Menopause and incontinence: Women need to stop suffering in silence

With one in four mothers having urinary incontinence and symptoms escalating with the menopause, women need to stop suffering in silence. Photo / 123RF

"It was my eldest child's school sports day when I finally reached a tipping point," says Elaine Miller. "I'd recently had a baby – my third child in four years – and I joined in the parents' sack race."

But after a few leaps in the sack, Elaine stopped dead as she realised she'd wet herself.

"I just thought: 'Oh my God', because this wasn't like a little leak you could hide – and the whole of my daughter's school was watching," she recalls.

Other mothers watching the race immediately realised what had happened and helped Elaine off the field and into the toilets to clean herself up.

"That's when I knew I had to finally get help for my incontinence," she says. It was an issue she had been avoiding dealing with since the birth of her daughter in 2004, more than five years previously.

"Mine was a classic case where it didn't start off too badly and I buried my head in the sand. But gradually it got worse and worse and started affecting my daily life," she explains.

In the years leading up to that incident, Elaine had stopped exercising out of fear of leaking in public. She'd quit her gym membership and boxercise classes. She'd stopped taking public transport in case she couldn't easily access a toilet and avoided long car journeys. She also deliberately dehydrated herself so that she wouldn't need the toilet as frequently.

The consequences for her overall health were dramatic.

"I put on loads of weight and became really sad. The impact on your mental health is huge because you see yourself as dirty and a bit broken," she explains in an interview on the Mother Bodies postnatal health podcast.

She is not at all surprised by a recent survey by Nuffield Health which found 47 per cent of women in the UK had done no vigorous exercise in the past year. She believes many could be worried about wetting themselves, as she had been.

Elaine Miller: 'I buried my head in the sand, but gradually it got worse and worse and started affecting my daily life'. Photo / Instagram @gusset_grippers

As a society we may be finally speaking more openly about other aspects of women's health – from periods to the menopause – but incontinence is rarely discussed, despite affecting an estimated 14 million people in the UK. It can occur in both men and women, although it is more common in women because pregnancy and childbirth – particularly vaginal birth – can strain or damage the muscles and connective tissues in the pelvic floor and bladder which control the release of urine.

Other factors which can contribute to incontinence include obesity (because carrying excess weight puts pressure on the pelvic floor); age-related muscle weakness (which can affect the pelvic floor and bladder); medications – such as some antidepressants; and anything that puts repeated pressure on the pelvic floor, such as straining with constipation or a chronic smoker's cough.

There are several types of urinary incontinence but the most common are stress incontinence, where urine leaks when your bladder is under pressure, such as when you cough, laugh, sneeze or jump – the issue that affected Elaine – and urge incontinence, where leaks happen as soon as you feel you need the toilet. Studies show around a fifth of women have a combination of both, known as "mixed incontinence".

According to the NHS, one in three women will experience urinary incontinence in the first 12 months after giving birth and one in four will have symptoms for up to 12 years.

With close to three-quarters of a million babies born in the UK annually, this means up to 250,000 women will develop childbirth-related incontinence each year.

But the Chartered Society of Physiotherapy says as many as 71 per cent of women could be affected. Data is hard to verify because many women are too embarrassed to come forward – especially those from some minority ethnic groups.

Elaine, now 50, who lives in Edinburgh with her husband Stephen, a lawyer, their daughter and two sons, now aged 18, 16 and 14, is far from the only mother to put up with the condition for years.

"It takes the average woman with urinary incontinence seven years to get help," says Tina Mason, pelvic health physiotherapist at Women's Health Brighton.

She puts this down to a lack of education during pregnancy about how to recognise the issue and the fact that many women feel dismissed by healthcare professionals when they do summon up the courage to mention it.

"Often when women see the GP, health visitor or midwife, especially in the early days [after birth], they're told: 'That's normal. You've had a baby'," she adds. "Actually, although it's common, it's not 'normal' and women shouldn't have to live with it."

Many women find their mild incontinence escalates into a major issue when they hit the menopause. Photo / 123RF

She thinks the UK should operate a system like that in France, where all women are given around 10 state-funded pelvic physiotherapy sessions in the months after birth.

Early intervention like this could help prevent issues later in life, she explains, as many women find their mild incontinence escalates into a major issue when they hit the menopause.

The menopause-related drop in oestrogen levels affects muscle bulk and elasticity, which can weaken pelvic floor and bladder muscles and worsen incontinence.

Mason says many of the menopausal women she sees with the condition feel "sad and frustrated" that they weren't given information about how to prevent it after they had children.

"Often they feel like it's now too late. It's not – it's never too late. But it is harder to work on at a later stage than if you'd done [the exercises] postnatally and carried on since then," she explains.

Unlike most new mothers, Elaine was a trained physiotherapist. So she knew exactly what was wrong with her and the exercises she should have been doing to treat it – yet she still did nothing about it.

It's indicative, she says, of the way mothers typically put themselves last.

"I was so busy with three young children, the days just flashed by. Every night I'd get into bed and think: 'Ah, I meant to do something about that. Oh well, I'll do it tomorrow.'," she says.

She is not alone. When celebrity mother-of-six Kris Jenner was shown experiencing stress incontinence in a 2011 episode of Keeping Up With The Kardashians, she echoed what many mothers feel when she said: "I don't have time to go running to the doctor every time I have a leak."

Elaine finally got advice from a pelvic health specialist after the sack race ended in disaster. She began doing exercises three times a day, which involved contracting her pelvic floor muscles in a combination of long and quick squeezes.

"I set an alarm on my phone and did them every time it went off," she explains. "I told myself I'd give it three months and see what happened – in fact, within two weeks I noticed a difference and by 10 weeks I was completely dry."

Pelvic floor exercises have a proven record of success. A Cochrane Review which analysed the results of 31 trials found women with incontinence who received guided pelvic floor exercises were five times more likely to report the issue was cured than those who had no or inactive treatments. This rose to eight times more likely with stress incontinence.

The exercises – first pioneered by American gynaecologist Arnold Kegel in the early 20th century – are often all you need. A 2020 study across 12 centres in the UK and New Zealand, published in the BMJ journal, found no discernible advantage to using pelvic floor training devices.

Yet it is astonishing that, when the cure is so simple, so many women continue to live with incontinence. Elaine, who specialised as a women's health physiotherapist after her experiences, says making women aware that their problem can be fixed is half the battle. To help raise awareness, she is currently performing a stand-up comedy show on gynaecological health – Viva Your Vulva – at the Edinburgh Fringe Festival.

While some cases are more complex, Elaine believes many women of all ages could be cured with just three months of focused exercises.

Her oldest client was an 82-year-old who had struggled with leaks since the birth of her son, 60 years previously. Age-related loss of muscle tone meant she had now lost all control of her bladder and was worried she would have to go into care due to her incontinence.

"I showed her how to do the exercises and she got better within a few months," says Elaine. "It's so sad to think how different her life could have been if she had been given that education years earlier. All she needed all that time was advice."

NOTE: The information in this article is not a substitute for medical advice. If you suspect you have incontinence, see a pelvic health physio or ask your GP to refer you for an assessment.