A weak bladder might be more common than hay fever but it’s still a hugely taboo subject.
So women everywhere applauded Hollywood actress Kate Winslet when she talked openly about her post-children bladder problems.
In a TV interview last November the Oscar winner, 40, confessed: “I can’t jump on trampolines anymore – I wet myself. It’s bloody awful, especially if you’re wearing a skirt. When you’ve had a few children it’s just what happens.”
A third of British women admit they’ve suffered from stress incontinence after a fit of the giggles or an exercise session.
And although more commonly associated with women following childbirth, stress incontinence is a problem that can affect both sexes, with one in 10 men in the UK also affected, most often following prostate surgery.
Too shy to seek help
Most suffer in silence with around half saying they’re too embarrassed to see their doctor about symptoms. According to the same survey, by medical devices company Coloplast, a similar number of people feel “uncomfortable” even talking to their partners about weak bladder issues. “
Women who leak urine or have to rush to the toilet often withdraw from lots of activities they used to enjoy,” explains specialist women’s health therapist Becky Aston.
“They’ll avoid exercise classes, dancing, playing with their kids, and steer clear of sex, plus there’s the expense and embarrassment of using incontinence pads. It can make life a real misery.”
Why it happens to women
Stress incontinence occurs when urine leaks out at times when the bladder is under pressure – this can be from laughing, coughing or from any exercise that involves jumping.
These activities cause the pressure inside the bladder to become greater than the urethra’s (urine tube) strength to stay shut.
For women this usually happens because the pelvic floor muscles that support the urethra have been damaged by pregnancy or childbirth, or have lost tone following the drop in hormones after the menopause.
Alongside stress incontinence, there’s a related condition also caused by weakened pelvic floors known as ‘urge incontinence’ – which causes a sudden sense of urgency forcing sufferers to rush to the toilet with little warning, or risk wetting themselves.
How men can be affected
For men, bladder weakness most commonly occurs after prostate surgery and can be one of the biggest challenges to overcome during the recovery process.
This is because the involuntary contraction of muscles in the prostate contribute to bladder control. Once the prostate is removed, the pelvic floor muscles must maintain control and prevent urine leaks on their own, which means they need strengthening.
Gaining full bladder control following surgery can take up to 18 months and a small percentage of patients experience ongoing permanent incontinence, which can have a huge impact on work, personal relationships and confidence.
Like women, men can also suffer from age-related loss of pelvic muscle tone. This is because the urethra, the tube that carries urine out of the body, is shaped like a U-bend.
In younger men the surrounding muscles contract strongly, helping expel the last drop of urine stuck in the bottom of the U-bend. However, with age these muscles can weaken, meaning some urine gets left behind.
As a man walks away from the toilet, the movement stimulates the urethra to push out and leak the last bit of urine.
What you can do – and the added sex benefits
“There’s good robust evidence that physiotherapy – exercises targeted to strengthen the pelvic floor muscles – will improve symptoms for 75% of people with bladder incontinence,” says Becky Aston.
“Men suffering with bladder weakness or difficulty establishing or maintaining an erection should also find that pelvic floor exercises help.”
A British study led by Professor Grace Dorey found that as well as improving erection problems by 75%, men who did the exercises also had stronger orgasms.
“Women notice greater sensation and better orgasms during sex after working their pelvic floor muscles, too,” says Becky.
Getting it right: How to work these muscles
Both men and women need to perform similar types of simple contractions.
However, more than 50% of people get these exercises wrong when they first try them – especially if they’re just reading instructions from a leaflet. This is because the muscles can be hard to isolate and people often end up working their stomach or thigh muscles instead.
Below are guidelines to help you get started, but the National Institute for Health and Care Excellence recommends seeking help from a physiotherapist first. Ask your GP for a recommendation or visit pogp.csp.org.uk to find one.
To identify your pelvic floor muscles, squeeze the muscles that you use to stop your urine flow.
The exercise: Sit, stand or lie with your knees slightly apart. Slowly tighten your pelvic floor muscles under the bladder as hard as you can. Hold to the count of 10, then relax. Repeat five times. Then do the same exercise quickly, holding for just a second. Repeat at least five times. Do this three times a day.
To identify your pelvic floor muscles, sit relaxing the muscles of the thighs, bottom and abdomen. Squeeze the bladder muscles as though trying to stop urine flow, while also contracting around the back passage as though trying to stop wind.
You should feel a dip at the base of the penis, while the scrotum rises slightly.
The exercise: Sit comfortably and slowly tighten and pull up the pelvic floor muscles as hard as you can for as long as you can – ideally 10 seconds. Rest for a few seconds then repeat. Do this three times a day.
Case Study 1: “After three months the urge went”
Mum-of-two Lucy Teear, 47, is a sales manager who lives in Kington, Herefordshire, with husband Chris, 49.
My pelvic floor wasn’t as strong after having children, but 20 years ago it was still taboo to talk about it, even with my midwife. But this changed when, at 42, I was diagnosed with stage-three breast cancer. After going through a lumpectomy, chemotherapy and radiotherapy, I got the all-clear, but my treatment triggered an early menopause.
I began to notice a real sense of urgency when I needed a wee and it became progressively more difficult to hold on.
My sales job involves a lot of driving and the final straw came when I couldn’t find a service station and had to pull into a lay-by and pee on the embankment!
I’d heard about pelvic floor training gadgets from a colleague and after researching decided on PeriCoach as it could be used with your smartphone.
After four weeks of using it twice daily I saw a difference. I could actually feel where my pelvic floor muscles were whereas before I had no idea if I was doing the exercises correctly. I found the gadget easy to use and the app sent me daily reminders.
After three months the desperate urge has gone and I never have to worry about making it in time. Now I just use the gadget a couple of times a week to keep my muscles in shape. It has transformed my life.
Case study 2: “I was using four pads a day to hide the problem”
Alpha Koroma, 73, is a retired NHS cardiac support worker/NHS nurse and a grandfather of 11 who lives with his wife in Newham, East London
I was diagnosed with prostate cancer in early 2013 and had surgery to remove my prostate gland. I was warned bladder weakness could be a side effect and, sure enough, I started suffering from terrible urine leaks. I was having to use four incontinence pads a day to hide the problem. I lost my confidence and self-esteem and for over a year I didn’t want to go anywhere.
Then last year I was introduced to Innovo, a muscle stimulating device designed to tighten the pelvic floor muscles (see below).
I was sceptical, but within two months I started seeing a lot of improvement. After completing the recommended programme of five, 30-minute sessions per week for three months I’d regained complete dryness.
Now I’m back to normal and can do whatever I want without the constant fear of bladder accidents.
Gadgets that can help work pelvic floor muscles
- The PeriCoach is a discreet, use-at-home device and smartphone app that helps train your pelvic floor muscles through guided exercises, reducing the risk of leaks and improving orgasms. It monitors your progress as the muscles strengthen and sends you workout reminders. (£145, pericoach.com )
- Homecraft Aquaflex Weighted Vaginal Cones. These cones are used with gradually increasing weights which, when inserted into the vagina, trigger the pelvic floor muscles to automatically contract, strengthening them with regular use. (£23.50, Boots)
- kGoal Boost is a bicycle seat-shaped exercise tracker that men sit on to perform pelvic floor exercises. It will be available later this summer. The device connects to a smartphone app and as well as boosting bladder function it promises to help improve erections. (£75, pre-order at minnalife.com )
- The Private Gym Kegel Male Trainer uses weighted rings that go around the penis when you do pelvic floor exercises, gradually building their strength as you go. (£79.99,privategym.co.uk )
- Innovo is a non-invasive way for men and women to train their pelvic floor. Similar to body toning machines, it uses patches attached to your thighs and buttocks to send targeted impulses that tone the relevant pelvic muscles. (£249, restorethefloor.com )
Is surgery the answer?
An operation will do nothing to improve muscle strength, warns physiotherapist Becky Aston.
“It simply reduces pressure on the bladder,” she says, “which may help with stress incontinence, but not with urge incontinence nor sexual function.”
Botox injections into the bladder wall can ease urge incontinence. “But the best way to avoid surgery is to keep your muscles as toned as possible,” advises Becky.