Like most women affected by incontinence, 43-year-old Luce Brett has her horror stories. As a 30-year-old first time mum she recalls wetting herself and bursting into tears in the “Mothercare aisle of shame”, where maternity pads and adult nappies sit alongside the baby nappies, wipes and potties.
But, she adds, these isolated anecdotes don’t really do justice to what living with incontinence is really like. “It’s every day, it’s all day. People talk about leaking when you sneeze or when you laugh, but for me it was also when I stood up, or walked upstairs. It was always having two different outfits every time I left the house to go to the shops. Incontinence robbed me of my thirties; it made me suicidally depressed,” Luce explains.
“Everyone kept telling me it was normal to be leaky after a vaginal birth. It took quite a long time for me to find the courage or the words to stop them and say: ‘Everybody in my NCT (National Childbirth Trust) class can walk around with a sling on, and I can’t do that without wetting myself constantly’,” she adds.
Luce is a mum of two boys, based in London, and previously worked as a media regulator. She’s been blogging about her experiences with incontinence since December 2010.
Now, 13 years after a traumatic birth wrought havoc on her pelvic floor, Luce is the author of PMSL: Or How I Literally Pissed Myself Laughing and Survived The Last Taboo To Tell The Tale. Published in June, the book combines a poignant memoir of her experiences with a feminist manifesto for the one in three women who are affected by incontinence.
In a 2018 Mumsnet survey of mothers who had given birth between 2013 and 2016, 42 per cent said they had experienced problems with continence or their pelvic floor. The NHS estimates that between three and six million people in the UK live with some degree of urinary incontinence, with women roughly five times more likely than men to be affected.
Research also suggests new mothers suffering from urinary incontinence are twice as likely to develop postnatal depression as those without bladder problems. For Luce, the combination of urinary incontinence and postnatal depression felt like “a stigma two for one; they’re both so embarrassing to talk about”. She describes being “so full of shame I’d cross out the clinic names on my letters to get the time off work, because I didn’t want everyone to see my knackered fanny clinic letters. You feel totally humiliated, and constantly on the edge of being exposed.”
Sara Conroy, a 50-year-old physiotherapist, also suffered from urinary incontinence for several years after sustaining a third-degree tear during the birth of her daughter. “I was 30 when I had her, but I didn’t really notice the leaking until I tried to go back to sport,” she says. “I’d always played netball at quite a high level, and I never quite managed to get back to that level. Regardless of whether I’d been to the toilet, I always felt like I’d better not jump for the ball just in case.”
For Sara too, incontinence had a huge impact on her postnatal mental health. “I joined a gym and started running long distances when my daughter was about four to six months old, to get my sanity back really. I was trying to re-establish my identity after having kids, so it was something for myself, where I could go out for an hour and a half with nobody shouting ‘mum’. Running and sports became a kind of crutch for my mental health, because I did struggle with postnatal depression. But it was also when the incontinence reared its head the most, and it was very difficult not being able to do the one thing I’d always enjoyed,” she explains.
“It was very dependent on where in my [menstrual] cycle I was. Some days I could run for 10 miles and be fine, and then halfway through my cycle, when the muscles soften up, I would go for a run and be embarrassingly soaking. I had to wear black leggings all the time, and I would often pay the entry fee for a race but have to let them know the night before if I’d be running or not. I would only go if I knew I wasn’t going to end up wet,” Sara says.
Fellow runner Kristy Chong, 41, first experienced incontinence in her early 30s, but says she particularly noticed the impact on her life when she was training for a marathon, after the birth of her second child. Determined not to let leaking slow her down, Kristy was inspired to found period and leak-proof underwear brand Modibodi.
“Some medical professionals say to switch from high impact exercise such as running or HIIT training to something lower impact, but I think it’s so important not to let leaks stop you from doing what you love, so I continue to run and I also do Pilates,” she explains. “It sounds simple now, but pelvic floor exercises really have helped, though I know they can take a while to see results.”
Like Luce, Kristy feels the biggest challenge with incontinence is breaking down the taboos and mentioning the ‘unmentionables’. “The reality is that women do leak! In recent years, conversations surrounding women’s health and specifically leaks – incontinence, periods, sweat and pregnancy – have seen a huge shift towards normalisation, but nine years ago when it happened to me, this just wasn’t the case,” she explains.
“Urinary incontinence has a massive impact on every aspect of your life. It’s important to remember that it’s a symptom, not a diagnosis, so it’s often a sign that something else is wrong – often connected with weakened pelvic floor muscles, which can also lead to prolapse,” explains Myra Robson, a pelvic physiotherapist and co-founder of campaign group Pelvic Roar.
Besides childbirth, she adds, causes of stress incontinence – the most common type of urinary incontinence, where leaking occurs as a result of coughs, sneezes or other stress on the bladder – can also include persistent constipation, obesity, and lung diseases including cystic fibrosis and severe asthma. While incontinence can affect people of all ages, it is particularly common after the menopause, and becomes more problematic in older, frailer age groups, when having to rush to the toilet during the night increases the risk of falls and fractures.
However, the good news is there are ways it can be treated, says Myra. “Eighty four per cent of women with stress incontinence can be cured or significantly helped by pelvic floor exercises.” Myra recommends seeing a specialist pelvic physio for a proper assessment and personalised physio programme.
“Research recommends exercising your pelvic floor three times a day for life, and for some people gadgets work really well. Kegel8 and Pelviva are electrical stimulation machines to get the muscles working, and Elvie uses biofeedback to pick up what you’re doing so you can tune in to it better. You can also get weights, like kegel eggs or cones, which make your muscles work harder. But other people are fine just doing the old-fashioned exercises,” she says.
Myra’s own award-winning pelvic floor app, Squeezy, also combines handy reminders with evidence-based information, and a visual guide to help women ensure they’re doing their exercises correctly.
If women do need additional intervention, Myra explains, there are vaginal pessaries, bulking injections, and finally surgical techniques, which should be seen as a last resort. This was the case for both Sara, who had a Tension-free Vaginal Tape (TVT – a form of the now-controversial vaginal mesh, the use of which has been restricted on the NHS since 2018) procedure, and Luce who underwent a colposuspension – a more invasive surgery.
“Being a physio myself, I tried all sorts of contraptions and I went to pelvic physio religiously for ages after my second child was born. My [pelvic floor] muscles got to be really strong again, but it just wasn’t enough,” Sara explains. “I’m mixed race, and black people do scar differently, so I get a lot of scar tissue even just from a cut. I think that, when things softened up in my hormonal cycle, there was nothing for the muscles to pull on.”
Both she and Luce have seen significant improvements following surgery and ongoing pelvic physio, but say much more now needs to be done to tackle the stigma. “There needs to be change to healthcare policy, and proper recognition that postnatal bodies are your bodies for the rest of your life, not just the first six weeks. There’s got to be more care available for women, and we’ve got to address the real gulf in sex and body education,” Luce says.
“I don’t think we know much about our bodies at all. Most people couldn’t sketch their pelvic floor, but it holds your whole life together,” she adds.
Reflecting on her own experience, she adds: “My depression was compounded because I thought I wasn’t coping with something everybody else was coping with. Lots of people perpetuated the lie that incontinence is a normal thing post-childbirth. It’s common, but it’s not normal and it can be fixed; it’s not something women just have to put up with.”
An NHS spokesperson said: “GPs are required to review the physical health of new mums, giving them the opportunity to raise any concerns about their pelvic health and incontinence six to eight weeks after they give birth.
“The NHS has written to manufacturers of women’s hygiene products urging them to be clear that incontinence products offer temporary support and advising them to direct women to NHS advice on prevention and treatment.”
