World Continence Week

 This week I was invited to do an interview on ABC South West Victoria’s Breakfast Radio show with Jeremy Lee.

It is such an important topic to highlight so I thought I would share the transcript with The Lady Physio community in case you missed it!

You can listen to a recording in the link above, and you can also listen with the transcript on with the link below the text, so I hope it is as accessible as possible.

Jeremy: This week is one of those weeks highlighting a condition, which I imagine a lot of people find it difficult to talk about, and that is incontinence. There are some surprising statistics here though, according to the Continence Foundation of Australia, one in four people over the age of 15 experience incontinence, which seems like a huge figure. One of the largest groups of people affected by this, I would imagine, even if only on a temporary basis, are pregnant women. Chloe Burger is the Director of The Lady Physio in Warrnambool and a specialist in pelvic floors and with you this morning to talk particularly about this. Chloe welcome to you.

Chloe: Thank you.

Jeremy: What firstly made you want to work with women in this area?

Chloe: I think just over the years, when I first became a physio, I had lots of friends who were having babies and I found that a lot of the care they received, maybe wasn't... They didn't have access to care about their pelvic floor and about incontinence. So I found that, you know, going back to study, I did a postgraduate degree in pelvic floor physio, it just really was an area that I think was a massive need and affects people's lives so much.

Jeremy: Is it one of those things, that's maybe a bit of a surprise or, once again, just not really spoken of people thinking you're having a baby, that's great. Of course it is. But then other things can flow on from that.

Chloe: Yeah, definitely. And I think women have probably put up with these things for years and years and years, like, you know, our parents' generation, they probably have put up with leaking and just thought it was normal and that there's not much you can do about it after you've had a baby. And I think that's, you know, part of the reason why people stopped playing sport or stopped doing things that they might otherwise want to do. So it's a massive effect on people's lives.

Jeremy: How common is it as well in your experience?

Chloe: So two out of three women who've had a baby will have some issues with their pelvic floor or leaking, you know, especially if they've had a vaginal birth, it's a little bit more common than a C-section birth, but just because you've had a C-section doesn't mean that you won't have any incontinence issues, because just being pregnant will put a lot of pressure on your pelvic floor.

Jeremy: Of course, are there any, you know, age groups or… I don't know, body types that are more likely as well, or is it, is it just across the board? Is it something you can't really predict?

Chloe: Yeah, so there is some risk factors. Having a family history is obviously a big risk factor. So if you know someone in your family who's incontinent or has issues with their pelvic floor, then it's going to be much more likely to happen to you. Also if you have your first baby over 30 years old which is so common these days. One of the other big risk factors is having, you know, chronic constipation. So straining on the toilet a lot, that's going to really affect your pelvic floor or also doing a lot of heavy lifting. So if you have a job where you do a lot of heavy lifting or, you know, you're a weightlifter or high impact exercise at the gym or sport, then again, you're much more likely to have issues with incontinence.

Jeremy: Yeah, are there other sort of warning signs as well, that something, you know, might be developing?

Yeah. I think a lot of people might just put it off. If they have a little bit of a leak when they cough or sneeze or, you know they can't jump on the trampoline with their kids anymore. And they say, well, that's just something I can't do. And then, you know, they avoid it and just put out with a small amount of leaking, but then later in life, that's something that can develop into a big problem. And you know, is one of the main causes of people going into a nursing home is not being able to manage their incontinence.

Jeremy: So do most people, do you think, what, just don't do anything because they think it will resolve itself or it'll just go away on its own.

I think a lot of it might be that people are, I guess, a bit worried to talk about it and it is, you know, one of those things that's embarrassing. So maybe they just think, well, if I ignore it, it will get better. Or that it's something they just have to put up with. But a lot of people don't know that there's treatments out there and that, you know, I've had clients who've had leaking for... since the birth of their child 25 years ago, and they come to me and after three months of doing some pelvic floor exercises, they can run up and down a flight of stairs without leaking. So it's can be a massive change and improvement in people's life if they do get help.

Jeremy: Yeah, right. I mean, how easy is it to, how easy is it to fix as well if you are somebody who's in that situation?

Chloe: It just depends on what's causing it, but if it is a weak pelvic floor, then it's about being really consistent to exercises and it takes about three months to strengthen your pelvic floor. So it's not going to be a quick fix. There's going to be no magic pill that will fix your leaking. Yeah. But it is going to be, you know, that consistent exercise and strengthening those muscles that can help most people. And some people will need other interventions, but that's where we can point them in the right direction towards, you know, seeing a gynecologist or a urologist, if they need to get extra help as well.

Jeremy: Yeah. I mean given that childbirth is one of the big causes here as well is enough sort of done around this, do you think? Are people given enough information when you're sort of having your maternity classes and so on? To really understand what the risks are here and what you should be doing to try to prevent this or minimize it?

Chloe: Yeah, I think that's a really massive lack. So only 11% of pregnant women were doing pelvic floor exercises in one study, which is so small. And I think pelvic floor exercises are one of the biggest preventers that you can do in terms of stopping you from developing leaking while you're pregnant or after you're pregnant. And I think that, you know, people just aren't told, a lot of the feedback that I get on my social media is that we just didn't know this. Nobody said anything. So I think it's one of those things that maternity care needs to do better at and needs to recognize that the pelvic floor is so important for mothers and it's not just about, you know, the baby's health and the mother's health. It's, you know, their quality of life that matters in terms of their pelvic floor.

Jeremy: Yeah indeed, so well good to be able to talk about it, I guess, given that it is incontinence week this week, but obviously you've been talking about it all the time I guess. What's the sort of first step then here. I mean, to you know, is a GP, the first step, or?

Chloe: Yeah. So a lot of people will find if they go to their GP, their GP will be able to make some recommendations and hopefully give them a referral to a pelvic floor physiotherapist. So you need specialised training to treat this. So not any physio can see you. And I think if you have trouble finding someone, then obviously you usually Google. If you look up incontinence physio, or pelvic floor physio, a lot of places will come up with someone in your area. And the stat that you spoke about before from the Continence Foundation of Australia, they have a find a physio part on their website. So you can go into that and look for a physio in your area as well, which has really helpful.

Jeremy: Absolutely. You've gotta be sort of trained in the things you need to know. I understand that in France, they have a, there's a government program I don't know if you're aware of this or not, but, what mothers get 20 sessions do they? As a part of the whole childbirth experience to help, sort of, cope with this.

Chloe: Yeah, they do. So the French government does prioritise pelvic floor physiotherapy. So they do get 20 sessions that are funded. And, you know, the best that we can get here is if you have a chronic condition, you might get five sessions Medicare rebated. And that means that you've had to have that condition for at least three months and you have to be eligible based on a GP referral. So it's not automatic, like it is over there. And obviously they have a lot less rates of these issues after pregnancy and during pregnancy because of that preventative care and that recovery afterwards.

Jeremy: So there's a real argument here perhaps to, look at something like that. Not just in France, but across the world.

Chloe: Yeah, it would be so great if the government put more money towards these things, but I guess we know the budget and everything that's happening it's probably not the first thing on their list. But I think, a lot of the time it's not a massive investment, so you might have to have three or four sessions with a physio and then you might be okay to continue on your own strengthening and maintaining that strength. So if you can put aside that money for a few sessions that you need then it will make a massive difference.

Jeremy: As you say, I mean, obviously given that it can really impact on your quality of life so, you know, if you are experiencing that you should really attend to that I guess and try to catch it before it gets... before it's too late.

Chloe: Yeah, that's right. And I think if we can prevent more and more women having issues while they're pregnant, so that throughout their birth and their recovery, they don't have significant injury and they're much less likely to then go on to have significant ongoing incontinence and it's one of those things that the more we can do before you have a baby or before you have issues, the better it's going to be.

Jeremy: Chloe well thanks very much for that message. Good to meet you and I'll chat to you soon.

Chloe: Yeah, Thanks so much.

Jeremy: Thanks again. Chloe Burger there, who is the Director of The Lady Physio in Warrnambool.