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Half of women suffer from incontinence after pregnancy — yet it’s still ignored


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FEELING the liquid trickling down her leg and into her shoes, Denise Harding was powerless to stop it.

“I’d been laughing really hard with my daughter, then I started to wet myself,” remembers the mum of four. “As I felt the wee coming, no matter what I did, I couldn’t stop it. Suddenly my laughter turned to sheer horror. I just felt so embarrassed.”

According to experts, around 7million women in the UK can relate to Denise’s post-natal incontinence, caused by a weakening of the pelvic floor during pregnancy and birth, with the condition costing the NHS over £233million a year. Last month, actress Jada Pinkett Smith, 46, revealed she’d had bladder issues for years, while in March, England’s Chief Medical Officer Dame Sally Davies, 68, admitted she suffered from the condition after the birth of her daughter.

With so many affected, why isn’t more being done to lift the stigma of this debilitating condition?

“I regularly see women who have suffered in silence with urinary incontinence for many years,” says Dr Patrick Campbell, a consultant gynaecologist and urogynaecologist from Maypole Cosmetech Clinic in Holywood, Northern Ireland. “Worryingly, a recent NCT survey showed 38% of women are self-conscious discussing incontinence with their doctor, and 46% feel uncomfortable talking about it with their friends. Plus, so many see it as a ‘normal’ consequence of having children. This shouldn’t be the case.”

While urinary incontinence can affect anyone, Dr Campbell says a vaginal delivery can increase the risk of developing complications. “Research has shown women who give birth this way are twice as likely to develop stress incontinence, compared to those who had a C-section. And it’s three times more likely when compared with women who undergo a planned C-section,” he says.

Denise, 55, from Kent, suffered with urinary incontinence for over 30 years. “After I had my first child, Jack, in 1985, I assumed leaking a bit of wee if I coughed or laughed was part and parcel of motherhood,” she remembers. “Some of my mum friends were in the same boat, but if we ever chatted about it we never discussed trying to fix the problem – it was always just with an embarrassed giggle and how we’re learning to live with it.”

A year after her fourth child, Rose, was born in 1994, Denise had a hysterectomy, which she says made her incontinence worse. “Even though I did pelvic floor exercises as suggested by my GP, I had to wear a sanitary towel all the time because the leaking had become so bad,” she explains. “I’d try to pretend it wasn’t affecting my life, but my confidence plummeted. During the day I’d monitor how much I drank so I would never get caught short, but there were so many things I couldn’t do with the kids, such as running around in the park or trampolining.

“I couldn’t even get a proper night’s sleep because I’d be up two or three times in the night to go to the loo. Although my husband Jack would never have said it, I did worry incontinence was costing me my femininity and couldn’t help but feel unattractive at times.”

The following year, Denise went to her GP for help. “He could see I was really upset by it and offered to prescribe me Cymbalta. Traditionally used as an antidepressant, in a different dose it could also help with urinary incontinence,” she remembers. “But I didn’t want to take it, as I was worried I might end up addicted.”

Instead, Denise spent years avoiding situations that would cause her to leak – something she bitterly regrets now. “I wasted so much time worrying about my weak pelvic floor,” she admits. “Every time I went out I’d have to know where the toilets were. It ruled every aspect of my life.”

And with nearly half of women surveyed in GP surgeries admitting they’d suffered urinary incontinence in the past month, Professor Linda Cardozo, a urogynaecologist at King’s College Hospital, London, says it’s not just mothers who are affected.

“The reality is around 50% of women will leak urine at some time during their lives,” she explains.

“Even elite gymnasts with really strong pelvic floor muscles can suffer from urinary incontinence, so it is a much more common issue than many women would like to believe. While pelvic floor physiotherapy can help, the provision for women’s health physiotherapists just isn’t available across the country.”

And even more frustratingly, one popular method of treatment – which was once hailed as a potential wonder cure for incontinence – is now in the grip of controversy. Clinical trials from the late ‘90s to early Noughties found the transvaginal tape implant – commonly known as “mesh” and attached to the weakened pelvic floor using dissolvable stitches and tissue – to be an effective procedure.

However, recent NHS stats show one in 15 women have since had to have the mesh removed for various reasons, one of which is because their implant has broken through the vaginal wall. A third of women who’d had the procedure since 2008 have required treatment for trauma.

Erica Foggett, 42, a fitness coach from Worthing, Sussex, suffered with incontinence for three years after the birth of her son Marley. But what started out as minor leaks turned into something much worse.

“With two traumatic labours behind me – an episiotomy in 2008 with my daughter Maisie, and a ventouse in 2011 with my son Marley – any control of my bladder had disappeared,” says Erica. “Like so many women who vowed to do pelvic floor exercises religiously, I did very few. I was just too busy looking after the children.”

Having always been into fitness, Erica decided to return to her workout classes just a few months after Marley was born.

“I didn’t realise at the time, but the high-impact classes I was doing were actually weakening my pelvic floor further,” she explains. “Thankfully it never affected my sex life and I’d talk to my husband and friends about it, but there didn’t seem to be much information or support from experts. The general attitude I got was: ‘It’s simply an annoying side effect of giving birth.’ Ridiculously, not being able to control your bladder is still not deemed a serious problem, but nothing could be further from the truth.”

It was during one keep-fit class in 2014 that Erica realised her incontinence had become unmanageable.

“I remember looking around the class and having such a buzz as we’d just finished an intense workout,” she remembers. “But then I suddenly felt a wet patch on my leggings, and realised I must have leaked a substantial amount of urine. As I looked down, it was clear it wasn’t just visible to me, but everyone else in the class, too. Thankfully no one said a word, but I felt so embarrassed and upset. As I showered, I knew I couldn’t live like this for the rest of my life.”

Erica confessed what had happened to a friend, who suggested she try a specialised training programme specifically aimed at restoring pelvic floor strength. The workout involved one half-hour session and three or four 10-minute exercises a few times a week, all done at home.

“It was called Holistic Core Restore and seemed so different to every other fix I’d read about,” recalls Erica. “There was no surgery or invasive treatment, which had always put me off. And being a fitness coach, the idea that I could do exercises for it really appealed. It worked – in just six months I was chasing after Marley and back to how I’d been before babies, even bouncing on trampolines!”

For Denise, the solution came in June 2017 in the form of a £1,200 injection after she mentioned her plight to a private doctor she saw for facial fillers. “He explained to me about a one-off procedure where blood is drawn and whizzed in a centrifuge to create plasma-rich protein, which is then injected into the clitoris to encourage cell regeneration.

"He said that while it doesn’t work directly on the pelvic floor, it thickens the tissue between the anterior vaginal wall and the urethra, adding a support around the muscle and in turn treating incontinence. Thankfully I didn’t need to be referred by my GP, and the only risk was a bit of bleeding and pain.

“Although it sounded brutal, having given birth four times, the idea of being injected in the clitoris didn’t faze me,” adds Denise. “And I haven’t looked back since. I really can’t believe I wasted so much of my life and my kids’ childhoods without seeking proper help.”

But according to Dr Campbell, Denise’s story is all too familiar. “Only 10-20% of women come forward for treatment to combat incontinence,” he says. “That’s why it’s really important they know there are options available, and the reason they are still wetting themselves is not simply because they didn’t do their Kegels.

“If you are still leaking urine at your six-week post-natal check, tell your GP or midwife. They may refer you to a physiotherapist or continence nurse for advice and a course of pelvic floor muscle training.”

Since fixing her pelvic floor, Erica has helped more than 200 others do the same after retraining as a coach for Holistic Core Restore.

“Seeing women regain their independence is incredible,” she says. “The incontinence industry is worth millions, with so many products, pants and pads out there to manage the symptoms, but none of it offers a solution. We need to be proactive in fixing the cause. Wetting yourself should never be seen as the norm, which is why we need to make more noise about it.”

‘Women shouldn’t be embarrassed to ask for help’
Harriette Foulkes Arnold, 35, from Reading, started experiencing urinary incontinence just days after giving birth in September 2015.


“When my daughter Persie was born, she weighed 9lb 8oz and I ended up having an episiotomy with stitches. Within days of giving birth I couldn’t get to the toilet on time, or if I coughed I’d let out a little bit of pee, and I hated it. I’d always been fit and healthy and to suddenly not be able to control my bladder was beyond embarrassing. As soon as I left hospital I saw my GP about it, but all he did was give me a sheet with some exercises on – no support, no advice, no help other than a single piece of paper.

"Thankfully, I knew my gym had a physio who specialised in women’s issues, and when Persie was two weeks old I went to see her. Through an internal examination, she helped me learn how to do Kegels properly, and while it definitely made a difference, I was still leaking every time I sneezed or coughed.

"Then a couple of weeks later a friend at the gym recommended a pelvic floor toner – an electronic stimulation device where you strap two garments on to your thighs and bottom, which send pulses that strengthen the pelvic floor. I tried it for three months along with my Kegels, using it for half an hour a day, five days a week. By the time Persie was four months old, my pelvic floor was back to how it should be. I was even able to do a 10k run leak-free.

"While I realise I’m lucky I remedied my incontinence quickly, I know so many others who are still living with it. When motherhood arrives, you let yourself become the lowest priority. Women also put up with it because of the embarrassment of seeking help.

"I came close to just getting on with it rather than coming up with a solution, but no one should have to live with the debilitating limitations of urinary incontinence. There are solutions and cures out there if you persevere with them.”

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