October 20, 2020

Esther Aarts

By Mara Altman and Luce Brett

“I mean, seriously, we need to change the conversation.”

— Luce Brett, the author of “PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale,” about her battle with postpartum incontinence

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Women have sat on the Supreme Court. They’ve traveled to space. They’ve run billion-dollar companies. And they’ve run for political office. Yet when it comes to speaking openly about women’s bodily functions, all bets are off.

Take incontinence. Although it’s a condition that affects up to one-third of women, it’s rarely openly discussed. And as long as it’s not discussed, it remains shrouded in shame, secrecy and falsehoods.

What is the price we all pay by not having the conversation, however uncomfortable, about continence, childbirth, changing bodies and taboos?

For In Her Words, two writers who’ve made bodies their business, have a candid conversation to break down the stigma.

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Mara Altman is a journalist and the author of “Gross Anatomy: Dispatches From the Front (and Back),” a book that takes an unapologetic look at the parts of our bodies that we don’t discuss, try to ignore and often feel shame about. Luce Brett is the author of the memoir, “PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale,” exploring her decade-long battle with postpartum incontinence.

Lightly edited excerpts from their conversation follow.

Mara: Hi Luce. Let’s get right to it. You had quite a brutal and traumatic birth. You wrote that the go-to response by well-meaning people was to remind you that “at least you had a healthy baby and that’s all that really matters.” It rightly brought up what we neglect (i.e., the mother’s health and well-being) when we say things like that.

Luce: Yes — I think we have that as a default response. I was grateful, but the first text I sent didn’t say my son’s name or birth weight or anything, it just said, “It’s a conspiracy!”

Mara: Right?! Many of us aren’t prepared for what’s about to go down. I expected my planned C-section to be chill, but during the procedure, my husband said that I looked like Leonardo DiCaprio getting thrown around by the bear in “The Revenant.”

Luce: The thing is, I do think mine is a very everyday story. My birth wasn’t brilliant, but it didn’t reach the Top 10 in the Hit Parade of Worst Births. And yet … it was cataclysmic in many ways. The original title of my book was “Shame, Broken Fannies & an Everyday Taboo.”

Mara: I want to see that title on every best-seller list.

Luce: God, me too!

Mara: The stats on “broken fannies,” to borrow your words, Luce, are astonishing to me — one woman in three will experience incontinence at some point in her life.

Luce: Earlier this year, I spoke at a World Federation for Incontinence and Pelvic Problems event in London — I know, life goals! — but it was so interesting. The figures are astonishing. Globally, the figure stands at around 400 million people. And all the experts say the case numbers are underreported. And women are affected more than men.

Mara: Yes, I saw the same undercalculations in my own look at hemorrhoids. Researchers can’t calculate properly when people are too ashamed to admit to having a condition.

Luce: I was joking about it with Elaine Miller, a Scottish physical therapist who wrote the introduction to my book and who I met during my incontinence odyssey. If someone asks if you pee yourself, you tend to say, ‘No!’ not, ‘Yes, I do!’

Mara: Exactly. I mean, I wrote a whole chapter about anuses and yet I still found it difficult to ask my doctor to take a good close gander back there when mine felt unwieldy and questionable after the birth of my twins.

Luce: People have asked me a lot about why I wrote this book when I am inclined to being squeamish and it feels so uncomfortable. For me, it was three things: First, the statistics — yes, they offered comfort that I wasn’t alone, but they are also an absolute outrage. Why were we not doing something about it when there are loads of treatments and cures? Second, a research study said sick people in the hospital considered double incontinence to be a state worse than death. Third, my primary care physician said I was the first person in all her years of practicing to talk to her about how depressing bowel incontinence is. I just kind of thought, ‘Enough!’ I looked around and nobody else seemed to want to dive in, so I did. I mean, seriously, we need to change the conversation.

Mara: Yes, and many of us spend too much precious time and mental space hiding parts of ourselves due to shame.

Women have been pushed to extremes, sometimes even dangerous ones, to fit into the status quo. The Bates College professor Rebecca Herzig has written extensively on the women who frequented X-ray epilation clinics in the early 20th century to get their facial hair removed. Even when radiation was deemed dangerous and the practice outlawed, many continued to go. They suffered lesions, cancer and even death all in order to not be caught in public with a beard — an impulse I can relate to, even if I hate admitting it.

While researching my book, I spoke to a colorectal nurse, Theresa Porrett, who really brought it home when she told me that “people literally die of embarrassment” — the taboos are so strong around some parts of the body that people won’t bring up troubling symptoms with their doctor until it’s too late.

Then there are also the everyday activities and joys that women miss out on when these issues take over their lives.

Luce: I definitely missed out on a lot. Both through the incontinence — and the drudge and work and expense of it — and from the depression and trauma it caused. It impacted my relationships too. When you leak, because it is such a primal shameful thing for us, it massively impacts body image and (dare I say it?) sex life. And that is the taboo in the taboo!

Mara: I’m so glad you went there!

Luce: I had to partly because, you know, it is so, so, so desperately lonely when you think you are the only one who wets herself. I was afraid of my own bedroom and I didn’t know where to go with that.

Mara: The stigma surrounding these issues is so strong, but really not all that surprising when you learn, for example, that “pudenda,” the Latin word for female genitals, literally means “to be ashamed of.”

Luce: Yes! The stigma runs very very deep. We can see it in medical history. I found references to middle-aged women in the Middle Ages pissing themselves at a pub and it was the same sort of shameful joke we get now.

Mara: Yes, and when you look back at vaginal douche, for example, it was originally a (lackluster) contraceptive, but it morphed into a way to make our apparently gross and smelly crotches (we are nasty women after all!) smell like flowers.

Luce: But what is kind of ignored in piling on the shame is that there is a real person underneath the broken body. A real, normal, upset, exhausted, fed up, tired, funny, loving woman underneath, who just needs a break. And to not pee her pants all the time.

Mara: I think the antidote is to talk about it, to tell our stories. It all feels so heavy when parts of our bodies — asymmetrical labia, fragrant crotches, hairy nipples — are supposed to be kept a secret or are even vilified. I had to trust that I wasn’t so original, that out of billions of women, I couldn’t be the only one feeling these ways about my body or having thoughts like, “Who’s going to pluck my chin hairs if I’m ever in a coma?” And luckily, the No. 1 response I’ve gotten from readers of my book is, “I feel normal for the first time in my life.”

Luce: Readers have said that about my book too. They feel it gives them permission to think about something they’ve hidden. When the stigma is there all around us, we absorb it, become defined by it, and with incontinence, when shame and also silence win out, you think you must be the only one not coping that well.

I had a brilliant pelvic health physiotherapist and when I told her a story about how I deliberately spilled a drink and smashed a glass on the floor at a work Christmas party to cover up a puddle because I would rather people thought I was a drunk than incontinent. I was so steeped in my own upset that it didn’t occur to me that someone might look on that with compassion. She said, “If you weren’t in trouble, you wouldn’t be here.”

Mara: Luce, you’ve been through so much in the past decade, yet you’ve managed to use so much humor. I am fascinated by the way you crack so many jokes at the same time you question your use of them to tell your story.

Luce: I think that we joke when we are nervous, to make things palatable. It also really helps educate people and break the ice. But incontinence is serious and really does affect lots of people and really isn’t treated with enough seriousness and compassion. And that means people don’t treat themselves with seriousness and compassion. I didn’t treat myself with seriousness and compassion: I made a huge mess of things, got angry, absorbed the stigma, was self-loathing, and I wanted to share that too, even though it no doubt reflects badly at some points in my story. If we just laugh about it, then other people like me just have to laugh too, and I don’t know if that is fair or the best — or only — way to move forward.

Mara: That really speaks to me. I agree. I think humor is a great way in for a lot of people, but at some point, it’s time to get real and say, “We don’t have to put up with this!”

Write to us at inherwords@nytimes.com.

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In Her Words is edited by Francesca Donner. Our art director is Catherine Gilmore-Barnes, and our photo editor is Sandra Stevenson.

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