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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 · 23/05/2014 07:06

Ooh Gussie! Imagine! I wake up and there is an email in my inbox telling me to come here and what do I see? What do I see? Only delicious stats that I've been wondering about for over a year, but never had the time to really look for!!

Amazing and shocking. Thanks for putting them up!

I guess I must miss the WH segments then. Do they do it from an angle of "You DO NOT need to put up with this, it's not normal."?

As for spending time in a basement writing about vaginas, I think I've missed parts of this thread, so the basement doesn't sound good, but vaginas? We send people to the moon, probes to mars, have satellites could gearing our "near space", can drill 8 miles (or so) into the earth under the sea, but we know nearly nothing about women's anatomy!! You're on a mission greater than any NASA one, albeit, sadly, one where you don't escape gravity! One small step for women... WinkSmile

BunnyPotter · 23/05/2014 07:08
  • congesting, not could gearing - grr phone
BunnyPotter · 23/05/2014 07:31

Gussie what about stats for cases of prolapse (all types and stages) in comparison to France? Do you have them? They might be more easily comparable (and I've also been wondering about them for a while!). Maybe the French have at least fewer or less severe cases.

I also think that stress incontinence (actually any sort) should routinely be discussed in antenatal visits, and/or in birth preparation classes. Women should know beforehand that it's in the box of "normal" to have an issue, but the sooner they seek help, the better. The 6-week checkup should make a point of it too.

holditmama · 23/05/2014 09:02

Hi Gussigrips, loving the conversation!

Hold It Mama is specifically for Pregnant & Postpartum mums & covers PF in pregnancy, prepping it for labour, effect of labour interventions, improving birth outcomes for PF, early postpartum PF care, recovery after vaginal and caesarean births, PF self assessment, mobilising c-section scars, episiotomies, tears, restarting sex, return to postpartum exercise, & birth & postpartum care in other countries.

Hold It Sister is for women generally & covers healthy & damaging PF habits, preparing for PF success with step by step actions to - Find It, Control It, Train It (PF), PF in girls, sport, pregnancy, birth, postpartum, return to activity, after c-section and pelvic surgery, sex, pain, gym, at risk women, menopause, prolapse, UTI's, older PF, charts & resources.

So important to adore your pelvic floor, it's the Queen of the core muscles.

Mary O'Dwyer
WH Physio

gussiegrips · 23/05/2014 09:10

Hiya Holditmama

gussiegrips · 23/05/2014 09:11

Ohbaby I could borrow Beatrice's Vagina Hat for the ceremony? That'd be perfickt.

gussiegrips · 23/05/2014 09:18

Bunny - basement was last August. I wrote a stand up show, "Gusset Grippers" for the Edinburgh Festival Fringe - and, genuinely thought it was going to be a long, lonely month, who'd come and see a show about vaginas at lunchtime?

However, it won "Weirdest show of the Fringe". I was a bit indignant about that initially, have you seen the crazy on Edinburgh's Royal Mile in August? But, it's a compliment - and, the award brought some press, and that brought an audience.

I'm hoping to tour it, and do research to see if using humour improves compliance with the exercises. Am trying to get some funding for that - but, that's trickier than I thought.

It's evidence based, but, the evidence is disguised as fart jokes.

Everyone secretly loves a fart joke.

gussiegrips · 23/05/2014 09:26

Bunny I am not aware of any stats directly comparing the incidence of prolapse between countries. We all think France is the gold standard, but, I'm not sure it's actually been measured. Seriously, the dearth of research speaks volumes...it's as if science has thought "It's only a vagina, it doesn't matter"

There has just been a huge study completed looking at pfexs in managing prolapse (up to G3) in UK, Oz and NZ.

Guess, what, it works. They did 1:1 teaching, totally effective [[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61977-7/abstract POPPY trail, Lancet link]]

If anyone knows of any international stats I'd really appreciate them. I have a collection of fanjo studies. And a despairing husband.

AngelaOctopus · 23/05/2014 09:32

I have very slight colorectal leakage and occasional urgency issues from the tear. They did an MRI scan at my last hospital and diagnosed general weakness of my colorectal muscles but not severe enough for surgery. I had a gyne phsyio who got me to pelvic floor exercises with the stimulator (vaginally). It helped my pelvic floor and my score went up but there was no effect on the leakage. The incontinence nurse strongly advised pessaries. They worked sometimes but not all, and on two occasions made things really bad so I won't go back to them. She also recommended sitting in a more elevated position when on the toilet - no effect.

I don't smoke, barely drink alcohol/caffeine, I eat pretty healthily... I do try and keep up with my pelvic floor exercises but it's probably haphazard.

Is there anything more anyone can do? What should I be asking for at my next appointment?

gussiegrips · 23/05/2014 09:47

Did you get a unit home with you? If there's no muscle spasm and it's just a weakness, might be worth a concerted effort for a few months?

So, questions:
Is there any sphincter damage?
Is there a levator ani avulsion?
Is there pudendal nerve damage?

What is their regime for e-stim? Would you be offered a long course, or, can they supply (or recommend) a home unit? Would trying an anal probe be useful?

Is there a rectocele?

Is there any muscle spasm or scar tissue?

Are there any medications which might help?

What is the criteria for further surgery?

If nothing is done, what will happen in the future?

AngelaOctopus · 23/05/2014 10:02

Yes, I had a home unit for a couple of weeks, maybe a month...? We got up to a point where she said it was "good enough" and she didn't think there was much point in carrying on with it because it was having no impact on my colorectal leakage and I had no urinary complaints. That was the point that she referred me to the colorectal team (who did the MRI and recommended the pessaries etc).

Thanks Gussie. I'll make a note of those, and take them in as soon as I get my appointment. I never saw the doctor to discuss the MRI results. Whoever picked up the phone said it was a "generalised weakness", it wasn't worth doing surgery and I should just stick with the lady dishing out the pessaries. So there was no scope for questions!

If I was eligible for surgery, can it sometimes make things worse? That's what I was told by the pessary lady, so I never pursued the doctor as I thought I can live with what I have now, it would be horrendous if it got worse.

goodasitgets · 23/05/2014 10:11

Stupid question (possibly!) but can you make your pelvic floor too tight? For instance if you already have a noticeably strong pelvic floor, should you still do the exercises or can you overdo it?
This question may or may not be related to the time a nurse commented on it after I fired a speculum at her Blush

gussiegrips · 23/05/2014 12:12

Angela surgery's really outwith my knowledge base. Certainly, if there's actual damage to the sphincter it can be very difficult to restore complete function - but, that doesn't mean it's impossible. Some surgeons are just amazing.

You need answers to your questions - sounds like you've been left dangling a bit.

Write an actual list and take it with you.

gussiegrips · 23/05/2014 12:16

Good, well, in theory, I suppose you could.

But, we spend so much time sitting now, we're not as active compared to our grandmothers, and we're heavier and our poor wee muscles still have to deal with gravity - so many stresses that I've never come across a woman who's issue is a pelvic floor made of girders.

Spasm's different, too tight because of abnormality's associated with pain.

Impressed with the speculum trick. Respect.

Lesuffolkandnorfolk · 23/05/2014 12:39

Have retweeted to the RCM who follow me.

Have always wondered why women are so accepting of their 'lot' as regards urinary incontinence. It shouldn't be left untreated.

TravelinColour · 23/05/2014 12:55

This reply has been deleted

Message withdrawn at poster's request.

HoleySocksBatman · 23/05/2014 12:57

This reply has been deleted

Message withdrawn at poster's request.

ActuallyMummy · 23/05/2014 13:06

This is hugely topical for me as I sit on a cushion recovering from a prolapse repair operation. I was great at pelvic floor exercises, and sometimes it's not enough. But I'm totally on it once I get back to full health

PacificDogwood · 23/05/2014 13:32

Just to say, 'Hold it Sister' is on its way to me Smile

Thank you for coming on here, holditmama.

AFAIK (and I am not an expert) it is possible to have to taut a pelvic floor and this is (rarely) a problem for supremely fit women in certain sports/disciplines (apparently a VB can be difficult for female ballet dancers/gymnasts at the top of their game - of course these are often petit, v slim women, so I am sure any problems they might face will be multi-factorial).

Shooting things out of fanjos is a popular entertainment trick in certain circles. I'm told. Apparently. Blush

AngelaOctopus · 23/05/2014 13:47

Thanks Gussie. I will. I didn't realise there so much unanswered and hadn't even thought twice about being brushed off on the phone without being able to properly discuss my results with someone knowledgeable.

Mind you, I was probably just relieved not to see my consultant again. The first time I met him he told me 'You should blame your son' for my birth injuries. I still haven't forgiven him even if he was half joking.

I'm normally quite assertive but I seem to go to pieces at the doctors...

PacificDogwood · 23/05/2014 14:35

Angela, it is seriously SO worthwhile writing questions down before you see any HCP - keep a diary or jotter handy and just add to it as and when you remember something, no matter how daft it might seem.
You can always edit the list before you actually go along for any appointments.

It is well recognised that people do not retain about 3/4 of what they are told during a consultation (that is assuming that communication was perfect… [hmm[), so it is also worthwhile writing answers down and/or having another person with you as a second set of ears/eyes/scribe IYKWIM.

Re 'lighthearted' remarks: I know I am guilty of making them at times in a (possibly ill-considered) attempt to lighten the mood Blush. 'Blaming your son' is something that you can chose to say flippantly, maybe not so much the consultant…. Remember, drs are people too, but sorry on behalf of the profession. 'Tis not easy to always get it right.

goodasitgets · 23/05/2014 14:47

Thank you for answering Grin
She made me laugh while I was being examined hence the firing trick. I think many years of riding has probably done it, and I do a lot of exercise that needs core work so... Will keep doing exercises anyway!!!

gussiegrips · 23/05/2014 14:56

lesuffolk splendid, thanks for tweeting.

The RCM and CSP are doing some really great collaborative work to improve services and outcomes for women. #squeezeandlift is theirs, the link to the video is on here: midwives link

If enough women tweet, FB and talk, we might get somewhere. So, thanks.

gussiegrips · 23/05/2014 14:58

Travelin thanks. It was fun, I do love The Stand Comedy Club. (if you're in Edinburgh, Glasgow or Newcastle, you should go! Not everyone talks about incontinence, mind. Shame)

Lesuffolkandnorfolk · 23/05/2014 14:58

That is handy to know- I have added your guest post (fully credited to you and with links all back to you, of course) to the Mumsnet Suffolk/Norfolk editorial blog. It looks great.

I've also sent it to some other friends who work as American MW's.