The Dr Louise Newson Podcast - 031 - Pelvic Floor Health - Jane Simpson & Dr Louise Newson

Episode Date: January 21, 2020

This week, Dr Newson is joined by Jane Simpson, a continence nurse specialist who works from The London Clinic in Harley Street.  In this episode, Jane and Dr Newson discuss all aspects of pelvic floor health relating to the menopause, including stress incontinence, an overactive bladder (key in the door syndrome!), vaginal dryness/atrophy, pelvic organ prolapse, constipation and the bowels and last but not least the pelvic floor and how menopause can affect our sex lives.  You can find Jane at www.thepelvicfloorbible.com and on Instagram @jane_thepelvicfloorbible. Jane's Three Take Home Tips for pelvic Floor Health: Make sure you are exercising the correct muscles Once you're sure that you are, make sure you do it regularly If you are unsure or think there could be a problem, then please seek help!  

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today I'm really delighted to have Jane Simpson with me, who is a nurse who specialises in the pelvic floor, and she's also an author of a best-selling book, which we're going to talk about in a bit. So welcome, Jane.

Thank you, Louise. it's very nice to be doing this podcast with you today. No, it's great. So we first, I can't actually remember when we first met. I think we probably met like most of my relationships seem to be now through social media or the media. And as you know, I do a lot of menopause work. And people don't think that the pelvic floor is associated with the menopause.

So we're going to explore that a little bit in this podcast. But before we get right in there talking about pelvic floor, could you just explain a bit about your background and what you're going to do you? you do and where you work? So I trained as a nurse, Attenbrook's Hospital in Cambridge, and I actually then went on to be a district nursing sister, which is where my kind of love of thing to do with the pelvic floor at that time, really incontinence in the frail in the old, started and I realised there must be something better than what was available at the time for them, which was sort of one pad fits all, that was the only thing you could do to treat people.

So I then became a continent's nurse specialist. One of the first really, there wasn't, nurse specialist was in its beginnings when I became a nurse specialist. And that's wonderful. It's wonderful now that that's totally changed and there's lots of nurse specialists in lots of different areas. I then worked in the NHS and I then moved into private practice where I've been at London Clinic for the last 25 years and loving every minute of it. And 18 months ago, somebody said to me, you've got to write a book. And so here I am talking to you. And my book is the pelvic floor Bible. And that's published by Penguin, isn't it? It's published by Penguin. It came out at the end of May this year. And as you said, it has been a bestselling book for a lot of that time,

which is fantastic. And it's about spreading the word to women who, you know, think there's nothing that can be done for their pelvic floor problems. Yeah. And I mean, I don't know about you, but I read lots of different figures about how many women are affected with symptoms related to bladder problems, so urinary incontinence, or even just having. to rush to the toilets because they haven't got the same capacity as they used to have. What is your take on how many women are effective? I think it's a much bigger problem than the statistics tell us. And if you actually want to look at raw data, you'll find that between 25 and 40% of women suffer from stress incontinence and stress incontinence happens when you cough, laugh, sneeze. And I'm sure

lots of people listening to our podcast can relate to that. There are other forms of incontinence that's key in the door, urgency, which equally, awful. And I think that it's a much, much higher numbers. If you went and asked 10 of your friends, how many of them have got an issue, whether it's a degree of prolapse, constipation, stress incontinence, you can't get to the loo in time, even if it's just frequency of going to the loo, I'm sure we'd find it's a much higher number than between 25 and 40% of women. I think you're right. And I think incontinence is quite a horrid word, really. And I think women feel if you're incontinent, then you have to wear a big pad or you're emptying your whole

bladder, but even just a few dribbles when you cough is still classed as incontinence, isn't it? It is. And I think that you're right, absolutely right. Nobody wants to class themselves as incontinent. The reason we must do something about it is that most of the time, particularly if it is just a few leaks when you cough and sneeze, it's very curable. And nobody should put up with it. Nobody, but nobody should put up with that. It's a very curable problem. And I think that's so important, isn't it? I think more and more, the work that I do is about preventative medicine, because we know how strain the NHS is, the more that we can look after ourselves. So hopefully the less will drain the NHS going forwards. But actually, when people have a few symptoms, it's

often easier to treat than when they're more severe in any aspect of medicine. But I think certainly when you're looking at pelvic floor dysfunction or incontinence, if women get help early, then they're more likely to have good results, aren't they? That's certainly true. And if you look at the French system where when you've had a baby in France, you're given 10 sessions of intensive pelvic floor physiotherapy in the form of electrical stimulation, pelvic floor exercises, biofeedback, and women will not tolerate or put up with it.

And occasionally I have a French patient who comes to see me postnacely. And they're like, well, I'm here with my prescription because, you know, this is normal. So then they can't understand why it's been difficult to find someone like me to treat them. And if we dealt with it immediately after we had a baby, of course it's better when we've still got all our estrogen, when we've still got all our hormones. And if you, you know, wait until the menopause, it's obviously harder. And obviously your muscles are worse because you might have had more babies by then. And also, I mean, I've got, as you know, three daughters and the older two are, well, 17 and 15. and they've got friends who can't even go on our trampoline in our garden because they say,

well, no, it's, and so should we be thinking about doing pelvic floor exercises at a lot younger age, do you think? We should. I think it's a slightly difficult subject with children. There is an area of incontinence that happens with children called giggling incontinence. This is not the trampolining thing. Giggling incontes, we really don't quite understand, but we think it's related to overactive bladder, i.e. your bladder's a bit unstable and when you giggle it has a squeeze before you're near the loo.

But, you know, a lot of us are doing a lot more exercise a lot younger and a lot longer. And we're living longer. So we can do all this high impact exercise. My mother never went to the gym and ran on a treadmill, you know, but we're all doing it. And your children and their friends and, you know, teenagers are up to sort of 30. the penguin team who helped me with my book, they're all really interested in it because they hadn't really heard about it. You have a little issue that you don't want children to end up with two tight pelvic floor muscles. But in general, I think it's better to be doing your pelvic floor exercises, whatever age you are. We're always in a grey zone with children talking about that part

of the body. Yeah, but certainly when women are in their early 20s, really thinking about, so we're both talking about pelvic floor, but what is the pelvic floor? It sounds a bit weird, a floor in a person. Some people think it's just a little muscle that holds in the wee, but actually it's not. Can you just explain what the pelvic floor is? Yes, of course. If you think about your pelvic floor as the bottom part of your core, and we're all learning about our cores more now doing our Pilates and yoga lessons, and if you think about your tailbone at the back and your pubic bone at the front, which is the hard bone that you can feel underneath your pubic hair. And you think about a hammer sprung between two trees.

Your pelvic floor goes right from your tailbone, right to the front of you, and forms the bottom of the core. Coming through it is your bladder, the urethra, which is the opening to the bladder, the vagina, and as well, your anus. So if you suffer with constipation, that can really affect the pelvic floor quite badly. And at the front, you've got your lower abdominals, and at the back, your lower back muscles. And we need all of those together

to keep us stable, upright, help with movement and keep us continent of urine and feces. So we don't want to be farting in public. So making sure your pelvic floor stays strong is a good thing. And the pelvic floor is wrapped around the anus tightly and the vagina. So we're kept in a state of continence unless something happens like we have a baby

and we sneeze and be a leak bit. So it's a huge area then, isn't it, in our bodies with lots of muscles. And then when we talk about pelvic floor exercises, people often don't know what they are or they're doing them wrong. And I think a lot of people avoid doing them because there's a bit of uncertainty as to what they are. So are you able to just talk through how to do them? I think that's the point. And I think with anything to do the pelvic floor, the pelvic floor exercises, you need to be sure you're using the right muscles, because if you're not, there is no point. And I sometimes see patients who tell me they've been doing the exercises for months.

And then when I examine them, they're actually just using completely the wrong muscles. There's some good tips to find your muscles and use the right ones. If you sit on a hard chair, I actually think sitting on the arm of a chair is quite good. And you can try squeezing your anal sphincter, scooting a bottom muscle. Imagine you're about to pass wind or fart and you had to try to stop yourself. So it's a sort of pulling in, pulling up and holding. So it's a squeeze, lift and hold. And at the same time, imagine the muscles around the vagina. So you can either think of, imagine you had a Tampax in there and you were trying to pull it out and you were doing a tug of war with it. Right. That's very

good description. Yeah. It's quite descriptive, isn't it, ladies? Sorry. Imagine if you had a you're trying to stop peeing midstream. Now, this was something that in the past, that's what the doctor told you, make sure every time you have a pee, stop and start a few times. And we don't recommend that now. It's not good for your bladder.

But it's a very good way of working out, A, if you can do it, which shows your muscles are working or they're not, and B, whether or not you're using the right muscle. So I think trying to stop the flow midstream, imagine you were pulling on a tampon string and doing a tug of war, and you could imagine you're squeezing your partner's penis when you're having sex.

That's another way. And sitting on the arms of chairs, though you were pulling the vaginal muscles and the anal sphincter away from the chair that you're sitting on and squeeze and lift and hold and try to start with five seconds of holding. Because I think, you know, people think, well, I'll hold on for 20 seconds. Pelvic floor tires very easily. and I think if you are, you know, starting out, you should hold for five seconds, then rest for five seconds and repeat five times.

And you're aimed to hold on for 10 seconds, repeating 10 times, and actually resting at 10 in between. So you'd go for 5, 5, 5, 5, 5, and it's easy then, and build up to 10 eventually. Never hold on for longer than 10 seconds. It's enough. Your pelvic floors, you know, it needs you and it'll be nice to you you look after it well. So it's building it into our routines, isn't it? A lot of women,

although I often say to women think about when you're cleaning your teeth or if you'd want to do it, sitting down, you know, a time, a fixed time, because everyone thinks it's a bit of a faff and then they don't know what to do. So just to make it fast for your routine is really important, isn't it? It is. And even if you do it a couple of times a day and whether that's the times when you're cleaning your teeth or when your alarm goes off in the morning, you know, everyone says do it at the bus stop, but actually if your pelvic floors, week, it's quite hard to do it standing up. So, you know, sitting, so if you're driving to work or taking the children to school, you can do it while you're at a red traffic light. It's just the regularity of it. And so if you

always, every morning sit and have a piece of toast, you know, do it then just find something that you can associate it to. And if you really can't do it, there's lots of gadgets out there, which I'm kind of a fan of. Some of them you would need because sometimes a pelvic floor really isn't working very well. And in that case, you really must go and seek the help

of a women's health physiotherapist or a nurse specialist because you don't want to be doing exercises without using the right muscles. So one way of doing it is to use vaginal weights. They're like little tampons that you put in the vagina and they vary so you go up through light ones up to heavy.

ones. They're quite good if you've got a very small issue. They're no good if you've got a prolapse. There's something called the LV trainer, which is a very modern piece of kit, which uses an app on your phone. It's a very expensive piece of kit. If you've spent a lot of money on it, you might be more inclined to use it. There's a very nice little app called Squeezy. There's quite a few apps, but I like the Squeezy one. It's been done by some NHS physios, and it's a really good little app, and I think it's two pound something, so it's very affordable. for everyone. Or if your muscles really aren't working, you possibly need to do some electrical stimulation for the muscles and then you need to go and seek help and find out what the right thing

for you is. So lots of options, which is really good. I speak to a lot of, even quite few of my friends who do have some problems. They don't think it's that bad because they say it's only, I just have to, I always know where the toilet is. As long as I know where the toilet is, then that's fine. but they do end up rushing and they've got less capacity than they used to sometimes leaking like you say when they cough and sneeze, but they say, oh, I've always done my pelvic floor exercises. But what would you say to these women? Should they be going to see a doctor or should they be seeing a nurse like you with a special interest in a pelvic floor? What should they be doing? Because I speak to a lot of them and they end up going to see

sometimes a urologist or a gynecologist and they go down an operation route, I think, almost a bit too quickly. What would you recommend for women who want sure? where to go? I mean, I think definitely, I mean, you could go to the GP and have a urine test just to check you haven't got to urine retract infection. That's a very simple option. And I think, you know, less is more. So we should definitely start by seeing a woman's health physiotherapist or a nurse specialist. They're very skilled at working out whether you've got a minor prolapse, whether you've got a lack of vaginal estrogen, whether or not you've got no sensation in the vagina at all from having two four-set deliveries. They will be able to tell you categorically,

you know, what you need to do to make yourself better. And, you know, sometimes it is a surgical solution, but not often. I'm saying very much patience to surgery. And I think that's very important because certainly having worked as a GP, it's very hard. You know, you've only got 10 minutes. And it's often actually the last thing someone says, you'll talk about something else. And then they say, oh, by the way, or you go and examine them. And you say, why are you wearing a pad? And they said, oh, no, I've won it for the last 15 years. And you say, gosh, what's going on? But then we're often pressurized for time. So I think pelvic floor physios and nurses have a special interest often have a bit more time, don't they, to take a really thorough history and do a proper targeted

examination. And that's actually why I wrote the book, Louise, because I just felt that there was all these ladies out there. And it's extraordinary because I'm having ladies, you know, email me and things and saying, oh, my God, you know, I'd no idea that I had this problem. I've read your book. It's me. And, you know, that is very heartening. And so if you're a bit shy to go and seek help, then, you know, that's available. But, you know, if you're really not sure what to do at all, you ought to go and see a women's health professional because they will be able to help you. And, you know, all my appointment times are 45 minutes long.

So unlike GPs, who really are very pressed for time. And you'll find that if you go to see a women's health specialist, you will get a lot more time and you will get to the root of your problem, I think, is the answer. So in the long term it's very time efficient. And I mean, we have talked a little bit about the menopause. And clearly, as you know, Jane, all I do is talk about the menopause. But we have estrogen receptors in our pelvic floor muscles, don't we? We also have them in areas of our bladder as well. And in our vagina.

So a lot of women have symptoms such as urinary symptoms, urinary frequency, vaginal dryness. And don't always relate them. to the menopause because sometimes they can occur early but sometimes they can occur later, can't they? So a woman might have had her flushes and sweats and sometimes they can last for many years and then they might improve and they think great, I've done the menopause and then suddenly they're finding it hard to sit down or they're finding they're going to the toilet more frequently. But they won't realise it's related to this low estrogen that occurs locally. It's extraordinary how,

I mean, I examine women all day every day. That's what I do. And It's extraordinary how many women I examine who have no idea that they have no estrogen in the vagina and that's really the root of their problem. And they've given up having sex, they're rushing to the loo with frequency and urgency. They've given up coffee, tea, alcohol. They've tried everything they can think on never thinking that it was actually a dry estrogen that was the cult. And often these women have been given lots of courses of antibiotics as well, which is totally, we know there's a problem with antibiotic resistance and we shouldn't be giving antibiotics inappropriately.

So it's really important and as you know I talk a lot about giving HRT for women who are in the menopause but women who have gone through the menopause sometimes don't need or want HRT but they can have local estrogen like you said earlier, can't they? So estrogen as a vaginal tablet or a ring or even cream can make a huge difference, can't it, to people? It really can and I recommend, you know,

All of those three depends on the person, really, and how they are, which one they would prefer to do. Some people like putting the estring because they can just leave it up there for three months and not worry. And I have such positive results with it. It really is something that I bang on about all the time because partly I see lots of menopausal women who have these issues, who have got no vaginal estrogen, it breaks my heart. And they'll say, well, I haven't had sex for five years and, you know, it's painful and I'm weeing all the time. And I'm so happy to be able to give people back their sex lives and also relieve the symptoms of key in the door urgency or frequency of urination. It's such a simple thing to do. And as you say, it's not like taking systemic HRT at all.

No, and I think it's very important that women realise that because when you look at the patient information insert with badgyfem or the estring or one of those, it groups it as a hormone. So it will talk about risk of breast cancer, risk of heart disease. And it's not true because we know from studies that women who have local, as in vaginal estrogen, the amount that's absorbed is similar to placebo. So they don't get a systemic absorption. So even women that have had breast cancer in the past can still usually have a type of vaginal estrogen. And that's really important, isn't it?

It's very important. And I've had patients who have been so delighted and they've got their. their vagina and then sort of six weeks later they've come back to see me for review and I've examined them and said well it doesn't really look much different really and they said well I haven't used it I read the leaflet yes oh no yes that's so wrong really that the leafly is so terrifying when you know as you say it's not the same at all as no well I am behind the scenes doing some work with the MHRA to try and change it because I think it's completely wrong You'll have one happy person in me for that, really.

And so it's very important that I strongly feel that women need to have evidence-based and unbiased information. And we have really good evidence how safe vaginal estrogen is. And in fact, in Finland, you can buy it over the counter. But some women need slightly more. So some people need to use a slight higher doses of vagifem or they need to use it slightly more frequently. Some women, we often give a non-hormonal vaginal moisturiser as well, which can help. But some women use systemic HRT as well, even with using local estrogen. And as you know, it's very safe to use both together.

So there's lots of options for women, aren't there? There are in another area, which I think is helped by local HRT, is prolapse. And there are lots and lots of women out there, like a ticking time bomb. We know that 50% of women, and this is just the ones we know about, who are over 50, have a grade 1 prolapse or a degree of prolapse. and I think it's something that is a very underdiagnosed problem. And if a grade one prolapse becomes a grade three prolapse, we have big difficulty in fixing it.

So if we can get everybody doing pelvic floor rehabilitation, would prevent huge amounts of it happening. So just to explain the prolapses when the womb, the uterus, descends, doesn't it? And there are different grades depending on how far it descends. Or the walls of vagina as well. Yeah. So there's a front wall, which is next to the bladder and the back wall next to the bowel.

And there are a lot of, we're talking about urinary incontinence, but there are a lot of people that have fecal incontinence as well, and the two can go together, can't they? They absolutely can. And fecal incontinence is, it's a deal breaker. You know, if you've got a bit of urinary incontinence, you wear a pad, you don't like it, but it's somehow fecal incontinency is significantly more distressing, understandably.

and so trying to make sure your pelvic floor is as strong as it can be is of vital importance. I have to say fecal incontinence is not a big issue. I don't see huge amounts of it at all. Urinary incontinence is a much, much bigger issue, but you have got fecal incontinence. And for anyone who's listening who does have fecal urgency or fecal incontinence, there's a wonderful organisation called the Masick Foundation, which is mothers with anal sphincter injury. and they are really wonderful and you can look them up online.

And I think just knowing that other people are having similar issues is hugely beneficial to women. Yeah. It's really important. I mean, as you know, I've done a lot of work trying to break this taboo of the menopause, which affects all women. But I think urinary incontinence is even more of a taboo. People don't realise how common it is.

And it's so important that women who are listening know that seeing healthcare professionals, actually we're not embarrassed about anything. are we we we it doesn't matter not at all just so grateful and happy that you come you know i have you know my box of tissues for ladies who just burst into tears and say oh my god i'm so glad i'm here because i've been living with this problem for so long and didn't know what to do or where to turn and you know we've got to move on from that somehow and hopefully who and i are raising awareness of all things pelvic floor and all things through the menopause and that is such a good thing Well, it's so important so women can get help earlier. And your book is so important to try and empower women, but also men, because I know we've talked about women, but men can have some, and I know you do see men in your clinic as well, don't you?

I do. I read one whole chapter on men with a slight sort of hesitancy, I think, on the part of Penguin, who were like, oh, men, did they? Because the girls are young. And I said, yes, of course, men have pelvic floor dysfunction. and quite actually interesting, quite a lot of my patients who've bought the book have come and told me that they've found their husbands having a sneaky peek because it affects men, the key in the door syndrome affects them, it can affect their sex life, and certainly if they've had prostate surgery, that's often when I see men who've had radical prostate surgery for prostate cancer and they can have dressing continents afterwards.

So it can happen to both men and women. So it's vitally important that women are, given the right information. And although we're quite a digital age, I think people still like to own books, don't they? And there's something very different about touching and feeling and flicking through. And the way that you've got the lovely, the different chapters, it's very easy to read. You can delve in and out, can't you? You don't have to sit and read the whole lot all at once? And some people, I'm sure, just pick out the salient points. But hopefully daughters will read it. And friends and relatives of people who own the book. So I think getting the message out,

so women don't have to suffer is so important. A vitally important. Whether it's, you know, for urinary incontinence, prolapse, you know, key in the door syndrome, whether you've got constipation, whatever your problem is, even if it's your sex life is painful, it's very, very fixable,

and we should not suffer in silence anymore. We have to break the taboo and make it a much more talked about thing. Yeah, absolutely. I think that's really good. And a lot of the work that we're doing, you're doing, everyone's doing, is really going to help future generations, I hope. That would be a great legacy, Louise, wouldn't it?

Wouldn't it? Definitely. So we've covered a lot in quite a short space of time and I think I'm going to have to get you to come and do another podcast actually because there's so much more that we need to talk about. It would be my pleasure. So before we finish, Jane, can I have three top tips that you would give for women who are suffering whatever, whether it's a small amount or having a bigger impact on their lives? What are three things that you would suggest for them to do to help? Well, to make sure they're using the right muscles, to make sure you do it often enough. And if you absolutely aren't sure what you're doing,

please seek help. Absolutely. Really important. And I think certainly like you said before, there's so many more women who are exercising and I see a lot of people, a lot of patients who are running, their joggers or high impact exercise. And they think that will do their pelvic floor at the same time and it doesn't. It has to be treated differently. It can make it worse. So, so, but if you're not sure, ask, I think that's the most important thing. Absolutely. Yes. If you're not sure, please seek help. I mean, actually, just on that note, there was a great study not long ago showing 80% of female trampolinesists leaked when they sneezed. Now, you know, they're all going to live to ripe old ages and they'll be running and jogging and having babies

later than 35, which is also hard on the pelvic floor. So, you know, you're all going to live to ripe old ages. And they'll be running and jogging, If you think about all of those things, please do your pelvic floor exercises regularly because your pelvic floor loves you and it needs you and you need to look after it. What a great way to end a podcast. Thanks very much, Jane. Thank you. My great pleasure. For more information about the menopause, please visit our website www.com.