Women’s health physio Elaine Miller says everyone can play their part in tackling continence problems in women
Stand-up physio: Elaine Miller
I have an interest in women’s health and a hobby of stand up comedy. So, I did the obvious thing and combined comedy with continence to try and burst the taboo surrounding leaking. I wrote a 10-minute set about the time I wet myself on my doorstep in front of my neighbour – which is socially awkward, and, therefore, comedy gold.
The interesting thing was that, after the gig, women would approach me and murmur ‘me too’ – every single time. Vagina monologues are all very well, but a dialogue’s better – so, I wrote ‘Gusset Grippers’, which won ‘Weirdest Show of the Edinburgh Festival Fringe 2013’. This is, apparently, a compliment.
Disguising evidence-based practice as scatological humour and delivering it to socially cohesive groups of women is a powerful educational tool. If they laugh, they’ll talk, share experiences, empathise and encourage each other to seek help and comply with treatment.
That matters because the stats for incontinence are startling: one woman in three leaks. A third of the women in your ward, on your waiting list, or in your house, wet themselves. All the evidence shows that conservative management is the most effective treatment for pelvic floor issues. (Cochrane Review).
Go and read that again. The evidence says physio works. Yet, one woman in three leaks. So, is the evidence actually saying ‘you’ve got work to do’? ‘Women’s health’ is a highly effective and rewarding specialism. It takes place entirely behind closed doors. This provides both the necessary privacy for the patient, and a great hiding place for chocolate biscuits.
National Institute for Health and Clinical Excellence (NICE) guidelines recommend doing an internal while teaching pelvic floor exercises to ensure the woman is performing them correctly, assess power and check for pelvic dysfunction. Which is fine for that one, consenting woman – but, there are six million leaky ladies out there. We’re going to need a bigger room.
If healthcare professionals, fitness professionals, gyms, suppliers of continence products and the mainstream media spread the message that leaking is common, but not normal, we could burst the taboo. Periods were embarrassing 30 years ago, we can do the same for incontinence.
One-to-one treatment is regarded as the gold standard intervention, but – deep breath – I disagree. Gold standard has to be prevention. If we educated our young people about their pelvic floors and taught them to do the exercises when they brushed their teeth perhaps we wouldn’t have 50 per cent of post-menopausal women with vaginal prolapse. The excellent Association for Continence Advice leaflet is a perfect adjunct to the sex-education curriculum.
Silver standard is self-management. Perhaps there is scope for a ‘pelvic pack’ which contains an educator, a mirror, a list of instructions (including self-screening for red flags and pelvic floor dysfunction), information about good bladder and bowel management, with support online or by telephone?
If we can get the majority of women with stress urinary incontinence self-managing then the most complex cases get seen by a skilled clinician who can boast an 84 per cent success rate in five sessions (read it and weep, musculoskeletal colleagues) All of this relegates our specialised pelvic physios to a mere ‘bronze’. But, it might also mean the incontinence becomes as rare as gold dust.
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