Incontinence is still a subject that's rarely discussed in public, despite the fact that it's so common, especially post-childbirth. It's so common, in fact, that researchers estimate almost one third of Irish women leak urine upon a simple, sneeze, cough, laugh or bout of exercise.
In those who manage not to leak, there can often be an urge to rush to the loo, with the sensation of almost 'not making it in time'. In more severe cases, a woman who suffered a serious tear during birth can suffer from faecal incontinence.
As if this isn't enough to deal with post-childbirth, some women -- particularly those who suffered injury to the perineum or underwent an episiotomy -- can suffer from a loss of sensation or diminished pleasure during sex.
Having a caesarean delivery does not guarantee that a woman will avoid stress incontinence either, particularly those who underwent an emergency c-section, as she may have gone through the pushing stage, which stretches or can damage the pelvic floor muscles (the muscles, tendons and ligaments that form a supportive 'hammock' from the front to the back of the pelvis, controlling the openings for the urethra, vagina and anus).
Women, however, do not have to accept this as their fate, or as part of being a mother. The good news is that stress incontinence can be successfully treated with the rehabilitation of the pelvic muscles.
The effects of incontinence are often seriously underestimated. It is important that young mothers prioritise their own needs, and not just their young baby's, or those of other dependents.
A mother's well-being, both physically and psychologically, has a direct effect on the family's well-being.
In France, the chances of a woman regaining the health of her pelvic floor are not left to fate. As testament to the emphasis on this area of a woman's body, every single woman who gives birth is prescribed 10 sessions focused solely on their pelvic floor and abdominal muscles, to be taken between six weeks and three months after delivery. These sessions are reimbursed through the social security system.
Generally they can be taken either with a midwife, who has been trained in this area, or with a physiotherapist. The method is a combination of traditional floor exercises and biofeedback.
According to Gilliane Quinn, an Irish mother living in France who availed of this service after the births of her four children, "It can be a little disconcerting at first to find yourself in a medical clinic with many mothers all working their pelvic muscles linked up to a computer in different cubicles.
"The French definitely take their perineum seriously because they have an understanding that it is much more important to prevent incontinence rather than deal with it afterwards."
This leads us on to prevention -- what can a pregnant woman do to prevent future problems? Many women know about the pelvic floor-strengthening exercise called kegels, most often recommended during pregnancy and in the first six weeks after birth. These exercises simulate a similar feeling to attempting to stop urine mid-flow.
Another option available to pregnant women is pilates or yoga, with a specific focus on the pelvic floor muscles.
"A fundamental that women are often not aware of is that they need to learn the skill of letting go of the pelvic floor, rather than simply learning to contract the muscle," according to pregnancy yoga teacher Helen Bourke-Barnwell.
"Also, I try to make women in the class aware of their pelvic floor -- of how it feels and how to let go, both physically and mentally. A lot of women can hold on to tension in the pelvic floor and have a fear of letting go when, in reality, many midwives say that giving birth could be likened to doing a poo, making it essential to let go."
Although Helen tends to work mainly with pregnant women in aiming to prevent damage to the pelvic floor, she does also come into contact with women after they have given birth -- women who are looking for help as their bladder incontinence has caused a serious disruption to their lives.
"I've worked with women who went back to running too soon after the birth, where no work had been done to rehabilitate the pelvic floor, and they have been left completely incontinent.
"I know women with two or three children who can't drink coffee anymore as it is a diuretic, or women who can't run, jog or exercise at all without wearing a pad."
With these women, Helen focuses on kegel exercises, followed by pelvic tilts and drawing up the pelvic floor with more classical yoga poses.
This is similar to pilates, in that the focus is on the core muscles of the pelvic floor and abdominals.
"It is like any other muscles though, in that it needs to be pulled in, or contracted, and then released -- but the release is crucial."
Chartered physiotherapist Noreen Dockery, who specialises in rehabilitation of the pelvic floor, agrees that learning to relax, rather than contract, pelvic floor muscles is important to the success of managing stress incontinence.
"Not many women know that they actually have an extremely tight pelvic floor, or one that is in spasm. The goal here is to lengthen or relax the pelvic floor muscles so that the muscles are no longer in a constant state of contraction."
The exercise programme that Noreen uses comprises taking a deep breath into the stomach and relaxing the pelvic floor. This is called a 'flop and drop'.
"The pelvic floor muscles are very much connected to the abdominal muscles," Noreen says, "and releasing tension here can have a major effect on the tension found in the pelvic floor.
"Most patients feel their pelvic floor is weak but in actual fact the resting tension or already elevated tone prevents the muscle from lifting any higher.
"The muscle must be released in order to initiate any good full range contraction," she says.
"Supporting the pelvic floor is important for prolapse as well as for any incontinence issues, bladder or bowel. We also treat patients with pain post delivery, as well as those who have had pelvic girdle pain or dyspareunia (pain with intercourse).
"The important thing is that patients don't feel isolated or that they are the only one suffering from these issues -- they are very common."
Does she believe that Irish women wait too long to address this problem?
"I think that is improving as more women are seeking help nowadays. Still, I often see women who have teenagers and they have only got around to seeking help now, when it would be far preferential to deal with the post-partum incontinence a few months after the birth.
"It is hard for women though, especially with a new baby but, if it's left too late, symptoms can deteriorate, especially in menopause when the muscle tone gets more relaxed and hormones are involved."
Fiona Carney, one woman who left it too late, feels strongly that the onus should be on women themselves to seek help.
"It is such a sensitive issue and I can't stress how important it is to be proactive about resolving the incontinence in order to get quality of life back. It is easy to let it control you."
For more information
Helen Bourke-Barnwell -- www.greystonesyoga.ie
Noreen Dockery -- www.milltownphysiotherapy.com
Tracy Donegan -- www.gentlebirth.ie