When I heard about the hotly-anticipated Sex and the City reboot And Just Like That, I was curious at to what kind of figure Carrie Bradshaw, now well into her 50s, might cut walking up the steps of her iconic New York brownstone. I pictured her reaching for her keys and then doing what any mid-life woman will tell you happens at this juncture - trying not to pee herself. Maybe she’d be doing a jig as that ‘suddenly gotta go’ urge struck. Urinary incontinence, which affects one in four UK women, makes you, freeze and hold you hold your breath - and with luck your bladder too – just long enough to make it to the bathroom.
Writer Fiona Golfar has described how she was frequently not so lucky. “As I approached the front door, key in hand, I would think ‘I need a pee’ and that was that. On my doorstep, keys poised nice clothes… and a gush,” she told The Sunday Times. It's not called latchkey incontinence for nothing.
Incontinence, whether that happens on your doorstep, or simply while you're out shopping, affects women mostly 30-plus but not exclusively - and of course I never thought it would happen to me. I’m a yoga teacher, I squeeze my pelvic floor multiple times a day in my practice (mula bandha, in the yoga trade). I was never one of those women who simply couldn’t get on the trampoline with their kids without a leak and I could sneeze my way through hay fever season without a trickle.
But being fit didn’t make me immune, not that this was any surprise to Dr Galyna Selezneva, a body specialist at the Rita Rakus Clinic in London. She said I wasn’t the first yoga teacher she’d treated for pelvic floor dysfunction, especially in recent months.
Our pelvic floor strength has got worse since lockdown
The fact is, that during the past year of lockdowns, we’ve been moving less and it’s impacted our pelvic floors noticeably, says Dr Galyna. “Demand for treatment has increased since lockdown due to our lower levels of activity,” she tells me. The pelvic floor is closely linked to our core and is toned when we move – even walking helps. We’re simply not using it enough. Galyna mentions one of her patients, a former lawyer in her 40s who lost her job in the pandemic and came out of lockdown with urinary incontinence, through simply not being as active in her everyday life as she once was. Her story is not unusual.
There are two types of incontinence stress incontinence – when urine leaks out at times when your bladder is under pressure, for example when you cough or laugh. Then there’s urge incontinence when you feel a sudden, intense urge to pee. It is also possible to have a mixture of both, as I do.
What are the causes and symptoms of pelvic floor dysfunction?
Signs that your pelvic floor is weak are not just leaks, says Dr Galyna. They include constantly needing the loo, including in the night, planning your day around your toilet trips, letting out fanny farts (or any kind of wind) during sex or while bending over or lifting, reduced sensation or sensation of heaviness or bulging in the vagina and tampons not staying put.
What causes a weak pelvic floor?
It can occur when the tissues become stretched after giving birth or dimply the weight of the uterus, but you don’t have it have had children to get it. Heavy weight lifting at the gym, and anything that puts chronic pressure on it such as straining to poo when you’re constipated, constant coughing if you often get chest infections, and obesity are factors too.
Perimenopause and menopause are a time when women experience it more as tissues stars to become less elastic (as in my case, I didn’t notice anything til I turned 50). However, it can also be genetic. Dr Galyna had a 21-year-old patient, who thought that living with leaks was normal because her mother and sister did. “She thought it was OK to have urinary incontinence at the age of 21,” says Dr Galyna. “But four sessions – gone!”
What is the Emsella Chair and how does it tone your pelvic floor?
The magic sessions she is referring to is the brilliant Emsella Chair, a pelvic floor toning device that you sit on fully clothed while you read a magazine. It delivers the equivalent of 11,000 Kegels or pelvic floor contractions in one half-hour session. Typically, you need four-to-six sessions on the ‘kegel throne’ a few days apart.
My case was more severe and I needed ten. The effects can last for more than a year. Emsella’s own studies show 95 per cent of women reported improved quality of life and a 75 per cent reduction in pads usage.