Tackling the taboos – Alex Cole-Hamilton leads Holyrood debate on incontinence

As we reported last month, Alex Cole-Hamilton brought a motion calling for a National Continence Strategy to the Scottish Parliament. It was debated yesterday. Here is Alex’s speech. He is pictured here with Elaine Miller, his constituent whose show Gusset Grippers highlighted the issue at this year’s Edinburgh Festival.

If we ask anyone in this chamber or beyond it what their top five fears of age or infirmity might be, we can be sure that the subject of this debate will sit right up there. However, I state from the outset that, if we, as legislators, assume that incontinence is a condition only of the old or infirm, we are mistaken and are part of the problem. I called for the debate because women and men of all ages suffer in silence. It is high time that they are made aware of, and given, treatment, support and—most important—hope.

Incontinence is still taboo. Patients are shy and embarrassed to talk about it or to seek medical help, and many of them assume that nothing can be done for them. This may be the first time that we have debated the problem with such a focus in the Parliament. I am glad that members from all parties are present today and are prepared to put aside our hang-ups on the issue and look collectively towards relatively straightforward solutions.

Here are the facts: one in three women and one in nine men leak urine. A remarkable 30 per cent of women who have given birth vaginally will have damage to their pelvic floor, while those who sustain a third or fourth-degree tear during childbirth are likely to have problems with faecal incontinence. Statistics show that incontinence has a bigger impact on a person’s quality of life than nearly any other condition, and a recent survey of those over the age of 60 and in hospital characterised incontinence as a fate worse than death.

We do not know the true cost to Scotland of incontinence, associated products and the causal impact on physical and mental health. However, in 2010, Australia made a stab at researching the scale of the problem. A study there examined the cost not only of sanitary wear, medication and surgery, but of dealing with the depression and anxiety that can arise from the condition. It amounted to $43 billion dollars annually, which is astronomical. Our two countries have similar societies and face similar health challenges, so we can extrapolate that to around £5,000 for every Scot with the condition every year.

A range of additional health complications stem from incontinence, and they have much bigger associated costs. For example, incontinence is linked to falls. Many older people fall and break their hip by slipping in the night after not making it to the loo in time and may become part of the 25 per cent of those over the age of 80 who will be dead within a year after such a fracture. We are still waiting for the national falls strategy, which will build on the 2014 falls framework that the Scottish Parliament voted for earlier this year.

One of the only surgical interventions available when sufferers are beyond the help of physiotherapy is the transvaginal mesh implant. Last year, along with colleagues from all parties, I met mesh survivors on a visit arranged by Neil Findlay. Thanks to their campaigning efforts, we have all heard the awful traumas that they have endured as a direct result of botched treatment for incontinence.

There is also a direct causal relationship between male incontinence, erectile dysfunction and male mental health issues. Given that much of the increase in the suicide rate last year related to young Scottish men, we cannot afford to ignore that link.

There are, nevertheless, solutions to this terrible condition, and they are not rocket science. Those women who, after childbirth, are left with rectus abdominis diastasis—separated tummy muscles—are more prone to developing back pain and vaginal prolapse. They could easily be identified on the maternity ward and referred to a physiotherapist. We also have a six-week postnatal check in place, but there is currently no requirement to check how those muscles have healed and not all general practices routinely follow that up. We can prevent more women finding themselves with that debilitating condition if they are empowered with knowledge both before and after giving birth.

It is astonishing that a country that provides a box to new parents that contains a poem from the makar does not yet routinely train midwives and health visitors in basic pelvic physiotherapy. We must ensure that that is done as a matter of course, so that mothers are informed about post-partum exercises, what to look out for after tearing and when to seek treatment.

An understanding of pelvic floor exercises must be included as part of the curriculum in either personal and social education or physical education, so that young people are aware of their own pelvic health. There is evidence that physiotherapy works for all ages as well as years after the onset of symptoms, yet many people who suffer incontinence do not realise that treatment could improve their symptoms.

We need to normalise the discourse around the issue. Given that only 30 per cent of sufferers are coming forward for help, we need to build awareness so that everyone who is affected knows how to get help and that they are not alone. That would not cost much money but could significantly improve the quality of life of those who experience the condition at any time of life.

Incontinence is a huge and underrecognised public health issue in our country, but evidence shows that we can prevent and manage it with physiotherapy. We need to better support the many Scots who contend with the problem every day, some of whom are known to us personally.

I will close by thanking my friend and constituent Elaine Miller, who is a pelvic physiotherapist and comedian. She is leading a one-woman campaign to bring the issue out of the shadows and to an international audience. She is sitting in the public gallery today and will bring her show to the Parliament next Tuesday. I heartily recommend it to colleagues.

Incontinence is one of those health conditions that are indiscriminate of class or lifestyle. It ruins lives but we seldom give it the attention that it deserves.

* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings

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4 Comments

  • David Warren 17th Nov '17 - 3:18pm

    Really pleased to see this.

    I suffered with both bowel and bladder problems for a number of years.

    In 2014 I experienced a severe gastric flu which left me with IBS which is a major problem for me.

    I have a special diet and have to plan my life around the availability of a toilet.

    The biggest problem is the lack of understanding of the condition which is effectively a disability.

  • Lorenzo Cherin 17th Nov '17 - 4:57pm

    David is correct that there are hidden disabilities and every individual is or should be listened to accordingly, David , trust you’e doing better now, reach out to friends and colleagues

  • Steve Trevethan 18th Nov '17 - 7:20am

    Thank you for an excellent piece!
    Practicality, realistic perception, clear communication, compassion for all sections of our society and drive are what we need in all our activities and policies,

  • David Warren 18th Nov '17 - 3:11pm

    Thanks Lorenzo

    Unfortunately the sad fact is that my current condition is permanent.

    I have tried everything and there doesn’t appear to be any cure.

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