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2021 VOLUME 15 | ISSUE # 1
AUTUMN The Women’s
Health Edition
Get to
know
your
pelvic
floor
Invisible
disability
Gut and
brain
linkEDITOR Kasia Kosidlo
SUBSCRIPTIONS
Tel 1800 33 00 66
In this issue
AUTUMN | 2021
ISSN 1836-8107 (online version ISSN 1836-8115)
5.
What are the pelv
ic
floor muscles?
PUBLISHED BY The floor of the pelvis
muscle and other
like a hammock from
is made up of layers
tissues. These layers
of
stretch
the tailbone at the
to the pubic bone back,
at the front.
Continence Foundation of Australia NEWS
A woman’s pelvic
floor muscles support
bladder, uterus (womb) her
and bowel. The urethra
(urine tube), the vagina,
and the rectum (back
passage) all pass
through the pelvic
muscles. Pelvic floor floor
muscles help control
bladder and bowel. your
NATIONAL OFFICE
They may also help
6.
function. sexual
It is vital to keep your
pelvic floor muscles
strong.
Suite 1, 407 Canterbury Rd,
Surrey Hills VIC 3127 GET TO KNOW YOUR
Tel 03 8692 8400 Fax 03 9380 1233 PELVIC FLOOR
info@continence.org.au
7.
2
continence.org.au
TASH’S STORY
8.
@AusContinence
PELVIC HEALTH THROUGH
© Continence Foundation of Australia
THE LIFE STAGES
Bridge is published quarterly by the Continence
Foundation of Australia. It is supported by the 9.
Australian Government Department of Health WHAT DOES PROLAPSE
under the National Continence Program. FEEL LIKE?
10.
The information in Bridge is for general guidance
only and does not replace the expert and individual
advice of a doctor, continence nurse or continence SARAH’S STORY
physiotherapist. Bridge cannot be reprinted,
copied or distributed unless permission is obtained
from the Continence Foundation of Australia.
12.
ADVERTISING
PAINFUL SEX
The Continence Foundation of Australia appreciates
the support of advertisers in publishing Bridge.
13.
Advertising conforms to the standards required by
LEAKAGE DURING EXERCISE
the Continence Foundation of Australia, but
endorsement is in no way implied by the 14.
publishing of said material. SPEAKING WITH YOUR
REFERENCES HEALTH PROFESSIONAL
Email bridge@continence.org.au
for a list of references for any articles appearing 15.
in Bridge. MENTAL HEALTH HELPLINE Q&A
16.
SMOOTHIE BOWL RECIPE
National Continence Helpline
1800 33 00 66 Membership
A free service staffed by Nurse Continence
Become an individual, student or professional member of
Specialists who can provide information,
the Continence Foundation of Australia and receive many
referrals and resources 8am – 8pm AEST
benefits including discounted registration to the annual
weekdays. The Foundation, established in
National Conference on Incontinence, free publications and
1989, is a not-for-profit organisation.
timely information about events and education courses.
Email membership@continence.org.au
or phone 03 8692 8400.
2 / bridge / AUTUMNNote from the CEO
We’re starting off 2021 with a focus Angela who share their experiences of
on women’s health. Incontinence bladder, bowel and pelvic health.
is an important women’s health We really welcome your thoughts on
issue and affects women of all Bridge: tell us what you like, want more
ages, cultures and life stages. or less of, or any ideas for making the
magazine better. You can find the
While we use the term women in the
survey at www.surveymonkey.com/r/
edition, we hope the stories speak to
NG2YCRY or as always, send us an
people of all genders and experiences.
Pelvic health is important for everyone. email to bridge@continence.org.au
The Foundation values inclusivity and In the next edition, we’ll be
would like to recognise those in our highlighting World Continence Week
community who relate to these stories in June 2021 and the findings of the
but don’t identify as women – this Royal Commission into Aged Care
edition is for you too. Quality and Safety. Rowan Cockerell
Inside this edition, we share how your CEO
As well as Bridge, the Continence
bladder, bowel and pelvic health might Continence Foundation of Australia
Foundation of Australia operates the
change through different life stages.
National Continence Helpline on
We also take a look at how important
1800 33 00 66 and has free info in over
topics such as painful sex, exercise and
30 languages at continence.org.au.
mental health are more related to
pelvic health than you might think. Make sure to phone or head online
You’ll hear from Tash, Amy, Sarah and for more. Enjoy,
Women in Australia make up: 80% 62%
of people with urinary of people with faecal
incontinence incontinence
Let us know what you think in the
Bridge Magazine Reader Survey
In just 13 questions, you
can influence the articles
in future editions.
The survey takes five
minutes and we would
love to hear your feedback.
Take the survey
www.surveymonkey.com/r/
NG2YCRY
bridge / AUTUMN / 3Advertisement
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What Australia-wide water
bill savings would mean for
people with incontinence
The Western Australia In October 2020, the Western Australia asking providers to
Australian Water Minister announced extend their medical programs to
water provider led the way
new water bill savings for households include CAPS recipients.
in supporting people with
receiving the Continence Aids
incontinence, now it’s time for “Living with incontinence is
Payment Scheme (CAPS). CAPS is an
expensive,” says Rowan Cockerell,
all of Australia to do the same. Australian Government program for
CEO of the Continence Foundation
people with permanent and severe
of Australia.
incontinence to help with the cost of
continence products. People have to budget for
Under the WA Water Corporation’s the extra costs of washing
medical allowance, WA households laundry and bedding, soiled
with a CAPS recipient can use up to clothes and showers.
180,000 litres of water for free each
Being able to save on their water
year – saving on average $380.
bill would make a difference to over
The Continence Foundation of 135,000 CAPS recipients across the
Australia is calling on all water country. We know that most people
service providers to do the same. receiving CAPS are aged 65 years and
The Foundation wrote to the over, and many rely on a pension.
Water Services Association of
Find out more about CAPS at continence.org.au or phone the National
Continence Helpline on 1800 33 00 66.
Calls to see incontinence in the
Australian Government budget
With 6.2 million Australians set “One in four Australians are for the future and a population
to be affected by incontinence currently affected by incontinence, that is getting older.
by 2030, the Continence and it has long-term effects on both
physical and emotional health,”
A focus on prevention of
Foundation of Australia’s Pre- incontinence, as well as
Continence Foundation of Australia
Budget Submission calls for an CEO, Rowan Cockerell, said in improvement of continence
urgent action plan. February 2021. care, will reduce people going
Even though the number of into residential aged care
people experiencing incontinence because of their bladder
is growing, there is currently no and bowel health,
funding or action plan from the Mrs Cockerell said.
Federal Government after June 2021.
“Incontinence is one of the top
The Continence Foundation of reasons for a person to leave their
Australia’s submission shares how home and enter aged care. Research
action in the 2021-22 Budget tells us that once they are in aged
would improve quality of life of all care, their chance of experiencing
Australians, but especially for older incontinence quickly goes up.”
people and people with disability.
The Foundation looks forward
The Foundation says a new to working with the Australian
National Strategy on Incontinence Government to deliver improved
will make sure Australia is ready health outcomes for all Australians.
Read the full submission at continence.org.au
bridge / AUTUMN / 5bridge / PELVIC HEALTH /
Get to know your
pelvic floor
You can’t see them, but your Your pelvic floor is a group of muscles Working your pelvic floor
pelvic floor muscles are in your pelvis. They stretch like a
Just like any muscle, your pelvic floor
working hard to help your hammock from the pubic bone at
gets stronger from regular workouts.
the front, to the back, and side to
body with bladder and bowel These are known as pelvic floor muscle
side. They wrap around the openings
control, sexual function, exercises (called kegels in some
to your bladder, vagina and bowel to
and abdominal (tummy) and countries). You don’t need fancy gym
support your organs and stop leakage
equipment or to lie on the floor for
spine support. (urine and stool).
pelvic floor exercise – just a couple of
Two ways to try to find minutes throughout the day.
your pelvic floor muscles An exercise to improve or
1. Sit or lie down with the muscles of even cure incontinence
your thighs, buttocks and stomach
Pelvic floor muscle exercises have been
relaxed. Squeeze the ring of muscle
shown to be very effective at helping
around the anus (back passage)
urinary incontinence (leakage from the
as if you are trying to stop passing
bladder). Research tells us that when
wind. Now relax this muscle.
done with a health professional, they
Squeeze and let go a couple of
can be even more effective, as you will
times to be sure you have found
be shown how and when to exercise
the right muscles. Remember, do
and use your pelvic floor muscles. They
not squeeze your buttocks.
may help with types of incontinence
2. When you go to the toilet and are including overactive bladder, urge and
halfway through emptying your bowel incontinence.
Find out bladder, try to stop or slow the flow
about pelvic Most women see a change in leakage
of urine. Then, start the flow again.
floor muscle in three months, so check in with a
You are squeezing the correct
exercises with health professional if you aren’t seeing
muscles if you can do this.
our guide improvement.
Only try the second method once
Scan the QR code a week. If you do this too often Every woman is different
to go straight there or your bladder may not empty the You may have the same signs of
visit continence.org.au way it should. urinary leakage as someone else,
You should feel your muscles both but a different cause. Some women
squeezing and lifting. have weak pelvic floor muscles that
can be made stronger with pelvic
It can be hard to know if you’ve floor muscle exercises. Others may
What are the pel
found your pelvic floor muscles on have a pelvic floor that is too tight
vic
Pelvic floor muscles? your own. You can find a pelvic floor and is hard to relax (hypertonic). A
floor The floor of the pelvis
muscle and other
is made up of layers
tissues. These layers
of
physiotherapist or nurse continence pelvic floor physiotherapist, nurse
specialist in your area by phoning
like a hammock from stretch
muscle to the pubic bone
the tailbone at the
at the front.
back,
continence specialist or continence
the National Continence Helpline
A woman’s pelvic
floor muscles suppo
training professional can work out your cause
bladder, uterus (wom rt her
b) and bowel. The
(urine tube), the vagin urethra
a, and the rectum
on 1800 33 00 66.
passage) all pass (back
for women and a plan to help.
through the pelvic
muscles. Pelvic floor floor
muscles help contr
bladder and bowe ol your
l. They may also help
function. sexual
It is vital to keep your
pelvic floor muscles
strong.
Strong pelvic
floor muscles
mean good 2
bladder control
1
6 / bridge / AUTUMNbridge / LIFE STAGES /
‘IS THIS LIFE NOW?’
Tash’s experience of faecal incontinence
“I rang my mum on the phone, like oh going to be able to help me or this
my god I’ve pooed myself. This is my was permanent damage,” Tash says.
life now. I’m just going to poo myself.
Still on maternity leave, she started
This is it,” Tash says.
thinking about how tricky it would be
She nervously laughs, as the to return to her busy work, and how
experience was far from funny. incontinence might affect her hopes
“That was really distressing.” for children in the future. The very first
She had just experienced her first appointment with the physiotherapist
bowel leakage accident and didn’t gave her relief from all this worry.
know what to think. As a new mum “I can honestly say that from the first
with a career as a urology nurse, appointment that I had, she was just
she was well-versed in bladder so reassuring and so optimistic that it
dysfunction (problems). Going was going to be okay. That we could
through faecal incontinence herself fix it and that she could help me,”
came as a shock, even with her Tash says.
experience and knowledge.
… I left feeling in such a
Six months after giving
“I was very much aware of the risks different mindset and so
birth to her daughter in of bladder dysfunction post-birth,
February 2020, 28-year- motivated to help myself because
and during pregnancy, but when I
old Tash found herself in a I knew that there was hope.
experienced bowel dysfunction I was
huge panic about the future. totally out of my depths,” Tash says. She took everything in – regular
pelvic floor muscle exercises, learning
It started in April with bowel urgency,
about the FODMAP diet and more.
where she found herself rushing
The best news is that Tash says her
to the toilet and not being able to
bowel function became “a hundred
hold on. She spoke to a GP and was
times better” after just three months
waiting for a hospital physiotherapy
of treatment. Her bowel habits are
appointment when her first leakage
now back to how they were before
accident happened in August. The
giving birth.
accident prompted her to dig out
the hospital referral and make a call Now I feel happy. I feel I can
There is help available to follow-up, determined to get help. just live my life like I always have. I
Incontinence was already affecting
can go out when I need to. If I feel
Incontinence can be her life in huge ways.
the urge to go to the toilet, I’ve got
managed, treated or “I didn’t want to leave the house until
ample time to get there.
even cured in many I’d gone to the toilet for a poo that
cases. Your doctor, pelvic day. Because I just didn’t trust that After her experience, Tash is even
health physiotherapist if I was to have left the house, that I more passionate about encouraging
wouldn’t have had an accident. Or if I other mums to get help for their
or nurse continence
did get an urge, I wouldn’t be able to bladder, bowel and pelvic health.
specialist can all help. With her career as a nurse, she was
find a toilet in time.
comfortable starting the conversation
Phone the National Already COVID was very about incontinence but knows it can
Continence Helpline isolating anyway… I didn’t want be a hard topic to raise.
1800 33 00 66 for a to leave the house in case I was to “This is my day-to-day talk, it’s not
confidential chat with have pooed myself. It was weird for me to talk about bladder
an experienced Nurse very lonely. or bowel. So going to a doctor and
Continence Specialist. She says the fear of the unknown talking about that was quite easy.
was the hardest part to deal with. “…Being a new mum is scary and
Thoughts were running through her isolating and having this additional
mind constantly. problem was really stressful. I am
“Is this life now? Is this something I’m thankful that I’m happy to go to the
going to have to live with? It was that doctor and say ‘I’ve pooed myself,
fear of not knowing if a physio was please help me.’”
bridge / AUTUMN / 7bridge / LIFE STAGES /
Pelvic health
through the life stages
As you go through life, your 1. MENSTRUATION – YOUR PERIOD
body changes with you. Read One in nine women are affected by endometriosis, where tissue from
to find out how significant the uterus (womb) grows outside in areas such as the bowel and ovaries.
Endometriosis symptoms usually start a few years after the first period, but on
life events can mean different average it takes 6.5 years until it is diagnosed.
things for bladder, bowel and
One of the most common signs of endometriosis is pelvic pain (pain
pelvic health. anywhere between the belly button and pelvis) and this commonly starts just
before a period. Pelvic pain and other signs of endometriosis such as fatigue,
nausea and fertility issues can significantly impact quality of life.
Find out more at endometriosisaustralia.org
Where you are in your menstrual cycle can also affect your bowel movements
– thought to be due to hormonal changes. Women with inflammatory bowel
disease (IBD) have reported more symptoms before and during their period.
2. PREGNANCY
Pregnancy is full of big changes and milestones. These amazing changes
help prepare for birth but also have an impact on your pelvic health and
whole body.
Add pelvic floor
During pregnancy the body releases hormones that soften muscles, including
exercises to your day
your pelvic floor muscles. This, with the extra weight of a growing baby, can
with reminders from
weaken your pelvic floor and what it can support.
the free Pregnancy
Pelvic Floor Plan app. You can make it stronger by doing pelvic floor exercises before, during and
Download on the App after pregnancy. The exercises help reduce the chance of experiencing
incontinence after birth.
Store or Google Play.
3. CHILDBIRTH 1 in 3
women who
During a vaginal delivery, the vagina stretches and the have ever had
supporting tissue and pelvic floor can tear. Women who a baby wet
themselves
give birth to a larger baby, have a longer labour or difficult
delivery are more likely to have bladder or bowel problems.
Some women notice leakage (urine or stool) during pregnancy or after birth.
It can take time for your pelvic floor and muscles to recover after birth, and
every person is different. Most notice their bladder and bowel concerns
improve in the first six months after birth.
Make sure to raise any issues with your health professionals. They are there
to help and telling them what you feel (your symptoms) is important.
You don’t have to put up with incontinence just because it’s common during
THE PREGNANCY GUIDE pregnancy and after birth. There is lots of help available – find out more by
speaking with your health professional or phoning the free and confidential
Everyone has advice for you
National Continence Helpline on 1800 33 00 66.
when you’re pregnant or have
a new baby! This guide takes
the guesswork out of learning At appointments after my diagnosis of pelvic floor tear and prolapse,
I discovered how common it is to experience birth injuries, prolapse
about bladder and bowel
and incontinence. It is still hard to understand why something so
control. Download a copy at
common and grim is met with silence.
continence.org.au for yourself
or a new parent in your life. My dream is for more women who have experienced birth injuries
to know that they aren’t alone and that they don’t need to suffer in
silence. If we don’t start talking about common issues that occur from
childbirth, then how will we ever fix our overall quality of life? If you’re
Scan the
QR code reading this and any of it resonates with you, please seek support
because this doesn’t have to be your new normal.
Amy Dawes, Co-Founder of the Australasian Birth Trauma
Association birthtrauma.org.au
8 / bridge / AUTUMN4. MENOPAUSE – MORE THAN HOT FLASHES
EARLY MENOPAUSE means going through menopause before the age of
45. Early menopause can happen after medical treatment such as removal of
the ovaries and chemotherapy for cancer.
PERIMENOPAUSE is the time leading up to the last period (can be years).
This is the stage where many of the symptoms we think of as menopause
actually happen. Common experiences in perimenopause include changes to
menstrual cycle and periods, hot flashes, trouble sleeping, mood and mental
health changes, bladder and bowel symptoms.
MENOPAUSE means it has been 12 months since the last period. Post-
menopause is the time after this point.
How it can affect your bladder and bowel health
During the menopausal transition, the body starts to have less oestrogen (a sex hormone
needed for the female reproductive system).
Many women notice changes to their bladder and bowel health, including:
There’s more to A weaker pelvic floor – Because we usually lose muscle mass with age, the pelvic floor
muscles can weaken. This can lead to experiencing urinary or faecal incontinence, urine
menopause than
loss with coughing and sneezing, or needing to rush to the toilet more often.
people speak about.
Vaginal dryness – Oestrogen helps create mucus, and with less of this in the body, the
We challenge the
vagina and urethra (bladder tube) can become drier. This can be painful and irritating as
myths so you can well as put you at higher risk of urinary tract infections (UTIs) and incontinence.
understand how Prolapse – Some factors, especially a weaker pelvic floor, mean pelvic organ prolapse is
to look after your more likely to happen after menopause.
bladder and bowel A less elastic bladder – With age, it’s harder for the bladder to stretch (less elastic) and
health – before and this can cause an overactive bladder. An overactive bladder will cause you to pass urine
after menopause. more frequently.
Symptoms from childbirth – Some women experience damage to their anal sphincter
(muscle around the anus) during birth but don’t have symptoms until later in life. Faecal
incontinence because of this damage most commonly starts in perimenopause.
There is help for all of these changes. These could include pelvic floor muscle training,
bladder training, vaginal oestrogen cream or an oestrogen pessary, lifestyle changes and
surgery. Health professionals can guide you to help for your individual situation.
What does prolapse feel like?
About half of all women who Pelvic organ prolapse is when the pelvic You may notice these more later in
have had a child have some organs are not held in their right place. the day.
They may bulge or sag down. Other signs:
level of prolapse. Not all have
Feelings you may notice: • your bladder not emptying as it
symptoms – we know one
• a heavy feeling or dragging in the should
in five of these women seek vagina • weak urine stream
medical help. • something coming down or a lump • urinary tract infections (UTIs) keep
in the vagina happening
• a lump bulging out of your vagina • trouble with emptying your bowel.
Scan the QR code that you can feel or see For more help, speak with your doctor
or find out more at • sexual problems such as pain or less or continence health professional if you
continence.org.au sensation. are experiencing these signs.
bridge / AUTUMN / 9bridge / A PERSONAL STORY /
‘ONE DAY AT A TIME’:
Sarah’s story of spinal cord injury
Sarah Wise often finds herself explaining the most traumatic day of
her life to people she has just met. Complete strangers will come up
to her to ask about her walking stick and her reasons for using it. But
26-year-old Sarah is patient and kind-hearted – even when people
might not deserve it.
“I know people are just curious, but movement and sensation. Her injury
Sarah Wise’s time living
they don’t understand the weight of resulted in quadriplegia (paralysis of
abroad in London was cut
their question,” she says. arms, legs and torso). She also had
short after a serious fall in trouble speaking (vocal cord palsy)
“In those little moments I’m just
October 2019. Over a year on, after surgery and would have to spend
trying to educate people, one person
she reflects on what she’s more than three months in hospital.
at a time, using my story to raise
learned and what she wants awareness about spinal cord injury.” Learning to walk in
the world to know about
Sarah’s accident happened in hospital
spinal cord injury.
October 2019, when she fell off a
“On day 12, I moved my right toe for
friend’s shoulders at the back of a
the first time. That was like the best
concert. Paralysed from the neck
moment in my life,” Sarah says.
Issues with bladder and bowel down, Sarah was rushed into hospital.
She knew she couldn’t move or feel From there, she set an “ambitious”
function are very common in
her body but wasn’t sure what the goal to be able to walk by her
people with spinal cord injury
(SCI). injury would mean. birthday – three months away.
The spinal cord plays an “I just kept asking every single nurse Her background as a cheerleader
important role in sending and doctor who leant over my bed, and elite gymnast meant she was
messages to the brain, bladder ‘will I walk again, will I walk again?’,” used to pushing her physical limits. In
and bowel. Each injury is Sarah says. hospital, she swapped training with
different, but paralysis in this area coaches to training with surgeons and
“Their faces were… I don’t know how
can result in not being able to physiotherapists, impressing them
to describe it. The look of despair
control the bladder and bowel. with her quick progress.
when you don’t want to tell someone
There are many options to bad news. And they would say ‘I don’t Like an early Christmas present, just
manage continence care after know if you’ll walk again’, and so I two months later in December, she
spinal cord injury. These can didn’t really get any answers. They took her first wobbly steps without
include the use of catheters didn’t give me much hope.” help. By March she no longer relied
to drain the bladder, pads and on her wheelchair.
Sarah was told she had a C3
products, abdominal massage,
incomplete spinal cord injury, At first look, people see Sarah’s ability
medication and help from a
meaning the spinal cord was to walk as a complete recovery. She
carer. An individual assessment
damaged but had a chance for some was flooded with comments and
is very important.
Research shows that continence
problems affect quality of life
and are reported as one of the
most difficult symptoms after
spinal cord injury. One USA
study of women with SCI found
bladder and bowel health was
a “major source of stress and
frustration in their daily lives.”
Pictured from left:
A summer 2020 van trip; ice-skating in
Hyde Park; 1st injure-versary; in London.
10 / bridge / AUTUMNThe public make assumptions about me as a young person needing a chair to sit down
or use disabled toilets. People are quick to judge, but no one knows anyone’s story.
messages after sharing a video on hospital, and she remembers it as a without aids at the moment, but
social media, with people saying they “horrifying” experience. sometimes I do use a stick. So it is that
were so proud to see a total recovery. strange grey area between ability and
“I was crying and in total shock. I
This is one of the myths Sarah wants disability. I get fatigued very quickly
thought I was an independent 24-year-
to challenge. and have hand dysfunction which
old, so it was very confronting.”
impacts on simple tasks like washing
“Mobility isn’t the only issue people
“… Then you learn it’s not anything to the dishes,” she says.
with spinal cord injury experience, but
worry about, it’s part of the process
it’s the only thing onlookers see.” “Recently, I was almost not allowed
of learning to manage your bowel.
into a pub and questioned about my
“Spinal cord injury causes bladder and You just clean up, change clothes
stick and medical information.”
bowel dysfunction, loss of or changed and say, ‘things are a bit messy right
sensation, chronic pain, neuropathic now but it’ll work out’.” “The public make assumptions about
[nerve] pain, spasms, a weakened me as a young person needing a chair
Sarah has a light-hearted approach
breathing system, pressure sores, and to sit down or use disabled toilets.
to these important topics, and most
more. I also have to manage a lot of People are quick to judge, but no one
of all, wants to encourage other
medications. Every spinal cord injury knows anyone’s story.”
people to feel comfortable talking
is different. about them. She looks at facilities and places in
“I believe being open about your a different way now, interested in
… The reality is it’s not
situation will encourage others to how changes in design can make a
possible to have a 100 per difference to people with disability.
share their stories, and in the end will
cent recovery.”
reduce the awkwardness and taboo
What’s next
For Sarah, heading towards around bowel and bladder health.”
“This year, my main focus is my therapy,
independence in her bladder Everyone needs to go, to try reach my maximum recovery –
and bowel routine meant a lot.
some people just do it a whatever that is. I really want to learn
Second to moving her big toe, an
bit differently! to run this year,” Sarah says. As a social
unexpected moment stood out.
butterfly, she’s enjoying being back
“The second proudest moment was Invisible disability with family and friends in Sydney and
doing a wee by myself. That was Although awareness is growing, exploring her creative hobbies.
something I was pretty scared of after sometimes the public can forget there
“With everything going on it’s just
depending on an indwelling catheter are many kinds of disability and not
hard to plan the future. I would like
for seven weeks,” she says. all are visible. Sarah says she struggles
to go back to London and live an
with this as a young quadriplegic
Finding a new continence routine independent life. I haven’t finished
person with the ability to walk.
was filled with emotion and took that chapter of my life.
When she was using a wheelchair,
some time to get used to.
then walking aids, her experience “I’m taking one day at a time and just
Her first time having a bowel accident fit people’s expectations of what a focusing on my little improvements
was on her first day in rehabilitation disability is or looks like. “I can walk every day.”
bridge / AUTUMN / 11bridge / PELVIC HEALTH /
Are you experiencing …
Painful sex?
Many women experience pain Your pelvic floor muscles move and health professionals who will work
during sexual intercourse. react throughout the day in many closely with you to make sure that your
situations. For example, when we bladder, bowel and pelvic health are at
Physiotherapist Lissy cough or sneeze, we need the muscles their best.
Changuion explains how the to contract [shorten] to stop urinary
pelvic floor can play a factor leakage from happening.
in sexual function and shares
her advice if you’re
During intercourse, we need our
pelvic floor muscles to be able
Steps to deep
experiencing pain. to relax. Of course, it isn’t always
simple. Sometimes we hold tension
breathing
and stress in our pelvic floor muscles
– like the kind we may experience in
jaw and neck muscles.
What can cause pelvic floor
tension?
Common factors may include:
Lissy says deep, focused breathing is
• feelings of stress or anxiousness
one of the most effective ways to reduce
• increased bladder urgency or
stress and tension in the body and
frequency
pelvic floor.
• constipation or changed
bowel habits 1. Find a comfortable position, lying on
• pain. your back.
Many physical and lifestyle factors 2. Place one hand on your stomach
can lead to a slow build-up of pelvic below your rib cage and the other
There are also many factors
floor muscle tension, or not being hand on your chest.
which influence sexual
able to relax the pelvic floor during
intimacy, including: 3. For the next few minutes, try to focus
intercourse. Both of these can lead to
your attention to your breathing.
• pelvic shape and structure a painful sexual experience.
• arousal during sex 4. Take a deep breath in through your
• stress levels Who can help? What does nose, for the count of three seconds.
• vaginal health due to treatment involve? Feel your belly gently push your
hormonal changes A pelvic health physiotherapist can hand out, without your upper chest
• specific positions assess your pelvic floor and find any moving. Try to imagine the muscles in
• previous experiences and possible links to painful intercourse. the base of your pelvis getting softer.
feelings Often, treatment involves retraining 5. Slowly let your breath out through
• partner’s anatomy. the muscles to move and relax, your mouth for the count of 5
improvement of pelvic and hip seconds. Feel your belly return to
movement, pelvic floor stretches the resting position as all the air is
(sometimes with specific devices), pushed out of your lungs.
lifestyle changes, stress management
and a gradual re-introduction to 6. Try to take your time with each
intimacy and penetrative intercourse breath. If possible, slow down your
with a partner. breath in for the count of 5 seconds,
and your breath out for the count of
Listen to your body 7 seconds.
If you experience pain during 7. Repeat this for another 10 times.
intercourse, you should not be “pushing
Notice how you feel at the end of this
through” pain to have intimacy with
breathing exercise. You might like to
your partner. This will only increase the
keep repeating this until your body
body’s stress and pain response.
feels calm and relaxed.
Your body is experiencing pain for a
reason. There is help available from
12 / bridge / AUTUMNAre you experiencing …
Leakage during exercise?
Lori Forner, physiotherapist
and Always Discreet
DID YOU KNOW: Benefits
ambassador, explains what we
of regular exercise include
know about incontinence and
better sleep, more energy,
high-impact exercise.
improved mood, prevention
of chronic illnesses + more!
Physical activity described as “high-
impact” involves exercises like running
Australia’s Physical Activity
and jumping, when both feet are
Guidelines suggest:
repeatedly off the ground at the same
Adults 18 to 64 years time before landing (the impact). High- > Who can help? What does
Doing any physical activity is better impact activity increases the forces on treatment involve?
than none – you can start slowly! the body. It’s great for both bone and
Physiotherapists trained in pelvic floor
heart health but has also been linked
Aim for 2.5 to 5 hours of moderate dysfunction can assess why you are
to pelvic floor problems.
intensity physical activity, or 75 min to leaking. They can also work out if you
2.5 hours of vigorous intensity physical > What if you only experience need pelvic floor muscle training, or
activity each week (or a combo). leakage during exercise? a vaginal device like a pessary which
We don’t know exactly why this supports your pelvic organs or helps
Do muscle strengthening activities
activity is causing problems in some with continence. Help might involve
on at least two days each week (such
females, even when bladder and bowel modifying your training program and
as body weight exercises, weights,
health in their day-to-day life may be seeing how well you are moving. For
tasks around the house where you lift
completely fine. It could be that the example, are you breathing? Do you
or carry).
pelvic floor muscles aren’t supportive need to strengthen other muscles in
65 years and older enough during the landing phase, the the body? Do you need to stretch?
Do a range of activities for fitness, muscles get too tired, or the other If you are experiencing bladder
strength, balance and flexibility (such tissues supporting the bladder and leakage during high-impact exercise,
as yoga, dancing, stretching). other pelvic organs (ligaments and there may be simple changes to help.
fascia) are too lax. These could be changing your stride
Build up at least 30
minutes of moderate Bladder or bowel leakage length in running or finding a breath
intensity physical activity (incontinence) during sport or pattern such as breathing out two
on most, preferably exercise is never normal and is not a steps, in two steps, etc.
all, days. sign you are working hard enough! It’s best to see a professional to guide
Continually ignoring and pushing you because every person is individual
through leakage will most likely make and there are so many reasons this
this worse over time. may be happening.
bridge / AUTUMN / 13bridge / SPEAKING WITH HEALTH PROFESSIONALS /
Getting help:
What to ask on your
treatment journey
There’s a lot to take in when Speaking with your doctor or incontinence without surgery or
making treatment choices for health professional medication. These include pelvic
your bladder, bowel and pelvic floor muscle training or rehabilitation;
Head to your appointments with
improvement of bowel function, fluids
health. Remember, it is always confidence by taking our handy
or weight; or a continence pessary (a
your decision to choose the question prompts:
soft rubber or tampon-like support
help you would like. > What is causing the incontinence device). These treatments should be
or bladder, bowel or pelvic offered or tried first.
Congratulations on taking
floor issue?
the first step to improve your Urogynaecologist Dr Anna Rosamilia
> Do I need to be examined or shares questions to help you make
continence health – planning
have any tests? informed choices with your surgeon:
to seek help!
> Can it be treated?
> For my specific situation, which of
> What are the treatment options these surgeries would the surgeon
available to me? recommend for me? Please give
> What are the risks of these reasons.
treatment options? > Do I need to have any tests
> Should I see a specialist in (urodynamics) to give the surgeon
this area? more information?
> Are there products I can use? > Does the surgeon perform all of
> Am I eligible to receive any the possible options?
financial help for the cost of > What is the success rate you would
continence products? give me? Why? For example, a
cure of stress incontinence, no
Speaking with your surgeon about
or better urge incontinence? No
stress incontinence
complications (problems) such
Stress urinary incontinence (SUI) is as bleeding, bladder emptying
one of the most common types of difficulty etc, mesh exposure
incontinence women experience. problems or pain? Keep in mind
that pain can happen with any
Your health professional may
surgery.
recommend surgical treatments in
cases where conservative treatments > Is the surgeon able to manage
have not improved your bladder (take care of) any complications or
control. Conservative treatments do they have a colleague who can
are all the ways of helping your manage complications?
Angela, 77
Angela’s story
“My journey began some fifteen years ago with an attack of diarrhoea which did not settle. I saw my GP
but they didn’t want to accept there was anything wrong at all. We had the old “just drink lots of water
and eat lots of fibre” discussion. I had to push for a stool test referral and an examination where I was
told “you are all floppy down there.”
Since then, I have learnt a lot about my bladder and bowel health. I was diagnosed with an infection, bowel polyps,
weak connective tissues, Irritable Bowel Syndrome (IBS) and can’t eat FODMAP foods.
Today, I am eighteen months post-op from my fifth rectal prolapse repair, and in the care of surgeons, doctors and
physiotherapists – heroes all!
So, who do you talk to? Friends, family members, a good GP, pelvic floor physiotherapist, and the Continence
Foundation nurses are all there to help you. Seek them out. Reject offensive and nasty remarks, seek second
opinions, and don’t give up.”
14 / bridge / AUTUMNHelpline Q&A
Mental health and incontinence
> What is the link between the gut floor, for example struggling to use
Women are diagnosed (bowel) and the brain? the toilet or pass urine even though
with anxiety, depression Your gut has its own nervous you have the urge to go. This often
and PTSD (Post-Traumatic system called the ‘enteric nervous happens when you are in a toilet stall
Stress Disorder) at higher system’ which controls digestion and there is someone in the toilet
(the breakdown of food and drink). next to you.
rates than men.
This nervous system is always in Having bladder problems can also
communication with your central
cause anxiety, stress and depression.
nervous system (brain and spinal
If you have ever had an accident or
cord) through nerves and chemicals.
wet yourself, you might find that you
We often call this the gut-brain
worry about this happening again.
connection or relationship.
You may be more focused on or think
This means your brain can affect about your bladder more.
your gut and your gut can affect your
> How can someone tell if their
brain. If your gut is upset, this can
bladder or bowel symptoms
cause anxiety, stress or depression.
are linked to mental health
If you feel anxious, stressed or
issues? Should they see a health
depressed, this can also affect how
professional?
your gut moves and contracts. It may
speed up or slow down, which could If your bladder and bowel
Janie Thompson is the Continence symptoms are affecting your life
change your bowel motions and even
Foundation of Australia’s Clinical and bothering you, you should
cause pain.
Services Manager, leading the
see a health professional. It can
National Continence Helpline. > Why does anxiety sometimes
sometimes be hard to tell if a
feel like physical bladder or bowel
bladder or bowel symptom is linked
symptoms?
to a mental health issue.
For confidential information Because of the gut-brain connection,
anxiety can cause the gut to move It is important to look after your
and advice, you can phone the
National Continence Helpline faster or go slower. This can cause mental health as well as your
on 1800 33 00 66 (Monday to symptoms like ‘butterflies’ in your bladder and bowel health. If you
Friday, 8am to 8pm AEST). tummy, needing to go to the toilet notice your bladder and bowel
suddenly or having diarrhoea. symptoms are worse when feeling
anxious, stressed or depressed, or
The bladder sits close to your bowel.
the other way around, then it is
If your bowel is upset, this can also
important to have this followed
have an impact on your bladder.
up. There are now more clinical
The brain and spinal cord control the psychologists working with people
bladder. Anxiety can have a direct to help with continence, especially
effect on the bladder and pelvic bowel problems, with great success.
How can a psychologist help?
The role of a psychologist is to support fear, and challenging common
your concerns without judgement. thoughts we have about ourselves,
others and the world around us.
There are many approaches in
psychology we can use to understand Teaching mindfulness skills, relaxation
and manage the social and mental exercises and diaphragmatic
impacts of incontinence. breathing is useful when a person
For example, through Cognitive with incontinence is experiencing
Dr Lori Shore, Senior Clinical
Behavioural Therapy (CBT), we can accidents or flare-ups. These skills can
Psychologist at Caulfield Hospital
Continence Service, shares some of help people reduce stress and anxiety help with accepting accidents that
the ways a psychologist can help and increase mood. CBT involves may happen, and even have them
with the impacts of incontinence. changing behaviour, working through happen less often.
bridge / AUTUMN / 15Breakfast smoothie bowl
Accredited Practising Dietitian, INGREDIENTS
Milly Smith, has you covered for (serves 1)
breakfast with this cool and
refreshing smoothie bowl. Smoothie
This smoothie bowl ½ cup milk of choice (if
has a great mix using a milk alternative,
make sure to choose one
of things to aid our gut
with added calcium)
health, bone health and
keep us full for longer. ½ cup Greek yoghurt
1 frozen banana
The use of yoghurt and
milk provides us with a great 1 handful spinach leaves
source of calcium. Calcium ½ tsp ground cinnamon
is often lacking in Australian
½ tsp ground nutmeg
diets, especially for women over
the age of 50 who need more of it.
Toppings
The use of yoghurt also gives us ¼ cup untoasted muesli
some fabulous probiotics to help with
5 sliced strawberries
gut health. The oats, fruit, vegetable,
nuts and seeds all provide us with 1 tbsp crushed mixed nuts/seeds (choose your favourites.
I enjoy walnuts, macadamia and chia seeds)
dietary fibre to help keep our
bowels regular. Alternative topping options:
Hemp seeds, sliced fruit of choice, nut butter, other cereals
such as bran flakes, puffed brown rice.
Method:
1. Add all the smoothie ingredients together in a blender
and blend until smooth (if too thick, add extra milk until
you’re happy with it).
2. Pour the smoothie into a bowl and place your chosen
toppings on top.
ENJOY!
1 in 3
Australian women
are affected by
incontinence
We’re here to help
Speak with a Nurse Continence Specialist for advice
about your bladder, bowel and pelvic health
NATIONAL CONTINENCE HELPLINE
1800 33 00 66
8am – 8pm (AEST) Monday – Friday
continence.org.auYou can also read
