Elaine Miller 

Why I wrote a comedy show about incontinence

As a physiotherapist, I know a third of women don’t have reliable body control. I wanted to raise awareness of this taboo subject at Edinburgh festival
  
  

Elaine Miller
‘My hope was the audience would leave knowing what a pelvic floor is and where to take theirs if they wanted to laugh, but not leak.’ Photograph: Elaine Miller

I’m a physiotherapist, and as a fresh-faced graduate, my ambition was to work in elite sports. I did it, too, thriving on team spirit, travel and free trainers.

Then I had three babies in four years, each blessed with a bigger head than the one before. A dramatic sneeze during a zumba class showed me (and everyone there) that my pelvic floor had been reduced to rubble. In that excruciating instant, I realised that what really mattered was not being able to jump a tiny bit farther, or run a bit faster than others, but, being able to jump and run without wet pants.

In committing myself to sorting out my own soggy nether regions my career took a sharp u-bend, headed away from sports and straight to the toilet.

Human bodies have many unsung heroes; organs or systems quietly providing function that, if we’re lucky, we get to take for granted. The pelvic floor is one of these – it holds our guts up, keeps our mess in, and contributes to our sexual response (a flexible, coordinated pelvic floor can gift great orgasms). There is a sex difference, a male pelvic floor is usually less active than the female – but overall, human pelvic anatomy is remarkably uniform in appearance and function.

The numbers are staggering – a third of women don’t have reliable body control. Fewer men are affected because the common risk factors are pregnancy, labour, prolapse and menopause. Often, men’s continence issues are related to their prostate gland, which can become a troublesome with age.

I get really excited about undercarriages because physio is such effective treatment. There is oodles of gold standard research showing that physiotherapy helps vaginal prolapse, bladder and bowel incontinence and sexual dysfunctions. That really matters because the surgical options can be complicated – see the mesh crisis for details.

It takes an average of seven years for a person to seek help. I had a patient tell me she’d been leaking since the birth of her baby. “OK, and, how old is he?” I asked. “He’s 37 now …” she answered. Many people believe that leaking is an inevitable consequence of ageing or parenthood, and even if they recognise they have a problem, they are reluctant to discuss their symptoms because of embarrassment.

Truth be told, that exasperates me – why do we put up with it when simple, cheap, effective treatment is available?

That’s a message worth evangelising about. The only place I knew where nothing was taboo was on a comedy stage, so, I wrote Gusset Grippers, a show about pelvic floors. My hope was the audience would leave knowing what a pelvic floor is and where to take theirs if they wanted to laugh, but not leak.

Making socially cohesive groups guffaw about awkward topics makes them talk, share experiences, gain empathy and, hopefully, encourage each other to seek help.

Gusset Grippers won the weirdest show of the fringe award, which is, apparently, a compliment. There’s a sing-along-a-clench-along, a game with themed prizes, a vulva and evidence-based information. That means the show counts as continuing professional development for healthcare professionals.

Anecdotally speaking, using humour as a health promotion tool works well. Proving that is tricky – the only established fact is that comedy is subjective, so, conducting a random controlled trial is fairly challenging. However, getting the public to comply with simple lifestyle changes and health behaviours has always been difficult, so, perhaps an irreverent approach is worth a shot?

Incontinence interferes with every single thing a person wants to do, and, helping someone to live a life unrestricted by their bodily functions is wonderfully satisfying, far more so than helping someone win a medal for being marginally faster than someone else. Being part of huge sports events was glamorous and fantastic, but, I am happiest on stage, at conference or in clinic proclaiming that that everyone deserves to have a decent pelvic floor.

People have a universal and visceral need to be clean and dignified. So, see you in clinic. You’re not alone, and you don’t need to put up with it.

Elaine Miller will be performing Gusset Grippers at Edinburgh festival. See here for tickets. She is also doing a one-off comedy/debate with Cabaret Of Dangerous Ideas where an expert proposes a dangerous idea and debates it with the audience. Her website is www.gussetgrippers.co.uk and she is @gussiegrips on Twitter

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