Yes, it’s embarrassing. But I won’t be shamed into silence
It’s a subject few women ever discuss. But now a brave and witty memoir every mother must read dares to tell the truth about postnatal incontinence
‘You’re one false move away from disaster
TOnIght is a milestone. It’s my first night out since my son arrived five months ago. I have piled my doughy belly into control underwear and my boobs are resplendent in a fitted top with a sheer layer, chosen precisely because it isn’t suitable for breastfeeding.
Out with old friends having pizza, it’s so loud, so fast, and so different from the newmum world I now live in. nobody is about to cry or fall asleep.
I make an excellent series of jokes about pregnancy, labour and motherhood to an audience of women who have not yet experienced these things. I don’t mention my recent post-natal depression diagnosis as it makes me feel weird.
I don’t mention my incontinence, either. I’m hoping I can cure it before anyone finds out.
I’ve been doing my exercises religiously, whenever I remember I’m alive.
Which is ironic, because when the prosecco comes home to roost and I wet myself in the restaurant, I learn incontinence really does make you feel kind of dead inside.
I pray the others will just imagine motherhood has given me a new, slightly-startled resting face, and hobble to the loo.
Like many women, before motherhood incontinence was something I was largely ignorant about. In the weeks leading up to James’s birth, my main concerns were how to change a nappy on a little boy and what sort of novel I should write on maternity leave from my job as a media regulator.
I was almost wilfully naïve about the reality of what birth could do to a woman’s body.
While I knew that sometimes there was damage with childbirth, and that some older ladies had ‘no control’, I didn’t appreciate that these medical realities could soon become my own.
As it happened I walked out of the maternity ward in the summer of 2007, at the ripe old age of 30, with a collection of incontinence issues that would unfold, over the next decade, into an epic drama. It required countless internal examinations, endless appointments, two surgical procedures and an incalculable amount of self-blame and self-hatred.
At my six-week postnatal check, seconds from being signed off by my doctor as physically recovered from birth, I splurge it out: ‘I just . . . leak. If I laugh, or try to climb the stairs. Sometimes it starts when I’m breastfeeding. I can’t stop it. And nothing’s in the right place any more.’
When she asks if anything else makes it happen, I think of my first post-birth shag with my lovely husband, Robin. On the landing, with plenty of pillows and limited romance, our bedroom dominated by the briefly-sleeping infant.
‘Everything makes me wet myself,’ I say in a tinny, defiant voice.
On further examination, she diagnoses a prolapse: the muscles holding up my uterus are not working properly, so it is pushing into the wall of my vagina making a bulge. the bulge is pressing on my bladder.
my issues, I later learn, are caused by a combination of unexceptional but damaging internal injury, caused while pushing my baby out after a traumatic 19-hour labour, bad luck and a family history of flexibility that I’d always thought was a good thing.
As it turns out, my ability to do the splits in my teens just means my muscles and ligaments are easily stretched out of shape, especially the crucial ones in my pelvic floor. that day, the shame of admitting being incontinent to someone else, remains seared on my memory. It didn’t matter that my broken body shouldn’t be shameful. Incontinence remains an unmentionable — one of the last medical taboos.
We stick to an old lie that it’s just something women have to put up with, like wrinkles and mansplaining. yet it’s so common that one in three women experiences incontinence in her life.
Child-bearing is a big cause. During pregnancy, the weight of the foetus can lead to stress on pelvic floor muscles, while vaginal delivery can weaken muscles needed for bladder control and also damage nerves and supportive tissue.
After menopause, women produce less oestrogen, which can also aggravate incontinence.
my medical team, whether midwife, physio, nurse or surgeon, were amazingly kind and supportive. But largely because of the stigma, thousands of women in my place never try to get treatment.
ACCORDING to research from the national Childbirth trust, in 2016 38 per cent of UK women with incontinence issues were too embarrassed to tell a health professional. many don’t even tell their partners.
Women with incontinence are — as happened to me — also twice as likely to develop post-natal depression. marriages end because you may feel dirty and withdraw physically and emotionally. It nearly ruined mine.
From the start, Robin was on my side. Over the years he continued to find me lovable and physically attractive. I am grateful for his strength. the problem was not that Robin’s feelings for me changed. It was my feelings about myself that I couldn’t cope with. Incontinence makes it hard to love yourself, to find yourself attractive.
It didn’t kill our sex life but at times it came close. I always remember the risks that come with it for me. And, you know, that kills the mood.
Lots of research shows the link between incontinence and depression, yet it took years for a professional to make this link explicit to me. this made it easy for me to blame myself when I ended up on antidepressants a few months after James’s birth, the visit to the doctor’s prompted by a night spent panicking that I was going to jump out of an upstairs window.
But when you think about that combination of new motherhood, sleeplessness and a body that is broken at such a basic level, it’s no surprise depression strikes so often among women like me.
I remember, early on, shopping in mothercare for pads for myself and thinking, ‘nappies, nappies everywhere, even for me’ before bursting into tears. I was utterly miserable; and far worse, I swiftly realised that anything more than the most graceful sob caused me to lose control of my bladder.
I could only hope my jeans would soak up enough to save my dignity and pray that I got out of the shop without bumping into anyone I knew.
That I would escape without leaving an actual puddle on the floor.
Although I did eventually share what I was going through with close friends, for years my issues were something I didn’t dare to broadcast. Slowly, however, I realised how much I needed an honest conversation about what was happening. In an attempt to tackle the taboo, I began writing about my experiences on a blog.
I wrote about what it’s like to be just one false move away from losing everything. The fear that comes at work — I returned when James was around six months old — of a stair taken too quickly, a coughing fit, a jolt in the lift, an over-running meeting.
Many women (and some men) shared their distress, sometimes incidents from years before, things they had never told anyone.
The first line of defence for continence issues are women’s health physios, and that is where I was initially referred after confessing my leakiness to my doctor. For many, physio represents a cure or huge improvement. It’s often quick too. My experience was not typical. For me, it took around a year of Kegels (internal exercises to strengthen my pelvic floor muscles) to reach the point where I had only occasional accidents.
My love for baby James spurred me on. None of this was his fault and I never blamed him. It hatched new emotions in me, watching him roll and laugh and sit and stand.
At every milestone, his in life, mine in physio, my heart whispered temptations of a ‘normal’ future, where I could make plans, when I didn’t have to pack a change of clothes for myself to leave the house and keep wet wipes in my desk drawer. Where I could have another baby, even.
When James was two-and-a-half years old, I found out I was pregnant again. I knew I wanted another baby — we had been trying. But I couldn’t help wondering whether I would make it through the next 40 weeks, knowing what could go wrong.
Before I washed my hands from my pregnancy test, my stomach flexed out into a bump. My bladder muscles gave up the ghost the second they had a foetus to blame for their laziness.
In the end, Zack came just 30 minutes after I arrived in the delivery room. From 1cm dilated to 10cm in less time than an episode of EastEnders. Unlike the first time, there were no complications — but the incontinence returned, worse than before.
WhEN Zack was eight weeks old I was sent for a second course of physio. The night before my first session, I was terrified. I didn’t want to re-enter the world of the perpetual patient. I wanted to lie on the floor, blowing on my infant son’s face so he would blink and smile, to watch my boys connect.
As a mother, I couldn’t help also wondering how much of my energy was taken up with incontinence and connected conditions, like the post-natal depression, which I ended up suffering again. Were my complicated feelings about my body affecting my sons’ views of their own perfect bodies?
My new physio, Lizzie, told me I could improve in six or seven months but, unfortunately, she was wrong. Around a year and a half later, I was referred to the surgical team. It represented both hope and a trip even further down the corridors of shame. Deep down, I felt I was a social burden. Yet my consultant described my incontinence as ‘off the scale’ and offered to try and fix me.
Activists now argue it would be cheaper to assess all women for incontinence issues post-birth, and when they are menopausal, and encourage pelvic floor exercises in everyone. But unless we start a serious, general conversation about incontinence, I believe the cycle will continue.
There’s also a broader sense that because incontinence affects women more than men, it doesn’t get the attention it deserves.
This is brought home by the recent mesh scandal. When surgery became an option for me in 2012, the gold standard was a procedure where mesh is implanted to hold things in place. I was disappointed to find I wasn’t suitable and, instead, offered a more invasive procedure which involved sewing my bladder more firmly in place.
It later emerged that the mesh can disintegrate in the body — tearing into organs and causing lasting damage. It has been called a ‘shameful episode’ by the British Medical Journal. But the reason so many women went under the knife was ignored, as if they deserved blame for risking their health for a trifle, when in truth, their condition was unbearable.
I wish I could say that with my surgery in 2012 I got my perfect happy ending. Infuriatingly, the truth is that it worked ‘quite a bit’ rather than ‘completely’.
Over the next five years there were relapses and serious complications, more surgery and different medical interventions.
All I can say is that by my 40th birthday in 2017, I was finally in a place where I could handle a glass of wine without getting leaky.
I’m still operating fairly successfully, although if anything tips the balance I am in trouble — hayfever season, a cough, if I am overtired. I still do my exercises, and notice the effect almost immediately if I get lazy for any reason.
I still have to be careful if I drink alcohol or too much coffee, or am out with friends laughing a lot.
I love a jumpsuit, but have to do a risk analysis of what I will be up to before wearing one. I am also conscious of whether there are accessible toilets nearby.
I don’t want to say the whole journey was worth it.
I don’t have many answers, either. But even the most horrific moments simply can’t last for ever. Even the strongest emotions soften, somehow, with time.
For me, finding my voice and fighting stigma helped. It reminded me I was more than a broken body.
I don’t want others to feel as lonely as I did. There are thousands of us out here, millions in fact. And
loads of us have improved or cured our situation, once we sought help. You might be lonely, but you aren’t alone at all.
■ ExtractEd by clare Goldwin from PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last taboo to tell the tale by Luce Brett, published by Green tree on June 25 at £12.99. © Luce Brett 2020.
■ tO OrdEr a copy for £10.40 (offer valid until July 2, 2020), visit www.bloomsbury.com and quote the code daILYMaIL.