Guest post: Stress incontinence - 'Fallen fanjos are a feminist issue'
Did you know that one in three women aged 35-55 wet themselves? Stress incontinence is very common, and yet we're often too embarrassed to talk about it. Physiotherapist Elaine Miller (AKA gussiegrips) is determined to remove the taboo and encourage all women to do their pelvic floor exercises. In this guest post, she explains why it matters.
Posted on: Wed 21-May-14 10:55:17
(259 comments )
Doorstep piddling wasn't unusual for me - you know how you're okay right up until you get the key in your lock? Well, my poor neighbour caught me as I was wresting small kids and shopping with a post-coffee-bladder. She chatted away as I tried to disguise that I was bursting (standing on your tip toes works by the way, for a time).
Our relationship was mostly based on exchanging gardening tips and accepting parcels for each other. So, washing her down the driveway in a giant tsunami of my steaming piss was a bit, y'know, socially awkward.
And I had no excuse. I knew exactly what pelvic floor exercises were, how to do them, and why I should bother because <hangs head in shame> I'm a physiotherapist.
No excuse, but, there was a good reason – I was awfully tired. I lived with hundreds of tiny kids who were always trying to maim themselves, and each other, in ever-more inventive ways. I could barely remember my children's names, let alone remember to clench my nether regions.
But the great Dribbly Doorstep Disaster was the motivation I needed.
"Make it a habit" is the advice, so, I did them every time I shouted at my kids' (effective), every time I craved a glass of wine (remarkably effective) and every single time I thought an evil thought about my husband (dry in three months).
Here's the sciencey bit:
One in three women aged 35-55 wet themselves, and, about 50% of women over 55.
70-80% of stress incontinence can be cured with pelvic floor exercises within four months.
Read that again. At least a THIRD of your peers use pads, and MOST of them can be cured.
The exercises are cheap to teach, free to do and don't have any side effects. Unless you count toe curling, panting, blaspheming orgasms as a side effect (ask me how I know).
And it bloody MATTERS. Incontinence quietly disempowers women by interfering with every single thing they do, and yet, few complain. It matters because wetting yourself in the front row of Zumba, means you are unlikely to go back to Zumba (again, erm, ask me how I know), and we know that diseases of inactivity kill people. It matters because being "a bit leaky" is a big deal that can have a huge impact on your long-term well-being.
It bloody MATTERS. Incontinence quietly disempowers women by interfering with every single thing they do, and yet, few complain. It matters because wetting yourself in the front row of Zumba, means you are unlikely to go back to Zumba (ask me how I know), and we know that diseases of inactivity kill people.
We silence ourselves. It’s as if we are so ashamed of having less bladder control than our toddler that we'd rather continue to suffer in silence than seek help. I suggest we try being angry and vocal instead, because that’s how taboos change.
Even more silent are the one in ten people who leak poo, or the 50% of women over the age of 50 who have vaginal prolapses. Some wait until they are practically dragging their cervix behind them before seeking help.
It's common to be a bit disengaged with your "down below" because, well, you can't see it. We know that many women find the exercises difficult to do correctly, and that energetic eyebrow wiggling is not an effective alternative.
So, set the scene: You're in a tiny lift with your boss, your MIL and someone you've got a massive crush on. Imagine you can feel a fart brewing. A really nasty one. You know that bum-ole squeezing you do to hold in the mortifying toot? That's you working your pelvic floor. Hold it for a count of 10. When you let go you should feel a "drop" down into your pants. Or you could do 10 quick flicks and relaxes in a row - try doing them in time to the beat of music.
The important thing is to keep breathing and to relax your muscles in between the exercises. Do these three times a day, every day for four months, and then, once a day, every day, until you die. If you get pain, stop and take your bits to a GP or pelvic physio.
And, I'll even remind you via twitter - when I tweet, you twitch your twinkle. Midwives and physios are collaborating with #squeezeandlift. If you see it, do it!
Basic lifestyle changes – like reducing caffeine, citrus and alcohol (so, at least cut out the 'slice' from your rum and coke), controlling hayfever or asthma coughs and (even small amounts of) weight loss can make a huge difference to the amount of leaking you experience.
As with all things, the best place to start is with good information – there are brilliant blogs out there, like Evidently Cochrane, and lots of useful stuff from the CSP and the Bladder and Bowel Foundation. Or, you could even watch me, on a really bad hair day, doing stand-up comedy about pelvic floors.
The bottom line is that any leaking at all is abnormal. It is not an inevitable consequence of ageing or parenthood, and you don't need to put up with it.
Watch Elaine's alter ego Gussie Grips take the Edinburgh Festival by storm over on the Mumsnet YouTube channel - and don't forget to subscribe - lots more brilliant videos coming very soon.
By Elaine Miller
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?"
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.
lovecat - yep, if you forget it'll come back.
Every day - do them when you brush your teeth.
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.
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.
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.
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.
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.
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
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.
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?
Not a permanent solution obviously though!
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
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.
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.
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!
is trampolining bad? it always makes me 'clench' properly so i thought of it as good
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.
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.
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 problem Even my mum won't mention my prolapse problems directly, she talks in euphemisms!
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.
Yeah and it all magically cures itself at the age of 56...
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>
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?
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.
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