"Incontinence interferes with every single thing a person wants to do...People have a universal and visceral need to be clean and dignified."
So says Elaine Miller, a physiotherapist and now a comedienne at The Edinburgh Fringe, in her Guardian article on 10 August. I could not agree more. Initially, I was intrigued to read that a woman had written a comedy show about incontinence, then sad that there has been a need to write a show in order to raise awareness of a condition which affects millions of women.
One of my main specialisms is representing women who have sustained injuries during childbirth and who, as a result, suffer from a range of debilitating symptoms. These vary from incontinence of urine, to that of flatus and faeces.
Almost every woman affected by these injuries will have psychological and/ or psychosexual consequences. They will require physical and psychological therapies which they may need to have for years. Unfortunately, there is very little that can be done to fix these injuries. For many women, the physical symptoms get worse as they age.
As to how these injuries were sustained, similar, if not the same, patterns seem to emerge in my experience. Most women I represent will have suffered a tear of the perineum and a disruption of the anal sphincter during the birth of their child. In many cases that I have been involved with the tear itself has been caused by shortcomings in the care that the woman received, but not all are.
There seems to be a common theme in many cases: lack of training. This is despite the guidelines that are published by the Royal College of Obstetricians and Gynaecologists, NICE and the individual NHS Trusts. It is very often the case that there will have been a failure to identify and diagnose obstetric tears.
In many cases the woman is diagnosed with a superficial wound, or a tear of lesser degree, and as a consequence, no repair or an inadequate repair has been performed and she is sent home to the care of the health visitors and then her GP. It may take weeks or months before her symptoms are taken heed of and she is seen by an appropriately qualified doctor. It may be some years before she has a secondary repair and a chance of improving her symptoms.
Very little, if anything, is said to women during their pregnancies about tears, the risks of tearing and outcomes. Women should be properly counselled, informed and prepared for their labour and what may follow. Doctors and midwives need better training to minimise the risks of women tearing and to be able to make appropriate diagnoses and summon assistance and specialist colleagues when they are required.
The MASIC Foundation is making headway in raising awareness of the terrible suffering that women who have sustained obstetric injuries endure, the struggle of daily life, the impact on them, their families and their careers amongst all the other challenges that they face.
Public awareness has to improve and whilst it should not have to come from a comedy show at an arts festival, I am glad that Ms Miller is talking about incontinence so openly. I hope this will pave the way for there to be openness and better understanding for women who have endured, and continue to endure, life-changing symptoms as a result of giving birth.