NORTHERN IRELAND — Aimee Oliver, a 37-year-old Northern Ireland personal trainer, volleyball champion, and mother of three, is due to undergo pelvic floor surgery in the private sector after being told she would have to wait at least six years for the procedure within the NHS. She said that at 37 she is at the peak of her competition fitness and cannot wait six years for surgery.

Oliver's symptoms began in her 20s, when she started to leak urine after coughing or sneezing following the birth of her first child. "When my body stopped working as it should I actually began to mourn my old self," she said. "Leaking was extremely embarrassing."

She wears thick shorts, pads, a pessary, and a device when competing but still leaks visibly, which adds to the stress of competing. "In a recent competition in Belfast, I won overall female, but I was leaking while competing and wondering, 'can people see my shorts are wet?' That when I am running there is urine running down my legs and I can only ever wear black shorts to try and hide the wet marks," Oliver said.

Oliver has qualified for the women's Pro Hyrox World Championships for the second year. Postpartum physiotherapy is not routinely offered in Northern Ireland, though Oliver said some countries automatically offer physiotherapy appointments throughout pregnancy and for about 10 sessions after birth.

Incontinence is the involuntary or accidental loss of bladder or bowel control, ranging from minor, occasional leaks to complete loss of control. It is a common symptom of underlying issues, including weak pelvic muscles, neurological disorders, and infections. Pelvic floor muscles support the bladder, bowel, and uterus, and strengthening them can help prevent incontinence and organ prolapse. Most women can be cured of incontinence with pelvic floor muscle training alone, if done properly and early, which can avoid the need for surgery.

Continence specialist nurse Julie Edmonds said childbirth is the most common reason for a weakened pelvic floor. "It can affect anybody, any gender, any age, we are treating men and women from as young as 18 to most recently a woman in her early 100s," Edmonds said. "We are definitely seeing a shift especially among younger women who are just not accepting that because they've had children, or the menopause they have to put up with it." Edmonds also said: "We have a massive coffee culture now and people don't realise the impact coffee has on their bladder muscle which can cause increased urinary frequency." She added: "So simple things like swapping for decaf, also swapping fizzy drinks, alcohol, even green tea, for water and diluted juices will, after two weeks, make a massive improvement."

Advanced practice pelvic health physiotherapist Gráinne Donnelly, who is conducting doctoral research, said pelvic floor issues may be contributing to women leaving sport. "One in two women withdraw from their sport and that includes in their younger teens - and that drop off could partly be to do with issues around pelvic floor," Donnelly said. "If people are withdrawing from sport that is a public health priority," she added.

Belfast Health and Social Care Trust said it has seen a 25% increase in monthly incontinence referrals since 2020, with a six-week wait for urgent referrals and 13 weeks for routine referrals. South Eastern Health Trust reported routine incontinence appointments carry a waiting time of approximately 18 to 20 months, with urgent referrals taking about 12 weeks. Western Health Trust reported a 13% increase in its pelvic health physiotherapy service.