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

259 replies

MumsnetGuestPosts · 21/05/2014 10:55

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.

OP posts:
gussiegrips · 21/05/2014 22:54

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 · 21/05/2014 23:04

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 · 21/05/2014 23:11

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 · 21/05/2014 23:12

Hoboken - haven't seen that study...

gussiegrips · 21/05/2014 23:22

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 · 21/05/2014 23:23

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

ancientbuchanan · 21/05/2014 23:30

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 · 21/05/2014 23:54

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?

cardamomginger · 21/05/2014 23:56

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 · 22/05/2014 00:04

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 · 22/05/2014 00:07

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 · 22/05/2014 00:12

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 · 22/05/2014 00:17

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 · 22/05/2014 00:44

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 · 22/05/2014 02:00

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 · 22/05/2014 02:27

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.

nooka · 22/05/2014 06:18

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 · 22/05/2014 09:24

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.

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 · 22/05/2014 09:29

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 · 22/05/2014 09:30

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

gussiegrips · 22/05/2014 09:32

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 · 22/05/2014 09:41

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

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 · 22/05/2014 10:43

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.

Mabelface · 22/05/2014 11:15

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

GarlicMayonnaise · 22/05/2014 11:28

Thanks, gussie!

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