The common condition that can cause too much shame to be named

It causes one in three Australian women a problem they often don’t discuss, and one that can affect everything from their sex life to their self-esteem.

One in 10 men suffer with it, though are similarly reticent about sharing their experiences with incontinence or seeking treatment.

Fresh Monash University research shows leaking urine during exertion happens to a third of women who exercise, depending on the intensity of the sport, and that half of these “stop participating in a form of sport or exercise” due to their pelvic floor-related symptoms.

Leanne Murphy suffered life-changing incontinence after she gave birth to her second child.Credit: Arsineh Houspian.

Monash University physiotherapy lecturer, Dr Jodie Dakic, is among health and maternity experts who believe it is time the prevalence and impacts of incontinence, both urinary and fecal, are taken more seriously, and more screening and funded support is available across the community, to boost or restore quality of life.

In new research involving more than 4500 women, Dakic found half of female athletes in high-impact sports reported urinary leakage, and many women change what they do during exercise or sport to try to reduce the risk of it.

‘They spoke of avoiding group exercise, worried other people would find out, or experiencing being judged as lazy for having to back off.’

Dr Jodie Dakic, Monash University

“They reported things such as modifying their exercise, perhaps not sprinting at full pace, or avoiding high-impact manoeuvres,” she said.

“In interviews, they spoke of things such as avoiding group exercise, worried other people would find out, or they had experienced being judged in exercise facilities as being ‘lazy’ because they had to back off an activity.”

A systematic review had revealed one in two female high-impact athletes experiences issues such as leaking urine, but “we don’t fully understand the mechanism as to why some women who haven’t had children leak and some don’t … why it’s happening at such high prevalence.”

Many women were not telling anyone about their symptoms, Dakic said, and there was inadequate screening for pelvic floor health, which could help women find treatment.

The Continence Foundation of Australia, the Australian Physiotherapy Association, the Australian College of Midwives and the Australasian Birth Trauma Association are all calling for extended government-funded physiotherapy support before and after birth – especially for those who have experienced physical birth trauma.

When the birth trauma association published a Change.org petition calling for pelvic care physio sessions for pre- and post-natal women on Medicare, it attracted 43,000 signatures.

Up to five sessions funded by Medicare would help large numbers of women who end up with incontinence, many of whom may currently think “because they had a baby, it was just something they kind of had now, and had to put up with”, Dakic said.

Janie Thompson, helpline manager at the Continence Foundation (which marked World Continence Week last week), said birth trauma was not followed up the way it should be, and many women suffered, sometimes for years, before finding help for issues such as incontinence.

“All people with third or fourth-degree tears should be referred to continence services, and not only referred, but [support should be given] to make sure they can attend because doing so with a young baby can be very difficult,” she said.

Leanne Murphy lives with devastating impacts of a fourth-degree tear during the birth of her second child that was not treated until months after it happened.Credit: Arsineh Houspian

Victorian mother and counsellor, Leanne Murphy, has lived for years with devastating impacts of physical birth trauma injury sustained after a catastrophic tear of the tissue between her vagina and anus during the birth of her second child.

The injury was seen by her obstetrician, and she was due to go into surgery in the private hospital where she had the baby, but this did not occur, and Murphy was discharged needing to wear nappies. In the months until she waited for surgical treatment, there were times when severe incontinence made her contemplate suicide.

“I was discharged with my anatomy unrecognisable,” said Murphy, whose first vaginal birth had been smooth. “I’m broken.”

Though taboos around discussing both types of incontinence were disappearing slowly, she said feeling like you were alone in experiencing it made it worse: “Even doctors are uncomfortable talking about it … some can’t get the sentence out without it being awkward.”

The recent NSW inquiry into birth trauma, the first of its kind in the world, also recommended more physiotherapy be made available on Medicare to the one in three women who experience some form of it.

Catherine Willis, board member at the Australian Physiotherapy Association and team leader at the Royal Brisbane and Women’s Hospital, gave expert evidence at the NSW inquiry and said much more should be done for women even before birth to prevent injuries that commonly caused incontinence.

“About 30 per cent of first-time mums won’t have a tear at all, but 70 per cent will have a tear,” Willis said.

“As a result of this, we now have the NSW select committee inquiry recommendation that women who have suffered birth trauma have access to physiotherapy, but different states have different levels of funding [for it].”

That about 50 per cent of women who have a vaginal delivery will have urinary incontinence meant extended treatment should be guaranteed, Willis said.

“The [birth trauma] hearings should be replicated around the country to get a look at the actual rate of injuries and funding that goes into all services [to treat them]: physiotherapy, psychological and gynaecological and colorectal services.

“We need to stop talking about things like birth and subsequent injuries of birth as something that’s just women’s burden to bear.”

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