Crazy Costs, Continence and Comedy

This cross party evening event, sponsored by an MSP, was organised by Elaine Miller (aka Gusset Grippers) – stand-up comedian and physiotherapist – and was held in the Scottish Parliament building, Holyrood, Edinburgh on 21 November 2017.

Cochrane Incontinence were invited to attend this event organised to highlight the fact that incontinence (both urinary and faecal) and pelvic organ prolapse are common problems and that people should know that help, including non-surgical treatment, is available. 

The evening opened with Elaine Miller describing how common these conditions are and how people affected are often reluctant to seek help. They try to cope by themselves, not realising that treatments are available, until the condition worsens, leading to other health problems and potentially even social isolation. Elaine explained that putting resources into tackling these conditions early may lead to improvements in health and cost savings. 

In front of an invited audience, which included six MSPs, physiotherapists (including students), patient representatives, continence nurse advisors, health visitors and doctors, Elaine performed her stand-up comedy act. Elaine is a person with a very rare combination of talents - she is a physiotherapist who has a gift for stand-up comedy. Combining this with her knowledge of evidence-based healthcare and her personal experiences of some of these symptoms to great effect in her act, she encourages people to communicate about a subject that is often taboo.  

A lively panel discussion about how the Scottish Parliament can help people with incontinence and/or pelvic organ prolapse issues followed. Attendees called for more resources to be made available to help educate the public and healthcare professionals (such as nurses, midwives, health visitors and GPs). They felt that people should not feel afraid to speak to a healthcare professional about their incontinence (be it urinary and/or faecal) or pelvic organ prolapse symptoms. It is important that the public and healthcare professionals alike are fully informed as to what help is available and where they can find it locally.

Specialist pelvic floor physiotherapists and continence advisors are available for referrals (or even self-referral) but can be in very short supply. A number of attendees mentioned Pelvic Floor Clinics, to which a person with symptoms may refer themselves. There is an example in Birmingham, which has a GP, urogynaecologist, specialist physiotherapist and nurse continence advisor all in the same place at the same time.

Other suggestions by attendees include adding something relevant to the ‘Baby Box’ that every new mother in Scotland is offered and providing basic specialist pelvic floor dysfunction training to level 5/6 physiotherapists.

Education about incontinence is key

Panellists and members of the audience agreed that education about incontinence (urinary and/or faecal) and pelvic organ prolapse is key, especially:

  • Healthcare providers - to listen more carefully to, and not dismiss, patients who present with incontinence (urinary and/or faecal) or pelvic organ prolapse problems, including those who return with persistent problems. 
  • The population – education about the role of the pelvic floor and its muscles with continence and prolapse issues and what to do if it goes wrong is required.  For example, websites are needed, written in plain language with basic education on maintaining or improving the health of the pelvic floor. One audience member suggested that pelvic floor muscle training be taught in the early teenage years, especially to secondary school-aged children.
  • GPs – obstetrics and gynaecology training is no longer obligatory for GPs in training. Some audience members raised the concern that this may mean that GPs are less familiar with available treatments and that this could make it very difficult to get referred to a specialist physiotherapist (although it is possible to self-refer).
  • Physiotherapists-in-training – more pelvic floor education is needed as, currently, the pelvic floor does not form a large part of their training.  
  • Registered physiotherapists – once registered, physiotherapists should receive specialist training on pelvic floor disorders. In recent years, physiotherapists have needed to self-fund this. There was a call for professional recognition for those with additional training.
  • Surgeons – make sure that they adhere to the NICE guidelines and try conservative treatment first.
  • Policy makers and funders of healthcare. 

Evidence for decision-making

Audience members suggested that people with incontinence (urinary and/or faecal) or pelvic organ prolapse symptoms and healthcare professionals need to have up to date evidence-based information to help with informed decision-making. Cochrane Incontinence prepared and distributed flyers summarising Cochrane evidence about conservative treatment that can help and could be tried first as recommended in the relevant NICE guidelines.

At the end of the event there was time to talk to many of the very interesting attendees, a number of whom were keen to know more about our Cochrane review evidence and the group. Since the event, we have been approached by two professional organisations and a consumer organisation who would like to work more closely with Cochrane Incontinence. 

Panel members were:

  • Prof Mike Keighley, retired colorectal surgeon and founder of Mothers with Anal Sphincter Injuries in Childbirth (MASIC); 
  • Prof Doreen McClurg, Glasgow Caledonian University and also kindly representing Cochrane Incontinence; 
  • Mrs Kate Walsh, Executive member, POGP (Pelvic, Obstetric and Gynaecological Physiotherapy) professional network group (previously Association of Chartered Physiotherapists in Women’s Health, ACPWH);
  • Elaine Miller (organiser), comedian and physiotherapist.


1. National Institute for Health and Care Excellence (NICE). Urinary incontinence in women: management. Clinical guideline [CG171]. London, UK: National Institute for Health and Care Excellence (NICE); 2013 (last updated November 2015). URL: (accessed 2 December 2017). 

Words: Sheila Wallace