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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:
BunnyPotter · 22/05/2014 19:59

*forward tilt, not forward to of!

PacificDogwood · 22/05/2014 20:17

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 ), 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 · 22/05/2014 21:01

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 · 22/05/2014 21:12

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 · 22/05/2014 21:16

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

gussiegrips · 22/05/2014 21:22

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 · 22/05/2014 21:26

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 · 22/05/2014 21:35

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 · 22/05/2014 21:38

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 · 22/05/2014 21:41

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 · 22/05/2014 21:42

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 · 22/05/2014 21:47

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 · 22/05/2014 21:51

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

Brilliant.

AngelaOctopus · 22/05/2014 21:53

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 · 22/05/2014 22:01

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 · 22/05/2014 22:10

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 · 22/05/2014 22:14

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 · 22/05/2014 22:24

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.

PacificDogwood · 22/05/2014 22:37

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.

PacificDogwood · 22/05/2014 22:44

Btw, I am a GP , I have continence issues 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 · 22/05/2014 22:52

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 · 22/05/2014 23:00

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 · 22/05/2014 23:04

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 · 22/05/2014 23:05

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

BunnyPotter · 22/05/2014 23:11

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!

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