Let's Talk Incontinence

We need to talk about the fact that incontinence is more common than continence for women over a certain age.  That roughly 50% of adult American women have some degree of urinary incontinence ranging from "mild or temporary leakage" to complete wetting that's a permanent/recurring problem.  And those numbers go up once you hit 65:  At that age, a whopping SEVENTY-FIVE percent of women experience urinary incontinence.  (And around 2-15% of men ages 15-64 struggle with incontinence while up to 15% of men over 60 not in an assisted living facility are affected).  The UK's numbers aren't much better--research shows that 9% of UK women have wetting accidents daily and 34% have them at least weekly, which is more than the average potty training toddler.  There are 6 distinct types of incontinence:  stress, urge (aka "overactive bladder"), mixed, overflow, functional & reflex. 

Incontinent women outnumber fully continent women in the U.S.

I could sit here and list the numerous causes & treatments of incontinence all day, but there are plenty of websites that do that already.  If you're experiencing incontinence & it's negatively affecting your quality of life, don't hesitate to bring it up to your doctor.  You might be referred to a pelvic floor therapist who can help with exercises to strengthen or otherwise tone your pelvic floor and surrounding muscles (do not just do "kegels" without an evaluation first as this can occasionally worsen the problem!).  Likewise, medications & lifestyle changes may help bring the problem under control.

What I'd like to talk about is the stigma and negative social attitude toward incontinence & wetting--the way these female hygiene product companies make us feel dirty & smelly all our lives, then proclaim "Peeing in your pants IS NOT OK" which only serves to further stigmatize & shame those who suffer from this issue.  Which is most of us.  Would it be acceptable to say "Being a depressed sack of crap when your testosterone levels plummet after middle age is NOT NORMAL" or "Relying on a little blue pill to get it up is NOT OK?"  In fact, is there any other time in the health or mental health world where it's acceptable to use that kind of language?  

Calm down, miss.  Everybody pees. 

No, there is not.  And for good reason.  I get what they're trying to convey--that it's not "normal" in a medical sense; that it's not inevitable & can be treated--but that word ("normal") carries a double-meaning, and when you're talking about something that's already humiliating & comes with major social stigma, the harm done by using it is greater than the harm prevented.  If the goal is to prompt open dialogue & get people to seek help for something, telling them it's NOT NORMAL in all-caps is going to have the opposite effect.  So it'd be great if medical centers, adult diaper companies, pelvic floor therapists & everyone else would S T O P  S A Y I N G  T H A T. 

You are not alone.  💛

Secondly, I understand the difference between "common" and "unavoidable in an otherwise healthy person" but, IS there really a difference in this case?  That is to say, how many cases of incontinence are entirely preventable or curable when such a huge majority of women experience this problem?  Some estimates say 200 million people worldwide and 1 in FOUR women over age 18 experience incontinence occasionally, so forgive me for not believing it's all that preventable or curable for the average woman.  That's not to say certain measures can't reduce the incidence or severity of accidents but I'm loathe to believe you can completely prevent or cure the condition, especially in that many women.  Pelvic floor therapists are good but they're not miracle workers.  And if you can't entirely prevent or cure incontinence, that means it IS normal & telling sufferers otherwise is downright unethical and cruel.  

Lots of things are not desirable yet "normal" in old age:  presbyopia (farsightedness - 83-88% of people 45+), osteoarthritis (53.9% of people aged 75+), high blood pressure (80% aged 60+) & hearing loss (60% of people aged 71-80 years).  Could it be that urinary incontinence in women is just 'one of these things' and not something to feel shame & self-hatred about at all?  In other words, that is to say that urinary incontinence is perfectly NORMAL and OK.  There are things you can do to help treat it & lessen the impact of accidents on your life, but there is no reason to believe what you're experiencing is abnormal, gross, bad, weird or shameful.  It's not.  Urinary incontinence in women is more common than not.   Read. That. Again.
 


Toxic Solutions to Non-Issues: Misogynistic Marketing in Action

Throughout history, women have been made to feel like our bodily functions were dirty & disgusting by marketers & big corporations.   From advertising Lysol and Lysterine as a douche to "super absorbent" tampons that caused Toxic Shock Syndrome, the message is clear:  "if you don't buy the toxic crap we're selling, you'll never be the belle of the ball, your husband will reject you for someone younger & prettier (and better smelling) & you'll die an old, lonely spinster with only your cats to keep you company."

(Wow how awful.  Not).  

If 75% of U.S. women are incontinent, now is that not "the norm"?

Thus is the way of the corporate marketing machine:  make people feel inadequate & insecure so they'll buy stuff they don't need with money they don't have to impress people they don't even like.  A lot of our collective social phobias trickle down (pun intended) from these insidious marketing giants & I'd include our fear of public wetting in that.  The way people overreact to a little pee--something we ALL do every day, old & young, rich & poor, male, female, gay, straight & everything in between--is so out of proportion it doesn't even make sense.  The immature pointing & laughing when someone wets themselves, the melodramatic disgust reactions... You'd think someone just burned an American flag at a Springsteen concert by the way people behave.

I'll repeat myself for those in the cheap seats:  Urine is not a disease vector like feces or blood, and it comes from the same place as those "other" things (vaginal fluid, semen) you consider sacred/sexually arousing except, unlike those things IT'S NOT A DISEASE VECTOR.  Urine doesn't transmit HIV, Hepatitis, other STDs, fecal-oral diseases like norovirus/shigella/campylobacter or C. Diff.  The only real downside is the smell, and even that can be greatly decreased by staying hydrated.  So if you're severely icked out by pee it's an entirely conditioned response not grounded in evolution or medical reality.  Which is fine--we don't choose what grosses us out, but people don't choose incontinence either so a little kindness goes a long way.



Fighting the Stigma (Yes, You!)

So what can you, the everyday Joe/Jo do to fight the stigma associated with urinary accidents and incontinence?  Start by listening to those living with incontinence in a way that's neither judgmental nor sexually objectifying.  They're the experts on their reality.  Learn more online at sites like the National Association for Continence  and the International Continence Society, & consider donating to charities like the Simon Foundation for Continence. 

If you encounter someone "in the wild" caught in a desperate situation or who has wet themselves, don't stare or draw attention to it.  Behave as if it's not even happening.  Don't ignore THEM (unless they're giving clear signs that they want privacy like covering their face or crying) but ignore the accident.  Maintain a friendly but detached demeanor, offering help in the form of dry towels, directions to the nearest restroom or other kindnesses only if they ask.  Otherwise do not bring it up & continue on your way.  A good rule of thumb is:  No attention is good attention!

That's how you truly 'normalize' something--by behaving as if it's ALREADY normal.  Because in this case, it is.  We just aren't talking about it.

We've got to do better about treating people with dignity in this world.  Something that happens to so many people every day--a majority of women--cannot by definition be "abnormal" & thus shouldn't be shame-inducing  As the interviewee in this enlightening article puts it:  

" 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."

That interviewee is Luce Brett, author of "PMSL: Or How I Literally Pissed Myself Laughing & Survived the Last Taboo to Tell the Tale"

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Are you a woman or man living with incontinence?  Which "type" (stress, urge, etc) do you have, and how would you prefer people react if you were to have a very public accident?  What do you wish the general public knew about this extremely common condition?