What do you do if you worry about bladder leaks when running, at the gym, your exercise class, or playing with your children ? Mums I meet in clinic tell me that they avoid events that require them to look “sporty”. They worry about a VPL if they wear the normal figure hugging gym kit. They don’t want to stand out in a baggy tracksuit trying to hide a pair of substantive knickers with a pad.
There are 6 discreet work-arounds that I recommend to my physiotherapy clients
…….But first you have to promise that you will not use these ideas to make you complacent about a leakage problem or as an excuse to avoid the issue of your bladder for another 3 months.
Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”.
Incontinence is a sign of pelvic floor (or bladder) dysfunction. Something that needs addressing and that can be greatly improved or completely resolved with the right exercise and help.
Incontinence is also a sign of lack of pelvic floor support so you need to consider how pelvic floor friendly your sport is and may need to modify or lower the impact activities to protect yourself from risk of prolapse which is movement of the internal organs downward.
So, without endorsing pads and knickers as a solution, rather as a temporary, pragmatic stop-gap while you sort your pelvic floor out:
6 Tips to manage bladder leaks When running or with your sport:
#1. A pad designed for bladder leakage not menstruation
Sanitary pads and incontinence pads are not made of the same thing. The right pads for the task are worth the little bit of extra cost. With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid.
Blood is thicker than water. The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid. As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.
If you suffer with stress incontinence (leakage when coughing, sneezing, running or similar) or urge incontinence (leaking before you can get to the toilet on time) it is much better to use a pad designed for the purpose of catching & containing liquid. Pads for bladder leakage are now using the technology developed for babies nappies, such as little gel beads that swell with liquid, and fabrics that can wick fluid away from the surface. This means pads can be much slimmer than they used to be, keep dampness away from your skin and have good odour control too.
Some of the main uk brands are Tena, Always, Poise and Boots Staydry range. Unfortunately, the organic brands (Natracare and Cottons) don’t have a specific incontinence product (yet). The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage. The most common indicator is a row of variously filled ‘drip’ or circle symbols to indicate the level of leakage you wish to contain.
In general pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact. This makes a good starting point if you are looking for something to keep you confident and safe against a small leak.
If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes then look at the pads in bags which will be more absorbent. However, if you are getting that wet when you play sport your priority should be to solve the bladder problem further. Talk to your physio about what they recommend.
2. MODERN waterproof knickers
Forget dated images of plastic pants, the modern waterproof knicker is a far more sophisticated item than you could have ever imagined.
Pretty Clever Pants (previously called Diary Doll Pants)
Two pairs for £16.99 from Highstreettv.com and £19.99 for 2 pairs of the new lace panel style.
Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers to work with a protective pad – to give an extra leak-proof layer. She originally thought of the concept for her teenage daughters coping with their periods but now they are marketed for periods, postnatal and pelvic floor. One of those products you wish you had thought of yourself.
They look exactly like the classic cotton “girls pants” we’ve all worn in our day, complete with little middle bow but have a discreet waterproof panel back and front. The panel feels like thicker cotton and importantly doesn’t rustle.
They are designed to be worn with a pad but should give you the confidence to keep a pad thinner and lighter or to reduce your anxiety that your pad might overfill.
I like that there is attention to detail on the packaging, a range of colours including grey marl, an.
Shopping can be a little confusing as they were called “Diary Doll” pants for a a while but changed their name when they started being distributed by High Street TV.
When I first published this post last year these weren’t stocked in the UK but I included their website as I liked their open-ness about the need for products to empower women to be active. They have a rather quirky style of presentation and some bold adverts.
Good news – now available in the UK through their website.
3. Knickers with inbuilt protection
Good for the environment. Great if you are usually fine but like to know you have back up. Possibly more discreet if you need a thicker pad than a liner. Strip off in the changing room and no worry to dispose of a pad. Disadvantage, once they are wet you need to change the whole knicker. A couple of clients who have tried these swear they will never wear pads again, certain that the pad itself was irritating their vulva and making their incontinence worse.
Protect Dry panties and maxie panties
£19.80 (VAT exemption available*) per pair or www.imedicare.co.uk
We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear. The gusset in these Protech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface. Like some of the best quality pads but fixed in place with sealed seams. Quite a lot of bottom coverage here so you might like a skort or skirt on top to avoid a VPL (see below).
4. A subtle cover-up with skorts and skirts
It started with school uniform but now we can all wear skorts! Skirts over shorts is now an on-trend look. Perfect for just hiding a good pair of pants with a pad and getting on with whatever you wanted to enjoy doing.
A quick google shopping search for running skirts and running shorts shows a range in price from £20-£80 offered by brands Decathalon, Salomon, Reebok and many others.
5. Add extra support to your core from the outside
EVB shorts, leggings and capris
Have a look at these if you feel just generally ‘unsupported’ at the moment.
Maybe not so much worried about leaks, but more that your entire lower half moves about too much and that exercise is straining and fatiguing your pelvic floor and core muscles.
Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength. Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer creating more lift and support for the pelvis, abdominals and pelvic floor.
6. Add extra support to your bladder from the inside
The options have recently expanded for devices that aim to give support to the bladder from inside the vagina. The three brands below increase in price, chiefly reflecting the number of times that they can be used:
Contrelle Activgard (single use only)
Contrelle Activgard is a flexible foam plastic which you soak (to prevent drying the vagina), fold
double and then insert with an applicator into the vagina (not dissimilar to a tampon, but positioned nearer to the opening) to create uplift and support for the neck of the bladder. They are disposable, single use only, but you can wear one up to 16 hours without removing it.
You can still wee or have your bowels open as normal.
They work by providing more support for the bladder neck. When you move fast (jogging, playing tennis) or there is an increase in abdominal pressure (coughing, sneezing, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage. However, if the muscles are weakened and untoned that support can be lost. Imagine a running hose pipe, lying on soft grass. When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely. However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or the foam Contrelle Activgard in position) when you press down on the hosepipe the water flow stops.
These work particularly well where you or your physiotherapist feel that the bladder has dropped a bit (prolapse of the anterior wall/cystocele). Below is an informative video tutorial by a physiotherapy colleague Jane Appleyard.
As these are a more expensive option than pads, they are most popular with mums who are generally not experiencing day to day stress incontinence but know when they are going to leak. For example if they do a longer run, or go to a Zumba class. They use them only once of twice a week. They can put one of these in before they go and not need to worry with other protection (or maybe just a pair of Pretty Clever Pants “just in case”).
Do buy a starter pack first, as like tampons they come in different sizes. You will be able to use all 3 but there will be one size that feels best for you. Thereafter they come in big boxes of 35 at a time!
Contiform Pessary (re-usable up to 30 times)
£79.99 starter pack of 3, or £52.99 for an individual size from www.stressnomore.co.uk or available on NHS prescription from your GP [code ]
The principle of the Contiform and its position in the vagina is the same as the Contrelle Activgard but these are re-usable.
The Contiform Pessary looks like a hollow tampon. The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall. They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee up to 30 times, longer if not warn all day.
You can buy online or they are now available on NHS prescription. You would need to tell your GP about your symptoms, and ask him to prescribe a starter pack for you. While you are there ask for a referral to physiotherapy too if you haven’t already got your own pelvic floor coach.
URESTA (lasts a year)
And remember that promise….
Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”. It is a sign of pelvic floor (or bladder) dysfunction. Something that needs assessing and addressing. Commit to doing something about your pelvic floor muscles. Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment, support and advice. You can be much better than you are right now. #beyouroptiMUM #pantsnotpads
What are your tried and tested tips? Please share your experiences with other mums in our comments section below. Your story will inspire others.