In this guest blog, physiotherapist, comedian and recovered incontinent Elaine Miller looks at why incontinence matters, what we know from research about what helps and how we can let women know that they don’t have to put up with it and what they can do about it.
This is World Continence Week, so, the indignities and limitations urinary and fecal incontinence impose on people’s lives has been in the press (Huffington Post), mumsnet, newspapers and magazines (check out the David Emanuel gown made of toilet tissue) and, even better, in Evidently Cochrane! I was delighted to see the recent blog on Evidently Cochrane about pelvic floor muscle training, or PFMT, because I’m a physiotherapist with a slightly obsessive interest in pelvic floors. And, I agree with Cochrane, not NEARLY enough people talk about incontinence!
Why should you care about your pelvic floor?
In my experience, most women are vaguely aware of PFMT, but, only actually do them when they hear the words “pelvic floor”. Men are usually blissfully unaware they’ve even got a pelvic floor until their prostate misbehaves.
Wetting your pants won’t kill you (not even if you foolishly join in the mum’s race at the school sports day; “why did you just stop, mummy?”) but the secondary effects of it might. If you publicly wet yourself when you run, you don’t tend to go back running. Diseases of inactivity are major causes of death in the UK, with coronary heart disease Britain’s single biggest killer. So, odour control may be the thing that people with incontinence worry about, but it’s the whiff of a public health crisis that worries me.
Leaking’s not normal, but you’re not alone
Women with continence problems need to know that they are not alone, that they don’t need to put up with it, where to seek help and that most cases can be improved.
It’s not unusual for physios to hear from patients “I’m not incontinent, I just leak a bit”. Any leaking of anything (so, pee, poo or pumps) is abnormal. A failure to educate people on what normal is means that people don’t recognise that they have a problem, and one which often gradually gets worse over time.
Apart from the secondary depression, inactivity, sexual dysfunctions and hip fractures (elderly people hurrying to the toilet in the night are at risk of falls) the simple truth is that this interferes with every single thing that a woman wants to do – 1:3 of our women are being disempowered by incontinence. And, it needn’t be so.
We really need to burst the taboo about incontinence
The simplest way to burst taboos is to talk, either in person or via social media. Communication is the easiest way to challenge the beliefs that many women have, that leaking is an inevitable part of parenthood or ageing. It is simply not true and simple changes to lifestyle can have a huge impact on the symptoms that women experience.
Using social media can be useful because of the anonymity if affords. The fact is that people are often simply too embarrassed to discuss their incontinence, and social media can be an effective tool for sharing public health information (as previously blogged by Evidently Cochrane here). I’ve been trialling using twitter as a training tool (“I tweet, you twitch your twinkle” @gussiegrips) and am hoping to use that to see whether self management is effective in mild or occasional urinary incontinence.
I’d push for pelvic floor education (for both sexes) to be part of Health And Wellbeing within schools. Making a habit of PFMT from a young age has the potential to have a huge impact on the incidence of bladder disorders. And, as teenagers tend to be randy wee rascals, I’m fairly confident that if you tell them the side effect of PFMT is an improved sexual response, well, they’ll comply, won’t they?
Collaboration between the health care professionals, researchers, teachers, fit pros, sports coaches, continence product manufacturers, and the media could go a long way in changing attitudes. There’s recently been a powerful collaboration between physiotherapists and midwives to prevent incontinence, which is a good start.
So what can be done?
Evidently Cochrane asked me to look at some of the Cochrane reviews which bring together the best available evidence about PFMT and share my thoughts. So here goes:
A final word from Elaine…
I’m ok now, by the way. I do my PFMT every day. Turns out that disgracing yourself in front of 300 kids is a good motivator for starting to pay more attention to your pelvic floor. Not one I’d recommend, though!
From the boxes above you can click through to the relevant page on Cochrane Summaries,, which gives a short summary of the review. You can also visit the Cochrane Library website to see the full review from that page, or click on the links below.
Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub4.
Hay-Smith EJC, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD009508. DOI: 10.1002/14651858.CD009508.
Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009252. DOI: 10.1002/14651858.CD009252.
Ayeleke RO, Hay-Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD010551. DOI: 10.1002/14651858.CD010551.pub3.
Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD002114. DOI: 10.1002/14651858.CD002114.pub2.
Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay‐Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD007471. DOI: 10.1002/14651858.CD007471.pub3.
Page last updated: 13 June 2019