you can work them actively.

The bumhole thing works because it's a visual image we all understand, even small kids know how to hold in a fart and then choose not to. As you get stronger then you'll be able to do the back, front and in standing, whilst walking - it's just a progression of strengthening.

Try doing it lying on your tummy and see if you can feel something at the front. Or, get your kecks off and have a look with a mirror. That can be really helpful, but, don't do it when you're doing your pf exs in a supermarket queue. <good advice>

If you still can't feel it, have a rummage around. See if you can feel the squeeze on your fingers, or, get someone else to let you know if they have a handy finger.

Women tend to be dissociated from their pelvic floor - all these things are doing is getting your brain to link the muscle action with the sensation of it working.

So, working your bumhole is better than doing nothing - #liftandsqueeze often enough and you'll get the hang of it.

Or, get a referral and get someone to talk you through it. Well worth it, really.

gussiegrips Thu 22-May-14 09:29:03

Garlic get a referral. That sort of incontinence can be easily treated - but, figuring out what exactly is going on can be complicated.

Pelvic floors store anxiety - which sounds a bit "woo", but, bear with me. You know how an anxious person sits with their shoulders hunched up? Some muscles are emotional - trapezius in your shoulders get sore if you're stressed, and your pf is exactly the same.

Get it to relax, find out why your bladder's twitchy, sorted.

gussiegrips Thu 22-May-14 09:30:29

Meant to say, being confident that you're not going to wet yourself can help your anxiety levels no end. Obviously!

gussiegrips Thu 22-May-14 09:32:13

Oh, and leave your aquaflex for now. If your muscles have spasm, then, that's not going to help and might make it worse.

Do the breathing stuff with the pebble on the video link upthread instead and see if that helps.

gussiegrips Thu 22-May-14 09:41:17

Nooka incomplete emptying needs to be looked at.

Usually it's just because we're hurrying and don't properly sit and relax on the pan - too busy rushing around.

Sometimes it's a postural thing - there's a good graphic half way down this McMillan page www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Lifeaftercancer/Lateeffectsbowel/Possiblelateeffects/Treatingbowelfunctionproblems.aspx

So, sit properly - leaning slightly forward with your feet raised (these IKEA steps we give the kids so they can reach a sink are perfect). Pee. Count to 20, think happy thoughts, and see if you have any more pee. And, then, do that again until you are sure your bladder is empty.

You should see your GP regardless. Urinary retention can be a problem, the "stale" urine slopping around can cause UTIs and needs to be investigated.

Chachah Thu 22-May-14 10:43:10

Just to confirm what someone else said further up about French care postpartum - I gave birth in the UK, and my mother and sister were appalled to hear I didn't have a series of proper physiotherapy appointments, just a bunch of leaflets given to me. This is after a forceps delivery and major tear, too.

Madlizzy Thu 22-May-14 11:15:30

I have an irritable bladder which had been massively improved by quitting caffeine and medication. No more pads.

GarlicMayonnaise Thu 22-May-14 11:28:52

Thanks, gussie!

HalloumiToastie Thu 22-May-14 11:46:05

This thread is just what I needed. Having been to my GP twice I am getting nowhere.
I gave birth 5 months ago, epidural, forceps and bad tear. I've been doing my exercises religiously for 4 months but still have stress incontinence and (some) urge incontinence. I can't stop urine mid flow at all.

Someone up thread mentioned the hormonal effects of breastfeeding. I am breastfeeding and wonder if this has an effect on my Pf?

OhBabyLilyMunster Thu 22-May-14 11:51:59

What do you think of devices such as kegel8, gussie? Ive been using one for a few weeks and found it remarkable. I was doing pfe's before but theyve got some serious power to them with the machine. Feels like everything has kindof pulled upwards inside.

stoptalkingmoredoing Thu 22-May-14 12:31:48

I've just come back to this thread and I'm pleased I've confirmed to a few others that 'its not you' being deranged and yes, you do have a conscious understanding about your own body. I wish some bloody HCP realise this.

I was fobbed off and fobbed off for a good while by just being told, 'read the leaflet' and 'do them regularly and properly'. When I knew damn well I was doing them the best I could and if they were wrong, reading a flipping leaflet wasn't going to aid my understanding or ability any further.

Hooray for the sympathetic female GP in my surgery who responded with the following, 'oh we can't have that', when I told her how it affects my sex life, general day to day living, what I can do with my DD (No, I can't race you down the street like Daddy does because I'll piss myself before the second lampost )

As gussie says, my very best advice would be to either demand an appointment with somebody like herself through the GP or pay for a private appointment.

I was so relieved to learn that I am able to do the exercises properly and that my RHS is weaker, so that little 'flicker' I feel at a count of 7 / 8 is the RHS PF (if there is such as thing) giving way and doing any exercises after it's too tired isn't going to get me anywhere. Likewise my dribbling is not 'in my head'.

So, on my first long clench I hold for 4 seconds and see how I feel, if it feels OK, I clench for 5 secs, rest for 4, clench 6 secs, rest 4 and I increase until I hit that point where I can feel it getting too tired (although I stop after 10 clench sessions max. either way). Or, if it feels a bit weak, I just hold for 4, relax for 4. I then do my 10 quick flicks, either straight after if my PF feels strong or after an hour or two if it doesn't.

All in all I have a good 2 or 3 sessions a day and it will hopefully keep me at a level where I can get by with a light tena on my 'before period' days without having to resort to the band for a good few years.

I would also like to add that I'm very open about my PF issues. Even the blokes in my office know (they have wife's and kids, so I know that they'll know of the problem, even if they won't admit it!). I'm not embarrassed about it, after all it got knackered through carrying and birthing my gorgeous DD who was literally the size of a toddler at birth

Mo1969 Thu 22-May-14 12:39:14

Does anyone have any experience of bladder Botox?

After 5 years of stress and urge incontinence, a TVT op which has now 'failed' and now being diagnosed with irritable bladder which anticholinergenic tablets, electrical stimulation have not helped, I'm due to have bladder Botox in 10 days time.

Very nervous indeed and wondered if anyone out there has any pearls of wisdom?

gussiegrips Thu 22-May-14 12:45:00

Chachah yep, Vive La France!

French women wear white trousers too.

The two things are connected. I'm sure of it.

gussiegrips Thu 22-May-14 12:47:14

Madlizzy thanks for pointing that out, the difference that dietary changes make in some people is amazing.

Sometimes, even cutting out caffeine from 3pm is enough.

And, caffeine free tea and coffee is good now, not like in the Olden Days.

gussiegrips Thu 22-May-14 12:47:51

Garlic you are very welcome. x

gussiegrips Thu 22-May-14 12:56:37

Halloumi take this thread to your GP and ASK for a referral.

You have several risk factors and it would be perfectly appropriate for someone like you to be seen in clinic.

The hormone changes that take place during pregnancy/post-partum don't go back to normal until you stop breastfeeding. So, your ligaments remain a bit stretchier than normal, which means your risk of prolapse is higher than normal.

Doesn't mean you can't strengthen, or if you do have a prolapse, that it can't be managed, or that the overactive bladder can't be treated.

Main things about you though, is the bashing your undercarriage has had. Needs to be looked at to get it sorted. Don't. Put. Up. With. It!

OhBabyLilyMunster Thu 22-May-14 12:57:38

Dya know this really is a massive feminist issue. As if men would be sent on their way with a pack of tena lady and left to wee themselves for the rest of their lives. This really is evidenced by the aftercare french women recieve.

gussiegrips Thu 22-May-14 13:07:02

ohbaby there are some excellent gadgets out there, for sure. I especially like kegel8's trainer - the one that talks to you and records your strength so you can beat your record?

It's about compliance. Some people like gadgets and so are motivated to use them, some people have a drawer full of stuff bought in desperation that they've never actually used.

There are a lot of bits of kit with good evidence behind them, but, there isn't any evidence that using a machine is better than just doing your blardy exercises. Not that I've seen, anyway, am happy to be corrected.

Sherrie Palm's doing some research prolapse charity into preventing prolapse. She suggests that if you are wearing a sports bra that you should be using internal support too - something like an incostress - to reduce the impact on your pelvic floor. This is what runners know, and why they use tampons even when not menstruating to reduce their leaks. (Important to lube your tampon first, or, you'll give yourself raging thrush)

It's a bone of contention - some physios are not keen on machines at all. The problem is people buy gadgets without any idea about what will help - and sometimes can make their problems worse.

So, if you are going to spend £80 online, why not see a private physio first and make sure that you need the thing in the first place?

gussiegrips Thu 22-May-14 13:13:14

stoptalking <pins medal> thank you for your services to FanjoFu.

You have to make quite an effort for this stuff to work - you describe really well the way you need to pay attention to what you are feeling at least until function is restored.

It is worth it though. Well, I think so. Pads are a necessary evil for some people, but, not for all those who resort to them.

gussiegrips Thu 22-May-14 13:21:15

Mo that reads like broken-bum-bingo. I'm sorry you've been through all those procedures and glad there are further options for you.

Botox is really effective, but, beyond the scope of physio!

The good thing about it is it's not associated with the dry mouth and constipation that medications cause. It needs to be repeated after a while, but, if it works, it really works.

Of course, your bladder can no longer express surprise (baboom tssssh) (sorry)

gussiegrips Thu 22-May-14 13:25:56

ohbaby - it really, really is.

Apart from the indignity of living with incontinence, there can be a devastating impact on your sexual function.

There's masses of research and help for men with sexual dysfunctions - women, not so much.

We don't tend to complain about it, either. It's as if women don't think that orgasms matter that much, we accept that sexual dissatisfaction is part of being a parent. I think it's muddled up with the messages we get about modesty, but, really, if you are going to have a bonk, you may as well enjoy it. You're built for it - that's what the clitoris is for!

DaVinciNight Thu 22-May-14 13:53:27

I think a good reason not to talk about it shame. I mean who would want to acknowledge they wet themselves?
So along we go until things are so bad that we can't carry on ignoring them.
and yes I should be found g those bloody exercise too

cardamomginger Thu 22-May-14 14:01:53

Gussie - that's interesting about the Incostress during running or other high impact exercise. I asked my surgeon about the possibility of using a ring pessary to achieve support (I used to be a keen runner, but even though I am now 'fixed' I just daren't take the risk - I couldn't live with it if I 'broke' something, even though I know it doesn't work like that). But I never really got on with a ring pessary and they are a total faff to put in, you have to be measured, trial and error with different sizes, types, etc etc. But this sounds like it could be an easier option. Still not sure it's for me - things are still too friable and painful to insert anything like that, and I'm still too terrified to even think of running. But for other, it could be excellent, so thanks for the link!

Another thing that I think often gets overlooked is the possibility that although a woman may have healed at the skin level if she had a 2nd or 3rd degree tear, at the muscle level she may not have and she may have a gap. This could particularly be the case if, in the first few weeks after birth it became infected and/or opened up. I think it gets overlooked because people (including unfortunately some HCPs) assume that if it is healed outside, it must be healed inside. A gap is not going to help things at all - pelvic floor strength, muscle coordination, continence, prolapse. There is a lot that you can still do with physio, even with a gap (I managed to get from scoring 0 out of 5 for pelvic floor strength to scoring 3 out of 5 with a 3cm gap in my puborectalis which had been completely severed, using a combination of PFEs and electronic stimulation). Repair surgery can make all the difference.

Chachah Thu 22-May-14 14:12:39

cardamomginger, how do you go about finding out whether or not you have healed internally? When I voiced the possibility to the midwife who reviewed my birth notes, she seemed to have no clue what I was talking about.

DaVinciNight I agree that shame is a factor, but it's not the whole story. There's nothing more embarrassing for a man than to admit to erectile dysfunction, yet it's a much talked-about problem that receives tons of medical attention.

cardamomginger Thu 22-May-14 14:34:24

ChaChah - that's daft! You need an internal examination from someone who is specifically going to 'look' for a gap in any of the pelvic floor muscles (gaps can be in different muscles depending on what tore). From women I have spoken to on MN and in RL it seems that not even all gynaes do this. You certainly need one who specialises in pelvic floor repair. A very good women's health/gynae physio should also be able to spot a gap in a muscle.

DaftMaul Thu 22-May-14 14:41:49

Is there much difference between the two Mary O'Dwyer books, Hold it Sister and Hold it Mama? I see there is quite a difference in price. Is this a case of you get what you pay for? The latter is available for Kindle which makes I more accessible.

Chachah Thu 22-May-14 14:52:51

Thanks cardamomginger.

I can already see how this conversation with my GP's going to go, though. The response I've gotten so far when I've voiced my concerns (esp. regarding a future second birth) is something along the lines of "calm down dear, most women end up being just fine".

The problem is that even medical professionals are uninformed, so how are we supposed to get proper diagnosis/treatment?

cardamomginger Thu 22-May-14 15:41:36

Exactly chacha. And the argument about 'most women' doesn't really cut it when you are not amongst the 'most'.

In my case, my initial referral was for coccyx pain to an orthopaedic surgeon (private, but via the GP). He did an MRI and apart from the coccyx damage, he was concerned by what he described as 'areas of obvious swelling in the soft tissues'. So he referred me to the uro-gynae surgeon (again privately).

BunnyPotter Thu 22-May-14 17:55:22

I too gave birth in France and had the pelvic floor sessions. I did a version where you learn visualizations that essentially mean you automatically and subconsciously engage your pelvic floor whenever you do any lifting etc. That midwife (midwives can do it too) wanted all women to know about it BEFORE giving birth, because she was of the opinion that it would help first timers engage the correct muscles, thereby reducing the time spent trying to push.

I'm now seeing someone else (in a different country) after the birth of my second child. She's a perinatal physio (can work with stress incontinence in pregnancy too) and she's working with my posture: a slightly forward tilted pelvis with overly tight (not strong) glutes mean that levels and all the squeezing exercises will ultimately stop working.

I am also on a mission on this subject. It's unfathomable that women are expected to live with this. My experience of discussing it with women a bit older than me is that they don't like it, but have found it a "bonding" experience with other women and deny that stress incontinence can be sorted out by a physio - or anybody else. They were in a sort of denial, rather than wanting the number of the physio. I find that deeply saddening, although I can understand why.

My MIL is French. When I discussed it with her and told her the figures she was speechless: it was incomprehensible that our medical system left women to suffer - and tells them they're not!!

French men also get pelvic floor work after prostate operations (I'm guessing UK men don't) and apparently a lot or chronic prostatitis is due to a weak pelvic floor, resulting in organs (not sure what!) resting a bit on the prostrate.

It's not just a feminist issue!

Oh and those French women also get sessions with the physio (min 10 sessions) after the pelvic floor work is finished, for their abs!!! Every single woman after every single birth!

Mosling Thu 22-May-14 18:02:36

So ... Is it my wee muscles or poo ones that I clench? Cos they're different. Not that I do it as often as I should, you realise, so I should probably do it right.

cardamomginger Thu 22-May-14 18:14:07

Bloody hell Bunny - that's phenomenal! And as it should be!

HalloumiToastie Thu 22-May-14 18:39:19

Many thanks for replying to me Gussie.

BunnyPotter Thu 22-May-14 19:58:39

It is phenomenal!

My last post should say kegels, not levels!

I think Mumsnet and Woman's Hour (because they maybe have a wider age range) should team up in a campaign on this issue. It is a specialist area (I think a lot of physiotherapy courses don't even cover the pelvic floor in a general sense), for qualified midwives and physios, so it's not like it's something that could be fixed over night, but it should be campaigned on. Too many people suffer.

According to my current physio, there's an emerging epidemic amongst richer nations and richer people in less well-off nations, because we spend so much time sitting with poor posture (essentially everyone who sits on a chair, rather than squats). Everything we do that essentially moves the tail bone closer to the public bone (bottom of spine to front of pelvis) shortens the pelvic floor. It needs to be supple to have long-term "strength". If you think of your arm bicep, if you lifted weights every day, but never properly opened out your elbow, eventually you'd have trouble opening your elbow. You may be lifting a heavy weight, but the muscle would be too short to properly function. Similar with the pelvic floor. So, sitting poorly, having a forward to of the pelvis etc are all things, from what I understand, that impact the pelvic floor's flexibility and long term function. Strengthening with kegels has a use, but if the muscle is not in an optimum position to start with, they can be ineffective. This is apparently common (and is my case) so the pelvic floor work starts with stretching hamstrings, calves, glutes, being aware of sitting posture etc).

There is also a branch of osteopathy that works with the pelvic floor too, but it's quite rare and from what I could find out not practiced in the UK.

BunnyPotter Thu 22-May-14 19:59:55

*forward tilt, not forward to of!

I would also like to add that I'm very open about my PF issues
stoptalking, I am so glad to hear you say this and hope that there are many other women out there too who talk about it more openly.

I have a personal and professional interest in the subject and I am really relieved that people like gussie exist - not just motivational, enthusiastic specialist physios, but also prepared to 'got public' about this not-very-'sexy'-subject (literally AND figuratively). No politician/public figure is likely to stand up and fight for better incontinence care when there is childhood cancer to 'beat' etc… Much better for the publicity (and of course very, and one could argue, more important in the greater scheme of things).

I had never really thought about it, but gussie makes a very good point in her stand-up routine: Men tend to seek help when their sexual function is affected (i.e. erectile dysfunction), women seem to be almost resigned to the fact that they are unable to achieve an orgasm. Men are more likely to accept a dribble as they age (or skid marks <boak>), but as soon as their 'cock is broke' (nice turn of phrase, gussie! grin) they are NOT HAPPY - and quite rightly too.
Of course many men only want a little blue pill and do not want to be told about PFE and equally it has to be said IME many women would prefer to have the perceived 'quick fix' of a tape, say, rather than having to do exercises several times a day forever…

I am not sure what the solution is - there is much health promotional work going on out there re healthy diet, exercise, smoking alcohol etc but very, very to get people to actually put all the advice in to action.
I wish I knew how to motivate myself enough to regularly do my lardy exercises, never mind other people!

gussiegrips Thu 22-May-14 21:01:29

DaVinci yep - but, if a third of us had athletes foot, would we discuss how to manage it, what helped, what to avoid?

It's just a social norm.

Periods were embarrassing 30 years ago. I just had the joy of The Chat with my 10 year old daughter, no shame, no secrecy, no embarrassment.

We can do the same for incontinence. Fair enough, it's ABnormal, but, it is common!

gussiegrips Thu 22-May-14 21:12:17

cardamom - pessaries are becoming more common, lots of new training for physios and nurses around. There's new pessaries too, silicone ones instead of the kind of rigid plastic ones. Much more comfortable.

Previously, pessaries were only offered to older women who were unsuitable for surgery. Things are changing, slowly, but, they are changing.

So, the incostress is like an off the peg pessary. It looks like a silicone tampon, and, yep, for people who want to be active it can be very helpful. Can buy them on Boots, Amazon, or direct from the website. Tell Ms Incostress that Gussie sent you (I'll ask her for a discount for MN!) (well, if you don't ask, you don't get)

The best advice, really, truly is, if you have a prolapse, avoid impact. But, if you can't, or you won't give up running, or your job requires it, then the incostress can be a good compromise.

Am glad you're not jogging though, Cardamom. Best look after that undercarriage, by the sound of it.

gussiegrips Thu 22-May-14 21:16:55

DaftMaul actually, I don't know! I've got the "sister" book. I've tweeted Mary to find out. Hing oan.

gussiegrips Thu 22-May-14 21:22:59

Chacha that is exactly the rub. Medics don't recognise the problem because under-grad training is limited. That is because research is lacking. That is because funding is lacking. That is because there isn't money to be made from a wonder drug (think Viagra, for instance) and because the perception is that there's little need. And, THAT's because we don't demand it.

Don't take "oh dear. Never mind" for an answer. If your quality of life is being reduced then you deserve to be referred on.

So, ask, (nicely, GPs are people too!), but, seriously, don't put up with it.

gussiegrips Thu 22-May-14 21:26:03

And, when I say that under grad training is limited, I'm not having a pop at medical training.

Physio under-grad courses barely mention the pelvic floor. Midwives do, but, only really about stitching it back up - not really about function. Nurses too.

It's as if it's too embarrassing to even study.

Another thing on my "to do" list.

gussiegrips Thu 22-May-14 21:35:36

Bunny going to be in my gang?

Interestingly, I've not come across any significant evidence that says that the incidence of incontinence in France differs from here. What IS different is that there women are far more likely to seek help, and understand how to look after themselves.

There is a train of thought that the fabulous French set up was to restore Wifie post-birth so she could get back to the conjugals ASAP...but, really, I'd prefer their system to ours ("somewhere in your Bounty pack there's a leaflet about something REALLY IMPORTANT")

Now - the menfolks. That's a whole other High Horse of mine.

PFexs are more effective at treating erectile dysfunction than Viagra. And, they cure/restore function in premature ejaculation in about 70% of men within 3 months. Yes to helping manage prostatitis. Yes to other countries giving physio pre-op to men who are going to have prostatectomies - because the evidence is that the earlier they start the better the outcome will be. Here? Poor bloke will be referred at 6 week checkup, if at all. They dont' tend to complain though, most of them are just so happy to no longer have cancer that they accept the loss of their erection and bladder control.

Makes. Me. Cross!

gussiegrips Thu 22-May-14 21:38:49

Mosling if you can differentiate between front and back, well, that's splendid! The aim is to #squeezeandlift the front and back together, just because it's simpler and so you are more likely to remember to do it.

Go and follow me on twitter, @gussiegrips, I'll nag you into it. "When I tweet, you twitch your twinkle" I'm looking at doing some research into whether it works or not. it's going to be pretty embarrassing if it turns out to be a heap of nonsense!

gussiegrips Thu 22-May-14 21:41:15

Oooh, or, there's a HEAP of apps.

Though, most people seem to buy one, use it for a few days and then forget.

A good free one is pelvic floor first which is Australian. Great website too. It talks you through the exercises, and ALSO pelvic floor SAFE exercises. Well worth a look.

SailorJane Thu 22-May-14 21:42:07

Hmm. This thread (for which a thousand big thank yous) has inspired me to have a look in a mirror - I think I may have a bit of a prolapse going on. Is this something I could even see in a mirror, or am I just symptom-spotting?! Would this explain post-wee leaking, despite religiously doing the exercises? If my gp is likely not to be terribly informed about options, what should I be asking for?

gussiegrips Thu 22-May-14 21:47:47

I think Mumsnet and Woman's Hour (because they maybe have a wider age range) should team up in a campaign on this issue. It is a specialist area (I think a lot of physiotherapy courses don't even cover the pelvic floor in a general sense), for qualified midwives and physios, so it's not like it's something that could be fixed over night, but it should be campaigned on. Too many people suffer.

Bunny for president.

gussiegrips Thu 22-May-14 21:51:26

Bunny, I've just tweeted that to MNHQ, Woman's Hour, my governing body and their specialist interest group.

Brilliant.

AngelaOctopus Thu 22-May-14 21:53:41

Great post Gussie. So important to raise awareness of these issues. I barely remember anyone mentioning tears in any ante-natal class but here I am still with issues from a fourth degree tear with my DS 2.5 years later. The solution my old colorectal team gave me was use a pessary everyday to flush everything out sad. It didn't even always work and sometimes made things worse. Now we've moved house, I'm taking advantage and trying to get a second opinion.

I wish we'd been given more information in our antenatal classes. I carry the gene for Huntingtons Disease so am likely to be facing incontinence issues in the future anyway. It would have been nice if someone (anyone, even us) had of put two and two together and properly considered the risks of VBAC vs ELCS for someone such as myself. Afterall, I had the HD test specifically so we could make life choices that would minimise HD-related health risks to me and our family (DS is egg donation to avoid passing it on). It is frustrating that for whatever reason, I did not know enough to make a properly informed decision.

Maybe we should just all move to France?

gussiegrips Thu 22-May-14 22:01:00

I'm getting a sore neck from all the nodding I'm doing with all your posts!

Pacific yes. It's a sad fact that a significant percentage of women are seeking surgery because they perceive it to be a "quick fix".

I think that's because they HAVE tried the exercises and believe them to have failed, because they didn't work - and so, are resigned to needing an operation. That's what their experience tells them, that's what their friends tell them, that's what their GP tells them, and the surgeon, well the surgeon KNOWS the operation is effective and wants to help the woman. It's totally logical.

There are lots of studies that show that prolapses and incontinences can be managed effectively with conservative treatment. But, you've got to actually DO the bloody exercises! Three times a day, for at LEAST three months, possibly 6. Without forgetting half way through. It's not easy, it takes a big commitment to make the habit.

Interestingly, men are very committed to doing their rehab post-prostatectomy. See, women are used to pads, it's not a shock to us to have to use one, whereas, for men, they go from being continent to having no control overnight. It's really not acceptable to them, so, they #doyerblardyexercises.

It's not that women are lazy, or that they want a soft option. We are busy, not good at putting ourselves first and already conditioned to believe that it's not that bad.

I'll say it again. You don't have to put up with it!

gussiegrips Thu 22-May-14 22:10:14

Sailor well, if you have some cillitbang for your eyeballs handy you could google image it...

See, we don't know what our NORMAL is! So, how do we know when there's something new bulging out? Give your pre-pubescent daughter a mirror and make it normal to check out her own bits!

Anyhoo - so, have a look at the vaginal opening. If you contract your pelvic floor it'll lift up and if you relax it'll drop back to where it was. Well, now, bear down, as if you are having a gentle, satisfying poo. Is there anything bulging in the vaginal opening? Cos, there shouldn't be.

If there is, don't panic. It's very common, and if ou look after it, can be perfectly manageable. But, take it to show a medic and ask for a referral to physio.

If there's nothing poking out, well, don't be smug. STILL take your fanny to a medic, not all prolapses can be seen externally.

I could post a pic of my own, Grade 2 prolapse on my profile, if that'd be helpful? Maybe not. Google it.

But, don't google procidentia. You thought Dragon Butter was bad? That's a bedtime story in comparison.

gussiegrips Thu 22-May-14 22:14:38

Didn't answer your question, sorry, was having a flashback to the time I foolishly searched for images for a powerpoint presentation...

post-wee dribble means there's incomplete emptying for some reason. That CAN be because of a prolapse, but, there's a bunch of other stuff that needs ruled out. Especially UTI.

So, scroll back to the bit with the McMillan Charity link about how to sit on the loo and do that stuff.

And, get a pee sample and see your GP.

Ask for a referral.

Say something like "I leak after I have emptied my bladder. I do my pelvic floor exercises. Mumsnet have a thread where a physio suggested I ask you for a referral to a women's health physio. Can I have one please?"

And, if they say "no" then show them the thread. Might count as CPD, actually joke

gussiegrips Thu 22-May-14 22:24:06

Crikey, Angela that's a rubbish hand you've been dealt.

A G4 tear is a serious injury. Faffing about with pelvic floor exercises is not going to fix that on it's own - but, you know that. Glad you are getting a second opinion.

I would suggest asking for a referral to your specialist continence nurse. Whilst I hope that you will never need to see them because of your HD, they have all sorts of strategies and gadgets to help manage bowels, especially if there's a progressive neuro condition lurking around. Besides which, every single specialist continence nurse I have met has been hilarious, a good way to spend an hour. Their stats say that 80% of continence (bladder and bowel) problems can be improved, and that includes people with neuro issues.

But, importantly, congratulations on your son.

So, ask, (nicely, GPs are people too!), but, seriously, don't put up with it
Hear, hear to that smile

Thanks for the app tip - I've got one on my phone, but have never ever actually used it blush.

I am currently trying to do myblardyexercises at every red traffic light - thing is, I am not sure I drive enough to get 3 red lights a day… hmm
May try that app.

Btw, I am a GP <outs self>, I have continence issues <outs self some more> after 4 kids.

I asked to be referred to a specialist maternity physio after DS3, I think, simply to check that I was doing my exercises right. She was great and agreed (at my request) to do an internal examination while I was doing PFE to confirm I was doing them in the right direction IYWIM. That was I needed/wanted. Do ask and don't be embarrassed. There's too many of us to be coy about it IMO.

Btw, gussie, I am now 48 and 4 years post-DS4, doing myblardyexercises most days and things are still not great (my main bugbear is not being able to run - not even necessarily for exercise but just, ya'know, for the bus/after the kids/in a hurry) and I don't think I can feel some of my innards. After 1.prolonged induction 2.enCS 3.+4.fast and furious VBACs x2 I was wondering how likely I am to be left with some kind of nerve damage that stops innervation to the relevant muscles from working?? Is that a possibility? Orgasms are fine btw blush
I am not expecting you to diagnose me, I am just wondering whether it is time to see a good urn-gyn person...

BunnyPotter Thu 22-May-14 22:52:16

Gussie - yup! I'm a little one-woman team on my own over here! Gets kind of lonely sometimes!

I think that (no prof. expertise, just personal experience) that if the stress in continence and prolapse rates in France aren't any different, then it's a sign that the techniques used in the mainstream postnatal "reeducation" are not taking postural issues into account. From my own, friends' and general things I read and heard there, they are not commonly looked at, only the "squeeze" function, which has - apparently - limited efficacy. It's a Belgian technique that deals the postural issues, but I very usefully can't remember the name of the man who developed it! I do remember that in the city I lived in the physios who used this technique had waiting lists. I didn't "get it" then though, so didn't do that sort.

Hope MNHQ and WH get on board. Has WH ever even done a segment on the PF? Maybe, but it's definitely not a frequent topic in proportion to the number of their listeners who will be effected!

Thanks for bringing the issue up here! It's made my night! Nobody ever wants to discuss it with me!!

AngelaOctopus Thu 22-May-14 23:00:05

It's been a rollercoaster ride these last few years, luckily with enough highs to get us through the lows! DS definitely being one of them grin

I struggled with my last continence nurse if I'm honest. She was cross with me for not wanting to use the pessaries. I also saw a gyne physio who didn't really know what to do with me. I'm hoping for a better setup at the new place.

TeWiSavesTheDay Thu 22-May-14 23:04:56

Pacific - I have fanjo nerve damage after dc3 - presented as vaginismus (or however it's spelt!) and spd. Don't know if that would be relevant to you!

I've had success with Exercises btw! Things were not great after dc2 but fine now.

TeWiSavesTheDay Thu 22-May-14 23:05:47

...and I thought your stand-up was great gussie.

BunnyPotter Thu 22-May-14 23:11:28

Gussie - apologies, I'm kind of talking at you! You know all this stuff, I just don't get a chance to get it out of my head very often!

gussiegrips Thu 22-May-14 23:14:30

Pacific am awfully glad I was nice about GPs...phew.

Your wonder about "doing them right" is why the NICE guidelines recommend doing an internal when you teach pfexs. Which is fine, for the one, consenting woman you have in front of you...but, the millions of them wandering around outside...? Every one of them, a slip hazard.

There's clearly a need to 1. educate women that ANY leaking is abnormal 2. that most cases can be improved if not fixed 3. that they are not alone (actually, that should be #1) 4. that they don't need to put up with it 5. that they should be on MN. ok, #5's pushing it, but, honest, I've got a big MN crush going on because of this thread!

So, yep, feeling like something's going to drop out is a symptom of prolapse. And, seeing as how the States (I can't find the reference, I'll have a dig) allegedly regard it as normal for a woman who's had 2 vaginal deliveries to have a G2 prolapse, well, you fit the criteria.

If it were me, and my bits, I'd be looking for a good urn-gyn person. But, that's mainly because showing my bits to people is practically a hobby of mine.

What's the negative about having an assessment? Worst scene scenario is being told "That is normal for someone of your age with your maternal history. Please do x, y and z to keep it that way"

<shrug>

Go and show off your bits. They'll have seen worse (probably mine)

Oh, and, stealth boast about the orgasms duly noted... and that you DIDN'T say "probably outing myself here" with THAT nugget

rosypsypuddingandpie Thu 22-May-14 23:29:08

gussie, i have had 4 dcs, and generally the pelvic floor is holding up pretty well (i do my exercises), however i definitely do have a bit of a vaginal prolapse. I am not prepared to go to the drs about this as i had a very bad experience with gynaecological surgery many years ago.
my only problem is when i am galloping and jumping my horse, sometimes i wee myself, and if i am on my period i cannot wear a tampon as it literally falls out mid round. (fine the rest of the time) do you think i should try the incotampax thing you refer to whilst going cross country?

grin

gussie, you've always been nice to me even though I did not make it to your Fringe show and me feelings (personal and professional) are not easily hurt (and I am very nice and would never/have never said to any woman "Ah, well, love, you've had kids, wadda'ya expect")

Your threads are always a joy and a laugh and an education <feels the MN love too>

gussiegrips Thu 22-May-14 23:30:41

Oooh, Bunny, I can can't hold my pelvic geek back much longer...

It's not that the French stats are the same as ours. It's that the measurements here are wildly different from theirs. For a start, theirs are great, ours are rubbish.

I can back that up.

UK estimated spend on managing incontinence? £288 million.

Australia's spend on managing incontinence? $43billion (from memory, I'll check. Either $43 or $46. I'll find the reference, it's a Deloitte study done in 2010)

See, UK government only really add up the cost of pads and surgery.

Australian's are smart. They include the cost of managing the secondary depression, the obesity, the heart disease, the hip fractures, the loss of tax from folk having time off from sick leave, the cost of welfare payments due to families who have split up because sexual dysfunction put the tin lid on the relationship...etc.

Australia has a HUGE government funded campaign to drag this stuff into the light. Have a look at this video. It's brilliant. 30 seconds of genius. On their tellies. Let's be honest, it's funded because their government realises it'll save money, but, it REALISES! Our assorted politicians don't seem to notice me yet

Australia 30sec ad

Acksherly, whilst I geek out about numbers...

I did a Companies House search to see what the post-tax profit was of pad manufacturers...one company makes more than twice our national NHS spend. One company.

About £180million a year is spent in supermarkets by people buying pads.

50% of sanitary towels (estimated) are destined for bladder management (hint, if you are 65, you're kidding no one in That Aisle)

I have no problem with companies making a profit. But, I DO have a problem with companies making more than twice the NHS funding WITHOUT ANY HEALTH PROMOTION ON THE PACKAGING!

It wouldn't be expensive to put #doyerblardyexercises on every incontinence pad.

You wouldn't forget then.

woodja?

bodo2 Thu 22-May-14 23:36:24

Thanks gussie. The NHS physio I saw suggested that the nerve damage was permanent, but pleased to hear that nerves can heal. I'm going to ask to explore other avenues before TVT surgery. I absolutely can't stop the flow of urine (which always seems to be the suggested way to identify the PF muscles) but encouragingly, I have recently started running again and can do so without leaking. Maybe there's hope for me yet... It's so difficult to judge the severity of ones symptoms when no one talks about it openly. At my last appointment I felt like I was being pushed down the TVT route but perhaps although I do have symptoms that I shouldn't have to put up with, it's good to know that perhaps there are other options to try first. I've got an electrical stimulation device which I bought on advice from a private physio and used a bit between DD1 and 2 and a little bit after DD2 was born but that was 3 years ago... Sounds like I need to reacquaint myself with it again!

gussiegrips Thu 22-May-14 23:37:07

Oh, and yes, yes, yes to posture - but, really tricky to do remotely.

Easy to fix if you have one person in front of you - well, not easy, but, easier than online. People are weird, I can say that because I've seen a few in a state of undress. Honestly, it's amazing most of us can stand, with our creative posture.

Less sitting. More standing. More activity.

Would do me the power of good.

gussiegrips Thu 22-May-14 23:38:59

yep, WH have done PF stuff.

Twice a year, by my reckoning.

If you're relying on external prompts to remind you to #doyerblardyexercises, Women's Hour is not clinically effective.

Shame.

They totally could be.

Less sitting. More standing. More activity.

Me too blush

Then again I have this theory that almost all human illness could be solved if we all ate less, moved more, did not smoke, drank alcohol in moderation and were not overweight.
I have hundreds or no studies to back that up (depending on how you look at it) wink

<sigh>

How about swimming? Is that any good? I must do something…. the middle-aged state of me is ridiculous.

In word of one syllable, what do I have to do to join The Dark Side Twitter to have you tweet me??
That might actually work for me…

I am thinking of going off to see Dr Karen Guerrero/a (?) at the Southern General in Glasgow - do you happen to know of her?
Sorry, I am shamelessly taking advantage of you good nature now. Feel free to ignore me, honest.

gussiegrips Thu 22-May-14 23:48:03

TeWe TBH, I'm not sure how to spell vajisheemush either. I never, ever use it in scrabble.

Nerve damage isn't common, but, isn't a shocker in clinic. Glad you're good now, and, I hope the vayjaychimooch is well and truly resolved.

If not, you're going to see your GP and get a referral, aren't you?

I totally know how to spell it

gussiegrips Thu 22-May-14 23:50:23

TeWi it's Much Better Now, that was a preview where I rambled on a bit. I blame Commander Hadfield and a bad hair day.

I have since MET The Commander (wanted to lick his face, resisted. Proud of myself) and, found my hairbrush.

Must make another video...

gussiegrips Thu 22-May-14 23:52:50

Bunny are you kidding? If I have my way, this thread Will Never Die.

The only person who listens to me in real life about this is my stupid budgie...why do you think I landed up spending a month of my life in basement bar wittering on about vaginas? Self indulgence.

Keep posting <slightly sweaty> We. Must. Keep. The. Thread. Alive.

You made me look up who Commander Hadfield was - result or what?! <air punch>

gussiegrips Thu 22-May-14 23:54:58

Pacific so, you wouldn't go with a big, juicy procidentia image, then?

Probably for the best.

<slump>

No, IME big procidentias are v rarely juicy wink - definitely stay with a astronauts grin. Who's the new guy? Luca?

Are you doing this year's Fringe?

gussiegrips Fri 23-May-14 00:07:45

Ooooh, Rosy you're not going to like what I'm going to say, but you can guess what it is.

Horse riding's tough on your prolapse. I'm sorry you had a bad experience in the past, that can be really traumatic.

I'm guessing (and, clearly, it's a guess seeing as how I can't see or prod about in your fanjo) that your bits must be in Quite Good Nick considering your big brood (congrats) and that you only leak when your cuddy's* in 6th gear.

So, from that guess (am being careful incase I say anything less professional than my usual) then, I suppose you could surmise that an incostress might be helpful.

Pros:
You can try it without examination
it's about 30 quid, so, not cheap, but not horrific
it's not going to do any harm
it might do a lot of good

Cons:
You can try it without examination

Thing is, the incostress could well be the answer, but, if you have wee niggly muscle spasm up there, well, that could be treated and fixed. Then you could use the incostress as a preventative thing, and have bespoke education about how to best look after your bits so you can keep galloping

<now I've got the music to Black Beauty in my head>

I'm sorry you had a bad experience. But, I'd encourage you to let someone else fish around in your bits and see what they can see.

Otherwise, yep, I rate the incostress.

For women who are not going to engage in 1:1 treatment (of which there are millions, and, that's fair enough if it's an active choice) then things like apps and twitter (@gussiegrips, here all week, folks!) and incostress and kegel8's - well, its' better than nothing.

I'd rather you let me guddle* about in your vagina and tell you which one would help, though.

*one means "horse", one means "fish" in Scots. Guess which one. Prize is an incostress...

TeWiSavesTheDay Fri 23-May-14 00:21:30

Mmm commander...

Yes worry not, there is a whole treatment plan thing. I have a lovely GP.

gussiegrips Fri 23-May-14 00:35:30

Pacific I am always nice to you - but, I can turn...

Twitter's an odd thing. I never understood it until someone said it's like being in a busy pub, with loads of conversations going on round you, and you're listening in to two or three at a time.

So, sign up. Follow me @gussiegrips. Find someone you like (like, say, @Cmdr_Hadfield) and see who HE likes (note the absence of @gussiegrips there. I should have licked him) and follow the ones that appeal.

When someone tweet something you like, you tweet it to your folk. etc.

Busy pub.

but, it's totally underestimated as far as health promotion goes. Some good work amongst diabetes nurses - if it's an actual person doing the tweeting, well, you'll read it. An app, spitting out reminder-bots, maybe not.

Anyhoo, not doing a run in the Fringe - am working on trying to get funding to tour Gusset Grippers as a means to getting a research project going. Hoping to be ready in time for the Glasgow comedy Festival next March, then Edinburgh Festival, then the O2...ish.

gussiegrips Fri 23-May-14 00:40:04

swimming - yes, lots of it. aqua-aerobics - seen as beign for little old ladies, actually, an excellent workout (and, good biofeedback if you're in a council pool and you're jumping about. A chilly cervix reminds you to #doyerblardyexercises)

Southern's got a great reputation. Gwan, gwan, gwan. Gwan, gwan, gwan. Gwan. Gwan.

gussiegrips Fri 23-May-14 00:42:48

Who asked about Astronaut Luca? He's been and gone, some Japanese and Russian blokes up on the ISS now.

@Astro_timpeake goes up in a few months. Well, as long as the whole Crimea thing settles down. He's British. A British Astronaut.

I shall have a crush on him as soon as he hits zero gravity.

NASA has physios, you know. But, I only found that out last year. Dammit.

gussiegrips Fri 23-May-14 00:49:54

Bodo nerves can heal - but, sometimes they can't. It's always very, very slow and there is a point past which the nerves can't recover.

Sounds like you need some answers - or, that you've been seen, but, still have questions requiring answers.

There will be reasons why TVT has been offered, and, it's important that I don't say "#squeezeandlift will cure all" because, that's just not true.

Make a list of what you know, what you wonder, and what you're worried about. Take it to the clinic/physio/GP and tick off their answers. Insist on having an appointment to go through your questions, informed consent means that you need to have information.

You don't have to put up with it, true, but, sometimes, that means understanding the problem as much as getting dry with exercises. Good luck.

gussiegrips Fri 23-May-14 00:54:43

Tewis having inappropriate thoughts about Actual Astronauts is not compulsory. But, if I can get funding to do some research, well, sign up...

nooka Fri 23-May-14 01:28:50

Thank you for the advice gussie, I'm having a smear tomorrow so I'll ask then. I definitely don't want UTIs!

OhBabyLilyMunster Fri 23-May-14 06:53:24

I pretend one day Gussie shall be in the queens honours list for Services to Fannies

BunnyPotter Fri 23-May-14 07:06:40

Ooh Gussie! Imagine! I wake up and there is an email in my inbox telling me to come here and what do I see? What do I see? Only delicious stats that I've been wondering about for over a year, but never had the time to really look for!!

Amazing and shocking. Thanks for putting them up!

I guess I must miss the WH segments then. Do they do it from an angle of "You DO NOT need to put up with this, it's not normal."?

As for spending time in a basement writing about vaginas, I think I've missed parts of this thread, so the basement doesn't sound good, but vaginas? We send people to the moon, probes to mars, have satellites could gearing our "near space", can drill 8 miles (or so) into the earth under the sea, but we know nearly nothing about women's anatomy!! You're on a mission greater than any NASA one, albeit, sadly, one where you don't escape gravity! One small step for women... winksmile

BunnyPotter Fri 23-May-14 07:08:02

* congesting, not could gearing - grr phone

BunnyPotter Fri 23-May-14 07:31:59

Gussie what about stats for cases of prolapse (all types and stages) in comparison to France? Do you have them? They might be more easily comparable (and I've also been wondering about them for a while!). Maybe the French have at least fewer or less severe cases.

I also think that stress incontinence (actually any sort) should routinely be discussed in antenatal visits, and/or in birth preparation classes. Women should know beforehand that it's in the box of "normal" to have an issue, but the sooner they seek help, the better. The 6-week checkup should make a point of it too.

holditmama Fri 23-May-14 09:02:32

Hi Gussigrips, loving the conversation!

Hold It Mama is specifically for Pregnant & Postpartum mums & covers PF in pregnancy, prepping it for labour, effect of labour interventions, improving birth outcomes for PF, early postpartum PF care, recovery after vaginal and caesarean births, PF self assessment, mobilising c-section scars, episiotomies, tears, restarting sex, return to postpartum exercise, & birth & postpartum care in other countries.

Hold It Sister is for women generally & covers healthy & damaging PF habits, preparing for PF success with step by step actions to - Find It, Control It, Train It (PF), PF in girls, sport, pregnancy, birth, postpartum, return to activity, after c-section and pelvic surgery, sex, pain, gym, at risk women, menopause, prolapse, UTI's, older PF, charts & resources.

So important to adore your pelvic floor, it's the Queen of the core muscles.

Mary O'Dwyer
WH Physio

gussiegrips Fri 23-May-14 09:10:02

<waves shyly> Hiya Holditmama

<whispers to the rest of you - that's proper physio sleb on here>

adore your pelvic floor, it's the Queen of the core dammit, wish I'd thought of that.

gussiegrips Fri 23-May-14 09:11:47

Ohbaby I could borrow Beatrice's Vagina Hat for the ceremony? That'd be perfickt.

gussiegrips Fri 23-May-14 09:18:42

Bunny - basement was last August. I wrote a stand up show, "Gusset Grippers" for the Edinburgh Festival Fringe - and, genuinely thought it was going to be a long, lonely month, who'd come and see a show about vaginas at lunchtime?

However, it won "Weirdest show of the Fringe". I was a bit indignant about that initially, have you seen the crazy on Edinburgh's Royal Mile in August? But, it's a compliment - and, the award brought some press, and that brought an audience.

I'm hoping to tour it, and do research to see if using humour improves compliance with the exercises. Am trying to get some funding for that - but, that's trickier than I thought.

It's evidence based, but, the evidence is disguised as fart jokes.

Everyone secretly loves a fart joke.

gussiegrips Fri 23-May-14 09:26:44

Bunny I am not aware of any stats directly comparing the incidence of prolapse between countries. We all think France is the gold standard, but, I'm not sure it's actually been measured. Seriously, the dearth of research speaks volumes...it's as if science has thought "It's only a vagina, it doesn't matter"

There has just been a huge study completed looking at pfexs in managing prolapse (up to G3) in UK, Oz and NZ.

Guess, what, it works. They did 1:1 teaching, totally effective [[ www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61977-7/abstract POPPY trail, Lancet link]]

If anyone knows of any international stats I'd really appreciate them. I have a collection of fanjo studies. And a despairing husband.

AngelaOctopus Fri 23-May-14 09:32:21

I have very slight colorectal leakage and occasional urgency issues from the tear. They did an MRI scan at my last hospital and diagnosed general weakness of my colorectal muscles but not severe enough for surgery. I had a gyne phsyio who got me to pelvic floor exercises with the stimulator (vaginally). It helped my pelvic floor and my score went up but there was no effect on the leakage. The incontinence nurse strongly advised pessaries. They worked sometimes but not all, and on two occasions made things really bad so I won't go back to them. She also recommended sitting in a more elevated position when on the toilet - no effect.

I don't smoke, barely drink alcohol/caffeine, I eat pretty healthily... I do try and keep up with my pelvic floor exercises but it's probably haphazard.

Is there anything more anyone can do? What should I be asking for at my next appointment?

gussiegrips Fri 23-May-14 09:47:09

Did you get a unit home with you? If there's no muscle spasm and it's just a weakness, might be worth a concerted effort for a few months?

So, questions:
Is there any sphincter damage?
Is there a levator ani avulsion?
Is there pudendal nerve damage?

What is their regime for e-stim? Would you be offered a long course, or, can they supply (or recommend) a home unit? Would trying an anal probe be useful?

Is there a rectocele?

Is there any muscle spasm or scar tissue?

Are there any medications which might help?

What is the criteria for further surgery?

If nothing is done, what will happen in the future?

AngelaOctopus Fri 23-May-14 10:02:04

Yes, I had a home unit for a couple of weeks, maybe a month...? We got up to a point where she said it was "good enough" and she didn't think there was much point in carrying on with it because it was having no impact on my colorectal leakage and I had no urinary complaints. That was the point that she referred me to the colorectal team (who did the MRI and recommended the pessaries etc).

Thanks Gussie. I'll make a note of those, and take them in as soon as I get my appointment. I never saw the doctor to discuss the MRI results. Whoever picked up the phone said it was a "generalised weakness", it wasn't worth doing surgery and I should just stick with the lady dishing out the pessaries. So there was no scope for questions!

If I was eligible for surgery, can it sometimes make things worse? That's what I was told by the pessary lady, so I never pursued the doctor as I thought I can live with what I have now, it would be horrendous if it got worse.

goodasitgets Fri 23-May-14 10:11:48

Stupid question (possibly!) but can you make your pelvic floor too tight? For instance if you already have a <ahem> noticeably strong pelvic floor, should you still do the exercises or can you overdo it?
This question may or may not be related to the time a nurse commented on it after I fired a speculum at her blush

gussiegrips Fri 23-May-14 12:12:27

Angela surgery's really outwith my knowledge base. Certainly, if there's actual damage to the sphincter it can be very difficult to restore complete function - but, that doesn't mean it's impossible. Some surgeons are just amazing.

You need answers to your questions - sounds like you've been left dangling a bit.

Write an actual list and take it with you.

gussiegrips Fri 23-May-14 12:16:55

Good, well, in theory, I suppose you could.

But, we spend so much time sitting now, we're not as active compared to our grandmothers, and we're heavier and our poor wee muscles still have to deal with gravity - so many stresses that I've never come across a woman who's issue is a pelvic floor made of girders.

Spasm's different, too tight because of abnormality's associated with pain.

Impressed with the speculum trick. Respect.

Lesuffolkandnorfolk Fri 23-May-14 12:39:40

Have retweeted to the RCM who follow me.

Have always wondered why women are so accepting of their 'lot' as regards urinary incontinence. It shouldn't be left untreated.

Thanks for sharing your brilliant talk Elaine, I've shared it on FB.

HoleySocksBatman Fri 23-May-14 12:57:46

My massive babies caused my pelvic floor to go to shit, and I had 2 ELCS.

CS does not protect you from prolapses.

I have front wall bladder prolapse and 120 degree rotation of urethra, i have severe rectal prolapse and internal rectal intussusception, and I have a loop of sigmoid colon that descends. And of course, my womb is sagging a bit too.

Incdentally i do not leak a drop of urine. But if someone had told me my ability to poo would end up so mangled after 2 big babies, i may have reconsidered having them...

Am scheduled for partial repair in a few months, at last, after putting it off for many years.

This is hugely topical for me as I sit on a cushion recovering from a prolapse repair operation. I was great at pelvic floor exercises, and sometimes it's not enough. But I'm totally on it once I get back to full health

Just to say, 'Hold it Sister' is on its way to me smile

Thank you for coming on here, holditmama.

AFAIK (and I am not an expert) it is possible to have to taut a pelvic floor and this is (rarely) a problem for supremely fit women in certain sports/disciplines (apparently a VB can be difficult for female ballet dancers/gymnasts at the top of their game - of course these are often petit, v slim women, so I am sure any problems they might face will be multi-factorial).

Shooting things out of fanjos is a popular <ahem> entertainment trick in certain circles. I'm told. Apparently. blush

AngelaOctopus Fri 23-May-14 13:47:26

Thanks Gussie. I will. I didn't realise there so much unanswered and hadn't even thought twice about being brushed off on the phone without being able to properly discuss my results with someone knowledgeable.

Mind you, I was probably just relieved not to see my consultant again. The first time I met him he told me 'You should blame your son' for my birth injuries. I still haven't forgiven him even if he was half joking.

I'm normally quite assertive but I seem to go to pieces at the doctors...

Angela, it is seriously SO worthwhile writing questions down before you see any HCP - keep a diary or jotter handy and just add to it as and when you remember something, no matter how daft it might seem.
You can always edit the list before you actually go along for any appointments.

It is well recognised that people do not retain about 3/4 of what they are told during a consultation (that is assuming that communication was perfect… [hmm[), so it is also worthwhile writing answers down and/or having another person with you as a second set of ears/eyes/scribe IYKWIM.

Re 'lighthearted' remarks: I know I am guilty of making them at times in a (possibly ill-considered) attempt to lighten the mood blush. 'Blaming your son' is something that you can chose to say flippantly, maybe not so much the consultant…. Remember, drs are people too, but sorry on behalf of the profession. 'Tis not easy to always get it right.

goodasitgets Fri 23-May-14 14:47:10

Thank you for answering grin
She made me laugh while I was being examined hence the firing trick. I think many years of riding has probably done it, and I do a lot of exercise that needs core work so... Will keep doing exercises anyway!!!

gussiegrips Fri 23-May-14 14:56:17

lesuffolk splendid, thanks for tweeting.

The RCM and CSP are doing some really great collaborative work to improve services and outcomes for women. #squeezeandlift is theirs, the link to the video is on here: midwives link

If enough women tweet, FB and talk, we might get somewhere. So, thanks.

gussiegrips Fri 23-May-14 14:58:45

Travelin thanks. It was fun, I do love The Stand Comedy Club. (if you're in Edinburgh, Glasgow or Newcastle, you should go! Not everyone talks about incontinence, mind. Shame)

Lesuffolkandnorfolk Fri 23-May-14 14:58:58

That is handy to know- I have added your guest post (fully credited to you and with links all back to you, of course) to the Mumsnet Suffolk/Norfolk editorial blog. It looks great.

I've also sent it to some other friends who work as American MW's.

gussiegrips Fri 23-May-14 15:18:18

Holey bowel problems are the Devil's Work. Just awful, I'm glad you're on the way to being sorted.

One in ten have problems with fecal incontinence.

That stat doesn't include the people who have issues with with incomplete emptying of their bowel and who use their fingers to push the vaginal wall backwards so the jobbie can be unleashed. Awful.

gussiegrips Fri 23-May-14 15:19:35

Actually hope your recovery is smooth and your cushion is plump.

gussiegrips Fri 23-May-14 15:30:27

Pacific enjoy the book!

Athletes' pelvic floors are surprisingly rubbish. Shockingly high incidence in some sports, predictably, gymnastics and athletics are a problem.

Kari Bo's paper, pubmed link

A strong pelvic floor is associated with a reduced second stage of labour, put nicely in this paper:

The myth that strong pelvic floor muscles (PFMs) may actually obstruct labor and prolong fetal expulsion exists (Salvesen & Morkved, 2004). Using data from Morkved, Bo, Schei, and Salvesen (2003), Salvesen and Morkved (2004) performed a randomized study to evaluate the effectiveness and impact of pelvic floor exercises (PFEs) during pregnancy on labor and birth. They found that women randomized to intensive PFE training had a lower rate of prolonged second-stage labor, and theorize that PFEs and strong PFMs may actually facilitate labor. When the muscles of the PF and vaginal outlet are routinely exercised, they are more able to stretch and contract at the time of birth, thereby reducing the trauma to the muscles, which can result in lower incidence post-delivery UI (Saunders, 2004). PFEs may be beneficial antenatally, and may be a useful and inexpensive addition to routine prenatal care

Medscape link

It's a really good article looking at the impact of birth management on pelvic floors. Kind of night time reading at Gussie Arsenal...

gussiegrips Fri 23-May-14 15:37:33

Thanks lesuffolk - 'mon the revolution!

chrysanthemumtea Fri 23-May-14 15:53:48

Another thing I forgot to say upthread is leaking was my first sign of pregnancy with my second, even before a bfp. And continued entire pregnancy. Just me?

chrysanthemumtea Fri 23-May-14 15:54:54

Another thing I forgot to say upthread is leaking was my first sign of pregnancy with my second, even before a bfp. And continued entire pregnancy. Just me?

HoleySocksBatman Fri 23-May-14 18:41:05

Gussie: that's me. obstructed. Bleh.

gussiegrips Fri 23-May-14 19:13:47

*chrysanthemum" that's unusual! Early hormone changes might explain it, but, no leaking before the second pregnancy?

gussiegrips Fri 23-May-14 19:26:01

Holey there's a gadget called a femmeze that might help - it's available on prescription now, too.

femmeze

details your GP will need to prescribe it

It looks a little like a shoe horn, and is self explanatory. Very good for women who are pregnant and can't reach, or those who have poor dexterity for whatever reason.

chrysanthemumtea Fri 23-May-14 19:57:52

Hi gussie. Well what happened was this:

Asthma, developed as grown up, got worse in first pregnancy and from about 7 months had v chesty cough and also leaked. Cough so bad I kind of coughed baby out rather than pushed. Leaked for a couple of months post birth but still had cough and had also had manual removal of placenta so was totally sore and battered down there as well as catheter for epidural plus persistent post birth thrush (probs cos all the antibiotics). But eventually this all cleared up.
Then got pregnant again when dd was 15 months and it was more of less the first sigh. Like I say, even pre bfp. Asthma got worse again this pregnancy so I leaked the whole time. Cleared up again post birth but comes back when I have cough.

Am seeing Physio though. She said I have a floppy vaginal wall blush but gave my pelvic floor muscles a four out of five. Has given me exercises and another appointment in six weeks.

But want one more baby (though won't ttc for another year) and terribly worries this will happen again.

gussiegrips Sat 24-May-14 15:11:10

So, is anyone treating your asthma, Chrysanth? You shouldn't be left with an uncontrolled asthmatic cough, particularly when pregnant because your lung capacity is reduced by the bump using up all that space.

There's two contractions, the long squeeze and the quick flicks. Sometimes it's not so much lack of power as co-ordination, so, if the muscles don't contract when you cough then you will leak.

Lots of resources refer to "the Knack" which is you tightening your pf before you go to cough/sneeze/lift etc. It becomes a habit, like covering your mouth before you sneeze.

Can you do quick flicks? Can you do them so it's a good contraction about a second apart, in time to music, or with every step you take?(other artists are available, baboom tsssh)

I'm not offering a diagnosis, that's obviously impossible via a forum, and you're seeing someone who can have a fish around and tell you exactly what's going on. Ask her how your fast-twitch contractions seem.

And, see your practice nurse about the cough. That's no good at all.

Oh, and there's heaps of time to get this sorted before you've scheduled TTC. Don't worry - you know there's a problem and are doing something about it, so, there's no need to worry. It's the folk who are unaware that I fret about.

gussiegrips Sat 24-May-14 16:03:29

angela was remembering a new gadget I saw at a conference - qufora mini

Bowel irrigation's long been a bit of a faff at home, but, this is a neat wee thing, available on prescription.

It's for general bowel management issues, but, I saw it mentioned on the birth trauma website

Just another thought, I know there's a heap of new things on the market, might be worth a chat with a continence nurse if it's been a while?

PenguinsHatchedAnEgg Sat 24-May-14 17:21:52

Can I ask a question?

I've just had my final child (three weeks ago). Things have been 'not great, but not dreadful' since I had my first by forcep delivery 5 years ago. No daily leaking, but I need to think twice before running and physically cross my legs to sneeze type thing.

So my question is, with what would often be considered 'mild' problems, can I still expect to see a realistic improvement from a serious focus on exercises, or is it just likely to move serious problems to mild ones like mine? I really want one day to be able to sprint after my kids in the park without thinking twice...

coolmorechick Sat 24-May-14 19:57:12

I had a horrendous time during the birth of my first baby. Insanely I agreed to induction on my due date for no medical reason and had forceps delivery. It was very, very traumatic and I was left with devastating stress incontinence. I was 30 at the time. I run alot and had to wear full incontinence pads/nappies and still managed to drench myself whilst running. I went to physio, bought every machine and gadget under the sun. No improvement. I complained to the obstetrician and hospital and they subsequently wrote to my GP to say I had post natal depression.

I went to a different hospital and a different consultant and had the TVT procedure done 5 years ago. Ive never looked back. 3 years ago I had a natural delivery of 9lb 4 ounce baby and the TVT held up. It still does. I do regular speed, interval, hill training with my running club and never a drop leaked. The TVT was one of the best things I have ever had done; it gave me back my confidence.

gussiegrips Sat 24-May-14 20:05:33

All questions welcome, Penguin!

Short answer is yes, you'd expect to see a realistic improvement, or to become completely dry.

but, I'm not a fan of the short answer (you guessed that, right?). In fact, it's people with the "mild" problems who do best with #doyerblardyexercises.

People like you have the potential to self diagnose and self manage with the right information, and, always the caveat of "if you get pain, if it doesn't work, if it doesn't "feel right" then get an assessment".

The evidence is that if people with "mild" incontinence followed the advice, or, you know, were GIVEN the advice in the first place then they'd be dry, and potentially, would have less of a prolapse risk post-menopause.

I'd also question what defines "mild" incontinence. Any leaking at all of anything is abnormal (so, that's pee, poo or pumps) and, if it's not treated then it can gradually get worse and worse, until you land up like me, fecking miserable and dribbly.

I'm fine now <star jump> See? But, I DO have to do the exercises, and, I know if I put on half a stone it comes back a bit, and I know that too much caffeine doesn't agree with me. But, <burpee> I can show off a bit <hearty cough>

Congratulations on the baby, and try really hard to #squeezeandlift x3/day, which isn't easy when you are sleep deprived and harassed. Doing it at the same time as you brush your teeth will help remind you.

Be patient, takes a while to see a difference, especially when you are early post-natal.

Don't give up. Or, I'll come and nag you.

gussiegrips Sat 24-May-14 20:17:54

Coolmore you make an important point. Some women cannot be helped conservatively, sad fact.

Happily, the TVT is very effective surgery. (for those of you who've not heard of it, it's a tape that is slung under your bladder and supports your urethra (the tube the pee comes out)) I's got good long term effects, there's a study showing great results 7 years later, but, anecdotally, some were done 15 years ago and are still going strong.

You need 2-4 weeks off work and can't lift anything heavy for 6 weeks, and, you STILL need to #squeezeandlift afterwards.

Am pleased you got back to your sports, and, 9lb 4oz? Ouch.

gussiegrips Sat 24-May-14 20:45:10

This just popped up on twitter. Lucy Brett's blog about her urology assessment was featured on Mumsnet forever-ago. It's powerful stuff. Bonus mention of Michael Fassbender's willy.

Shame

PenguinsHatchedAnEgg Sat 24-May-14 21:07:41

Thanks Gussie. That's really encouraging.

I think I'm going to order that Mary O'Dwyer book (thinking 'Sister', since I've had my last child so all the pregnancy stuff isn't going to be that relevant) and maybe look at an app. I'm rubbish on Twitter. Unless it actually comes to me as a notification, I won't see it. I look on there about every two months, which I don't think is the frequency needed for results grin. TBH, perhaps I just need a 3x daily alarm set on my phone.

chrysanthemumtea Sat 24-May-14 23:29:18

Hi gussie. Yes the asthma is being treated now but during first pregnancy I never really realised it was anything more than a normal cough as was so caught up in pregnancy and then in the post baby haze looking after myself wasn't a priority.

Then with second pregnancy asthma uk helpline was amazing and insisted I get steroids and gp gave them to me reluctantly (but asthma uk shows risk to baby of steroids lower than risk to baby of mum struggling to breathe) but even when cough gone I just had no control throughout pregnancy.

But the kids are at nursery and very cold they get which is all the bloody time, I get it too and it goes to my chest. But I have good inhalers now. And confidence to demand steroids when needed.

gussiegrips Sun 25-May-14 11:20:49

and then in the post baby haze looking after myself wasn't a priority.
Maternal wellbeing is the best thing for a baby, and yet, we are put, or put ourselves, last.

I've got a total crush on Asthma UK. Middley-Grip has had shocking asthma troubles, the kind that makes consultants cry a bit, and that phone line has been beyond helpful to me. He's doing fine now, but, it's been a bit rough at times.

Actually, I wonder if they'd like to do a thing about pelvic floors and coughing?

Ooooh....

mumtoothree Sun 25-May-14 19:54:46

Women who have never had children can also have stress-incontinence, so don't just blame childbirth. I do wonder if the epidural rate will increase SI, due to many women in labour having to actively push, therfore maybe recommended home births/mlu might do some good. Would be interesting to know.

gussiegrips Sun 25-May-14 21:03:27

Mum of course, that's true.

About 15% of women aged 15-35 leak, a significant number in that age group don't have kids.

Certainly, pregnancy and childbirth INCREASE your risk - but, if you are hypermobile, with a family history of prolapse, you are overweight, you participate in impact sports, you have a job that requires heavy lifting, you have a nasty cough and you have never heard of pelvic floor exercises...well, you're probably going to leak.

And, it's worth mentioning that once you're post-menopause there is no difference in the incidence of women who leak who had children or did not.

Epidural's a good question - certainly, pushing against a not-fully-dilated cervix and/or a long second stage increases stress on the poor wee pelvic floor. I'll see what I can find.

gussiegrips Sun 25-May-14 21:32:02

Found another thread of leaky ladies...bringing em over here into the fold: pfexs go through me like nails on a chalkboard

love the description!

cardamomginger Mon 26-May-14 22:55:46

Sorry to start banging on about this AGAIN. But exactly gussie - there are groups of women who are more prone to pelvic floor/continence problems. I just think it would be really nice if when you have your antenatal appointments HCPs recognised that some women were at higher risk of these problems, were open and honest about the added risk that VB may pose and enabled you to make a informed choice about which birth you wanted - ELCS or VB. (And before someone else jumps all over me, yes, I know ELCS does not guarantee no additional problems! And yes, I know that ELCS is major surgery that has its own risks.)

In my case, I'm hypermobile, as was my mother and she had prolapse. And it really pisses me off (pun fulling intended) that no one antenatally raised this as a concern and that it is only when a team of physicians and surgeons tried to work out how to piece me together afterwards that they started saying things like 'Oh well, of course, with your hypermobility, you were at a much higher risk of these sorts of birth injuries.' Hearing it after the event really doesn't help me!

gussiegrips Mon 26-May-14 23:16:26

Yep, Cardamom I'd say that this point of yours in absent in most antenatal thinking - unless there's a diagnosis of EDS or other hypermobility syndromes.

It's an excellent point, and, depressingly, not one that I have seen a lot of chat about either amongst professional or social peers.

Hmmm. Mulling.

I wonder whether it's valuable to do an anonymous study (oh, say, on a parenting website, I'll think of an appropriate one in a minute or two) to find out what women's experience actually are - and whether that matches up with what the existing literature thinks they are.

Hmmm. This, and the other thread has cast up some really interesting points. Well, interesting if you are a pelvic geek. I do understand that some folk aren't interested in this sort of thing...even seen some of them walking around, like ordinary people. Amazing, I know!

cardamomginger Mon 26-May-14 23:46:45

The chat and the joined up thinking is starting. There's an MDT group that meets in London centred around hypermobility that includes ob/gynae, rheumatology, immunology, gastric, neuro-vascular.

And there is a lot of anecdotal chat about it all. But it's still pretty removed from the level of care that most of us would get, certainly on the NHS.

Research is needed. Papers. I spoke to 4 gynae surgeons and, whilst all of them were anecdotally up to speed with hypermobility and increased risk of birth injuries, none of them could point to a single paper that investigated the link. I did an internet search through an academic search engine. And again, nowt. So it's great if you get to see the person who has taken a professional interest in the area and has thought about the things they have seen and has had the 'right' sort of conversations with colleagues. But not much help otherwise.

gussiegrips Mon 26-May-14 23:57:12

You able to PM me a link to the group, Cardmom?

If you want to be totally depressed, do a pubmed search for anything to do with womens' pelvic health.

You are right. Everything you say is right.

cardamomginger Tue 27-May-14 00:11:56

That's true!! Am PMing you.

Longrun Tue 27-May-14 00:57:18

Great post Gussie! I’ve learnt a lot, had no idea that hypermobility is a risk factor for PF weakness.
Slightly off topic, I wear pads but often have a hard time keeping them in place. There is purpose made underwear for the job but it reminds me of the net bags you get onions in. Not sexy.
For those of us who do wear pads, what is everyone using? And how are you making them stay put?

nooka Tue 27-May-14 04:02:05

Hi gussie, just to say that my GP was very sympathetic and suggested a urine test to check if there was any infection going on. Weirdly though since my smear I've not leaked at all. Is it possible that she moved something around inside me that got things better aligned (I had incomplete emptying after peeing). She did a internal to check my ovaries and uterus felt OK (apparently routine here in Canada) so there was a bit more rummaging than normal.

BunnyPotter Tue 27-May-14 10:03:16

IT'S ON WOMAN'S HOUR TODAY!!!

gussiegrips Tue 27-May-14 12:39:51

I just caught it, Bunny! Fan-bloody-tastic, the CSP and RCM's collaboration is really important and deserves to be on WH!

Here's the link for those of you who missed it BBC iplayer link

What did you guys think of the article? (I'm a fan)

GarlicMayonnaise Tue 27-May-14 12:41:49

Longrun - control pants ... No wonder I have thrush every few weeks blush

gussiegrips Tue 27-May-14 13:01:40

Long Yep, hypermobility's a big problem. Just means you're naturally stretchier than the average bear, so, resisting gravity and intra-abdominal pressure is harder for your elastic tissues. #doyerblardyexercises will help, and, really, I'd advise you to look at using a pessary like incostress or a contrelle if you are a runner guessing that from your name

So, firstly, usual party line - any leaking of any sort is abnormal and so needs to get checked out. But, some people will, sadly, be reliant on pads, and you raise something really important - the pads are rubbish!

They move, they unstick themselves (and re-attach elsewhere, which can be a bit nippy) and they can be too bulky for ordinary knickers to keep in the right place.

Big, close fitting pants will help. I came across these guys at a conference recently enso Nice kecks, no seams, won an award. They also make clothes to accommodate stoma. Anyway, I've not tried them <show off star jump> but, they are sexier than the onion bag versions <arf>

gussiegrips Tue 27-May-14 13:03:21

nooka you get a shiny for going <pins it on carefully and salutes>

Some people have a urethra (pee tube) that kind of kinks. Wonder if that's it?

Glad you had a good experience of care, so good to hear.

gussiegrips Tue 27-May-14 13:06:57

Garlic yep, spanx are one I see people using. But, they're not comfy for everyday use and, there's a train of thought that because they alter your breathing pattern from diaphragmatic to heaving-bosom, that they can actually worsen incontinence.

I haven't seen any research on that, it's anecdotal, but, here's an article Huff Post link about the evils of control wear

GarlicMayonnaise Tue 27-May-14 13:20:11

Hmmm! I don't wear them all the time, just when I'm feeling - er, insecure. I have noticed, though, that the pressure makes me pay more attention to my pelvic/tummy muscles which is probably a good thing. I buy ones that fit, not the sort that push your entire belly up to your bra strap grin

Another friend uses cycling shorts.

gussiegrips Tue 27-May-14 13:45:44

Me too, I squeeze myself into them whenever I need to wear a frock. wonders about a corset

GarlicMayonnaise Tue 27-May-14 14:16:09

Well, Gussie, there's quite a crowd of retro underwear fanatics on MN! I'm sure they'd be happy to help you find your preferred instrument of self-torture wink

gussiegrips Tue 27-May-14 14:18:06

Hmmm, "retro" or fewer tunnocks teacakes....

tough choice.

Pull my stays, Garlic?

GarlicMayonnaise Tue 27-May-14 14:49:02

<laughs maniacally> Sure, G, just clench ... tighter ...

Get a room, you two grin

Thanks for the link upthread - will read later.

Or 'watch' rather… blush

Nevermind PFE, I need dementia meds (get in there early… hmm)

Oh crap, listen - 'tis radio <walk of shame out of thread>

Did I forget any senses?
Could I feel WH? Or smell it? Hope not
<sigh>

Laughing about myself, so others laugh with me, not at me….

gussiegrips Tue 27-May-14 23:46:33

Arfed at the thought of sense of smell and WH.

How about a big health promotion campaign in glossy magazines with a "scratch and sniff" bit on the #doyerblardyexercises as a motivational tool. But, then I felt a bit bad about it. Sometimes, I take things a little too far (that would totally work though)

Meerka Wed 28-May-14 08:22:41

I used to get leaks as a teen (blush) thank heavens the worst one, on the hockey field, I happened to have a towel in cause I was expecting the monthlies. Lived in fear of another leak after that though.

Post second vaginal delivery a few weeks ago I'm finding things notably worse than first time around, sneezing and coughing is really embarassing.

Thanks for putting up the stuff about -how- to do the exercises gussy. Hadn't heard about the lift one before. Now adding that to me 5 x dailly exercises.

Does being prone to bladder infectoins make it worse?

flowersinthewind Wed 28-May-14 19:34:27

I use a electronic toner which is brilliant solved alot of problems for me

Well, gussie, I am once again so inspired by you that everybody who stands still long enough in my (professional) presence, will be offered advice of PFE these days blush - I discussed them with an elderly demented lady and her daughter today, including written instructions and diagram and the lot. Little did they know that I was sitting there actually doing them while I was talking about them. Why is it impossible to talk about them without actually clenching….?

Meerka, congrats on your new baby.
It is my understanding that a weak pelvic floor can predispose you to urinary tract infections, rather than the other way round (gussie will know the evidence).

gussiegrips Wed 28-May-14 23:20:12

Meerka if you have problems when you are young then you're more likely to have them later on.

That's interesting about the bladder infections, there's an element of cause and effect there. If you have a kink in your urethra, or incomplete emptying of your bladder, well, bugs like that. Equally, pf sagginess can mean the urethra's wobbling about and not beign supported which increases risk. Had it checked out?

gussiegrips Wed 28-May-14 23:21:56

Flowers good for you. Glad you're better now, but, still #doyerblardyexercises every day.

gussiegrips Wed 28-May-14 23:28:20

Ooops, x-posted with you, Dogwood!

The main reason I'm drawn to this work is because of the constant reminder to do my own blardy exercises. I have an undercarriage made of girders now, and, I don't want to go back to the soft shocker!

Kari Bo's stuff on pf and elderly - works a treat. M, Bird M, Carey M, BÝ K, Galea MP 2011 ?Incontinence improves in older women after intensive pelvic floor muscle training: an assessor-blinded randomized controlled trial? NEUROUROL URODYN, Vol. 30(3), pp. 317-24.

Oh, you have the evidence for everything; I am impressed, truly smile.
Well, I figured it won't hurt and might just help…
Thanks for the link.

gussiegrips Thu 29-May-14 14:55:19

<re-files collection of pelvic geekery in "Date Read" order>

It's a bit of a worry, really. Might try and blag a job out of Cochrane to see if there's a point to it at all!

I have given a very sprightly older bird (her description, not mine) with a new rectocele the link to your Fringe show on YouTube today grin
She was SO up for PFEs and RV in 1/12 after she's been to see a specialist physio - when I said your show was not for the 'fainthearted' she was even keener… I hope you don't mind.
(She also got a heck of lot of very SERIOUS information, a pv examination, a discussion about her options and all in about 30min of her 10 minute appointment hmm)

DaVinciNight Thu 29-May-14 21:33:15

gussie can I ask you a question/ Would you advise women to do some exercises whilst they are pregnant or is that a no-no?
I see quite a few pregnant women through my work and was wondering if I should talk to them about it.

See, I can go the chat, but I am so not an academic and much as I quite like quoting research to back my drivel up, I cannot actually read through it without falling asleep and would make a rubbish scientist.
You are woman of many talents, funny and clever and give dirty talks with science bits grin

HoleySocksBatman Fri 30-May-14 10:49:47

The repeated bladder infections is why i'm getting my repair done - i am sick and tired of having round after round of antibiotics. The yeast is killing me. :/

Uro/gyn says he thinks the ventral rectopexy will fix the sagging bladder. The rectal / general surgeon guy says it wont.

I just lurve being caught in the middle of disagreeing professionals at the same hospital [facepalm]

gussiegrips Fri 30-May-14 11:06:47

Pacific of course I don't mind. Every youtube hit is like a little more rub on my ego.

To balance up the whole ego massage thing you've got going on (thanks, by the way), I am also a slovenly housewife, an impatient wife and am entirely unable to hang a picture straight.

Hope that helps.

gussiegrips Fri 30-May-14 11:10:13

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.

gussiegrips Fri 30-May-14 11:16:49

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

desertgirl Fri 30-May-14 18:27:03

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

gussiegrips Fri 30-May-14 21:18:45

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.

mercibucket Sat 31-May-14 18:22:55

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)

gussiegrips Mon 02-Jun-14 09:43:32

Hi Merci

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.

Janela Thu 05-Jun-14 15:37:53

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...

gussiegrips Fri 27-Jun-14 13:45:11

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.

www.evidentlycochrane.net/incontinenceisntfunny/?utm_source=evidentlycochrane&utm_medium=socialmedia&utm_content=blog&utm_campaign=incontinenceweek

LittleMissMarker Fri 27-Jun-14 16:42:20

Is GussieGrips doing the Fringe again this year? I missed last year and couldn't see you in this year's programme...?

Helen1977 Fri 27-Jun-14 16:52:34

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.

ItsAllGoingToBeFine Fri 27-Jun-14 21:21:02

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?

gussiegrips Sat 28-Jun-14 00:32:39

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.

gussiegrips Sat 28-Jun-14 00:34:06

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.

gussiegrips Sat 28-Jun-14 00:52:52

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.

gussiegrips Sat 28-Jun-14 00:55:26

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.

LittleMissMarker Sat 28-Jun-14 13:51:46

Yup, I'll be there! Boggles at audience participation - synchronised squishing? grin

gussiegrips Sun 29-Jun-14 23:46:52

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.

Helen1977 Mon 30-Jun-14 17:01:27

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....

ItsAllGoingToBeFine Mon 30-Jun-14 17:28:38

mamasweat.blogspot.co.uk/2010/05/pelvic-floor-party-kegels-are-not.html?m=1

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.

ItsAllGoingToBeFine Mon 30-Jun-14 17:31:44
gussiegrips Sun 06-Jul-14 18:50:33

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.

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