Guest post: Stress incontinence - 'Fallen fanjos are a feminist issue'

[MumsnetGuestPosts]

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 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.

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 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 - and don't forget to subscribe - lots more brilliant videos coming very soon.

[MrsRTea]

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

[Callani]

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]

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

[mercibucket]

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

[confuddledDOTcom]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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.

[PacificDogwood]

Gussie, I think I luffs you - just watched your Fringe show . 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]

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.

So well done Gussie and co!

[alikat724]

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]

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]

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]

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]

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.

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

[gussiegrips]

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:www.juliewiebept.com/video/the-diaphragm-pelvic-floor-piston-demo/

[gussiegrips]

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]

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]

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?"