Why we need to talk pelvic floor muscles

Stress urinary incontinence …whoa – what? SUI – stress urinary incontinence, is the official term given to those moments when you laugh, cough, jump or sneeze (or could be any kind of activity) which are accompanied by unwanted leakage of urine. For many women, talking about incontinence still causes distress and often the condition is never really dealt with, it is just managed. Historically it has been seen as ‘inevitable’ and in some cultures, still is. UI is perceived as something that happens with aging, the menopause, after childbirth and sometimes with strenuous physical activity, or chronic coughing..and while these might be ‘risk factors’ they do not constitute certainty.

The history of incontinence can be traced back to Egyptian manuscripts from the 2nd millennium BC, where devices for collection of urine are mentioned for both men and women.

However, over time, surgery was refined and became the mainstay of treatment options, dominated by men. As our understanding of the mechanism of urinary incontinence improved, and the role of pelvic floor muscles, particularly for stress urinary incontinence is now recognised. Indeed, Arnold Kegel in the 1940’s, developed ‘kegel exercises’ where he prescribed ‘active exercise to restore the normal function to the vaginal muscles ….relieving urinary stress incontinence’. Since then, there has been considerable research on how effective pelvic floor muscle exercise/training can be. There is also now, good evidence that doing pelvic floor muscle training in pregnancy as a PREVENTION reduces that risk of incontinence after birth. So, being pro-active and not waiting until you have symptoms, getting into the habit particularly while you are doing other things (integrate them into your daily life) is the goal.

So I would like to bust a few myths ..Urinary incontinence is never normal, not inevitable, not inherited, and not something to be ‘put up with’. There is also no such condition ‘light bladder leakage’ – that is clever marketing. It is, however, common. Urinary incontinence affects between 25-45% of women globally, although this is likely unreported due to the stigma still associated with the condition. (Milsom et al., 2017). This is so much more than bothersome, impacting significantly on quality of life as well as being an economic burden.

But for so many, pelvic floor exercises, are a mystery. How to do a correct ‘squeeze and lift’, how many to do, and for how long – is just plain difficult. The pelvic floor research group at the ABI, in collaboration with urogynaecologists and pelvic floor physiotherapists, have been working on this problem for over six years.

We have since developed new technology to help take the mystery out of kegels. Our dedicated team of researchers have designed a product, femfit, that gives real-time direct feedback on if those ‘squeeze and holds’ are effective. The unique intravaginal pressure sensor array communicates via Bluetooth to a proprietary application on your mobile, guiding the user through a clinically validated exercise programme. JUNOFEM, which has now spun out of the Auckland bioengineering institute, is dedicated to supporting women on their journey to pelvic floor health, using this new technology.

In line with International Women’s Day and the growing device technology industry, a whole new genre of the industry ‘femtech’ is emerging. The ‘femtech’ revolution is still in its early days, but according to a recent report from McKinsey & company, indications are that public awareness, company awareness and funding are surging (refence if needed:

The caveat is that femtech companies still only receive 3% of all digital health funding, but the opportunities are there. Investments into femtech are gaining traction, with $1.69 billion invested by H1 2019 (Frost and Sullivan 2022). Women, certainly in western countries are demanding more both in their professional lives but also in the ability to manage their own healthcare needs. As mentioned at the start of this piece, talking about UI is still taboo for many. The rise of technological innovations to make access to solutions, which do not necessarily involve healthcare professionals are attractive and particularly women led VC’s are starting to recognise the opportunities. However, the segment is still very male dominated and other tech solutions reflect this.

As a woman-led startup company, attracting or convincing male investors of women’s health needs is not easy. According to ‘Pitchbook analysts’ investors are reluctant due to the lack of ‘sizeable exits’. But the landscape is changing. We make up 50% of the world’s population and for western women at least, opportunities exist that our mothers and grandmothers could not imagine. Although the numbers of women in all STEM sectors are still small, as are the numbers of women led VC’s; funding for femtech companies and numbers of women on company boards… they are growing. Our voices need to be heard, we need to advocate for those whose voices are still silent, and technology is a way forward.