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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 · 23/05/2014 15:18

Holey bowel problems are the Devil's Work. Just awful, I'm glad you're on the way to being sorted.

One in ten have problems with fecal incontinence.

That stat doesn't include the people who have issues with with incomplete emptying of their bowel and who use their fingers to push the vaginal wall backwards so the jobbie can be unleashed. Awful.

gussiegrips · 23/05/2014 15:19

Actually hope your recovery is smooth and your cushion is plump.

gussiegrips · 23/05/2014 15:30

Pacific enjoy the book!

Athletes' pelvic floors are surprisingly rubbish. Shockingly high incidence in some sports, predictably, gymnastics and athletics are a problem.

Kari Bo's paper, pubmed link

A strong pelvic floor is associated with a reduced second stage of labour, put nicely in this paper:

The myth that strong pelvic floor muscles (PFMs) may actually obstruct labor and prolong fetal expulsion exists (Salvesen & Morkved, 2004). Using data from Morkved, Bo, Schei, and Salvesen (2003), Salvesen and Morkved (2004) performed a randomized study to evaluate the effectiveness and impact of pelvic floor exercises (PFEs) during pregnancy on labor and birth. They found that women randomized to intensive PFE training had a lower rate of prolonged second-stage labor, and theorize that PFEs and strong PFMs may actually facilitate labor. When the muscles of the PF and vaginal outlet are routinely exercised, they are more able to stretch and contract at the time of birth, thereby reducing the trauma to the muscles, which can result in lower incidence post-delivery UI (Saunders, 2004). PFEs may be beneficial antenatally, and may be a useful and inexpensive addition to routine prenatal care

Medscape link

It's a really good article looking at the impact of birth management on pelvic floors. Kind of night time reading at Gussie Arsenal...

gussiegrips · 23/05/2014 15:37

Thanks lesuffolk - 'mon the revolution!

chrysanthemumtea · 23/05/2014 15:53

Another thing I forgot to say upthread is leaking was my first sign of pregnancy with my second, even before a bfp. And continued entire pregnancy. Just me?

chrysanthemumtea · 23/05/2014 15:54

Another thing I forgot to say upthread is leaking was my first sign of pregnancy with my second, even before a bfp. And continued entire pregnancy. Just me?

HoleySocksBatman · 23/05/2014 18:41

This reply has been deleted

Message withdrawn at poster's request.

gussiegrips · 23/05/2014 19:13

*chrysanthemum" that's unusual! Early hormone changes might explain it, but, no leaking before the second pregnancy?

gussiegrips · 23/05/2014 19:26

Holey there's a gadget called a femmeze that might help - it's available on prescription now, too.

femmeze

details your GP will need to prescribe it

It looks a little like a shoe horn, and is self explanatory. Very good for women who are pregnant and can't reach, or those who have poor dexterity for whatever reason.

chrysanthemumtea · 23/05/2014 19:57

Hi gussie. Well what happened was this:

Asthma, developed as grown up, got worse in first pregnancy and from about 7 months had v chesty cough and also leaked. Cough so bad I kind of coughed baby out rather than pushed. Leaked for a couple of months post birth but still had cough and had also had manual removal of placenta so was totally sore and battered down there as well as catheter for epidural plus persistent post birth thrush (probs cos all the antibiotics). But eventually this all cleared up.
Then got pregnant again when dd was 15 months and it was more of less the first sigh. Like I say, even pre bfp. Asthma got worse again this pregnancy so I leaked the whole time. Cleared up again post birth but comes back when I have cough.

Am seeing Physio though. She said I have a floppy vaginal wall Blush but gave my pelvic floor muscles a four out of five. Has given me exercises and another appointment in six weeks.

But want one more baby (though won't ttc for another year) and terribly worries this will happen again.

gussiegrips · 24/05/2014 15:11

So, is anyone treating your asthma, Chrysanth? You shouldn't be left with an uncontrolled asthmatic cough, particularly when pregnant because your lung capacity is reduced by the bump using up all that space.

There's two contractions, the long squeeze and the quick flicks. Sometimes it's not so much lack of power as co-ordination, so, if the muscles don't contract when you cough then you will leak.

Lots of resources refer to "the Knack" which is you tightening your pf before you go to cough/sneeze/lift etc. It becomes a habit, like covering your mouth before you sneeze.

Can you do quick flicks? Can you do them so it's a good contraction about a second apart, in time to music, or with every step you take?(other artists are available, baboom tsssh)

I'm not offering a diagnosis, that's obviously impossible via a forum, and you're seeing someone who can have a fish around and tell you exactly what's going on. Ask her how your fast-twitch contractions seem.

And, see your practice nurse about the cough. That's no good at all.

Oh, and there's heaps of time to get this sorted before you've scheduled TTC. Don't worry - you know there's a problem and are doing something about it, so, there's no need to worry. It's the folk who are unaware that I fret about.

gussiegrips · 24/05/2014 16:03

angela was remembering a new gadget I saw at a conference - qufora mini

Bowel irrigation's long been a bit of a faff at home, but, this is a neat wee thing, available on prescription.

It's for general bowel management issues, but, I saw it mentioned on the birth trauma website

Just another thought, I know there's a heap of new things on the market, might be worth a chat with a continence nurse if it's been a while?

PenguinsHatchedAnEgg · 24/05/2014 17:21

Can I ask a question?

I've just had my final child (three weeks ago). Things have been 'not great, but not dreadful' since I had my first by forcep delivery 5 years ago. No daily leaking, but I need to think twice before running and physically cross my legs to sneeze type thing.

So my question is, with what would often be considered 'mild' problems, can I still expect to see a realistic improvement from a serious focus on exercises, or is it just likely to move serious problems to mild ones like mine? I really want one day to be able to sprint after my kids in the park without thinking twice...

coolmorechick · 24/05/2014 19:57

I had a horrendous time during the birth of my first baby. Insanely I agreed to induction on my due date for no medical reason and had forceps delivery. It was very, very traumatic and I was left with devastating stress incontinence. I was 30 at the time. I run alot and had to wear full incontinence pads/nappies and still managed to drench myself whilst running. I went to physio, bought every machine and gadget under the sun. No improvement. I complained to the obstetrician and hospital and they subsequently wrote to my GP to say I had post natal depression.

I went to a different hospital and a different consultant and had the TVT procedure done 5 years ago. Ive never looked back. 3 years ago I had a natural delivery of 9lb 4 ounce baby and the TVT held up. It still does. I do regular speed, interval, hill training with my running club and never a drop leaked. The TVT was one of the best things I have ever had done; it gave me back my confidence.

gussiegrips · 24/05/2014 20:05

All questions welcome, Penguin!

Short answer is yes, you'd expect to see a realistic improvement, or to become completely dry.

but, I'm not a fan of the short answer (you guessed that, right?). In fact, it's people with the "mild" problems who do best with #doyerblardyexercises.

People like you have the potential to self diagnose and self manage with the right information, and, always the caveat of "if you get pain, if it doesn't work, if it doesn't "feel right" then get an assessment".

The evidence is that if people with "mild" incontinence followed the advice, or, you know, were GIVEN the advice in the first place then they'd be dry, and potentially, would have less of a prolapse risk post-menopause.

I'd also question what defines "mild" incontinence. Any leaking at all of anything is abnormal (so, that's pee, poo or pumps) and, if it's not treated then it can gradually get worse and worse, until you land up like me, fecking miserable and dribbly.

I'm fine now See? But, I DO have to do the exercises, and, I know if I put on half a stone it comes back a bit, and I know that too much caffeine doesn't agree with me. But, I can show off a bit

Congratulations on the baby, and try really hard to #squeezeandlift x3/day, which isn't easy when you are sleep deprived and harassed. Doing it at the same time as you brush your teeth will help remind you.

Be patient, takes a while to see a difference, especially when you are early post-natal.

Don't give up. Or, I'll come and nag you.

gussiegrips · 24/05/2014 20:17

Coolmore you make an important point. Some women cannot be helped conservatively, sad fact.

Happily, the TVT is very effective surgery. (for those of you who've not heard of it, it's a tape that is slung under your bladder and supports your urethra (the tube the pee comes out)) I's got good long term effects, there's a study showing great results 7 years later, but, anecdotally, some were done 15 years ago and are still going strong.

You need 2-4 weeks off work and can't lift anything heavy for 6 weeks, and, you STILL need to #squeezeandlift afterwards.

Am pleased you got back to your sports, and, 9lb 4oz? Ouch.

gussiegrips · 24/05/2014 20:45

This just popped up on twitter. Lucy Brett's blog about her urology assessment was featured on Mumsnet forever-ago. It's powerful stuff. Bonus mention of Michael Fassbender's willy.

Shame

PenguinsHatchedAnEgg · 24/05/2014 21:07

Thanks Gussie. That's really encouraging.

I think I'm going to order that Mary O'Dwyer book (thinking 'Sister', since I've had my last child so all the pregnancy stuff isn't going to be that relevant) and maybe look at an app. I'm rubbish on Twitter. Unless it actually comes to me as a notification, I won't see it. I look on there about every two months, which I don't think is the frequency needed for results Grin. TBH, perhaps I just need a 3x daily alarm set on my phone.

chrysanthemumtea · 24/05/2014 23:29

Hi gussie. Yes the asthma is being treated now but during first pregnancy I never really realised it was anything more than a normal cough as was so caught up in pregnancy and then in the post baby haze looking after myself wasn't a priority.

Then with second pregnancy asthma uk helpline was amazing and insisted I get steroids and gp gave them to me reluctantly (but asthma uk shows risk to baby of steroids lower than risk to baby of mum struggling to breathe) but even when cough gone I just had no control throughout pregnancy.

But the kids are at nursery and very cold they get which is all the bloody time, I get it too and it goes to my chest. But I have good inhalers now. And confidence to demand steroids when needed.

gussiegrips · 25/05/2014 11:20

and then in the post baby haze looking after myself wasn't a priority.
Maternal wellbeing is the best thing for a baby, and yet, we are put, or put ourselves, last.

I've got a total crush on Asthma UK. Middley-Grip has had shocking asthma troubles, the kind that makes consultants cry a bit, and that phone line has been beyond helpful to me. He's doing fine now, but, it's been a bit rough at times.

Actually, I wonder if they'd like to do a thing about pelvic floors and coughing?

Ooooh....

mumtoothree · 25/05/2014 19:54

Women who have never had children can also have stress-incontinence, so don't just blame childbirth. I do wonder if the epidural rate will increase SI, due to many women in labour having to actively push, therfore maybe recommended home births/mlu might do some good. Would be interesting to know.

gussiegrips · 25/05/2014 21:03

Mum of course, that's true.

About 15% of women aged 15-35 leak, a significant number in that age group don't have kids.

Certainly, pregnancy and childbirth INCREASE your risk - but, if you are hypermobile, with a family history of prolapse, you are overweight, you participate in impact sports, you have a job that requires heavy lifting, you have a nasty cough and you have never heard of pelvic floor exercises...well, you're probably going to leak.

And, it's worth mentioning that once you're post-menopause there is no difference in the incidence of women who leak who had children or did not.

Epidural's a good question - certainly, pushing against a not-fully-dilated cervix and/or a long second stage increases stress on the poor wee pelvic floor. I'll see what I can find.

gussiegrips · 25/05/2014 21:32

Found another thread of leaky ladies...bringing em over here into the fold: pfexs go through me like nails on a chalkboard

love the description!

cardamomginger · 26/05/2014 22:55

Sorry to start banging on about this AGAIN. But exactly gussie - there are groups of women who are more prone to pelvic floor/continence problems. I just think it would be really nice if when you have your antenatal appointments HCPs recognised that some women were at higher risk of these problems, were open and honest about the added risk that VB may pose and enabled you to make a informed choice about which birth you wanted - ELCS or VB. (And before someone else jumps all over me, yes, I know ELCS does not guarantee no additional problems! And yes, I know that ELCS is major surgery that has its own risks.)

In my case, I'm hypermobile, as was my mother and she had prolapse. And it really pisses me off (pun fulling intended) that no one antenatally raised this as a concern and that it is only when a team of physicians and surgeons tried to work out how to piece me together afterwards that they started saying things like 'Oh well, of course, with your hypermobility, you were at a much higher risk of these sorts of birth injuries.' Hearing it after the event really doesn't help me!

gussiegrips · 26/05/2014 23:16

Yep, Cardamom I'd say that this point of yours in absent in most antenatal thinking - unless there's a diagnosis of EDS or other hypermobility syndromes.

It's an excellent point, and, depressingly, not one that I have seen a lot of chat about either amongst professional or social peers.

Hmmm. Mulling.

I wonder whether it's valuable to do an anonymous study (oh, say, on a parenting website, I'll think of an appropriate one in a minute or two) to find out what women's experience actually are - and whether that matches up with what the existing literature thinks they are.

Hmmm. This, and the other thread has cast up some really interesting points. Well, interesting if you are a pelvic geek. I do understand that some folk aren't interested in this sort of thing...even seen some of them walking around, like ordinary people. Amazing, I know!