Mish was having incontinence episodes at the gym. She was advised to stop exercising.

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As the mum of two young kids in her mid-30s, keeping active and teaching fitness classes was critical to Mish Wright’s mental and physical health. It was also the trigger for increasing episodes of incontinence.

Feeling self-conscious about teaching on stage with her crotch at eye-level, Wright began wearing black to mask signs of leakage and cut back on fluids before class. What started as the occasional bladder leak while she was working out soon became something she had to plan her life around.

Mish Wright sought more effective treatment for incontinence when the initial advice she received was unhelpful.

“I had to think about what I was going to wear, what I was doing, how much I would drink – it was definitely impacting my life,” Wright, now 55, says.

When Wright sought help, she was initially told her issues were a result of her exercise routine, and if she didn’t stop, she would likely require surgery for a prolapse.

“That was both unhelpful and untrue,” Wright says. “Surgery would not be the recommended first-line support for a prolapse, and it was very unhelpful for me to be told I could not exercise the way I wanted.”

She resolved to learn as much as she could about the pelvic floor and how she could better manage her bladder health.

Why women experience incontinence

Not many Australians would readily admit they struggle with incontinence – defined as involuntary leakage from your bladder or bowel – yet it’s a problem for more than seven million people nationwide, according to a report by Deloitte Access Economics for Continence Health Australia.

“Many people feel embarrassed or believe they’re the only ones facing these challenges – but that’s far from the truth,” specialist pelvic health physiotherapist Libby Oldfield says.

Urinary incontinence is the most common form of the condition, affecting around 10 per cent of men and up to 38 per cent of women.

Oldfield says the female anatomy makes women more susceptible to incontinence, and physical changes during pregnancy can stretch and weaken the pelvic floor – regardless of whether a woman gives birth vaginally or via caesarean.

“Being female and being pregnant for the first time are the two biggest risk factors for pelvic floor and continence problems,” she says.

Perimenopause and menopause are further pressure points.

“During this time, the body produces less oestrogen, a hormone that helps support the strength and function of pelvic floor muscles,” Oldfield explains. “As oestrogen levels decline, these muscles can weaken, leading to bladder and bowel control issues.”

And, Oldfield stresses, it’s not something only older people face.

“Over half of women with urinary incontinence issues are under 50,” she says.

For some women, incontinence is not tied to motherhood or menopause. Exercise load, constipation and lifestyle factors can all affect continence health.

For Anna Powell, 31, who has lived with urinary incontinence since childhood, it is believed to have been exacerbated by a long and severe battle with anorexia.

“My bladder seems to be the same shape and size as most people’s, but I’m told it’s more about the contracting mechanisms which have been damaged by my eating disorder and other notional sensitivities due to autism,” Powell says.

Anna Powell, 31, has been living with, and managing, urinary incontinence since childhood.

You don’t have to live with it

While incontinence is common, Oldfield says it is not normal.

“Many people assume that bladder or bowel leakage is just a normal part of life after having a baby, but it’s not something you have to live with,” she says.

“With the right treatment, many people can significantly improve or even fully cure their incontinence.”

Oldfield recommends seeking help if you’re unable to control your bladder or bowel without leaks, going to the toilet more than six times a day or multiple times through the night, or you’re experiencing frequent urge and urgency to wee.

Treatment depends on the type of incontinence, but first-line options include pelvic floor exercises along with diet and lifestyle changes. Surgical intervention may be considered, but Oldfield says it’s generally not offered without first trialling a tailored lifestyle plan and supervised pelvic floor program.

“A good diet is key to good bowel health. We should all be able to poo easily, without straining, and regularly – which we do if we eat well and drink enough water,” Oldfield says.

Lifestyle tweaks may also be needed, including the type and amount of exercise you do and maintaining a healthy weight.

When done properly, pelvic floor exercises can be one of the most effective ways to manage urinary incontinence – something Wright discovered firsthand and now teaches through industry fitness courses, workshops and seminars.

Pelvic floor exercises can relieve the symptoms of incontinence.

“The pelvic floor is a muscle, like any other muscle in the body – it can be trained, it can be lazy, and it can be tight,” she says.

Understanding the cause of your incontinence is key to tailoring an appropriate muscle rehabilitation program, Wright says. She is now a passionate advocate for continence health and its impact on overall wellbeing.

“A weak pelvic floor won’t kill you, but inactivity can,” she says. “Exercise is not just about physical health, it’s [also about] mental health – and women can be robbed of it if they’ve had a pelvic floor injury and feel they can no longer exercise because of incontinence.

“But achieving a healthy, fully functioning pelvic floor is not that difficult if you get the right help.”

Wright continues to lead a full and active lifestyle free of incontinence episodes and prolapse.

For Powell, the road to a life without incontinence is less clear, and she isn’t hopeful. But she would like there to be more understanding of the issue.

“I think there needs to be more social awareness,” she says. “People talk about periods – and rightly so – but incontinence affects people of all ages and genders and still feels incredibly taboo.

“I’d love for it to be de-stigmatised and treated like any other biological condition.”

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