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Stress incontinence and the menopause - a Q&A with Dr Helen Webberley

15-10-2018   Health

Its World Menopause Day on 18th October 2018 and with 1 in 3 women suffering with stress incontinence, we hope we can help your pelvic floor issues

While it may not be a topic that many of us are happy to talk openly about, urinary incontinence, affects a significant number of women. In fact, research suggests that as many as one in three suffer, to a greater or lesser degree. As we enter into the menopause (around the age of 50 but can be earlier) this problem can get worse. When I set up Sent To Thrill I had a clear vision in my mind that the products I sold would be part of the solution.

Here, I talk to Helen Webberley a doctor with a specific interest in sexual health, about why our pelvic floor can struggle to cope with ageing and what we can do about it.

Shelley Morelli


Sent To Thrill


SM: So, Helen, can you tell me a bit more about urinary incontinence?

HW: There are two main types of problem that can lead to unwanted leakages, these are known as stress incontinence and urge incontinence. Stress incontinence typically happens when you laugh, cough, sneeze, jog or run etc. Those affected will note that the bladder is comfortable holding the urine but if there is a sudden increase in pressure, some urine is expelled. This happens because the bladder support, or pelvic floor, has been weakened, a condition most commonly brought about by pregnancy, childbirth, weight gain or the menopause. In mild cases, the symptoms can be improved through an exercise programme. 

In the case of urge incontinence, the brain tells the bladder it needs to be emptied before it actually does, leading it to empty just when you don’t want it to. This can be a very distressing problem but there are tablets that can be used to stabilise the bladder muscle and stop this from happening. If you are suffering from these symptoms speak to your GP.


SM: What are the symptoms of stress incontinence?

HW: For some women stress incontinence is a minor inconvenience, a little leak when kicking a ball about with the kids in the garden, or jumping on the trampoline, but for others it can be life changing. There are women who dare not leave the house for fear of emptying the entire contents of their bladder in the middle of their weekly supermarket shop. As a GP, I have seen both ends of the spectrum and everything in between.


SM: You mentioned exercises for improving the symptoms – do these actually work?

HW: Yes, they do work! However, evidence suggests that few women perform them with the degree of regularity required to make a real difference. There is a definite focus on the role of pelvic floor exercises in strengthening the support for the bladder post childbirth but more often than not they fall by the wayside. Instead of exercising regularly, those with mild stress incontinence often find themselves refraining from engaging in certain ‘bladder heavy’ activity.


SM: So, what are the consequences of not exercising regularly?

HW: The harsh truth is that if pelvic strength is not addressed and restored through exercise, the symptoms may get worse with age, and particularly after the menopause. This is borne out by the number of women who, in spite of suffering for many years, only bring the issue to their GP for the first time when they reach the menopause and they are at their wit’s end.


SM: Why do you think women wait so long to talk about the issue and what is it about the menopause that makes symptoms worse?

HW: Embarrassment has a major role to play in preventing women from seeking help. But timing is also a factor. When we become mums, our lives are at their busiest. So often we are juggling the demands of the children with our role as a wife and in many cases, we are also holding down a job. Many sufferers begin their pelvic floor, or ‘Kegel’ exercises with good intentions but do not keep them going. I have found that many women, and new mums in particular, put their own health on the back burner in the hope that it will sort itself out. Of course, some health issues do resolve themselves, but others, such as a weakened pelvic floor, may not.


SM: So why does this particular area of the anatomy cause so many issues?

HW: Let’s start by looking a little closer at the pelvic floor. This sling of muscles which supports the urethra (the tube that empties urine from your bladder) and the bladder itself, is essential for keeping everything in place and keeping the bladder ‘exit’ tightly closed. The process of carrying a child and giving birth can weaken this area, but regular exercise can restore some of the strength so that we are less prone to wetting ourselves when we sneeze or cough. Failure to exercise the area, on the other hand, means that when our bodies go through the natural changes brought about by the menopause, we reach the point where exercise alone may not be enough.


SM: Can you talk a bit more about these ‘natural changes’ which are brought about by menopause?

HW: As we age, our muscles weaken naturally. Then, with the onset of menopause, there is a reduction in oestrogen production, which causes the vaginal tissue to become less elastic and the lining of the urethra to thin. So, when we enter this life stage with an already weakened pelvic floor, we are in for a bumpy ride. A strong pelvic floor will still be subject to these life changes but it will respond much better to the ageing process.


SM: So, what can we do to help ourselves?

HW: Exercise, exercise, exercise! There are two key areas which need your attention. The first is at the front of the pelvic floor area. Imagine you want to stop your wee mid flow. Do this and hold for a count of ten, then repeat as ten smaller pulses. The second area is towards the back of the pelvic floor. This time imagine you are trying to stop yourself from passing wind. Repeat the same pattern, hold for ten, then ten pulses. Follow this with the same exercise for both the front at the back at the same time.


SM: How often should we be doing these exercises?  

HW: If you do this correctly three times a day over the course of 12-16 weeks, you will see a difference. Try timing your exercises with an activity such as putting the kettle on to serve as a reminder. There are plenty of resources online to help you to master pelvic floor exercises, check out the NHS Choices website as a first port of call.


SM: Are there any other benefits from having a strong pelvic floor?

HW: The benefits of Kegel exercises do not stop at better bladder control; a strong pelvic floor can also result in increased sensitivity during sex and better orgasms. They are also beneficial for men, and can help ease problems such as erectile dysfunction.


SM: At Sent To Thrill we are firm believers in the power of the pelvic floor, but even we can find it a struggle to keep up with our exercises. This is why we curated a range of pelvic floor strengthening devices (or Kegel balls). As a doctor, do you think such products can be helpful?

HW: For those who find it difficult to motivate themselves to exercise or who want to increase the intensity of their work out, there are lots of products available on the market designed to add gentle resistance. While it is difficult to compare the effectiveness of pelvic floor exercises with and without the products in place, experts believe that the simple act of investing in such items can help to motivate the user into action. As with the tried and tested products on offer via Sent To Thrill, it’s important to provide women with a choice of different materials, designs and weights, to enable them to find something that will suit their specific requirements.


SM: Why do you think it’s important for women to talk about this topic?

HW: Awareness is key in affecting behavioural change. The more open we are about our problems the more normal they become and the easier it is to find solutions. Women can sit side by side suffering in silence, but ignoring the problem won’t make it go away and we are all getting older.


SM: We recently started rolling out a series of at-home events which are aimed at encouraging women to share their experiences while learning more about our products. At the heart of these sessions is a desire to help women, like us, who have been affected by stress incontinence and who perhaps don’t realise they can improve their situation.

HW: Actually, realising that you don’t have to just accept wetting yourself as a part of getting older can be a key turning point for women. Anything that can be done to encourage us to share our experiences and recognise that there are solutions is definitely a worthwhile mission and the home environment is the perfect place to tackle this sensitive issue.


SM: Is there any other advice you can give as a doctor to women suffering as they enter the menopause?  

HW: Many women don’t actually realise that medical interventions such as HRT (either full HRT or even just some vaginal oestrogen cream) do much more than stabilise mood. They also help to bring back the elasticity and youth to the tissues. It is worth discussing the options available to you with your doctor.