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Normalize This: Urinary Incontinence

is incontinence a normal part of aging

Welcome to the first installment of our Normalize This Series, where each month, we’ll shine a light on a different “taboo” to provoke thought, spark conversation, and, as always, remind us all that we are not alone on this journey. It’s about encouraging openness about the journey, and inspiring empathy, connection and community through heartfelt conversations.

Our inaugural post tackles urinary incontinence (UI), a condition addressed by our launch collection of body-and-earth-friendly products. The sad truth is that one-in-three women experience bladder leaks, yet it is something that most of us have rarely, if ever, discussed with the women in our lives. But times are changing, and little by little, women are speaking openly about the struggles and unmet needs within women’s health, UI included. 

We had the honor of chatting with Luce Brett, author of the first-ever memoir to look at incontinence, entitled PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale. She’s warm, witty, and a bit brazen — so naturally, we’re smitten. She’s also English. Out of respect (and delight), we’ve kept her Britishisms intact in our conversation below. 

Join us, as Luce shares with us her journey, and all that she’s learned along the way.

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Can you describe your experience with urinary incontinence?

I developed incontinence issues when I was 30, just after the birth of my first baby. Initially, it felt like there wasn’t much advice that was aimed at me - as we still, as a culture, hush up incontinence and see it as a problem for older women. I had a difficult labour which left me with a prolapse, poor bladder control, and poor sensation. I had physical therapy, but while for many that can be a fairly quick fix, for me it wasn’t. So that birth kickstarted a decade-long vaginal voyage of discovery in which I found out just how limited my anatomical knowledge was, the importance of a strong pelvic floor, and the damage stigma can cause. 

I had physiotherapy, operations, counseling, and some pretty intense tests and procedures. Luckily my care was mostly amazing. I still vividly remember the first doctor who listened and how important that was. Mostly, I remember being shocked though — at the indignity of wetting myself in public, and also that however brave and rude and feminist I was, I was stuck in an infuriating contradiction: Incontinence is common, it affects millions and millions of women, and yet it is still seen as embarrassing, hushed up, dismissed, and ridiculed. Worse, it is sometimes treated unkindly and often poorly understood, not least by women themselves who often don’t realize how treatable it is. How can that be? How can something be taboo and everyday?

You are such a talented writer. The honest, visceral, witty-yet-deeply-emotional way you talk about incontinence, not just as a physical condition, but its effect on so many other aspects of your life and wellbeing, is a gift to all of us. Mind giving us an overview of your writing career?

Thank you! I do think PMSL is a lesson in ‘be careful what you wish for’. I always wanted to write a book, but I guess I wasn’t really imagining it would be this book, where I would describe some of my most humiliating experiences.

Writing about it is hard. At first I only spoke frankly on a mums forum online where I could be anonymous. I didn’t feel normal. I felt broken and traumatical, like a soiled Anne with an E. But soon I felt frustrated. I just couldn’t believe I was the only one who felt like I did. When my second son was born, I started a blog. Not just about incontinence, but about other sacred cows too, like having to feel forever grateful, the pressure to enjoy breastfeeding, the myth of multitasking being a good thing for women, and being rendered irrelevant as soon as the cord is snipped. When I touched on incontinence though, I got the biggest responses. People I had never met told me intimate secrets. Women wanted to talk, but it felt like they needed permission, for someone else to speak first and break the spell by admitting: ‘it doesn’t feel great, actually, to wear these pads every day. It affects my confidence but also my sense of self, and my sex life’. There was so much solidarity, pain, humour, and relief in those early messages, and some horrendous stories too. And I think then I knew I had to do something. 

In PMSL I wanted to tell the truth — in all it’s pissy unglory — including my own bodily ignorance and the shame and conditioning I’d absorbed about what mothering, birth, bodies should be like. PMSL is really graphic in parts but it is also funny, and, I hope, touching. I tried to be honest about it all — the blood, the shit, the tears, the sex, the mistakes we make, the self-loathing we can slip into — and the simple truth that any trauma, however brutal, doesn’t exist in a vacuum. We have to find a way to live through it, around it, and to remember there are good bits too. There’s joy. For me, they were little boys who made fart jokes at bedtime, and a brilliant support network who, with my partner, helped me heal and raise my voice. 

But mostly, PMSL is about hope — about the nurses who believe you, friends who hold your hand, the next generation of women speaking out so loudly, manufacturers innovating, better treatments, and finding out there is a you (an older, wiser you, a ten-years-further-down-the-road you) who is more capable of compassion for her younger self. Because when I was standing in the wind in my wet skinny jeans after a hospital appointment where I pissed up a man’s arm and he described my leaking as ‘off the scale’, I needed to know she existed and was possible.

In writing your book, you’ve done an enormous amount of research. Can you share some of the most powerful findings you’ve encountered in the process?

It took me a few years to pluck up the courage to actually write a book. I wanted to research and understand the bigger cultural picture — why we stigmatise incontinence, the history of surgeries and treatment. I found out so much more: it is political, stigma seeps into policy and spending decisions, and poor education about female anatomy. 

There are hundreds of millions of incontinence patients; figures suggest somewhere around 1-in-3 women suffer from it at some point.  It made me incredulous to read about how common it is and how it can take women years to get help, with lots of women feeling unable to tell anyone — not even a doctor, partner or relative. The social impact is proven too: incontinence is associated with depression, anxiety, isolation, postnatal depression. It makes older women more likely to fall, and that impacts their quality of life and life expectancy. And one report showed some people would rather die than be doubly incontinent.

We legitimately cheered when we read your article in the New York Times, and have literally underlined and highlighted bits of text throughout your entire book. We know we’re not alone. Can you describe the response you’ve received from your book? 

Thank you! The NYT piece was a huge highlight for me, and it was brave of them to publish it. Some outlets wouldn’t read or cover it. We had so many letters, and it jumped onto the front page, so there is an audience — there are people who do want to connect with this topic. One man wrote to say he wished he’d known about this stuff when his wife was still alive and could have talked to her about it.

In fact, I’ve heard quite a lot from men — one man who’d had lifelong incontinence problems thanked me for empowering him, he said I was the first person he’d come across that ‘owned’ their incontinence. The most moving have been from people I have known for years, saying they hadn’t discussed these things but had similar experiences or feelings of bewilderment, ghoulish humour, feminist rage from other traumatic medical events. I have cried many times reading about silenced female voices, but it is very powerful when it is people you know who perhaps haven’t had an outlet for those stories before.

My favourite though was this week, from a woman the same age as my grandmothers would have been, who said she loved all the swearing in PMSL and was buying it for her younger friends!

When we talk about destigmatizing UI, there are many stakeholders involved in this process — one of which is the healthcare community itself. Now, obviously the UK’s healthcare system differs from ours here in the States, but what message do you hope that healthcare providers take from your story / your work?

Be kind and honest - things are embarrassing for many patients and that isn’t because they are being silly. Society as a whole is very unkind and unforgiving of incontinence problems. Don’t underplay the impact - especially when it comes to mental health. 

It took ages for anyone to make a connection between depression and incontinence - and when they did make it, professionals were incredibly unkind. Perhaps there are taboos that impact healthcare professionals too — it is delicate and difficult but maybe they need to really think about how they can create a safe enough space for patients to bring up massive hidden taboos like severe depression, fecal incontinence, or leaking during sex. 

Historically few people have spoken about this but at least now there are some voices speaking out. I really hope a proper conversation is beginning. You talk about solving for UI as being a feminist issue. Tell us more.

Oh man. We already live in a world where women’s health is treated like a curio. Their broken bodies are some inconvenient nightmare that we can’t talk about. That’s pure bullshit, but as you know, that doesn’t stop it still being true in so many places. Then incontinence just throws itself headlong into that mix. 

And because it is so similar to those other taboo things, like menstruation, menopause, and birth, women fall in to putting up and shutting up about leaking wee, because it is just another one in a long line of humiliating knicker issues. Incontinence is often poorly treated. And because of the taboo, people don’t always donate to the charities that treat it, or fund research which impacts innovation, and some have argued this means incontinence doesn’t get enough attention as a public policy issue. And this is a feminist problem because incontinence affects women the most. Because it is more prevalent in those with female anatomy, and also because women are far more likely to be carers for those with incontinence issues of all ages.

Also, the myths persist. UI is common, but it isn’t “normal”, meaning you don’t have to put up with it. I love that PMSL has come at a time when that has started to change. 

As you know, UI is shockingly common, and we want to normalize how we discuss it openly and honestly, so that women feel less alone, better informed, and more empowered to get help. That “help” can come in many forms. What advice do you have for women as they navigate their own UI journeys?

First (though this is for all women, leaking or not), give yourself a break. There is so much guilt to absorb and only so many hours in the day. But if you are incontinent, get help — whatever that looks like for you. I can’t say what will work for you as I haven’t seen down your pants, but there are lots of people who can help, and may well be able to cure you or improve your experience if you still leak. So many people stick to the lie that incontinence is just part of being a woman, the price we have to pay, and it isn’t. We don’t have to take it. And the earlier you get help, the better position you will be in as you age.

Also, you know, be kind to yourself, and don’t think for a second it is silly to feel ashamed. I am a loud hairy scary feminist and I was desolate. But just because the shame is real, it doesn’t mean you deserve it. We only get one body, and we all know that they are often shit at giving birth and sometimes they break, right? It happens. You aren’t disgusting. You aren’t broken. You aren’t “no good” at being feminine / sexy, or a grown-up / parent / person if your urethra waggles or your bottom isn’t top notch and you are feeling depressed about it. It’s sad, and you will be able to feel less bad with help — but don’t feel guilty about that. The mental impact is common but poorly discussed, even when people get drunk and confess that they need to wash their jeans twice if they go at it too hard on the dance floor. Be kind. Use products that help and make you feel better. Wear nice knickers. Find ways to exercise if you can. Oh and while I might be mouthing off about it, if that’s not your style, that’s fine too. Do what you can, just don’t absorb the shame around UI or bowel nonsense, if you can help it. It is a load of old bullshit and the world should do better.

We saw a brilliant conversation between you and Elaine Miller, Scottish Pelvic Floor Physiotherapist (and Comedian?!), and it got us excited about who else you have in your circle of inspiration. Or rather, who do you admire in the UI and/or women’s health space? Who should women have on their radars as we collectively look for truth, information, and inspiration?

Elaine’s comedy wins awards and she’s an incredible advocate; she made inroads in parliament asking for investment in education, prevention and physiotherapy, and managed to get onto the BBC in a vulva costume talking to mums about ‘fishing around in fannies for a living’. 

She set up Pelvic Roar with Emma Brockwell and Myra Robson. They are fearless fanny warriors. Myra’s behind the NHS approved Squeezy app and Emma hosts a podcast called At Your Cervix, and has a book coming out this year. They all do amazing work on Instagram to promote pelvic health. There are so many amazing physios and coaches on social media showing women how to exercise, improve their pelvic health, increase their chances of a healthy continent life.

Mars Lord is a doula who helped me with my second birth. She’s a campaigner for safer and better birth for black women and is an amazing forceful speaker and advocate who is also passionate about lifting women and inspiring them.

I’ve been really inspired by many younger women too — journalists like Sarah Graham or the hosts of The Naked Podcast, Jen and Cat, who delve into how we feel about our bodies. Going on that was a watershed moment — you are interviewed nude and it showed me that vulnerability can be really fierce. Helen Ledwick is another podcaster who was told that talking about incontinence and prolapse was too niche, but went on anyway and created Why Mums Don’t Jump, and has worked to bring a conversation about this into the mainstream.

Internationally, though we aren’t BFFs yet, I also think Chrissy Teigen and Clementine Ford have done a lot for franker conversations about women’s health.

Luce, thank you so much for sharing so generously with us. On behalf of Attn: Grace and our entire community tuning into our Normalize This series, thank you for helping shed light on and destigmatize not just urinary incontinence, but the honest experience that is women’s health and wellness as we age.