Do you have questions about postpartum incontinence or bladder weakness? Ask INNOVO’s experts - £200 voucher to be won

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Please note, questions have been answered and the experts are no longer available to answer new questions.

Post-birth incontinence can be difficult to come to terms with both physically and emotionally. Despite many women suffering from it, it’s rarely discussed, which is why [[https://www.myinnovo.com/uk/
INNOVO]] wants to encourage conversation and raise awareness of the issue. INNOVO’S experts, Dr Meg Arroll, a Chartered Psychologist and Behavioural Change Specialist, and Aoife Ni Eochaidh, a Chartered Physiotherapist and Clinical Specialist in Women’s Health & Continence, are here to help answer any questions you might have about bladder weakness.

Here’s some more information about Dr Meg Arroll:

“Chartered Psychologist with The British Psychological Society. Dr Meg started her career in academia, focusing on medically unexplained conditions that leave people feeling lost, neglected and at sea in a world of symptoms, stigma and pain. Dr Meg's interest in bladder conditions stemmed from her own experience of bladder pain and the sheer lack of open discussion on this topic, leading her to publishing What's Up With Your Bladder (Hammersmith Books) in 2018. Dr Meg's aim is to guide people through their journeys, so that they have the confidence to move forward with resilience and psychological flexibility, rather than shame and embarrassment.”

Here’s some more information about Aoife Ni Eochaidh:

“A Chartered Physiotherapist and clinical expert in the field of Women’s Health & Continence, founder of International Pelvic Physiotherapy Management (IPPM). Aoife is a peer nominated Medico Legal Pelvic Physiotherapy Expert, providing services in the UK & Ireland. Passionate about the pelvic floor, Aoife was inspired to work in pelvic floor physiotherapy seeing first hand the awful impact pelvic dysfunctions had on her late Grandmother.”

Would you like to know more about the causes of postpartum incontinence or bladder weakness? Maybe you would like to know how to cope with it and treat it? Have you got questions about how you can strengthen your pelvic floor? Does bladder weakness and experiencing leaks affect your emotional wellbeing, making you feel anxious? Whatever you question, please post them on this thread. Dr Meg Arroll and Aoife Ni Eochaidh will be back on the 12th July to answer a selection of them.

All who share a question on the thread below will be entered into a prize draw where one Mumsnet user will win a £200 voucher for a store of their choice (from a list).

Thanks and good luck!

MNHQ

Insight Terms and Conditions apply

@littlecottonbud

I am waiting for an operation for a pelvic organ prolapse, and this has been cancelled twice so far, is there any exercises I can help to constant leaking I can feel bulging and lower back pain, I do not see my operation being brought forward any time soon.

Hello @littlecottonbud, and thank you for your question.

I am so sorry to hear your operation has been cancelled twice, hopefully it will go ahead soon for you. Yes, there are exercises you could be doing now as a pre-operative measure, you could also use electrical stimulation, such as Innovo, but best to be assessed by a pelvic floor or women’s health physiotherapist, first. These exercises and the electrical stimulation should be continued after your operation too, but you might need to wait for six weeks after your operation to use electrical stimulation again and you also have to wait for six weeks after your operation to begin your exercise again, you can ask the hospital after your surgery when you can begin the exercises again. It is important to keep up the exercises for life, and some women keep up some amount of electrical stimulation too. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line would be best for you. Good luck with it and thank you for posting your great question!

• Aoife

@DinkyDaffodil

am 4 years post partum from DS2, and still have leakage, and dread sneezing when out in public, I did pelvic floor exercises, and did stretching with oil of my perineum, and did not tear when I delivered 2 babies - so cannot understand why I still have leakage. Pelvic floor exercises have not helped - and I don't think it's bad enough for surgery - so what's your best advise ?

Hello @DinkyDaffodil and thank you for your questions.

I am so sorry to hear that you are having leakage with sneezing, it is so upsetting and especially as you have done your best with your pelvic floor exercises yourself. I am pleased to hear that you think that you are not bad enough for surgery though, as it’s great if surgery can be avoided as there are risks with it. You are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed, and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo, but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line would be best for you. You will be able to build on the great work you did already yourself, but it just might not have been enough to get you pelvic floor muscles fully in the normal range of function. Good luck with it and thank you for posting your great question!

• Aoife

@Montydoo

I have serious anxiety about going out due to leakage following 2 births in 2 years, I won't drink when I am out, and have regular dreams about being in a supermarket and loosing control of my bladder. When I think about it logically because of the amount of leakage, and then fact I wear tena, this won't happen - it's just my inner anxiety getting the better of me - I think the stresses of the pandemic, lockdown with 2 little ones have just been so hard to cope with - are there any self-help (recommended) that I could use. (I do the clench and hold technique several times a day)

Hi @Montydoo and thanks so much for sharing your experience.

What you’re describing is something I see all the time – where the fear over leaks become more problematic than the underlying issue itself in terms of anxiety. But there are so many mental exercises you can do on top of the pelvic floor strengthening. It sounds like you’re already trying some cognitive behavioural therapy (CBT) techniques by challenging the anxious thoughts with logic and evidence but on top of this try to use other stress reduction techniques such as guided imagery to halt the stress response that is being triggered by leakage. It may sound odd to use a method such as this but my feeling is your overall stress levels mean your cup is pretty full, and guided imagery is a good way to find a bit of balance again. This technique has also been shown to benefit has bladder conditions and it’s something that you can do anywhere, at any time. The steps are:
• When you have a few moments to yourself, perhaps when your little ones are sleeping, find a peaceful place and loosen any tight clothing, remove glasses if you wear them and either sit or lie down.
• Make sure you’re breathing deeply through your diaphragm (belly rising on the inhale and falling on the exhale).
• Gently close your eyes.
• Now think of your favourite type of outdoor space – this could be the beach, a forest, the countryside, mountains, anything you like.
• What can you see? The crystal blue colour of the sea; the bright green of palm trees; the blinding light of the full sun?
• Now think about the sounds you can hear – the distant crashing of the waves to shore; light hum of music in a coastal bar; children splashing in the shallow water.
• What aromas are wafting by? Coconut oil from someone’s sunscreen; sizzling meat from a restaurant up the coastline; sense the smell of the seaweed.
• What can you feel? Soft grains of sand in between your toes; penetrating warmth of the sun; slight moisture on your body.
• What can you taste? Subtle saltiness in the air; sweetness of a refreshing beachside drink; charcoal at the back of your throat from a BBQ.
• The purpose here is to not just think about the beach as a remote picture, but to feel as if you are there.
• Now notice your muscles relaxing as you focus on each sense.
• Feel the calm washing over your body and mind as you enter deeper into your chosen scene.
• When you’re ready to re-enter the here and now, slowly count backwards from ten.
• On opening your eyes, you should feel more relaxed and calmer, yet alert.

Now that lockdown restrictions are easing, do try and get some time for yourself if at all possible. Life has been incredibly stressful during the pandemic so if there are any friends, family or community groups that will allow you a touch of respite, try to take it. I wish you all the very best.

• Meg

@Montydoo

I have serious anxiety about going out due to leakage following 2 births in 2 years, I won't drink when I am out, and have regular dreams about being in a supermarket and loosing control of my bladder. When I think about it logically because of the amount of leakage, and then fact I wear tena, this won't happen - it's just my inner anxiety getting the better of me - I think the stresses of the pandemic, lockdown with 2 little ones have just been so hard to cope with - are there any self-help (recommended) that I could use. (I do the clench and hold technique several times a day)

Hello @Montydoo, and thank you for your question.

I am so sorry to hear that you have worries around the urge to empty your bladder and the fear that you have, that you won’t be able to hold on and make it to the bathroom in time. What you are describing, is called Over Active Bladder, there are two types, Over Active Bladder Dry and Over Active Bladder Wet. This is such an upsetting condition, however, it is a really common problem. Unfortunately, I hear about this problem all the time in my clinic from my own patients who have it. What is happening is that your pelvic floor muscles are not working automatically with your bladder muscles as they should, to ensure normal filling, storing, and emptying of your bladder. The good news is that so much can be done to treat this awful problem. You are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle so that the normal filling, storing, and emptying of your bladder will take place. The strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed also and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep your bladder working correctly, might not be right. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, I use four types of electrical stimulation in my clinic, with my patients, a device such as Innovo could really help you, but it is best to be assessed by a pelvic floor physiotherapist first. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, it would be best for you. Monty Doo, sometimes people will need to be assessed by their doctor for medication to take along with the pelvic floor muscle training and electrical stimulation for a period. If you are under the care of your pelvic physiotherapist, you will be referred for this but you can also talk to you doctor about it yourself. Usually, the medication can be stopped when the pelvic floor muscles are in the normal range of function, usually after about 12 weeks. Good luck with it and thank you for posting your great question!

• Aoife

@Mezema78

Since having the kids (my youngest is now 7) I dread going to places where I don’t know where the toilets are. There have been times when I’ve been out and I’ve just pee’d in my pants without any control over my bladder, no matter how hard I tried. I wear a sanitary towel everyday. I’ve tried pelvic floor but hard to be consistent as I’m so busy. I also don’t drink much as this makes me want to pee more. Please help.

Hello @Mezema78 and thank you for your question.

I am so sorry to hear that you have worries around the urge to empty your bladder and the fear that you have, that you won’t be able to hold on and make it to the bathroom in time and that you dread going to places where you don’t know where the toilets are located. What you are describing, is called Over Active Bladder, there are two types, Over Active Bladder Dry and Over Active Bladder Wet. This is such an upsetting condition, however, it is a really common problem. Unfortunately, Mezema78, I hear about this problem all the time in my clinic from my own patients who have it. What is happening is that your pelvic floor muscles are not working automatically with your bladder muscles as they should, to ensure normal filling, storing, and emptying of your bladder. The good news is that so much can be done to treat this awful problem. Even though you have done some pelvic floor training already yourself (well done on that!), and you are right it is difficult to be consistent but also to do on your own without the supervision of a pelvic floor physiotherapist on hand. You are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle so that the normal filling, storing, and emptying of your bladder will take place. The strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed also and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep your bladder working correctly, might not be right. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, I use four types of electrical stimulation in my clinic, with my patients, a device such as Innovo could really help you, but it is best to be assessed by a pelvic floor physiotherapist first. Electrical stimulation will repetitively contract and relax your muscles a high volume of times and this will have a huge training effect. Also, electrical stimulation will stimulate the nerve supply to the muscles, making the nerves work better. We cannot do for ourselves what the electrical stimulation can do for us, but is important the both pelvic floor muscle training and electrical stimulation are done together for best results. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, it would be best for you. Your pelvic physiotherapist will also put you through some other exercise techniques around lifestyle changes, called bladder retraining, this will include advice on fluid in-take and other things and tips and tricks. Drinking less (though that’s what you have to do at the moment to manage) than you should be drinking, could unfortunately make the problem worse. Good luck with it and thank you for posting your great question!

• Aoife

@junebirthdaygirl

I suffer from the urge to go even when l have just been..over active bladder. I am older and this began in the menopause. I am paranoid about knowing where toilets are and during Lockdown this has becomea bigger issue. I find myself turning down opportunities as l know there will be no toilets nearby and it is very stressful. I have never even had a tiny leak..its the feeling of urgency that is so debilitating. It is taking up too much of my thoughts.

Hi @junebirthdaygirl and thanks so much for sharing your experience of overactive bladder syndrome (OAB) and the toll this condition is taking on your life - you are not alone. If you’re concerned about finding a toilet when out and about you can order a Radar Key which gives access to over 9,000 accessible toilets in the UK that are usually locked to the general public, so that people with disabilities or bladder and bowel problems don’t have to wait in a queue. Some local councils give Radar Keys free-of-charge to people with health conditions, or you can order one via Disability Rights UK and the National Key Scheme for £5. You can also get a 'Need to Pee' card from The Urology Foundation for a nominal donation of £2.50. This discrete card fits inside your wallet and has been designed to help people with urinary incontinence to gain quick access to a loo when needed. The text on the card explains the circumstance of incontinence, which can allow those with bladder weakness to feel more confident about being in public. See here for more information. If you are finding these worries are consuming too much of your headspace try this mental exercise called the STOP technique when an intrusive thought comes into your mind:

S is for Stop. Pause for a moment and stop whatever it is you’re doing.

T is for Take a breath. Ground yourself by reconnecting your mind and body through a deep breath to anchor you in the moment.

O is for Observe. Now increase awareness of what’s happening right now – how do you feel? What sensations, thoughts and actions are you engaged in?

P is for Proceed. Make a mindful decision about whether you want to continue with this thought pattern or whether you’d like to move your mental awareness to something else, such as an enjoyable activity or hobby that occupies your mind.

Using this technique allows you to break patterns that maintain anxiety. Often just bringing awareness to your thoughts is enough to halt anxious feelings. Give it a go and after you start using the technique on a regular basis, you should find that your mind can shift more easily into less anxious thought patterns.

• All the best, Meg

@junebirthdaygirl

I suffer from the urge to go even when l have just been..over active bladder. I am older and this began in the menopause. I am paranoid about knowing where toilets are and during Lockdown this has becomea bigger issue. I find myself turning down opportunities as l know there will be no toilets nearby and it is very stressful. I have never even had a tiny leak..its the feeling of urgency that is so debilitating. It is taking up too much of my thoughts.

Hello @junebirthdaygirl, and thank you for your question.

I am so sorry to hear that you have worries around the severe urgency to empty your bladder and the fear that you have, that you won’t be able to the bathroom if you are away from home and that you dread going to places where you don’t know where the toilets are located. What you are describing, is called Over Active Bladder Dry. This is such an upsetting and uncomfortable condition, however, it is a really common problem. Unfortunately, I hear about this problem all the time in my clinic from my own patients who have it. What is happening is that your pelvic floor muscles are not working automatically with your bladder muscles as they should, to ensure normal filling, storing, and emptying of your bladder. The good news is that so much can be done to treat this awful problem. You are having severe urgency because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle so that the normal filling, storing, and emptying of your bladder will take place. The strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed also and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep your bladder working correctly, might not be right. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, I use four types of electrical stimulation in my clinic, with my patients, a device such as Innovo could really help you, but it is best to be assessed by a pelvic floor physiotherapist first. Electrical stimulation will repetitively contract and relax your muscles a high volume of times and this will have a huge training effect. Also, electrical stimulation will stimulate the nerve supply to the muscles, making the nerves work better. We cannot do for ourselves what the electrical stimulation can do for us but it is important that both pelvic floor muscle training and electrical stimulation are done together for best results. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, it would be best for you. Your pelvic physiotherapist will also put you through some other exercise techniques around lifestyle changes, called bladder retraining, this will include advice on fluid in-take and other things and tips and tricks. Some other things may be added into to your pelvic physiotherapy treatment plan too depending on your assessment findings. Your pelvic physiotherapist may also refer you to your doctor to be assessed for a prescription treatment called vaginal oestrogen and this might help you also. You could also talk to your doctor about vaginal oestrogen too. Good luck with it and thank you for posting your great question!

• Aoife

@Softpebbles

So after many referrals I’ve the last 18 years, private physio appointments and NHS it has finally been concluded that there may be damage caused by my daughters first birth. Generally things are ok. However there seems to be a hormonal change in the month and things get bad - how come there seems to be little online regarding hormone changes and the impact on your pelvic floor? Is there any hormone we can take to help? I had no issues with my pelvic floor when on Zoladex (just no sleep and severe hot flushes). Thank you 😊

Hello @Softpebbles and thank you for your question.

I am so sorry to hear that you have birth related pelvic floor muscle damage. It’s great you have had access though to pelvic physiotherapy and I hope you are managing to keep on top of your pelvic floor muscle training and all advice given already. Well done, on keeping things generally ok, however it would be great if you could get a little better! You are so that right that there are monthly hormonal changes that affect us and our pelvic floor muscles. It can occur once a month, this hormone change can be sudden, and it can be that one night in the month that we don’t sleep very well because of this hormonal shift. If our sleep is disturbed, our gut hormones and our digestion processes are affected too. We can be more sluggish and bloated in our tummies around this time and any sluggishness, constipation or difficulty emptying the bowel can weaken our pelvic floor muscles and put some pressure on our bladders too. It is important that we keep up our pelvic floor muscle training routine at this time, at a time when we feel most feel unlike doing it! It is vital to keep up our general exercise also at this time. Electrical stimulation might help you further too,, something like Innovo might suit you. Best to see your pelvic physiotherapist about it though. There are some fantastic Dieticians that could help with hormone related gut advice too, your pelvic physiotherapist will refer you. I see in my own private practice with my own patients, that Birth trauma relating to third degree tear, to mothers that had a forceps delivery or that have pudendal neuropathy (pelvic nerve damage) will be more affected by this hormonal, pre, peri or post-menopausal often monthly worsening of symptoms. You are right that there is more to be said about this and thank you for asking such a great question!

• Aoife

@jacqui5366

I am wanting a hysterectomy (preventative for family ovarian cancer) and I do have a weak pelvic floor following 2 large babies and 2 long labours, can this surgery to help the bladder weakness be added on, or is this a totally new surgery (thinking of killing 2 birds with one stone so to speak)

Hello @jacqui5366, thank you for your question and good luck with your surgery!

The surgeon is the best person to ask about it. From my experience with my own patients though, there isn’t really a surgery for pelvic floor muscle weakness that tackles the muscles themselves. You will still need to be vigilant with your pelvic floor muscle training. After your surgery you will also need to follow your post op guidelines given to you at the hospital where you have your surgery. A pre op assessment now in advance of your surgery would be a good idea so you can hit the ground running so to speak after your surgery when you have the ok to resume your pelvic floor muscle training plan. This could include electrical stimulation, like the Innovo device, it could be used too pre-op and again post op six weeks after your surgery. The best thing would to be under the care of a pelvic physiotherapist and to attend in person or on-line. Good luck!

• Aoife

@lotstolose1

Do the levels of incontinence or leaking differ between natural births and csection biryhs?

Hello @lotstolose1, thank you for your question.

Yes, levels of incontinence are greater in women who have had natural births. However, be mindful ladies that C-Section does not protect you from Pelvic Floor Muscle Dysfunction. In my own private pelvic physiotherapy practice, over 25 years of treating thousands of ladies with incontinence, the main ladies that need my help are, mothers in their 20’s, 30’s, 40’s, 50’s, 60’s, 70’s with stress urinary incontinence. This is urine leakage that happens with physical stress from lifting, coughing, sneezing or exercise. Women that have had baby’s over 8lbs, those that had a long second stages of labour and those that had a forceps delivery and Mums that have several children attend seeking treatment, most frequently. Many women need supervised, targeted, and progressive pelvic floor muscle training, other pelvic physiotherapy treatments like supervised bladder and bowel retraining and many need electrical stimulation, like the Innovo device. Please note that no amount of leakage is normal, and a 100-year-old muscle can be trained. Thank you for a great question!

• Aoife

@FuckYouCorona

I've had an overactive bladder since birth. I am literally the person in the posters at the motorway service station toilets. My life has always been ruled by knowing where the nearest toilet is. I'm fast approaching 50 & its only getting worse. I get up several times a night to go to the toilet. I can't go anywhere that doesn't have a toilet. I can't even visit my dad in his care home anymore at the moment because of needing a covid test & having to wait for the results before actually seeing him is too long. Its driving me nuts & I'm desperate to find a way of fixing things!

Hi @FuckYouCorona and thank you for sharing your experiences and concerns.

I’m so sorry you haven’t received effective treatment for your overactive bladder syndrome and my first port of call as a health advocate would be to question why this is – it can be incredibly challenging to find the right treatment, but your GP should be in a position to support you to do so, particularly if the symptoms are worsening. Always ask for a second opinion if you don’t feel your symptoms are being dealt with appropriately. But there are methods you can use yourself too and I’m wondering if you’ve tried bladder retraining which involves delaying voiding/emptying the bladder. This technique is usually accompanied by a bladder diary where you list the time you felt the urge to wee, how long you could wait before you actually did wee, and the time between subsequent wees. The idea of bladder training is to try to leave it a bit longer before you empty your bladder, once you have felt the urge to do so. It's good to keep a bladder diary for a week or so first. So, before you try any bladder training, keep a diary which will help you to see how much progress you make once you start bladder training. There are two main types of bladder training:

1. Delaying emptying bladder for gradually lengthening periods of time.
2. Scheduled bladder trips, where you empty your bladder whether or not it is necessary.

Here are examples of the each method:

1. Imagine you just got up, and you empty your bladder at 8.00 for instance. Perhaps you have a cup of tea or coffee and find you have an urge to wee at 9.00. Bladder training requires you to try to hold out, say, until 9.05, or 9.07, whichever you can do without being in agony. At first it's hard to do this. But please don’t hold on so much that you fail to reach the toilet when you do need it - you need to have a realistic goal. Maybe you can only hold on until 9.05. The next time you need a wee, you might hold on for another minute. Note it down in your journal. Many people monitor the amount of urine they empty each time (an old measuring jug is useful here). This is good because it should show that at the beginning of training, you needed to wee when your bladder was for instance 100ml full, but after a few days/weeks, you find you do not need to wee until your bladder is 250ml full, and perhaps eventually, 300ml full. Try to drink and eat normally when you're trying this technique.

2. Scheduled bladder trips (timed voiding). This is similar to the above, except that you will decide on regular times when you will empty your bladder. So perhaps the first day, you decide you will wee every hour. So at 8.00 and every hour until bed, you empty your bladder, even though you might not need to go. The time elapsed is then lengthened for the following days, e.g. the next few days might be every one hour 15 minutes and the following days every one and a half hours. You will need to decide whether in your particular situation, scheduled bladder trips or delaying bladder emptying gives the best results. The final goal of bladder training is to only need to empty your bladder once every three hours or so. Of course, there's always going to be times when you need to go much more often - usually connected with food/drinks/infections – so don’t let these special circumstances damage your commitment to the training. Best of wishes with it all.

• Meg

@FuckYouCorona

I've had an overactive bladder since birth. I am literally the person in the posters at the motorway service station toilets. My life has always been ruled by knowing where the nearest toilet is. I'm fast approaching 50 & its only getting worse. I get up several times a night to go to the toilet. I can't go anywhere that doesn't have a toilet. I can't even visit my dad in his care home anymore at the moment because of needing a covid test & having to wait for the results before actually seeing him is too long. Its driving me nuts & I'm desperate to find a way of fixing things!

Hello @FuckYouCorona, and thank you for your question.

I am so sorry to hear that you have worries around the severe urgency to empty your bladder and the fear that you have, that you won’t be able to the bathroom if you are away from home and that you dread going to places where you don’t know where the toilets are located. What you are describing, is called Over Active Bladder. This is such an upsetting and uncomfortable condition, however, it is a really common problem. Unfortunately, I hear about this problem all the time in my clinic from my own patients who have it. What is happening is that your pelvic floor muscles are not working automatically with your bladder muscles as they should, to ensure normal filling, storing, and emptying of your bladder. The good news is that so much can be done to treat this awful problem. You are having severe urgency because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle so that the normal filling, storing, and emptying of your bladder will take place. The strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed also and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep your bladder working correctly, might not be right. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, I use four types of electrical stimulation in my clinic, with my patients, a device such as Innovo could really help you, but it is best to be assessed by a pelvic floor physiotherapist first. Electrical stimulation will repetitively contract and relax your muscles a high volume of times and this will have a huge training effect. Also, electrical stimulation will stimulate the nerve supply to the muscles, making the nerves work better. We cannot do for ourselves what the electrical stimulation can do for us, but it is important that both pelvic floor muscle training and electrical stimulation are done together for best results. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, it would be best for you. Your pelvic physiotherapist will also put you through some other exercise techniques around lifestyle changes, called bladder retraining, this will include advice on fluid in-take and other things and tips and tricks. Some other things may be added into to your pelvic physiotherapy treatment plan too depending on your assessment findings. Your pelvic physiotherapist may also refer you to your doctor to be assessed for a prescription treatment called vaginal oestrogen and some prescription bladder medication. The combination approach of the oestrogen, the Over Active Bladder Medication and the pelvic floor muscle training other pelvic physiotherapy and electrical stimulation could really help you. You could also talk to your doctor about vaginal oestrogen and Over Active Bladder medication yourself too. Good luck with it and thank you for posting your great question!

• Aoife

@Singlebutmarried

10 years after giving birth and I had my pre op assessment for a bulkomed procedure. Just waiting for a date now.

Cannot wait not to leak all the time.

Hello @Singlebutmarried, thank you for your post and good luck with your bulkomed procedure!

From my experience with my own patients though, you will still need to be vigilant with your pelvic floor muscle training. After your bulkomed procedure, you will also need to follow your post op guidelines given to you at the hospital or clinic where you have your procedure. A pre procedure pelvic floor muscle assessment now in advance of your bulkomed would be a good idea so you can hit the ground running so to speak after your procedure and help maintain the hopefully good affects of the bulkamed procedure when you have the ok to resume your pelvic floor muscle training plan. This could include electrical stimulation, like the Innovo device, it could be used too pre-procedure and again post procedure though you have to wait six weeks after your procedure. The best thing would to be under the care of a pelvic physiotherapist and to attend in person or on-line before and after your bulkomed procedure. Good luck!

• Aoife

@lovemyflipflops

Do you think we should know about the risks of bladder weakness pre-delivery and why is there such little pre-preparedness amongst mums-to-be so exercises can be carried out pre delivery to help some mums from this debilitating condition ? I would have loved to have my surgery to have given me exercises and preparedness for this

Hello @lovemyflipflops, thank you for your great question!

Yes, I absolutely do think we should all know the risks of bladder weakness and other pelvic floor muscle problems pre-delivery. The reason so many women do not know, I think might be related to lack of resources, but it is so important. Some countries like France and Germany offer excellent ante-natal and post-natal pelvic floor muscle training and electrical stimulation (post-natal only) free of charge. I think there is embarrassment around bladder weakness. It is so fantastic that mumsnet are opening up the discussion here, (so thank you!) and this allows women to be brave and come forward and talk about their problems and access the help they need. This will allow women to work, travel and exercise and enjoy their lives without fear of leaks and other pelvic floor muscle problems!

• Aoife

@lovemyflipflops

Do you think we should know about the risks of bladder weakness pre-delivery and why is there such little pre-preparedness amongst mums-to-be so exercises can be carried out pre delivery to help some mums from this debilitating condition ? I would have loved to have my surgery to have given me exercises and preparedness for this

Hi @lovemyflipflops and YES, absolutely!!! There have been recent news reports that pelvic floor and bladder health and exercises should be taught at school and I sincerely hope this transpires for future generations. Thanks for this question.

• Meg

@ohdannyboy

Is surgery the only real solution to constant leaking, or should I persevere with the exercises - i cannot get anywhere with my GP as he says the waiting list is around 19 months long - thank you.

Hello @ohdannyboy and thank you for your question.

I am so sorry to hear that you are having constant leakage, it is so upsetting and especially as you have done your best with your pelvic floor exercises yourself. You are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed too and most importantly, the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo, but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, that would be best for you. You will be able to build on the great work you have done already, but it just might not have been enough to get you pelvic floor muscles fully in the normal range of function. I would exhaust all non-surgical options before opting for surgery. Also, please note that it is recommended to keep up all pelvic floor muscle work after surgery too (you must wait 6 weeks after surgery though to use electrical stimulation). Good luck with it and thank you for posting your great question!

• Aoife

@LittleDeeAndME

What can I do to help my sister who has severe post partum leakage of pee, she has severe anxiety over going out because of the worry of wetting herself, she has gone from a bubbly confident young woman to one who has made herself housebound, thinking I can smell her (I cannot) and showering 4 or 5 times a day down below - I think OCD and anxiety is more of a problem than the leakage she experiences - she has asked her HV for advice and has been recommended exercises. Her mental health has been more affected than her physical health. Thank you.

Hello @LittleDeeAndMEDee, thank you so much for your question.

Firstly, no amount of leakage is normal. I am so sorry to hear that your sister is affected by post-partum leakage. So much can be done about it though. Your sister is having leakage because her pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep her dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed too and most importantly the movement internally of the pelvic floor muscles that she needs to lift her bladder neck and keep it a the right position to keep her dry might not be fully working correctly. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. Your sister could also use electrical stimulation, such as Innovo but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by a pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If your sister can get an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, that would be best for her. Your sister will also need assessment from her doctor regarding her anxiety levels, but her physical symptoms will need to be dealt too at the same time. Good luck with it and thank you for posting your great question, your sister is lucky to have you to watch out for her!

• Aoife

@LittleDeeAndME

What can I do to help my sister who has severe post partum leakage of pee, she has severe anxiety over going out because of the worry of wetting herself, she has gone from a bubbly confident young woman to one who has made herself housebound, thinking I can smell her (I cannot) and showering 4 or 5 times a day down below - I think OCD and anxiety is more of a problem than the leakage she experiences - she has asked her HV for advice and has been recommended exercises. Her mental health has been more affected than her physical health. Thank you.

Hi @LittleDeeAndME and thank you for your question about your sister.

On the mental health aspect, you may want to support your sister in finding psychological help via the NHS’s IAPT (Improving Access to Psychological Therapies) services, which can be accessed via her GP, although in many areas of the country you don’t even need to see your GP as patients can self-refer, see here for more information. If your sister is experiencing OCD a trained and qualified professional will be able to help her through this service.

In the meantime, deep breathing techniques can reduce the stress response, which is triggered when we worry about anything, including incontinence. To do this, simply put one hand on your belly and one on your chest. Deep, diaphragmatic breathing occurs when the belly lifts on the inhale and dips on the exhale. Breathe in for a count of three and out for a count of four, repeating the word ‘calm’ in your mind. This will reduce the cascade of brain-bladder signals that are triggered by the stress response, giving you enough time to find a facility. Using these breathing exercises along with pelvic floor muscle strengthening, either with electrical muscle stimulation in INNOVO or by engaging these muscles yourself, will benefit both mental and physical health. I wish you and your sister all the very best.

• Meg

@AlCalavicci

I have suffered from bladder weakness all my life , it is a hereditary issue . It affects my daily life and in the past has meant I haven't taken jobs that I have been offered due to the lack of enough loos in the building. I always have to carry a spare pair of knickers with me and staying away overnight is not possible as I have wet the bed in the past when I cant get up quick enough . It runs my life !

For them that use tena , have you tried Always for sensitive bladders ? I find them much better esp the extra long ones , in places like home barging's they are around the same kind of price as Tena's the only down side is they are scented .

Hello @AlCalavicci, thank you for posting your comment.

I am so sorry to hear about your bladder issues and to hear how it has been restricting your life. Thank you for sharing the tip on the extra long Always for sensitive bladders. I recommend that women with leakage use pads while they are seeing their pelvic floor or women’s health physiotherapist. Maybe you would consider being assessed yourself?

Though you said your leakage is hereditary, you are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed too and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo, but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-going basis. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, this would be best for you if you are interested in trying it. Good luck with it and thank you for posting your great comment!

• Aoife

Thank you so much Aoife. I will see if I can see someone about this. Thank you fir the advice.

@NigelWithTheBrie79

When I gave birth to my last child nearly 13 years ago I had over 100 stitches as they got stuck behind my pelvis (Shoulder Dystocia). I've suffered with incontinence ever since. If I need the toilet and have to wait I start leaking even before I sit down. It is so frustrating. I am still feeling the effects of the scarring around my stitches and get so sore if I can't effectively clean my private quickly. (Like when I'm at work or out and about) Is there a way to deal with my leaking and not make my scarring worse?

Hello @NigelWithTheBrie79, thank you for posting your question.

I am so sorry to hear about your bladder issues and your scarring form your stitches. I recommend that you see a pelvic floor or women’s health physiotherapist. You are having leakage because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed too and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly. The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training.

You could also use electrical stimulation, such as Innovo, but it is best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If you get an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, this would be best for you if you are interested in trying it. Good luck with it and thank you for posting your great question!

• Aoife

@hannahbjm

Does pelvic floor exercises help? Even a year after the birth of my child?

Hello @hannahbjm, thank you for posting your question.

Yes! Pelvic Floor Muscle training helps even after a year after giving birth. I recommend that you see a pelvic floor or women’s health physiotherapist to be assessed though. Your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be as good as needed, and most importantly the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly.

The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, this would be best for you if you are interested in trying it. Good luck with it and thank you for posting your great question!

• Aoife

@Newchallenge

TMI

Why do I accidentally do a small poo when squeezing the last drops of wee out? Only happened since third baby.

Hello @Newchallenge, thank you for your question.

You are leaking a small poo (anal incontinence) when you are squeezing out the last of your urine because you have weak pelvic floor muscles. In my own private pelvic physiotherapy practice, over 25 years of treating thousands of ladies with anal incontinence, the main ladies that need my help are, mothers that had have a third degree tear with the birth of their child. This faecal leakage (wind or gas can also leak) can happen with physical stress from lifting, coughing, sneezing or exercise. Women that have had baby’s over 8lbs, those that had a long second stage of labour and those that had a forceps delivery all are most frequently at risk of anal incontinence.

Women with anal incontinene need supervised, targeted, and progressive pelvic floor muscle training, other pelvic physiotherapy treatments like supervised bladder and bowel retraining and many need electrical stimulation, like the Innovo device. Thank you for a great question!

• Aoife

@Laney79

How likely are you to suffer weakness/prolapse after a c section?

Hello @Laney79. Approximately 30% of cases suffer a weakness/prolapse after a C-Section. Thank you for your question!

• Aoife

@Kakiweewee

From what my urogyn explained to me, the neck of my bladder and urethra prolapsing are the cause of my urge and stress incontinence. I feel incredibly uncomfortable standing whenever there is as little as 20ml in my bladder. This impacts where I go and what I do because walking is uncomfortable and I need to constantly go to the toilet for a basically empty bladder.

Is there anything I can do to reduce this sensation of painful fullness all the time?

Hello @Kakiweewee, thank you for your question.

What you are describing is a type of pelvic organ prolapse, called cystocele. Unfortunately, your bladder is not adequately supported to keep it held in the right place in your pelvis and it has come down (or prolapsed down) in the pelvic cavity. Pelvic Floor Muscle training will help you. I recommend that you see a pelvic floor or women’s health physiotherapist to be assessed though. Your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to help with the leakage, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be good as needed and most importantly, the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly.

The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo, but it's best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis. If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, this would be best for you if you are interested in trying it. Good luck with it and thank you for posting your great question!

• Aoife