Let’s talk about incontinence

‘One in three women experience some form of incontinence after childbirth,’ says Dr Mayoni Gooneratne ( ‘This increases to 40 per cent of women over the age of 65, due to the loss of the protective effects of oestrogen during the menopause.’

The most common form is stress incontinence, which is characterised by a leaking of urine when the pelvic floor is under stress (when we cough or a sneeze, for instance). ‘This leak can be very minor and only when trampolining or skipping,’ says continence specialist, Jane Simpson, ‘but can sometimes be so bad that simply standing up from a sitting position can cause a leak of urine.’

Whatever the symptoms, accessing treatment is essential, Jane stresses: ‘Many of my patients spend a long time assuming these sorts of leaks are completely normal before they finally come to see me. It is not, and should never be thought of as normal!’

‘If you suffer from even minor stress incontinence it is really important to address it sooner rather than later,’ she advises.

What can be done?
Pelvic floor dysfunction is curable and does not need to be life-limiting. As more and more incontinence pads fill up supermarket shelves, it’s important to note that these should not be used as a replacement for active treatment. The National Institute for Health and Care Excellence (NICE) is clear that pads should only be recommended as ‘a coping strategy pending definitive treatment or an adjunct to ongoing therapy’.

Five strategies for going pad-free

1. Squeeze!
Stress incontinence is caused by weakening pelvic floor muscles. ‘These muscles are wrapped tightly around the urethra, vagina and anus, and are always in a slight state of tension to keep you continent,’ Jane explains. The first step to strengthening your pelvic floor is isolating the correct muscle. ‘I often ask my patients to squeeze their muscles as if they were in a lift full of people and suddenly needed to pass wind,’ she says. If this fails, she recommends inserting a tampon, gently pulling on the string and contracting the muscles to prevent the tampon from coming out (much like a tug of war).

If your pelvic floor remains elusive, seek the help of a continence nurse: a painless electro-stimulation procedure can wake up the muscles and help you to locate them. ‘Once you’ve located the muscles, squeeze and lift them, and hold for the count of five,’ Jane continues. ‘If you feel that your muscles have let go before you get to five, hold for as many seconds as you can. Keep practising and slowly build up until you can hold on for ten seconds.’

‘Once you have held on for up to ten seconds, let go gently and rest for five counts. You then need to repeat the same exercise (hold for ten seconds and release for five) five times. This will take a few minutes each day.’

‘Try to do the exercises three times per day,’ she advises, ‘but don’t worry if you occasionally only manage it once or twice a day. It has to work for you.’

2. Drink Smart
‘I see many patients who tell me that they don’t drink all day, in case they can’t get to a loo in time,’ says Jane. ‘This can make matters worse, leading to strong, concentrated urine that irritates an ever-shrinking bladder.’ Be kind to your bladder by drinking 1.5 to two litres of water a day and cut
back on diuretics such as alcohol and caffeine.

3. Ditch the Habit
Making healthy lifestyle tweaks can help to take the pressure off the pelvic floor. ‘Carrying excess weight around the abdomen can weaken your pelvic floor,’ says Jane. Similarly, the chronic cough that comes from smoking can add to this strain.

4. Low and Slow 
A review has shown that regularly playing sports increases the prevalence of incontinence, with high-impact sports causing the most strain. Seek out strengthening, low-impact exercises, such as Pilates, to replace or support high-impact activities.

5. Viveve
Dr Mayoni cautions it’s important to not feel like a failure if pelvic floor exercises don’t work: ‘Though the exercises are effective, in reality only one in seven women has success – as a busy mum myself I know the struggle to find the time and inclination!’

In other cases, radio frequency treatments can be helpful. Viveve is an FDA-approved, non-invasive treatment that involves inserting a probe into the vagina. It stimulates collagen production by heating and cooling the tissue, which tightens and supports the urethra.

Four gyno-gadgets for going pad-free

1. Squeezy
An excellent app from the NHS. You can follow a pre-set pelvic regime or
tailor to suit your lifestyle.
£2.99, App Store

2.Kegel Trainer
Consistency is key. This free app allows you to set reminders and time your pelvic floor exercises.
Free, App Store

3. Intimina Laselle Exerciser
Take your pelvic training to the next level! These easy-to-use weights are available at 28g, 38g and 48g, or as a set of three.
From £9.95,

4. Elvie Trainer
This intra-vaginal device connects wirelessly to your smartphone, allowing you to measure
the strength of your pelvic floor contractions. If you struggle to stay motivated – this is for you.

For more information, tune in to S4E9 of Wellness With Liz Earle with Dr Mayoni, and pick up a copy of Jane Simpson’s book, The Pelvic Floor Bible (£9.99, Penguin).