Katie Woodland was 15 when she started having to run out of classrooms mid-lesson because she needed to wee so badly. Her bladder weakness only got worse throughout her twenties, leading to “countless awkward situations”, including when she had to tell a hairdresser to stop mid-hair cut – she was worried she might have an accident.
“I don’t think people quite realise, it’s not the same as needing the toilet. If I need to go, I need to go,” Woodland, now 36, from Telford, tells HuffPost UK. ”By the time I’ve run, as soon as I sit down it’s not like a small drip, it’s there, it’s done and it’s out. I know that if I don’t go, I’ll wet myself.”
Around 34% of women are affected by incontinence at any one time, according to the NHS, but Dr Brooke Vandermolen, who works in obstetrics and gynaecology, believes the figure may be even higher, due to the volume of women who are too embarrassed to seek help for their problems.
“Urinary incontinence is the complaint of any involuntary urinary leakage,” explains Dr Vandermolen, who blogs about women’s health alongside her work in the NHS. “There are two main causes: overactive bladder, resulting in symptoms such as having sudden urge to pass urine which cannot be controlled, and weakness of the pelvic floor and urethral sphincter, resulting in stress incontinence.”
In Woodland’s case, doctors believe her overactive bladder may be due to recurrent urinary tract infections (UTIs), but she’s yet to get to the bottom of why she’s so susceptible to them.
Meanwhile, stress incontinence – which leads to unintentional passing of urine when coughing, sneezing or jumping – frequently occurs after childbirth.
Luce Bett, 42, from London, started to experience stress urinary incontinence at the age of 30 after the birth of her first child. She had experienced a second-degree tear during labour and further complications after the delivery, because part of her placenta was retained, leading to several haemorrhages.
At its worst, simple but necessary movements like picking up her baby or pushing the pram up a curb would cause her to pass urine. “I felt desperate,” she recalls. “One of the biggest taboos about incontinence is that is can also cause serious depression. It made me feel awful.”
Physiotherapy reduced her symptoms slightly, but Bett’s incontinence came back “worse than ever” when she fell pregnant with her second child and continued after the birth.
“It made me feel wretched, disgusting, and also really furious.”
Going out became a chore, particularly because she would have to carry a spare outfit with her in case she had an accident – whether she was popping to the supermarket or attending a wedding.
“I was always nervous of wetting myself or smelling,” she says. “It made me feel wretched, disgusting, and also really furious. I feel like a terrible feminist saying it, but I thought it wasn’t fair, because I was so young and this sort of thing doesn’t usually happen to women in their thirties. I just thought: ‘Why me?’”
Her health problems also affected her relationship with her husband – a side effect of incontinence she thinks women rarely speak about. “I felt disgusting and worried that he wouldn’t love me,” she says. “I felt like I wasn’t sexual anymore or attractive. Also, you’re irritable when you’re walking around with a wet Tena Lady on.”
While many cases of incontinence do start with motherhood, Woodland does not have children and believes stigma around incontinence is particularly prevalent for women who are not parents.
“From my perspective, if you’ve been pregnant and you’re struggling to control your bladder, that’s acceptable and people are talking about that more now. It’s considered just one of those things that happens,” she says. “But I haven’t had a baby and I’m not an older woman, so it makes me feel like there is something wrong with me.”
Woodland’s incontinence was at its worst during her early twenties, when she was working in retail and would sometimes need to run off the clothes shop floor to the staff toilets. “One of the ways I used to manage it was that I just wouldn’t drink when I was at work, which is obviously really unhealthy. I was constantly dehydrated,” she recalls.
“I haven’t had a baby and I’m not an older woman, so it makes me feel like there is something wrong with me.”
To encourage women to seek support sooner, Elaine Miller, a physiotherapist specialising in pelvic floor exercises, has created an evidence-based comedy show about incontinence, which is currently running at the Edinburgh Fringe. The show, called Gusset Grippers, includes taboo-busting elements like the “sing-along-clench-along”, to teach the audience what their pelvic floor is and “where to take theirs if it is a bit wonky”.
“I use comedy to address the embarrassment of these most intimate of issues and that enables people to ask for help,” says Miller, who describes herself as “recovered incontinent”.
“I noticed that making women laugh makes them talk, and that means they share experiences, gain empathy and nudge each other to remember to do their exercises,” she adds. “Women are very good at mutual support.”
When she’s not on stage, Miller is campaigning for better public awareness around incontinence and the benefits of pelvic floor exercises. Her online petition is calling for the Scottish Government to include pelvic floor education in Baby Boxes – a cardboard box of clothes and equipment offered to mums-to-be in Scotland and parts of England – to help reduce stress incontinence amongst new mothers and improve women’s life-long health and wellbeing.
Pelvic floor exercises are usually the first thing your GP will advise if you’re experiencing incontinence, says Dr Vandermolen, but if you have been doing these without much improvement, it’s time to explore other treatment options.
She recommends getting your GP to refer you to women’s health physiotherapy – they will perform specific tests and advise certain exercises depending on your case. You can also keep a bladder diary, documenting fluid intake and trips to the toilet. There are templates available to download online, which can help for future appointments. It is important to cut out food or drinks that make the problem worse such as caffeine, so do write down what you are having.
If these steps don’t work, you should be referred to a urogynaecologist where you may have further tests such as urodynamics (which assesss the bladder and urethra) or ultrasounds scans if you’ve previously had a tear from childbirth. Your doctor will then be able to advise if surgical managements would be appropriate depending on the exact cause of incontinence. If you predominantly have symptoms of stress incontinence, you may be offered an injection with a bulking agent to help reduce the leakage of urine, says Dr Vandermolen.
Vaginal mesh was previously a common surgery prescribed to women for incontinence, but the treatment option has been “paused” amid reports of life-changing complications from women. Other surgical options are prescribed on a case-by-case basis.
“The surgical options are varied, but you may be offered a procedure called a colposuspension where the neck of the bladder is lifted up and stitched in this position,” Dr Vandermolen says. “The other option involves a sling procedure where tissue is used to form a sling to supports the tube that carries urine out of the body (the urethra).”
Bett has had two different surgeries and says her symptoms have improved, although she is still affected by incontinence and seeing specialists. Woodland has been prescribed UTI antibiotics, but has largely improved her symptoms through lifestyle changes, including documenting her triggers.
Physiotherpaist Elaine Miller argues that the most powerful thing women can do to beat incontinence is talk about it to one another. “Talking is kryptonite to taboos,” she says. “Just telling women that they don’t need to put up with this dreadful intrusion into their lives can be enough to encourage them to seek help from their GP or midwife.”