Incontinence Challenges Following Childbirth
Fitness enthusiast Aimee Oliver, now 37, never anticipated that childbirth would lead to her requiring surgery for incontinence. Her difficulties began in her 20s, when she started experiencing urine leakage triggered by coughing or sneezing after the birth of her first child.
"When my body stopped working as it should I actually began to mourn my old self,"
Northern Ireland's five regional health trusts have reported an increase in individuals seeking assistance for incontinence. A specialist nurse noted a "massive increase" in self-referrals from both men and women.
Aimee, a personal trainer, fitness enthusiast, and volleyball champion, has qualified for the women's Pro Hyrox World championships for the second consecutive year. She described the condition as both mentally and physically debilitating, which is particularly ironic given her role in leading a group focused on helping women build strength and fitness, especially postpartum.
Incontinence is defined as the involuntary or accidental loss of bladder (urinary) or bowel (fecal) control, ranging from minor, occasional leaks to complete loss of control. It is a common symptom associated with underlying issues such as weak pelvic muscles, neurological disorders, and infections.
Aimee expressed that leakage is "extremely embarrassing" and often causes many women to cease exercising or reduce social activities.
She detailed some of the strategies she employs to remain active despite her condition.
"In a recent competition in Belfast, I won overall female, but I was leaking while competing and wondering, 'can people see my shorts are wet?' That when I am running there is urine running down my legs and I can only ever wear black shorts to try and hide the wet marks. I am wearing thick shorts, pads, pessary and a device, and I am still leaking visibly – it just adds to the stress of competing,"
Six-Year Wait for Treatment
Aimee, a mother of three, believes that postpartum support for women in Northern Ireland is inadequate, as physiotherapy after childbirth is not routinely provided.
She noted that her personal training clients in countries such as France, Spain, and Sweden report more comprehensive postnatal support systems that include several months of physiotherapy.
"In some countries the whole way through pregnancy and after they automatically have physio appointments - often 10 sessions post birth and that can make a massive difference to a woman's health in the long-term,"
Aimee is scheduled to undergo pelvic floor surgery in the private sector, having been informed that the wait time within the NHS would be at least six years.
"At 37 I am at the peak of my competition fitness, so I don't have six years to wait,"
What Are Pelvic Floor Muscles?
Pelvic floor muscles form a sling-like layer spanning the base of the pelvis, essential for supporting the bladder, bowel, and uterus. They regulate the release of urine, feces, and gas, and also contribute to sexual function. Strengthening these muscles can prevent incontinence and organ prolapse.
Increase in Self-Referrals to Health Trusts
Continence specialist nurse Julie Edmonds reported that incontinence is "extremely common" and that there has been a "massive increase" in self-referrals among men and women in the South Eastern Trust, where she works alongside four other specialist nurses.
"It can affect anybody, any gender, any age, we are treating men and women from as young as 18 to most recently a woman in her early 100s. We are definitely seeing a shift especially among younger women who are just not accepting that because they've had children, or the menopause they have to put up with it. They are starting to realise that there is something that can be done and they are coming forward for help,"
While childbirth is the most common cause of a weakened pelvic floor, Julie highlighted that drinking habits also play a significant role.
"We have a massive coffee culture now and people don't realise the impact coffee has on their bladder muscle which can cause increased urinary frequency,"
"So simple things like swapping for decaf, also swapping fizzy drinks, alcohol, even green tea, for water and diluted juices will, after two weeks, make a massive improvement."
Northern Ireland's largest health trust, Belfast, reported a 25% increase in monthly referrals since 2020. The demand exceeds service capacity, resulting in a six-week wait for urgent referrals and 13 weeks for routine ones.
Although none of the health trusts provided exact waiting list figures, the South Eastern Health Trust indicated a wait time of approximately 18-20 months for routine appointments and about 12 weeks for urgent referrals.
The Western area has experienced a 13% increase in its pelvic health physiotherapy service.
Pelvic Health and Sports Participation
Gráinne Donnelly, an advanced practice pelvic health physiotherapist currently engaged in doctoral research, focuses on pelvic health and encourages pelvic floor muscle training.
She emphasized the importance of long-term pelvic health for both individuals and the healthcare system.
"One in two women withdraw from their sport and that includes in their younger teens - and that drop off could partly be to do with issues around pelvic floor. If people are withdrawing from sport that is a public health priority. We need physical and cardiovascular activity for both our physical and mental health so we shouldn't let our pelvic floor function decline,"
Both Gráinne and Julie stated that there is high-quality evidence indicating that most women can be cured with pelvic floor muscle training alone. When performed correctly and early, this can often prevent the need for surgery.
Importance of Awareness and Support
Aimee advocates for increased knowledge regarding pelvic health and enhanced support for women after childbirth, believing it will ultimately reduce healthcare costs.
"Pelvic muscles are just like any other muscle in the body which need exercised. If you don't stay on top of them, it can have big consequences as we get older,"
