I have nearly 15 years specialising in pelvic health. My biggest frustration in clinic is the length of time it takes before people will come to see us. Many post-natal women regard urine leakage as a ‘normal’ part of being a new mum. It takes an average of seven years for someone to seek help, by which time their problem has usually become more complex to manage and may be significantly interfering with their life. Telling new mums that urine leakage is common, but not normal, may nudge them into help that can have a life-long positive impact on their well-being. It will also reinforce the message that incontinence is not an inevitable part of parenthood.
Key Issues
It is vital that we educate those who have had children that pelvic floor exercises can help the majority of women:
- Leaking in the first 6 weeks after having a baby doubles the risk of post-natal depression.
- New mothers with poor bladder control in the first 6 weeks who don’t do pelvic floor exercises are still likely to be incontinent when the baby is 12 and starts high school.
- About half of women who have had a child have a vaginal prolapse. Pelvic floor exercises can prevent and manage many prolapses, avoiding the need for surgery.
- Pelvic floor exercises, simple lifestyle changes and physiotherapy can quickly cure most cases of stress incontinence.
Current Provision of Information
A Parliamentary Question by Alex Cole-Hamilton MSP in November 2018 asked the Scottish Government what information was contained in the Baby Box regarding (a) pelvic floor exercises, (b) general pelvic health and (c) incontinence. Maree Todd MSP, Minister for Children and Young People, stated that ‘There is no information regarding pelvic floor exercises, general pelvic health or incontinence contained in the Baby Box. The Ready, Steady, Baby guide, which gets distributed to all mothers at their first midwife check-in and is also available online, has information on pelvic floor exercises and urinary incontinence.’
The timing of the provision of this information (i.e. early in pregnancy) means that many women receive it when urine leakage is not an issue.
Providing information in the Baby Box (which arrives later in pregnancy) would help to ensure women are made aware of help and support closer to the time when they most need it.
Cost
We do not know the total costs of managing incontinence in Scotland and there is currently no national continence management strategy in place. We can assume the costs are significant, with Australia calculating they were spending $42.9 billion per annum in 2010. These costs included medication, surgery, pads. They also included the costs of diseases associated with inactivity associated with urine leakage, mood disorders and hip fractures amongst the elderly (e.g. associated with urine urgency).
Our two countries have similar health challenges and communities, so it would be reasonable to consider that dealing with incontinence in Scotland at an early stage could also save a significant amount of money.
On an individual level, a woman no longer needing to buy pads for minor urine leakage, could save between £200-£1000 per annum.
Potential Environmental Benefits
All products designed to contain urine leakage contain plastics, which can take hundreds of years to break down in landfill. Disposable incontinence pads could be used by a person for decades, so avoiding their use could bring significant environmental benefits.
Other actions I have taken
I’ve talked to the Scottish Parliament Information Centre’s women’s group about the issue and hope to attend a future Women’s Health Cross-Party Group, chaired by Monica Lennon MSP. I am also seeking a meeting with Maree Todd MSP, Minister for Children and Young People.
I have set up a campaigning group, Pelvic Roar, with physio colleagues and a social enterprise, Sweet F Aye, with comedian colleagues to try and tackle these issues. Through these, I am aiming to access women who don’t come to clinic, specifically those in geographically remote, economically-deprived and culturally diverse communities, as we know these women are largely absent from statistics.
I have also written a Fringe show about pelvic floors which I performed part of at the Scottish Parliament in 2017. I speak on the radio and tv about pelvic floors, addressing this most embarrassing of issues in an accessible way.
Conclusion
The Baby Box is the perfect vehicle for reaching women, no matter where they live and what their circumstances are. If Scotland wants to improve the lives of new mums and their babies, then the inclusion of targeted information about bladder, bowel and pelvic health, in addition to a baby gro with a printed slogan – e.g. ‘do your pelvic floor exercises mummy’ – would be an economical way of doing that. I would also like the Baby Box to contain information about local physiotherapy services and the support they can offer in managing continence issues.