As a presenter on ITV’s Loose Women, no topic is off-limits for Nadia Sawalha.
The daytime TV show is famous for the full and frank exchanges and confessions of its panellists on everything from divorce to bullying and boob jobs.
‘I’m a professional oversharer: I share absolutely everything,’ says Nadia, 54, who lives in London with her husband, Mark Adderley, 47, a television producer and director, and their two daughters, Maddie, 16, and 11-year-old Kiki-Bee.
‘However, when I agreed to be an ambassador for an incontinence awareness campaign called Let’s Pee Honest, I did have to think about it for a minute, as there’s still a taboo about talking about bladder problems.
Did you know? Like one in three UK women, and one in ten men, Nadia Sawalha suffers bladder weakness – but is using her experience to spread awareness of the condition
‘When I decided to be open about my own problems, there was a little bit of me that was saying: “When anyone sees me now, are they just going to think that’s the woman who wet herself?” ’
She adds: ‘Like most women, when I’m with my female friends, we’ll go as far as saying: “Don’t make me laugh or I’ll wet myself,” but what we’re not good at is taking that conversation a stage further and saying: “Well, yes, it can be funny when we’re with all our friends, but, for a lot of women, it can be incredibly embarrassing and isolating.”
‘Some people are so bad that they won’t go out until they know where all the loos are, as they are so worried about wetting themselves — it’s so sad.’
Like one in three women in the UK, and one in ten men, Nadia suffers from bladder weakness — which causes involuntary leaks. In Nadia’s case, she experienced stress incontinence due to a weak pelvic floor, a sling of muscles inside the pelvis that supports the bladder and which is often damaged by the strain of carrying a baby.
Another common type of incontinence is urge incontinence, where there is a sudden, intense need to pass urine, with the person sometimes failing to make it to the loo in time. This is often caused by a bladder infection, diabetes or neurological problems such as multiple sclerosis.
Some people suffer from a mixture of both types.
Nadia, whose symptoms started after her youngest daughter was born, admits she’s had her fair share of embarrassing accidents over the past decade.
‘One time, about three years ago, I was sitting in a hospital corridor with my daughter, waiting for an appointment. Something made me laugh and I felt a leak and thought: “How the hell do I get up from here?”
‘I was sitting on one of those grey NHS plastic chairs and I was so mortified. I had to get up and go in for the appointment and all those people who had been looking at me were still there when I came back.’
A survey carried out in general practice in Leicestershire found it takes women an average of around ten years to seek medical help for incontinence, either because they are too embarrassed to discuss it with a doctor, or they simply don’t know that their bladder problems are fixable.
Update: Nadia tried self-help measures, such as weight loss and Pilates, to strengthen her pelvic floor, but she has been struggling on and off ever since
Many just accept it and wear incontinence pads, without ever addressing the underlying cause.
‘Childbirth, periods of weight gain and menopause are all times when stress incontinence can become a problem, due to hormonal changes and bearing extra weight, as well as straining due to constipation,’ says Sudhanshu Chitale, a consultant urological surgeon at Whittington Health NHS Trust and the private Princess Grace Hospital, both in London.
‘Men often suffer in silence with incontinence, too — especially after prostate surgery. Too many people accept it as a way of life and don’t get help.’
For women, potential solutions include muscle-strengthening pelvic floor exercises (guided by a physiotherapist) and vaginal weights (progressively heavier smooth cones equipped with a string or wire, which, when inserted into the vagina, like a tampon, are held in place by contracting the pelvic floor muscles), as well as lifestyle changes such as weight loss and improving diet in order to avoid constipation.
If these don’t work, patients can have injections of bulking agents or botulinum toxin, or surgery to lift up the bladder.
Vaginal mesh techniques, which, until recently, were widely used, are now unavailable due to safety concerns — an issue highlighted by Good Health.
Nadia tried self-help measures, such as weight loss and Pilates, to strengthen her pelvic floor, but she has been struggling on and off ever since. ‘I didn’t properly do the pelvic floor exercises you’re told to do after giving birth,’ she says. ‘I suppose it’s because I didn’t really believe they would make a difference.
‘I was stressed after Kiki-Bee was born — I was working a lot, doing a lot of travelling and ended up gaining 4 ½ st. My weight gain exacerbated my bladder problems — it was all that extra weight on my pelvic floor.
‘I did some Pilates, which really helped, cut down on coffee and lost the weight, but didn’t see a physiotherapist. People think: “Oh my God, why do people wait ten years to get help?” but it’s a problem that creeps up on you. Sometimes it improved, but it never really went away.’
Frank: Nadia, whose symptoms started after her youngest daughter was born, admits she’s had her fair share of embarrassing accidents over the past decade
When she hit the menopause at 49, Nadia’s symptoms came back with a vengeance. ‘One time, I saw something really funny happening in the wings while I was on set on TV and I burst out laughing. I was wearing gold trousers — and I couldn’t stop it.
‘People in the front row would have seen that, but I had to carry on until the break.’ Afterwards, she started to use pads in situations where she thought she might have an accident — such as when running.
Concerned, however, about the environmental impact of the pads, which take hundreds of years to decompose, Nadia looked for another solution.
It came in the form of special shorts (resembling cycling shorts) that send pain-free impulses to the muscles controlling the pelvic floor through a set of connective pads attached to the upper thigh and buttocks. Operated by a hand-held control, the pads contract and lift the pelvic floor muscles 180 times in just half-an-hour.
Nadia has worn the Innovo shorts for half-an-hour a day, five days a week, for eight weeks, and says she is now dry — in all situations. She explains that, while the motion involved is the same as with normal pelvic floor exercises, the contractions are ‘turbocharged’.
‘It’s fantastic,’ she adds. ‘I could burst out laughing right now and not have even a dribble. I could sneeze and I’m not going to have to cross my legs.’
The recommendation is that the shorts are initially worn for half-an-hour a day, five days a week, for 12 weeks, followed by once a week for maintenance.
A study of 19 women, published in the journal Neuromodulation in 2013 by researchers from the University of Dublin and North Georgia State University in the U.S., found that, after one week of wearing the shorts, 87.4 per cent of women asked to perform jumps and coughs reported a decrease in leakages. By two months of use, this had improved to 97.7 per cent.
In another trial across 12 U.S. hospitals of 180 women with stress incontinence, half were treated with Innovo shorts and the rest with an internal vaginal probe that was known to work.
Results suggested 87.2 per cent of Innovo users reported being dry or nearly dry after three months of use — similar to the 86.8 per cent rate with the probe.
Mr Chitale said that, while the results were impressive, ‘I’d say these shorts should form only part of a multi-pronged approach — if you’re overweight, for instance, and suffering stress incontinence, you still need to lose weight; and if you suffer from constipation, you need to change your diet to avoid straining. Both will take pressure off your pelvic floor.’
He also stresses that the shorts aren’t a fix-all, adding: ‘They won’t work for urge incontinence [which has different causes and is treated with drugs], and I’d recommend women check their incontinence is not caused by a vaginal prolapse [where pelvic organs such as the uterus or bladder drop down into the vagina] before they use this gadget, as they may need surgery.’
Sammy Margo, a physiotherapist based in North London, says the Innovo shorts, which are not available on the NHS and cost £249 a pair, could help improve the area surrounding the pelvic floor.
However, she adds, ‘they may not be as effective at isolating and targeting the pelvic floor muscles because these muscles are located inside and so are harder to reach’.
Nadia is a paid ambassador for Innovo’s Let’s Pee Honest bladder weakness campaign.