A Little Leak When You Burst Out Laughing? C’est la vie (apparently).

“C’est la vie” (that’s life) is the introductory comment on the TENA website one of the market leaders in incontinence pads. The happy smiling face of the attractive woman next to this comment implies that bladder control problems are an inevitable part of female life. While there may be a positive drive to be more open around many health issues including incontinence, with urine leaks described as “a natural part of life” such openness is misdirected if it ignores the medical message that with incontinence it is to your doctor you go to first not to the shelf of the local supermarket.

None of the labelling used by the market leaders in continence care includes the advice that pads only address the symptoms not the causes, and that it is vital to speak to a GP first about incontinence. All the packaging included a contact number and website address, but it was only Boots that stated clearly before anything else on their website that: “Bladder control problems can often be effectively treated. For help and advice consult your doctor”. The other websites made no clear statement before anything else about the need to contact your doctor in the first instance. Advice was lost in stylish articles in which it appeared only attractive, extremely happy and very physically active women had urinary incontinence. Worst of all in the frequently asked questions section no clear and unequivocal advice was given to contact your GP.

I emailed both TENA UK and Always via their web sites to ask why there was no advice on their packaging to consult a doctor first if you have bladder control problems. TENA’s reply from their Customer Care department stressed that my concerns would be brought to the attention of the Research and Marketing Department which would be in touch should it wish to investigate my idea further. To date I have heard nothing which suggests that for them it is not a priority, and anyhow why was a medical question classed as a marketing issue? Always assured me that their product design including colours is the result of extensive research, and while I must realise that preferences vary from person to person it would share my concern with the team. To date I have also heard nothing back.

Both companies speak of empowering women to live life “to the fullest” but fail to stress clearly and unambiguously that it is not normal to wet yourself, and that while “little leaks and oops moments should not stop you doing what you want to do” they can be effectively treated or controlled. No woman should be told to put up with bladder control problems and incontinence is not an inevitable part of ageing or post pregnancy life, but this is not the message given out by these companies. The images of attractive and glamorous women with lots of friends who are doing plenty of socialising and physical activity while happily living with bladder weakness is intended to be liberating, but really it just entrenches the quiet female acceptance of your lot which we are supposed to have moved away from. For the majority true liberation will come not from wearing a pad or designer disposable pant but from lifestyle changes, exercise, medication or surgery.

The two most common types of incontinence are stress incontinence and urge incontinence. Stress incontinence is the result of damage or weakness in the pelvic floor muscles which causes leakage when the bladder is put under pressure when for example you sneeze or laugh. Urge incontinence is a sudden and intense need to urinate without delay and is often caused by an over active bladder or difficulty emptying the bladder fully. Total incontinence is the complete and continuous loss of urinary control where leakage or emptying is the result of the bladder becoming incapable of storing urine. Incontinence can also occur as a result of injury, disease, illness or surgery. Clearly all types are relevant and need medical attention, but it is with stress or urge incontinence that for women the lines have become blurred between treatment and acceptance.

Stress incontinence is linked to damage or weakness in the pelvic floor muscles which act “sling or hammock like” to support your abdomen, bladder and vagina as well as supporting the efficient functioning of the sphincters in the anus, vagina and urethra. Some women may require surgery to treat a prolapse or tear, but for the majority the answer lies with pelvic floor exercises or “Kegels” as they are called. These exercises are a necessity for every woman, simple to do and there is plenty of support available (nhs.uk). While Boots are to be applauded for their clear advice to seek medical attention for incontinence, the inclusion of a £69.95 electronic pelvic floor trainer on their web site is a let- down that gives in to financial opportunism by implying a genuine need when Kegels are the ultimate do it yourself self- supporting exercise with no extras required.

Urge incontinence can also for some be addressed non-surgically through bladder assessment and training which involves slow incremental increases in delaying emptying the bladder. There is also evidence that exercise, posture, diet and weight loss can help. For others there may be a need for a bladder implant to stimulate the bladder or further surgical procedures.

It is still regrettable that a medical concern identified as (though not specifically) female is marketed around happiness in acceptance. The ready availability of incontinence pads and pants alongside sanitary pads and tampons suggests the necessity of both for women- a regular purchase in your shopping basket. Menstruation is part of being a woman incontinence is not, and although bladder weakness has been linked to the menopause the placing of these products side by side implies not just their inevitable role in a woman’s life but the whole of her life too. Male incontinence is not given such a high profile or the designer treatment, implying shame and concealment for men but an apparent open and happy acceptance of their inevitable lot by women. Openness about incontinence is always to be welcomed, but only if accompanied by the advice to go to your GP in the first instance as bladder control problems can be effectively treated.

Ironically while the market leaders focus on adding design details and sexiness to their products the minority for whom there is no solution may after assessment and budgets permitting only receive the larger and bulky incontinence pads on prescription.

The message must be “Don’t leak, speak!”

And don’t let anyone tell you otherwise.

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