When you gotta go… (tips for dealing with urinary incontinence)
Image: Michigan Health
Do you leak when you laugh? Or when you lift something heavy? Does the idea of getting on a trampoline strike terror? Up to one in three women will experience urinary incontinence (UI) at some point. Until recently, this might have been cause for stigma or shame. But attitudes may be changing, as with talking about periods and menopause. The topic is coming out of the (water) closet and being laughed off (careful…). A couple of years ago, a TV ad for Tena Lights panty liners featured women offhandedly referring to an ‘oops moment’, ie wetting themselves, a little. Although useful in openly discussing the issue, the ad’s implied acceptance of the condition was criticised by experts, such as Elaine Miller, a pelvic physiotherapist, recovered incontinent and award-winning comedian, whose Gusset Grippers show aims to encourage discussion of UI. ‘People think leaking is an inevitable consequence of ageing or parenthood, and that’s just not true,’ says Elaine, ‘The problem is not that women leak, the problem is that they don’t know help is available.’
Types of Urinary Incontinence
• Stress incontinence: Urine leaks when your bladder is under pressure, for example, when you cough or laugh.
• Urge incontinence: (aka overactive bladder) Urine leaks as you feel a sudden, intense urge to pee, or soon afterwards, due to problems with the bladder wall’s muscles.
• Overflow incontinence: You can’t fully empty your bladder, which causes frequent leaking.
• Total incontinence: Your bladder cannot store any urine, meaning you pass urine constantly or leak frequently.
Wondering whether you have UI? Take the NHS’s short questionnaire HERE
If you do have UI, here are some ways to help, and make life easier. If necessary, you can access pelvic health physiotherapy via your GP, or by self-referral in some NHS Trusts.
Do pelvic floor exercises daily
Your pelvic floor is a muscle ‘hammock’ inside the bony circle of your pelvis, which stops your internal organs falling out. You can feel your pelvic floor if you try to stop peeing mid-stream (don’t do this regularly; it’s not good for the bladder) or try to suppress a fart. The technique recommended by the NHS is to sit comfortably and squeeze the muscles 10 to 15 times. Don’t hold your breath or tense your stomach, buttocks or thighs. (Doing them now? Me too!) Next, hold each squeeze for a few seconds. After a few weeks, add more reps, resting between each set. It may take three months to feel the benefit. Everyone benefits from pelvic floor exercises, and they can make sex feel better (and help men with erectile dysfunction). An app can help with reminders and technique. Squeezy, £2.99, has a plan recommended by a pelvic health physiotherapist and is in the NHS Apps Library.
When you gotta go…
Several organisations offer free ‘toilet cards’ to show, to access the nearest toilet quickly and without question. Try Age UK, Urology Foundation or Bladder & Bowel Community.
Be free to pee… like men, because sometimes there’s no loo or blush-sparing bush handy, with a Shewee, an anatomically designed plastic contraption that lets you pee standing up. I got mine in 2009 and can confirm that it pays to practise in the shower.
Pads and pants
Many women use standard panty liners but these may not be absorbent enough, and the synthetic material may cause irritation. Two cotton options are Natracare Dry & Light, £2.79 for 20, or Sanature Pro Vivo pads and panty liners, from £3.99 for 24. You can also use fabric pads and liners designed primarily for periods, such as those from Etsy’s independent makers and sellers.
There’s a current TV ad for truly hideous disposable incontinence knickers that look like they’re made from crepe bandage scribbled with flowers. While throwaway underwear may be useful in certain situations, like travelling, there are much better-looking washable – and more environmentally sustainable – knickers that work out cheaper.
BP3’s comfortable sporty high-waisted knickers feature a lovely scalloped edge. The four-layered gusset which draws moisture in (up to 15ml) and keeps it in, was a lot thinner – and longer – than I’d anticipated.
Like a little lace? Drylife’s washable knickers have lace side panels and can take up to 250ml.
Giggle Knickers has cotton briefs and high-waisted knickers in sizes 4 to 24, from £12.99, with a touch of Spandex and a ‘hi-tech gusset’ to absorb up to 6tsp.
Underwear über-supplier Marks & Spencer has a ‘Confidence’ range. Four styles provide ‘everyday protection for light leaks’ via a three-layer gusset with ‘super-absorbent, anti-odour technology’ in a ‘no-show design’ that looks and feels like normal knickers. £12 each.
Cheeky Wipes has three styles of ‘period and pee-proof pants’, from £6.50.
Adrienne Wyper is a health and lifestyle writer.
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Discussion (22 Comments)
As a German yoga teacher who teaches many pre- and postnatal women, can I respectfully ask how many readers know exactly which muscles they are supposed to contract when doing pelvic floor exercises? In my experience, just thinking “down there” doesn’t work. The pelvic floor has three layers and a left and right side. It can be too loose, but it can also be too tight – and it can be loose on one side but tight on the other. Blanket instructions like “squeeze the muscles 10 to 15 times” are going to exacerbate your problem if your pelvic floor is too tight. I could go on… but, bottom (indeed) line: We need to talk about this, without taboo, amongst ourselves and to our doctors, and in a lot more detail than the NHS information site. Don’t resign yourself to hideous knickers. Get a physiotherapist who specializes in pelvic floor issues (many have no clue about the pelvic floor and are just as embarrassed about the issue as the rest of the population), and let’s not stop asking questions until it feels normal!
Hi Lorna, thank you for your expert advice. Agree, talking about this is beneficial, it’s good to see a physio and the knickers Adrienne mentions are hideous (surely someone can design a decent pair?!)
Tanya says:
Sadly for some women these “hideous” knickers are the only thing maintaining their dignity. I have suffered with incontinence for years, I’ve had an operation to lift my bladder, seen a women’s health physio, I have always done my pelvic floor exercises yet I still leak. I found your very flippant comment quite alarming, -physiotherapy doesn’t work for everyone! It is such a taboo subject and we should be talking about it more however you need to understand that some women have no other choice and they should not be shamed for that.
My apologies, Tanya. The feature quite rightly includes a range of pads and pants because women do have to use them. I was specifically referring to the ones Adrienne mentions in the feature (we had a conversation about them when she submitted her feature because I hadn’t seen the TV advert – and they are hideous!) but that doesn’t excuse it. I am going to amend that comment to make the point clearer, now.
Catherine says:
Thank you so much for this post – full of such useful information. Now 70, I have suffered from UI for several years as did my mother. It ruined her life. She ended up never going out because she was so worried about wetting herself. I was determined that, after 3 children in quick succession, it would not happen to me. I have had three rounds of Botox in my bladder on the NHS which is a marvellous treatment. Unfortunately each time, it lasts for less time but it is still years rather than months.
In addition to the excellent recommendations in this piece, can I add Yoni incontinence pads for light leakage? They are made from 100% organic cotton and are fully compostable – a win/win for a gardener like me! I’ve also been helped enormously by a book called The Pelvic Floor Bible by Jane Simpson.Yes, yoga can be hugely helpful (that’s how I got into the subject matter initially), but just like with the physiotherapists, it depends on what exactly you get up to.
Rach with an E says:
I eat well, take regular exercise and have plenty of opportunity for mindfulness and relaxation. I’m going to add pelvic floor exercises to that list as a preventative measure. A very informative post on another taboo subject. Thank you.
Joyce says:
How timely . I have an appointment this afternoon at a local urogynaecology clinic.
I have not experienced incontinence but I do have a prolapsed bladder.
My initial appointment was with a male gynaecologist who recommended pelvic floor exercises . I thought I had this covered with my regular Pilates and yoga and was disappointed that I nevertheless had a problem .
An article in the Telegraph highlighted specialist physiotherapists and I managed to find someone locally. After only 2 appointments my technique was much improved and I now feel confident that I am having an effect.
If only my initial gynaecology appointment had included a short session with a physio or had been followed up with a referral .
I would recommend finding a specialist physio to anyone with similar problems .Valleycat1 says:
Speax is a brand of cloth panties that have an integrated unobtrusive absorbent pad. Washable and reusable.
Nicola de Vries says:
Thank you so much for this post. The women in my family have all had issues with a “leaky laugh” and , in spite of knowing I should be doing pelvic floor exercises I always forget!! The link to Elaine Miller’s website is a fabulous resource.
Thank you both for reminding me to squeeze and for making me laugh (carefully) xSamira Harris says:
Thanks for this feature. I am currently on the waiting list for surgery (burch colposuspension is what the surgeon and I decided was most appropriate for me, after I declined the TVT surgery a few years ago, just as the scandal about surgical mesh was gaining momentum) having had urinary incontinence since the birth of my daughter 8 years ago. Physiotherapy didn’t solve my problems, but it helped a lot, and I second the advice from the physio above that there are three muscle groups that you learn to squeeze that I NEVER would have figured out on my own, or by using the gadgets you can buy like Elvie (which was an expensive waste for me), etc. Physio was great.
I recommend a book which came out very recently by the brilliant Luce Brett – PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale – for which Elaine Miller wrote the forward. It’s more a memoir of coping, but it has a great list of resources at the end too. I’m pretty unembarassable so I merrily tell everyone that I’m incontinent – doing my bit for breaking down the taboo! I do wonder if the UK had a better post-birth recovery programme, if things would be better, and fewer surgical procedures would be necessary. The French are rumoured to have good post-natal pelvic floor care, but I have never seen any comparative scientific evidence on it vs the UK non-intervention approach, and I tend to think we fall prey to misguidedly idolizing the French; as I understand it anecdotally, their pelvic floor recovery programme is often presented to women as a way to get back to being pleasing for their male partners rather than for their own well-being, so it may not be that effective at preventing incontinence. A well exercised pelvic floor doesn’t necessarily mean you won’t leak as it can have other causes (as in my case), which probably only surgery has a chance of fixing.
Janet Saunders says:
On my visit to a male GP about this problem, which was affecting my confidence in my regular running schedule, he suggested a pharmaceutical solution: Duloxetine. Although it led to odd feelings and dreams for the first 2-3 nights I guess my body adapted and it has always worked well for me even at a low dose.
diane says:
That is interesting. I am on Duloxetine for fibromyalgia as well as anxiety/depression. I found that it worsened my incontinence. I am on 30mg a day which is a fairly low dose. (I tend to respond to lower doses than typically prescribed.)
I am glad it is helping you!
Oh my, here I go to one of my favorite blogs and here is My Leaky Life! I thank you for addressing a common but rarely discussed problem. My muscle tone had gotten so bad I could not even feel myself doing a Kegel exercise. I am 58, post menopausal, never had children. It had gotten to the point where I had to do something besides stick ever thicker pads in my knickers.
I am currently using a device called Elitone (designed by a woman for her own problem) which is like a TENS appliance that creates muscle contractions which help strengthen the pelvic floor muscles and help diminish incontinence. It is external, nothing goes inside, it is passive in that it electrically stimulates the muscle contractions. I have been using it since the beginning of July and slowly but surely it has diminished my leaking episodes. I am down to a thin panty liner most of the time and I am very pleased with my progress. I may never be entirely leak free, but at least I can actually feel my pelvic muscles again and can do Kegels on my own now. I am so happy I found Elitone on a desperate internet search for Incontinence Cures. I am not affiliated with the company , nor compensated in any way for this endorsement. Look into it if you think it might help you.Cath Clarke says:
Thank you for raising this important topic. As a continence nurse advisor I applaud this discussion. Information and education, leading to health literacy is powerful. There are a few different reasons that can cause Urinary Incontinence and it is wise to have it investigated and treated correctly as there are different treatments for different causes. Women really need to practise Pelvic Floor Muscle Exercise regularly for all their lives to prevent other medical issues such as pelvic organ prolapse, not just for U I. I practise in Australia and am not familiar with your health system, but the UK has been a leader in Continence promotion. I recommend seeing a continence nurse who has specific training and go from there, commencing with conservative treatment first. U I is a problem that does get worse with age and needs to be addressed. I love my job as I can promote and empower change and see many women ” get their confidence and life back”. Again positive support of each other is profoundly powerful.
Goddessinthedetails says:
I don’t suffer from this but just wanted to reiterate what was said about identifying the pelvic floor. I did Pilates for years and it was only recently I learned what I should be looking to do in an exercise when I had a one-to-one with a Pilates teacher who is also a trained physiotherapist. It was an eye opener. I love Yoga but don’t find it strengthens the core in the same way.
Anna says:
Thank you for using your blog to talk about this important issue. I am also a yoga teacher with a specific interest in the pelvic floor and UI. Since having two children (youngest is 11) I have suffered from slight UI despite years of yoga and pilates practice and I agree that practising these activities alone is rarely enough to fully understand how to activate the correct muscles in a pelvic floor exercise. I got referred to a pelvic health physiotherapist who helped me with the technique and I am now getting back to higher impact activity like running. Remembering to do the daily exercises remains a struggle!
A lot of people believe that urinary incontinence isn’t really a health concern but just a natural part of aging; therefore, it doesn’t make sense to treat it. There are also many that believe that urinary incontinence can only be treated with surgery.
These are both just myths, and it’s important to understand that urinary incontinence can happen to you at any age, and it is possible to treat it without surgery as well. But since there are different types of incontinence, each with its own causes and symptoms, it’s important to reach out to experts to figure out the best course of action.My health coach Dr. Shelia Craig helped me a lot in this! She guided me thoroughly and I’m still very thankful to her.
Ana 
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Thank you for this post! Thank you for writing about this issue which is one of the, many, taboos women have to bear, even among themselves.
I started leaking when in pre menopause, which, like a lot of other women, I was not aware of.
Now I know that pre menopause can start till 10 years before the actual menopause, time during which women are experiencing a lot of change in their mind and body.
One of mine was leaking: I did not understand at first as I never had children, am a former long time ballet dancer and was doing Pilates. But it was not enough I had to do some research on the internet to try to understand better. By the way, I am french, and whatever documentation I could find, about leaking and menopause, was mostly in english. Not that french are not aware of these, but the taboo is, I think, even more important, even among the doctors, not speaking among women themselves.
I am open to speak about my leaking (well of course I am not going to start a conservation saying “I am leaking” but you’ve got my meaning) and I found that Pilates does help a lot (along with the rest of your body); being more relaxed and less focused on your bladder; being active.
I did not stop to drink water or tea, I do not wear any pads of any sort but yes, I have an aps which helps me to exercise and I do Pilates as well.
If the problem is too difficult to bear, here in France we can go to a physiotherapist, to which your gynaecologist can direct you too. I do not know if that is possible in England.
Anyway, that is to say that you can leave with leaking but you have to be regular with your exercise.