Elaine Miller (Gusset Grippers) - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence, prolapse, pelvic pain. Problems that affect millions of women, one in three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hi, everybody. Hope all is well. If this sounds a bit weird, it's because it's the Easter holiday, so we're on the road. So, of course, that means that the seven year old has chickenpox, poor lad, so he's suffering. But aside from that, all is well.

Thanks as ever, to everyone who's been sharing the podcast, shouting about the podcast. It honestly makes such a difference when you recommend it to friends or when you just drop a little note on a WhatsApp group, I notice it. It makes a big difference. I'm so grateful. And I also loved this week hearing from a woman who said that the podcast had given her the knowledge and confidence to push for a pessary appointment. This made me very happy. Good luck with that. I have mine this week too, finally. I'll tell you all about it in the next episode. Things you never thought you'd say on a podcast.

So, this week's guest is an absolute legend in the world of pelvic floors. She's one of the first people I called when I decided to start this. So it's ridiculous, actually, that it's taken me this long to get her on. She is, of course, Elaine Miller, aka Gusset Grippers, the fabulous comedian and Fellow, no less, of the Chartered Society of Physiotherapy.

Helen: So I wanted to start - we'll get through a few different bits - but I wanted to start by talking about your television appearances recently. So you were on the telly, you were all over the telly a few weeks ago, and the newspapers were saying that you put the entire nation off their Coco Pops, by talking about pelvic floors with Lorraine Kelly. What was going on there? How did that come about?

Elaine

I was doing a thing on social media, ‘Dry by Christmas’. So the evidence is that if women with stress incontinence do pelvic floor exercises three times a day for three months, about three quarters of them will get completely dry on their own. So, I've done it for a few years, but I'm not very good with social media, so it's always been a bit piecemeal. And I thought this year I'll put proper effort into it and see if I can get some data to show that this works: that using social media to remind women got engagement, because if I can demonstrate that, then I can hopefully get some funding to actually do it properly, next year. So, I had sent a press release out and I don't really know how, but somehow I got a phone call from ‘Woman's Hour’, and then ‘Steph's Packed Lunch’, and then the producer from ‘Lorraine’ got in touch because she'd heard me on ‘Woman's Hour’. So, yes, I'm practically a national treasure.

Helen

I bet you had a good laugh, did you? What was it like being in the studio, doing all of this?

Elaine

Yeah, it's really interesting because I'm quite nosy, and I quite like seeing how things go on behind the scenes. And I do enjoy being in a green room because you never know who else is going to turn up. That’s my favourite bit.

Helen

Did you meet ‘Wet Wet Wet’ ?

Elaine

Aye, but it wasn’t Marti Pellow. It was the new guy, and what's his name? Graham, the guitarist.

Helen

Oh, I don't know, poor old Graham.

Elaine

But there's politicians and things…Baroness Warsi was in that green room as well, and comedians. And that's interesting because then you've got them, you can talk at them, and say ‘this is what I think’.

Helen

Yeah, I just thought it was really interesting, just that idea that people were on social media saying that you'd put them off their Coco Pops, and that's obviously what the newspapers picked up on. And I was just like, why? Why are we so horrified about the idea of Lorraine Kelly doing a pelvic floor exercise?

Elaine

Yeah, it's interesting…the way… I quite liked it. So, if you're going to do comedy, the sort of ideal is you have quotes on your poster that say, “hilarious”, “really funny”, “brilliant person”, and then somebody calling you something really negative, because it's funny.

Helen

“Puts the nation off their Coco Pops!”

Elaine

Yeah! “Off putting” - The Daily Mirror. That's a great line to have in your promotion if you're going to do a comedy tour. But the Physio Network was really supportive. They were outraged and saying, “this is terrible because we must be able to talk about these things”. And I'm like, this is gold, because it's such an outrageous headline. Everybody that sees that is going to click on it, to find out what this awful woman has said at porridge time, and then they get the information. So, I think it was done deliberately. I think it's a journalist, that's their job, isn't it, to get click- through? So, I think that she knew what she was doing, and I'm going to get a tour T-shirt printed up with “Off putting” because it just thrills me…

Helen

You should totally utilise it. But I think that was taken from a social media post that someone put out there. And I know from when I used to work in radio, that if you did start to talk about this sort of stuff, you would get those messages. It's really horrible to people. And as someone who has pelvic floor problems, and hasn't been able to really talk about it in the past, I'm annoyed now that I have been horrified by myself. Like, why are we so…embarrassed about it

Elaine

Well, I think at the root of it, there’s just the very uncomfortable reality that the most derided person in society in the west is the ‘smelly old woman’. We're all frightened of her, and women are frightened of her, in case we become her. And that's why I think there's a lot of the fear and shame and stigma that surround these problems, that women don't want to acknowledge that they've got a problem because they think they're going to turn out like their granny, their great granny. And as far as the media goes, well, women are only really of value if they're young and hot. So ‘old lady problems’ just are a problem for the patriarchy. And I could go on about that.

Helen

Please do. I hear so often, oh, if this happened to men, it would have been sorted by now. I kind of believe that, but I also feel like… it's easy to say.

Elaine

It is easy to say, but I think that there is a root of truth in it. So, this year's Fringe Show that I did was looking in part at medical misogyny, and about why these problems exist. Because the uncomfortable truth is that we've known the solutions for stress incontinence, certainly for 40 years. And I get really angry, incandescent with anger, that if we had spoken to those women who were in their middle age in the 80s, when we found this amazing evidence - we'd always known it - but here's the actual definitive evidence, that if we teach women pelvic floor exercises, we'll be able to prevent problems in a percentage of them, a big percentage. And we didn't because, well, it's just a bit of pish, isn't it? It's not that big a deal. It's just a woman. It doesn't matter.

So those women are now in their eighties, and some of them will be having to move into residential care because of their incontinence, that may have been treatable over the course of 40 years. Maybe they had a birth injury and they were left with a prolapse that could have been managed over 40 years. Or maybe she has been left with a need to get to the toilet quickly, and she's been rushing to go to the toilet and has fallen and broken her hip, and now she can't go back home. And I have a real problem with that. It makes me so cross, because it's a Feminist issue. It just is saying that we do not care about women enough to give them basic information about their bodies.

Helen

And I guess, can I say, that you're kind of simplifying this for a lot of people? You are taking it back to pelvic floor exercises, right? Kegels. Kegels? I'm never quite sure what we call them. I wondered if we maybe could actually go back to basics on that and get a bit of factual information across.

Elaine

Yeah, I quite like the basics. I do quite like the simple end of things. It is complicated, but the challenge is simple. The challenge is that women don't know. They don't know the words to name their own bits, and they don't know what they can reasonably expect from their bits.

So a pelvic floor's job, so the muscles: it's really complex anatomy. There's 23 muscles, and they're in three layers. So when you start looking at it, it's a bit overwhelming because it's just like a giant stew ..of gristle and …stuff. But from a user's point of view, it doesn't really matter because all the muscles do the same thing. They all squeeze your holes shut and they stop your guts from falling out. That's their job. So their action is to squeeze and lift. So, when you're doing pelvic floor exercises, that's the aim. That's what you're trying to get the muscles to do. Just like if you were trying to fix your bingo wings, then you would be wanting to take your arm through the whole range of movement. You wouldn't just wiggle your arm around in the middle bit. You need to bend your elbow, and then straighten your elbow because that makes sense. So it's the same with your underneath, you just have to take it through the whole range.

But most women don't know what these muscles, what they actually do. So if you are bursting for a toilet, and there isn't one, that feeling of squeezing to stop any pee from coming out, that's your pelvic floor working. If you're trying to stop a fart from escaping, and you're squeezing really tight because you're sitting next to somebody that you don't want them to know the disgusting thing you ate for your dinner last night, then that's it. That's what the aim is.

But if you really pay attention to what your bumhole does, when you're trying to hold in a fart, it lifts up slightly. So it's not just holding it shut. If you really pay attention, you've got a good pelvic floor contraction, the whole thing lifts and that bit's important. We want people to be able to see that they can squeeze and lift, and if they can't feel both, then they probably have some weakness, or something in the way that's stopping that action. So we want them to come to clinic.

If you can feel it, then to do the exercise, you want to squeeze and lift on an exhale because the pelvic floor moves up and down as you breathe. And if you hold your breath and then try and contract your pelvic floor muscles, you're having to work against the force of your diaphragm coming down and it can make it a lot more difficult. So the easiest way to do it, is to sigh out, squeeze and lift your bumhole as if you're holding in a fart. And then the tricky bit is holding it for a count of 10 seconds, but breathe at the same time. So lots and lots of women find that they can only do it for 2 seconds, or less. And the 10 seconds is an aim, because if you can hold, if you've got a good contraction for a good solid 10 seconds, it reduces the urge to pee. And that's useful socially, when there's a big queue for the toilet or you're stuck in traffic, being able to reduce the urge is a useful skill to have.

Helen

And as you say, there is literally, the evidence is there, and it's been there for years, that this can really help?

Elaine

Yeah, there's Gold Standards, there's multiple Cochrane reviews showing that this stuff works, loads of them, like we're hanging in them. We don't really need much more evidence about pelvic floor exercises. We've got it. We just need to roll out what we already know. And the challenge with that is there's no money in it.

So, I've tried with politicians to get somebody to be the face of the smelly old woman, and be her champion and say, we want to make sure that women don't land up being derided socially because they can't manage their personal hygiene, because they've got a problem that's entirely preventable, it's just that we haven't bothered to tell them. And it's quite difficult to get a politician to take that on. It's not glamorous, is it, from a press point of view. When I first started wanging on about this, I wrote an article for a red top newspaper: that was going to the journalist, it's a useful technique, “Here, do you want a free column? I'll give you this”. And they were going to publish it until the editor said, “No, no, we don't want smelly old women in my newspaper. We're not doing that”. And they pulled it.

And the shame and stigma is real. Of course you're going to be embarrassed. It is embarrassing. These things are shameful. I can't find a society where it's okay to be incontinent, unless you're a baby. It's not okay. So, these are barriers to engagement, all of them. Unless you've got a role model, or a champion, or a hero in the narrative, it's really difficult to get above all the other stories that are going on in society, especially now with social media. Although that can also be a strength because things like podcasts, like you're talking about issues that are stigmatised in your podcast, and people can listen to them privately. So people are getting information without having to sit with a book on the tube saying “my fanny fell out”. They can get information…which I think is a great title, I would read that book. But I do see that some people might not want to explain why they're interested in such a topic.

Helen

I'm going to ask you in a minute about how you are using humour, obviously to try to reach the women who aren't being reached for all these other reasons. But just a really quick last one on the pelvic floor stuff. Actually two really quick last ones, for information. Right, I have a prolapse. Pelvic floor exercises are not going to cure me, so why should I bother?

Elaine

Because it'll stop it from getting worse. So you're right, it's not going to cure it, but it can maintain it. And what we know is that if women do their pelvic floor exercises, and they watch their weight, they avoid doing impact exercise that's causing them a problem, or they adapt their impact exercise so that they've got pessaries, or whatever, to support the prolapse so they can still exercise. And if they've got a cough, they get that under control, and they manage their bowels so that they're not constipated. If they do all of those things, then they will be able to keep the prolapse at the same as it is just now, for probably around 15 years. It will probably be longer than that, but that's what the science is showing at the moment.

And it's common for women to have prolapse. It's not necessarily a bad thing, it's not a great thing, but it's not necessarily doom and gloom, because about 50% of women over the age of 50 have got one. So if you look after it…I mean…stats like that…you could almost say it's so common, it's normal. It's not a normal thing, but it doesn't necessarily mean that you're going to land up having terrible problems if you look after it. You brush your teeth every day. It’s just you’ve got to look after your prolapse just like you look after your teeth.

Helen

There's an advertising slogan right there. My other question was about people who have a tight pelvic floor. Should they be doing pelvic floor exercises? Because surely that's just going to make it more tight.

Elaine

Yes. So the basic exercise of squeeze and lift, is your starting entry level Kegel. Once you've got the basic thing sorted, then you should be able to do the long hold count for ten. You also need to do quick flicks to help with stress incontinence, where you wet yourself if you laugh, or cough, or sneeze. So, it would be like a really hard and fast contraction for about a second or so, and then completely relax. And you squeeze and lift and relax. Squeeze and lift and relax. Ten in a row.

If you've got an overactive pelvic floor, it can be really difficult to know that unless you've got an assessment. Because people that their pelvic floors just aren't letting go, they can also wet themselves because the muscle is working really hard all the time. So a lot of the time, women misinterpret this, obviously, because all they know is that they're wetting themselves when they laugh, and they start doing more exercises to fix that, because they hear stuff like I'm saying, and it just doesn't make any difference at all.

So, I think that that's okay, because if it doesn't work, we get them in to clinic. I think it's not ideal to let people trial something, and then find it's failed. You're not going to do harm. The worst thing that's going to happen is you prolong their condition for a period of months. They might get pain. A lot of the time, people with overactive pelvic floors have got, like an aching in their pelvis a lot of the time. Or they get pain on penetration if they're sexually active, or they're going for a smear test, or they don't use tampons because it hurts. So that's a key bit of information, that if women knew if you have those symptoms, it might be that your pelvic floor is overactive, then they need to come in to clinic. But for the women that don't know that, if the message is, if this doesn't work, come to clinic, I think that's good enough.

Helen

So the funny stuff, how did that all start for you? So, you're a physio merrily, going around fixing people's bits and bobs, and then you're loving comedy on the side, and then you have a light bulb moment. What's going on?

Elaine

Yeah, I took up comedy as a bucket list thing. So, there was a bunch of us at the school gate, we're about to turn 40, and we thought we would give ourselves a name. And I couldn't really come up with anything. Like, one of them was going to run a marathon, and one of them was going to finish her degree that she'd left because she got pregnant, so she was going to go back and finish it. One of them got divorced, which I think is very funny, also, like, as a bucket list thing, “I'm getting rid”: she did it. She's very happy now. And I didn't really have any of those three options to choose from, so I said that I would do a stand up gig.

Because, years and years earlier, I'd been at some party telling a joke, not a joke, a story about a date that had been on the night before that had been, you know, it was funny, it was awful, and it wasn't criminal. But that's about all that you could say about it. It was just an excruciating story. And there was a guy there at the party, that was something to do with the Comedy Club, and he said, would I like five minutes on stage? Like, absolutely not. Why would I do that? That would be embarrassing. And he spent ages trying to persuade me, but I was unmovable because that was bonkers.

So all it did was plant in my head that I could do stand up if I wanted to. So 20 odd years later, then that was all I could come up with, with a bucket list. And I loved it. I did this, it was just like a five minutes set, and I didn't know…

Helen

Ahh, terrifying!

Elaine

Ach, it's only talking, like it was a carry on with all the women at the school gate…that's a bonkers thing to do…why would you do that? And of course, they all came, so I had a really, really good time. But I didn't realise that it was a Newcomers Competition. I entered because I thought that that would be for newcomers, and I was completely ignorant about how comedy works. So, being a newcomer means that you're looking for an agent. So I'm like, lined up with these people, that know what they're doing, and me going, “No, this is my first time”. So I got through the competition. I got through to the semi-final bit, and thoroughly enjoyed myself. It was a hoot. Loved it, because at the time, my kids were little, and one of them wasn't particularly well, so there was quite a lot of stress, and being able to go out at night with a bit of lipstick on and have a laugh, I just loved it.

So I kept going with it, and a patient in clinic was telling me a story about her wetting herself on the doorstep, which is a horrible thing to happen to anybody. And it wasn't just a wee bit, like she lost all control of her bladder, and her very snooty next door neighbour was standing next to her, and saw this happen.

Helen

Oh, no.

Elaine

So it is awful. And you wouldn't hear that and have anything other than sympathy for the person, but this patient was from Glasgow, so she was just naturally hilarious because they just are: Glaswegians are just funny. And a lot of people, particularly in Scotland, I think part of this culture, is using humour to manage difficult social situations. We're quite self deprecating and Glasgow is really good at that. They just are funny people. So I was in stitches listening to her tell this awful tale of woe, and said, “Can I use that (she knew I did stand up), because I need to come up with a new five minutes”. And I did it at the Comedy Club, but it was only five minutes, so nobody knew this was my job.

And afterwards, four women said to me in the pub,”Oh, me too. It's awful, isn't it”, and I thought, well, that's interesting, because only about a quarter of the women will ever speak to their GP about their incontinence. So, these four women who don't know each other, and don't know me, are prepared to speak to a stranger in a pub about pishing themselves, but not their GP…what would happen if I did it on the stage? So, I wrote a comedy show about pelvic floors, and the comedians were interesting because I was still new by that point, and they said, “You need to be going for ten years before you would do a solo show…like, this is crazy”…but it was my job. And when you're seeing people with the same sort of problems, any job, if you're dealing with the same sort of problem, you have the same sort of language you use. It's almost a script that you're using. So I just used patient stories, and the scripts that I said and made it what I thought was funny, and it turned out it genuinely was funny because it won a Comedy Award. So go me.

Helen

Well, there you go. Smashing it on all fronts. I mean, that's the thing, isn't it? There is a danger, I suppose, that you minimise it, and we know how badly it affects people's lives and stuff. But your evidence is there, isn't it? The women that come up to you afterwards and go, well, thank you for talking about that, because I haven't been able to talk about that, and I do need help and maybe that's the trigger.

Elaine

Yeah, I didn't realise it at the time, but a few things happened. There was a man, a male journalist, came to review the show, like a critic. And he said in his review, that it was strange for him being in a room where there was a comment made about incontinence pads. And he didn't see that it was a joke, but it definitely was a joke because all the women laughed. And I thought, that's really helpful because the woman who is struggling and ashamed, gets the joke, but she only gets the joke because she understands what it's like to wander round with an incontinence pad. And all these other women are laughing because they also understand, so you're not on your own.

So, the show did well at the Fringe here in Edinburgh, so I was invited out to Australia, which is quite flattering, and I got linked up with a university there whose project was looking at obesity and pregnancy, which is also a condition that's surrounded with shame and stigma. And the professor was interested in using humour to address that. So we did a literature review together, which was published in August, about using humour as a health promotion tool, which is invaluable, because, thanks to Professor Skouteris and her team at Monash, I now have evidence that this works. I have evidence that it is possible to influence behaviour through using humour.

So the next thing I need to do is show whether or not the show encourages help seeking. And if the data shows that about 25% of women will go and speak to their GP, if more than 25% of my audience go and speak to their GP afterwards, I get to call it an intervention, which is hilarious, because the challenge is, once we get women into clinic, they don't have a problem. I don't worry about those women, because even if they're not going to be helped with conservative treatment, we know where to send them so that they can see medics. And if surgery is the answer, then that's great, they'll be able to get surgery. The women who don't come, they're the ones that interest me. There's good evidence that if somebody sends a message out that's funny, you're more likely to remember it and pay attention to it. If you make people laugh about something, then they'll talk about it. And once you get women talking about this stuff, you can't shut them up.

Helen

This is it. This is exactly it. You're a woman on a mission to change the world, aren't you?

Elaine

Yeah. Get all those fannies fixed. That would make me very happy.

Helen

Love it. And the other thing Elaine did was to record a 60 second ‘Squeeze Along Guide to Pelvic floor Exercises’. So if you’re like me, and you do mean to do them, but you struggle to get it done, then you can find that as a bonus episode, and you can listen as many times as you like. So maybe load it into your podcast stack ready for listening, or bookmark it on the desktop, and then every now and then, it will pop up and you’ll have to do your pelvic floor exercises.

None of it is intended as medical advice, of course. Please seek out your own support.

You can find Elaine on Instagram. She's @Gusset_Grippers, and you can see her at the Edinburgh Fringe this summer. The show is, ‘Viva Your vulva: The Hole Story’. Tickets are available now.

Next week, I'm taking you to a pessary fitting. Yep. In the meantime, get involved, tell me what you think, and spread the word in any way you feel able.

You can support the podcast at buymeacoffee.com/whymumsdontjump, and you can find me on social @whymumsdontjump or online at whymumsdontjump.com