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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:
HalloumiToastie · 22/05/2014 11:46

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 · 22/05/2014 11:51

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 · 22/05/2014 12:31

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 · 22/05/2014 12:39

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 · 22/05/2014 12:45

Chachah yep, Vive La France!

French women wear white trousers too.

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

gussiegrips · 22/05/2014 12:47

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 · 22/05/2014 12:47

Garlic you are very welcome. x

gussiegrips · 22/05/2014 12:56

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 · 22/05/2014 12:57

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 · 22/05/2014 13:07

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 · 22/05/2014 13:13

stoptalking 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 · 22/05/2014 13:21

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 · 22/05/2014 13:25

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 · 22/05/2014 13:53

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 · 22/05/2014 14:01

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 · 22/05/2014 14:12

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 · 22/05/2014 14:34

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 · 22/05/2014 14:41

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 · 22/05/2014 14:52

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 · 22/05/2014 15:41

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 · 22/05/2014 17:55

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 · 22/05/2014 18:02

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 · 22/05/2014 18:14

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

HalloumiToastie · 22/05/2014 18:39

Many thanks for replying to me Gussie.

BunnyPotter · 22/05/2014 19:58

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.

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