Empowering makeover during chemotherapy
Advocating for yourself during prostate cancer
How to engage your pelvic floor
Jana Pittman champion on the track and in life
Reading between the lines incontinence and relationships
Continence and the gut microbiome
Checking in: R U OK?
Jargon busting Also in this edition
Scan here to order your free copy of Bridge Magazine
Say yes to your pelvic floor 4 September 2025 12:00pm-12:45pm
To celebrate Jean Hailes Women's Health Week 2025, Continence Health Australia will be hosting a FREE webinar.
We’ll be joined by two health professionals: nurse continence specialist, Janine Armocida and pelvic health physiotherapist, Dr. Jodie Dakic, to discuss how a healthy pelvic floor can support your bladder and bowel control health. Janine and Jodie will be joined by Kimberley Smith, a former corporate lawyer, elite netballer with the NSW Swifts and the Australian Diamonds squad and mum of three, who will share her personal experience with incontinence and pelvic floor muscle exercise.
Register your attendance at this free webinar before 4 September 2025 and submit your own questions for the webinar's moderated Q&A session.
bit.ly/webinarwhw25
If you would like to access a recording of the webinar after 4 September 2025, request access using this link
Welcome to the spring 2025 edition of Bridge Magazine. With a new season comes a gentle reminder to check in with ourselves and make our health a priority, especially before the summer rush of social catch-ups and festive celebrations begins. Now’s a great time to book your annual health check and chat with your doctor about anything that’s been on your mind.
In this edition, we focus on advocacy and empowerment. Two words that can make a big difference in someone's health journey. We hear from Julie who found strength and confidence during chemotherapy with a bold makeover, Ashley shares how self-advocacy played a powerful role in his prostate cancer journey, and Olympian Jana Pittman opens up about her experience with urinary incontinence while competing on the world stage. You will also find our bladder jargon buster, nutrition advice for a healthy bladder and bowel, and tips from a psychologist on how to ask—R U OK?
Continence Health Australia is proud to support a number of health organisations working to raise awareness about incontinence. Several of them are hosting events this month, and you’ll find the details throughout this edition. We invite you to join us in showing your support for these important causes.
Fill in our reader feedback survey for your chance to win a $100 gift voucher. HURRY! The survey closes and winners are selected on 30 September 2025.
Print ISSN 1836-8107. Online ISSN 1836-8115. Published quarterly by Continence Health Australia (formerly Continence Foundation of Australia) and supported by the Australian Department of Health and Aged Care under the National Continence Program. Medical information: The information in the Bridge Magazine is for general guidance only and none of the information provided is intended to replace the advice of a professional including that of a doctor, continence nurse or continence physiotherapist. Copyright: The Bridge Magazine cannot be reprinted, copied or distributed unless permission is obtained from Continence Health Australia. Images: Unless otherwise indicated, the photographs used in the Bridge Magazine are those of models and bear no resemblance to the story unless specified. Advertising: Continence Health Australia appreciates the support of advertisers in publishing the Bridge Magazine. Advertising conforms to the standards required by Continence Health Australia, but endorsement is in no way implied by the publishing of said material. Continence Health Australia does not make any representations or give any warranties about the accuracy, reliability, completeness or suitability of any advertised products or services. Testimony: Any testimonial, opinion, review, recommendation or lived experience of a product or service published in the Bridge Magazine is not intended to represent the views of, or any guarantee or warranty by, Continence Health Australia, and all Individual results may vary. Liability: To the extent permissible by law, Continence Health Australia will not be liable for any expenses, losses, damages (including indirect or consequential damages) or costs which might be incurred as a result of any of the information contained in the Bridge Magazine being inaccurate or incomplete in any way and for any reason. References: For a list of references for any articles appearing in the Bridge Magazine, please email media@continence.org.au. To become a member of Continence Health Australia: email membership@continence.org.au or Phone 03 8692 8400.
Pictured: Julie and her husband on a post-cancer roadtrip
At age 58, Julie was diagnosed with bladder cancer. She had her bladder removed and the surgeons created a neobladder out of a section of her bowel. She is now living cancer free. This is her story.
“I was getting some blood when I wiped after the toilet and at first I thought it was a gynaecological problem. I had it checked and they said everything was fine,” Julie tells Bridge Magazine. “This delayed my diagnosis because I assumed it was a urinary tract infection (UTI). In the end I had to push the doctor to do more tests because my mum had bladder cancer so I was concerned about it.” Julie was eventually diagnosed with bladder cancer via a cystoscopy (a camera which looks into your bladder via your urethra, which is where your wee comes out).
In December 2021 Julie had intravesical immunotherapy, or ‘BCG’ treatment. This treatment uses a vaccine, originally developed for tuberculosis, placed directly into the bladder through a catheter (a tube that goes into the urethra). This stimulates the person's immune system and stops the cancer from spreading. “I had to hold in urine for 2 hours and move position every 15 minutes to ensure the liquid fully covered the bladder,” said Julie. Julie waited 3 months for the bladder to heal and then went for another cystoscopy in March 2022 to check the treatment had worked. Unfortunately, the cancer had spread into the bladder muscle, so the doctor recommended having the bladder removed and sent Julie for a scan to check that the cancer had not spread anywhere else in her body.
“I was told by the oncologist after my bladder removal and a double dose of chemotherapy, that I would have a 50/50 chance of survival,” recalls Julie. “Chemo was horrible, but I had great care, they adjusted the chemo for the mouth ulcers and nausea.”
“My hair started falling out, and I looked very ill which was making me feel vulnerable and weak. I told my husband, ‘You need to shave my head’. After that, I felt so strong and so empowered with a fully shaved head every time I looked in the mirror. I felt as if I was taking control,” says Julie.
Julie after shaving her head
"Not looking like a sick person helped me not feel like a sick person."
When Julie was told her bladder had to be removed, she was offered the option of a stoma with a urostomy bag, which collects urine on the outside of the body, or a neobladder. “I was pleased to have the option of the neobladder, I thought that I could always go to a stoma at a later stage if it doesn’t work.”
Julie spent one month in hospital due to complications with her bowel. Infections also meant Julie had a few visits back to the hospital post-surgery. “The neobladder is not waterproof in the same way that a bladder is waterproof and means any small infections in your body can turn into life-threatening sepsis very quickly,” Julie explains. “I have to watch for signs of infection and carry emergency antibiotics with me. I take them at the first sign of pain to avoid a hospital stay”.
A neobladder is created by stitching a small section of the patient’s small intestine into a small bladder shape and attaching the urethra and kidneys to it. A neobladder can only hold 200ml of wee compared to an adult bladder which can hold up to 600ml.
“MY BLADDER CONTROL IS UP AND DOWN AND I DO EXPERIENCE LEAKAGE. I USE CONTINENCE LINERS, ESPECIALLY WHEN I AM OUT AND OVERNIGHT.”
“I struggled with incontinence after the surgery and pain from holding urine,” Julie tells Bridge. “I was taught to self-catheterise because I was struggling to fully empty my bladder (urinary retention). I now empty my neobladder with a catheter morning and night. I suffer quite badly with sleep deprivation because I have to wake every 2-3 hours to empty my neobladder. It means I often have to nap in the afternoons and can only manage a half day at work. I just feel lucky to be alive and have to accept the new me. Life is different.”
"When I first had to catheterise, I could only do it at home the way that the nurses showed me with a mirror. For a whole year, I didn’t really leave the house. I had gone from so empowered with a shaved head to feeling so useless.”
“After a lot of persistence, I managed to self-catheterise without a mirror and I went back to work. I was amazed at how much it lifted my spirits to be back at work and out in the world again. I am very prepared when I leave the house and have a pencil case I carry with me which has a catheter, sterilising spray and wipes.”
“I started getting out and about a lot more, and we even went on holiday, although I needed a whole
extra suitcase for all my bladder supplies! I had very interesting conversations with airport security explaining what the catheter was.”
Now at age 61, Julie is cancer free, pain free and living life to the full.
“After struggling for such a long time feeling stuck at home, I am always more than happy to share my story and help others where I can. Even if it involves sharing intimate personal details with other women. If it helps them learn how to self-catheterise when out and about, then it is worth it,” says Julie. " I joined the Bladder Cancer Australia (beatbladdercanceraustralia. org.au) group and they were very supportive from the beginning when I was choosing treatment options to now giving me opportunities to offer support to others who are getting used to the 'new normal' after bladder cancer." IF YOU ARE EXPERIENCING INCONTINENCE OR NEED SUPPORT WITH SELF-CATHETERISATION SKILLS, CALL
Mark’s wife Sharon has lived with incontinence for many years. Her journey was not easy, being repeatedly misdiagnosed with various conditions meant she didn’t get the surgery she needed for over a decade. We talked to Mark about how chronic conditions such as incontinence can affect relationships and what advice he has for other partners that might be going through the same thing.
Mark had been observing his wife Sharon attending appointment after appointment and never getting help. She had been experiencing faecal incontinence (loss of bowel control) and it was getting worse and causing her a lot of distress. “I knew she had these difficulties, but she always played it down, made light of it. There were several occasions when she was caught out [had an accident] and it was really devastating for her."
Over the years Sharon went to the doctors to ask for help multiple times and was always told her bowel leakage was being caused by IBS (irritable bowel syndrome). Sharon didn’t feel happy with that diagnosis as no change of diet or lifestyle made her symptoms better. “For some reason Sharon didn't feel able to stand up to the doctors herself. Despite the fact that she's a nurse and used to talking to doctors," explains Mark. "And the second thing was that she's actually a very good advocate for other people. If the problem was somebody else's problem, she'd be the first person there holding her hand up and saying what needed to be done. But when it comes to advocating for herself in those situations, she just didn't feel capable of that, or when she had tried to advocate in the past, she hadn't felt listened to and was just sent away without further help or investigations into her condition.”
Noticing that Sharon was having more accidents and how it was affecting her, Mark went with her to her next GP appointment. "In the past doctors would always start down the route of irritable bowel syndrome—because
that was the go-to diagnosis. And if she didn’t accept that, then it must be anxiety—it's the pressure of work, and you've got too much going on. Because I had this knowledge of how often she'd been fobbed off with this same diagnosis, it did help me to be able to say to the doctor, ‘you're not listening’.”
“I said to the doctor, 'IBS has been suggested several times and it's unlikely to be stress of work because she loves her work. We go through the rigmarole, and it's never sorted. You actually just need to listen to what she's saying this time'. There was a degree of luck in terms of the doctor that she saw having a fresh perspective because she hadn’t seen that doctor before and it was an opportunity to kind of break the cycle.”
With Mark advocating on her behalf, Sharon had an internal exam at the doctors that day which led to the discovery of her severe rectal muscle injury, which was caused by giving birth over a decade earlier. She has now had treatment which has improved her quality of life and mental health considerably.
READ SHARON'S STORY IN THE WINTER 2025 EDITION OF BRIDGE MAGAZINE BIT.LY/SHARONBRIDGE
1. Learn to read between the lines
“Part of the way a partner can help is to be listening and be mindful of what your loved one might actually mean when they say something vague. I still don't think I know the full extent of Sharon's problems. Because they were going on for such a long time and she felt she had to deal with it in a secretive way because it is such a personal issue. Sharon's very mindful about the language she uses with me, it is normally indirect. She'll downplay it because she doesn't want it to become the defining
thing about her or our relationship. She'll say things like ‘I've had a problem’, ‘I'm not having a very good day’ or ‘I've been ill’, but I now know what she really means is ‘I've been in the bathroom a lot’. So, understanding your partner's terminology is really important to be able to help them, unless you're tuned in and listening, you might not realise what they're saying. Always make a mental note of the phrases they use and what they could be trying to tell you, read between the lines.”
2. Encourage open and honest two-way communication.
“Ultimately, you can only help if they ask and you know what is actually going on. If Sharon was open and said, ‘I’ve **** myself again’, it would be much easier to deal with because I would know exactly where she's at. But I also understand that's not a very pleasant thing to have to talk about, or to say out loud. But it affects everything. It leads to other problems because for example if you were going out, if you've not listened to what the person's saying, you might be rushing them and saying, ‘come on, do your last trip to the toilet. We need to get going’. And actually, that's putting more pressure on them and probably causing them to resent you in that
moment, instead of recognising where they're at and trying to help them. So, I suppose there's a bit of two-way communication to try and be open with each other. “
“As the person experiencing health issues, try not to be embarrassed and just use language that really explains what is happening, even if it feels horrible and awkward to talk about. Humour often helps, but you have to read the room and judge that the person is ready to make light of it. As the loved one of the person with health issues, you might have to be brave and start the conversation and say, ‘what is really going on?'.”
3. Talking about the elephant in the room may improve intimacy
“I think often people don’t want to discuss toilet problems with their partners because they feel it will ruin the intimacy, but knowing what is happening and being really open with each other will make you closer. Instead of your partner turning you down if you suggest
being physically intimate, and you thinking they don’t love you or there is something wrong with you, you will know that it is their medical problem causing them to not want to be physical, not you. And I find that stops a lot of problems that can be caused by feeling rejected.”
National Continence Helpline
If you need advice on a loved one's incontinence, book a FREE telehealth with our nurse continence specialists or call 1800 33 00 66 8am-8pm AEST Mon-Fri.
BIT.LY/1800330066
If you have felt dismissed when discussing your bladder, bowel or pelvic health, know that your experience matters. You deserve to be listened to and validated by family, friends and health professionals.
If you feel that you are not being listened to, you are not alone. The 2023 Victorian women’s health survey (bit.ly/vwhs2023) found that 1 in 10 women felt dismissed by their health care provider, one-third of the women surveyed reported insensitive and disrespectful interactions with medical professionals, and only 54% reported receiving the care they needed.
Talking about bladder and bowel control, or pelvic health, isn't always easy, but taking that first step can be incredibly empowering. While it can take time to find the right support, help is out there.
It is important to remember that although incontinence is common, it is not something you have to live with and should not be ignored. No matter your age or stage of life, in most cases, incontinence symptoms can be improved, better managed, or even cured.
We talk to Amy Steventon, a pelvic health physiotherapist (physio) at Jean Hailes clinic and Her Care in Melbourne, for tips on how to be heard.
Q: WHAT IS THE MOST COMMON PROBLEM FOR PATIENTS REQUESTING TESTS OR FURTHER INVESTIGATION INTO THEIR BLADDER, BOWEL OR PELVIC PAIN?
A: People presenting with pelvic pain have often consulted many practitioners over many years to get a diagnosis for their pain, on average it takes 7 years for a diagnosis of conditions such as endometriosis. This will hopefully improve with the recent increase in awareness of this condition and other pelvic pain conditions. In comparison, bladder and bowel concerns seem to be more readily diagnosed and referred to specialists.
Q: WHAT ADVICE DO YOU HAVE FOR SOMEONE WHO FEELS THEY HAVE BEEN BRUSHED OFF OR NOT TAKEN SERIOUSLY BY A HEALTH PROFESSIONAL?
A: It is important to find someone you feel comfortable talking to about your incontinence or pelvic pain concerns. This may involve discussing intimate issues, as we often see concurrent sexual dysfunction when people present with incontinence or pelvic pain issues. One doesn’t necessarily cause the other, but they can often exist together.
If you feel your health concerns have not been met, or perhaps your health care provider isn’t the right person
"If you have your period on the day of your pelvic health physio appointment, you can still go for your consultation or treatment."
to speak to, it may be helpful to seek out a specialist who has an interest in bladder, bowel or pelvic health and is comfortable and knowledgeable discussing it.
The National Continence Helpline (1800 33 00 66 MonFri 8am-8pm AEST) can provide an empathetic and supportive environment to discuss your incontinence via their free telehealth service run by nurse continence specialists. They can also find local health professionals with a special interest in bladder and bowel continence health, such as pelvic floor physiotherapists, to refer you to.
To see a pelvic health physiotherapist you don't need a referral from your doctor. You can just book an appointment yourself. However, if eligible you can get a Chronic Condition Management Plan from your GP and get a rebate from Medicare to cover some of the cost.
Q: WHAT HAPPENS WHEN YOU VISIT A PELVIC HEALTH PHYSIOTHERAPIST?
A: During your first appointment your physiotherapist will take a medical history and ask questions such as:
• What are your symptoms?
• What would you like to be able to do that you cannot do now?
• How are your bladder and bowel working?
• Any pelvic organ prolapse symptoms such as a dragging or heaviness in the vagina or rectum?
• Any concerns you have with sexual intercourse, such as pain or incontinence (leaking wee or poo)?
• What does your day-to-day life look like in terms of work, family, hobbies, sleep, stress, and other lifestyle factors that may be affecting your symptoms?
Physical examination
Consultations may involve an internal pelvic floor examination if you and your physio think it will assist your treatment. This will be discussed in detail with you and
will only proceed with your informed consent. If there is anything that may make this examination difficult for you, it is important that you discuss this with your physio before your examination so you can make a plan together that makes you feel comfortable and safe. Other examination options can be used if you would prefer. Some physio clinics use an ultrasound to look at the pelvic floor muscles from the outside. Sometimes this is done with a probe on your lower stomach and other times the probe may be placed on the outside of your body on the small flat surface between the vagina (or scrotum) and anus.
Your physio will discuss with you whether the physical activity and exercise you have been doing is appropriate for you and suggest changes if needed. Together you will discuss the goals you would like to work towards and make a treatment plan. Your physio will design a home exercise program that is specific to your needs and fits easily into your day. It will usually include lots of education so you understand your symptoms and how you can work towards making changes and managing symptoms yourself. They will discuss anatomy and how the relevant areas of your body work, such as the pelvic floor muscles, bladder, bowel or other areas that relate to your issue.
If persistent pain is a concern of yours, your physio will teach you about pain, how it occurs and how you can help yourself manage it. You will usually be given exercises that will help your pelvic floor and other muscles, and suggestions on changes to day-to-day lifestyle factors to help with your symptoms. If your pelvic floor muscles are working too hard, your physio may teach you helpful ways to breathe, and strategies to relax these muscles specifically, and also relax you generally. Your physio might suggest using equipment such as biofeedback, muscle stimulation, or pelvic floor trainers to help you improve how your pelvic floor muscles are working.
As well as being a physical problem, incontinence can take its toll mentally. "In some cases, incontinence will cause people to stay home where they feel safe if they have an accident, exacerbating feelings of isolation and alienation," Amy tells Bridge. "It is important to talk to a trusted family member or friend about your symptoms, what has been happening and what you need help with. Together you can make a plan to approach health care providers who can guide you on the next steps for investigation and treatment. If you don’t know where to start The National Continence Helpline (1800 33 00 66 Mon-Fri 8am-8pm AEST) has nurse continence specialists who can confidentially discuss your concerns, give you advice about who can help, and about products available to keep you more comfortable. For eligible people there is financial government support for continence products; your doctor or the National Continence Helpline nurse continence specialists can give you advice on this process."
NEED A LISTENING EAR?
FOR A FREE AND CONFIDENTIAL
TELEHEALTH CONSULT WITH A NURSE CONTINENCE
SPECIALIST CALL THE NATIONAL CONTINENCE HELPLINE 1800 33 00 66
MON-FRI 8AM-8PM AEST.
Being prepared with questions and keeping a symptom diary to take to your health-related appointments can help you feel confident and in control of your care. Make a note of your bladder, bowel and pelvic symptoms, when they occur, what makes them better or worse and if they change over the day or night
PERIOD
• Results from any tests or scans you have had
• Record of previous treatments
• A list of other health care professionals involved in your care
• Obstetric, gynaecological, general medical history and current medications
• Your physio may also have symptom-specific questionnaires that they suggest you fill out to help guide your treatment
• Can you help with my bladder or bowel problem, or do I need to see a specialist?
• What type of incontinence do I have?
• Is a hormonal change or life stage (pregnancy, breastfeeding or menopause) playing a role?
• Are there exercises that may make my incontinence better or worse?
As a part of the 'Let's Speak About Leaks' campaign, we want to share real patient stories. This is Robert, and this is his story.
Robert was in his mid-seventies when he began losing control of his bowels. "I would be sitting in the pub chatting and notice a smell and think, oh no, it's happened again. I always had to carry spare undies with me," Robert tells Bridge. Otherwise in good health, Robert put his problems down to old age and didn't think there was anything that could be done. "I got sent to the colorectal surgeon for a colonoscopy and he mentioned that I could have a device implanted that could help me get more control. I had never heard of the surgery before and neither had my GP. I had the trial with the device and instantly got control back. It makes a vibration or tightening in your rectum (muscles that control your bowels) and gives you enough notice to get to the toilet in time."
"It has taken the embarrassment out of life. I can go to play bowls now and not worry that I am going to have an accident. I am back at work managing the Towong Turf Club. We hold an event here for 3,500 people once a year. I simply would not be doing this without the surgery."
"People my age don't tend to talk about the trouble we are having with bowels. Some of my friends have had prostate problems and are fairly open about it, but bowels are just not discussed."
"When I tell people about my experience they often then open up and tell me that they are going through something similar. But it would be great if people were more open about it at my age, our experiences could help each other."
Despite 1 in 4 people aged 15 years or over experiencing incontinence in Australia, the majority (70%) have not contacted a health professional about their bladder or bowel leakage. Many people assume incontinence is just a normal part of ageing or something to expect after childbirth, but that’s not true.
By building awareness around bladder and bowel control health, we can help people feel confident seeking support. There are effective treatment options available for people living with incontinence, and the first step is simply starting the conversation and reducing any stigma around discussing 'below the belt' issues.
ADVOCATING FOR YOURSELF DURING
Colin Ashley Reed (Ashley) is a prostate cancer survivor, an eternal optimist, and an advocate for other men experiencing prostate and incontinence issues. This is his story.
Ashley had an enlarged prostate which he successfully managed with medication for over 10 years before he had to have an operation where they remove excess tissue from the prostate (transurethral resection of the prostate or TURP) to allow free flow of urine (wee) from his bladder. During his surgery, it was discovered that Ashley had prostate cancer (tumour on the prostate).
The prostate is a gland that sits directly below your bladder and is part of the male reproductive system. The tube your wee comes out of (urethra) runs through it, which is why it can cause continence issues for men with an enlarged prostate or prostate cancer.
“To treat the cancer, I considered both radiation and surgery to remove the prostate," Ashley told Bridge. "Whilst both can have similar risks of side effects such as incontinence and erectile dysfunction, I had also heard of possible additional risks of faecal incontinence with radiation. After much research and asking a lot of questions at my medical appointments, I decided on surgery.” In 2023, Ashley had a robot-assisted radical prostatectomy (a procedure where the surgeon uses robotic tools to assist them to remove the prostate, which is less invasive than traditional surgical methods).
“For about 6 months after the surgery I had to wear continence pads because of frequent urinary leakage. I tried to plan ahead and have nappy bags with me in case there was no bin in the men’s toilet. I would just roll the pad in the plastic bag and put it in my pocket or my bag. I still keep a spare pair of undies in the car with me just in case. It has become a habit.”
After regaining his continence during the day, Ashley still struggled with nocturia (weeing at night) but has found the trick for him is to stay very well hydrated during the day and then stop fluids from around 7pm. This means he can get a full night’s rest, only waking
once in the night to wee. “I actually saw the tip about stopping fluids on TikTok, of all places! The only thing is, you have to drink enough during the day so you don’t get dehydrated, because concentrated urine is a bladder irritant and can make you wee more often,” said Ashley.
“My continence is at around 95% at present and I am therefore one of the luckier prostate cancer patients in this regard (at least to date anyway). I currently have only very occasional and minor leaks and have no real need for pads other than occasionally wearing a small 'panty-liner' if I am having a big day out or attending an event. Erectile function has also been a challenge to date but is improving with time. Despite these issues, overall, I am happy to be cancer free at the moment and be enjoying my retirement. I recently took a 6-week trip to Europe with my wife and have begun taking part in sports and fitness activities again."
“I ATTRIBUTE MY CONTINENCE SUCCESS TO AN EXCELLENT SURGEON (UROLOGIST) AND FOLLOWING ALL PELVIC FLOOR PHYSIOTHERAPY INSTRUCTIONS RELIGIOUSLY INCLUDING DOING PELVIC FLOOR EXERCISES 3 TIMES A DAY AND NOW MAINTAINING BY DOING THEM 3 TIMES A WEEK BETWEEN WEIGHTLIFTING REPS AT THE GYM."
"I also think my very strong fitness level prior to prostate surgery and ongoing exercise and fitness regime since (including a long and painful rehabilitation from broken femur resulting from a cycling accident 6 months into my prostate surgery recovery process!) has helped a lot."
"I have been a long-time endurance athlete and competed in 11 Ironman Triathlons, 26 Marathons and numerous other challenges including mountain climbing adventures on Ben Nevis Mountain (Scotland) and The Matterhorn Mountain (Switzerland). The wonderful support of my wife, Elizabeth, and friends and family and my local men’s prostate cancer support group has also assisted in my recovery."
AND ADVOCACY
Ashley thinks another key aspect to his successful treatment was taking full ownership of his prostate cancer journey and doing a lot of research, asking his health care team lots of questions, and not just following what he was being told without fully understanding the ramifications of decisions at each step of the way. “I don’t mind things going badly if I know I have done the research and tried my best to make the right choices, but I would be annoyed with myself if the treatment didn’t go as planned and I hadn’t been fully involved and advocated for myself during the process," Ashley
"For me, it was all about taking ownership and self-managing my care and recovery..."
tells Bridge. "I was very lucky to have a highly skilled and experienced urologist and surgeon, in whom I placed my faith and trust during the journey, and he was very good at answering my (many!) questions and clarifying options."
“I have met a lot of men with prostate cancer who don’t seem empowered to ask questions about their care or do their own research. I think perhaps some people just have their head in the sand and don’t want to accept that they are sick. I think personality also comes into it and how confident you are to speak up, as well as what you do for work. If you deal with highlyqualified professionals in your day job, you are used to questioning their decision making, but if you aren’t it could be very intimidating to question your doctors' or specialists’ decisions. It also probably depends on your level of health literacy (understanding of your health care options) and how much you have been involved in medical settings before. If you have never
had any illness or cared for a loved one with an illness, this might be your first experience in a hospital setting, which could make people anxious.”
“I think this is where support groups play an important role. You can meet people who are on a similar journey, or have already been through it, see what questions they asked, or listen to their lived experience of different treatment options and perhaps use these ideas to go back to your health care team with questions.”
“For me, it was all about taking ownership and selfmanaging my care and recovery, rather than leaving it in the hands of someone else. I believe this is how you will get the best results and enjoy the healthiest body and mind you can. It is all about being positive.”
The support of medical teams, family and friends is important for the mental health of those affected by incontinence or other side-effects of prostate cancer. The challenges can be distressing and cause anxiety and depression. Ashley has experienced both during his journey and worked through them by maintaining strong self-awareness and seeking help when he needed it.
“I have joined Continence Health Australia's Continence Consumer Network and the Prostate Cancer Foundation of Australia. Both organisations offer great support, contacts and resources including advice on mental health aspects," says Ashley. "The fact that I have joined up to participate in consumer support initiatives for these organisations and have this year been accepted into the Peter MacCallum Cancer Centre (Victoria) Consumer Register means that I am
not only ‘giving back’, but I have created a positive out of a negative in relation to my experiences.”
Ashley joined the Box Hill (Victoria) Prostate Cancer Support Group 2 years ago and found the group very helpful. Although he is currently in remission from prostate cancer, Ashley likes to engage with the group, mentor other men and encourage them to fully partake in their treatment and recovery.
Ashley is pragmatic and knows the possibility of his cancer coming back or spreading to other parts of the body. Like him, many members of the group have experienced side effects from prostate cancer treatments, including incontinence. He likes to listen to other men’s stories in the group and the various experiences and treatments they have undergone so he knows what to do should he be in that position in the future. He also likes that the group seeks to spread awareness of prostate cancer and assist and advise affected men through their journey.
“I continue to listen and learn, to research and to be informed and to maintain a very positive and proactive approach to my cancer-related challenges," Ashley tells Bridge. "At the same time, I am focused on getting on with all the other things life has to offer!”
HAVE QUESTIONS ABOUT YOUR PROSTATE? CALL THE NATIONAL CONTINENCE HELPLINE 1800 33 00 66 MON-FRI 8AM-8PM AEST.
The pelvic floor is the base of the group of muscles referred to as your core. These muscles are located in your pelvis and stretch like a hammock from the pubic bone at the front to the tailbone at the back, and from side to side. They support the bladder, bowel (and uterus), and play an important role in bladder control, bowel control and sexual function.
If your pelvic floor muscles don't work well you may leak wee or poo when you do things like coughing, sneezing, lifting, laughing or exercising. To stop this from happening you need to switch on your pelvic floor muscles. By exercising the pelvic floor regularly, you will train your muscles to work together correctly when they are needed.
Visit our YouTube channel (bit.ly/4mx3wzX) to see what your pelvic floor looks like when it contracts and relaxes.
Jana Pittman is no stranger to success. A two-time world champion and four-time Commonwealth Games gold medallist, she’s also made history as the first Australian woman to compete in both the Summer and Winter Olympic Games. But her journey isn’t defined by medals alone. This is her story.
Since the age of 16, Jana has lived with incontinence. Despite the fact that incontinence affects 4.8 million women living in Australia, it is often left unspoken about. Today, Jana is using her platform to shine a light on incontinence, sharing her personal experience and encouraging others to seek support.
For elite athlete Jana Pittman, success came early, but so did a lesser-known struggle, urinary incontinence.
“When I was a young athlete, one of the most challenging things I ever experienced was incontinence,” Jana tells Bridge Magazine.
She first began noticing signs of bladder leakage during the early years of her sporting career. “Even before having children, I experienced leakage during intense training sessions or if I sneezed,” Jana recalls.
At the time, she assumed it was simply part of the pressure elite athletes place on their bodies. “I initially thought it was a normal part of being an athlete pushing my limits. It wasn’t until after the birth of my first child that the problem intensified.”
Jana became a mother at 22 and wasted no time returning to competition. “For months and months, I pushed my body through training,” she says.
She admits it wasn’t uncommon for her to leak wee in the final 100 metres of a race, but kept the symptoms to herself. “I didn’t tell anyone, not my sports doctor, not even my beautiful mum. I was so embarrassed.”
While competing on the world stage, Jana developed creative ways to ‘self-manage’ her incontinence. Before major races, she would pour a full bottle of water over herself to mask any signs of leakage, and she often avoided post-race interviews altogether.
Despite holding one of the most prestigious titles in sport, Jana was quietly battling incontinence alone.
Her experience is far from rare. In fact, 1 in 4 people living in Australia experience some form of bladder or bowel control issue. Women are particularly at risk, with factors such as pregnancy, childbirth, and menopause increasing the likelihood of incontinence. Though incontinence is common, it is not something you have to live with. No matter your age or stage of life, symptoms can often be treated, better managed, or even cured.
For years, Jana managed her incontinence in silence. But everything began to change when she decided to seek professional help.
A turning point came when Jana started working with a physiotherapist who specialised in postpartum care. With expert support and guidance, she began retraining her pelvic floor muscles and learning how to better understand the connection between her bladder and pelvic health.
The results were life-changing. Now, after having her sixth child, Jana enjoys the freedom to jump on the trampoline and go for a run, without constantly worrying about bladder leaks.
Seeing how far she’s come, Jana is now passionate about spreading the word. She encourages others facing similar challenges to seek help and reminds them that recovery is possible with the right support.
Jana Pittman’s moment to raise awareness came when she appeared on the hit television show SAS Australia. Known for its intense physical challenges, the show pushed contestants to their physical and emotional limits, something Jana was well prepared for, but with one major concern.
“When SAS came along, I knew. I knew I was going to wee myself on national television,” she says.
The show involved gruelling tasks, 5km runs, burpees, squats and jumps, all known triggers for bladder leakage. During one particularly tough challenge, Jana felt her body fatiguing and lost control of her bladder. She turned to a fellow contestant and admitted, “I just pissed myself on that run.”
Though nervous about how viewers would respond to such a vulnerable moment, the reaction took her by surprise.
“It was incredible, all of these positive conversations about women’s health and incontinence, that came out of one embarrassing moment for me.”
Jana received thousands of supportive messages from both women and men, proving how widespread and under-discussed this issue really is.
“We need to talk openly about incontinence and seek help. Leakage is manageable with the right support, and sharing our stories can make a significant difference.”
With courage and honesty, Jana is helping to shine a light on incontinence and empower others to take control of their health.
Today, Jana is also working as a junior doctor, specialising in obstetrics and gynaecology. Her unique combination of medical training and personal experience with incontinence puts her in a powerful position to advocate for better awareness and support around continence health, for women of all ages.
Stress incontinence (leaking wee when you cough, sneeze, run or jump) can be caused by many things including a dysfunctional pelvic floor (muscles that hold up your pelvic organs). Symptoms of pelvic floor dysfunction can include:
• Bladder leaks (leaking wee)
• Bowel leaks (leaking poo)
• Needing to wee a lot (overactive bladder)
• Urinary retention (not being able to do a wee or fully empty your bladder)
• Pelvic pain, genital pain, rectal pain
• Back pain
• Pain with sex or problems with sexual function
• Constipation (going to the toilet less than three times a week)
• Straining on the toilet to do a poo
Samantha Cole, Clinical Psychologist
Suffering from long-term medical problems can be lonely and take a toll on the mental health of the person experiencing it or those taking care of them. We talk to clinical psychologist, Samantha Cole from OceansideClinicalPsychology.com in New South Wales, about how to check in on a friend or loved one.
Watching for signs. Not coping can look different in everyone, but signs to look out for include:
• Changes in someone’s mood persistent sadness, irritability, feelings of worthlessness and/or helplessness, or excessive worry.
• Changes in someone’s sleep trouble falling asleep or staying asleep, sleeping more than usual, or persistent fatigue.
• Difficulty with day-to-day tasks a decline in self-care tasks, difficulties with work responsibilities, difficulties with study or family demands.
• Social withdrawal and loss of interest can look like a friend cancelling plans more than usual or not responding to messages or phone calls. It could also be if someone stopped engaging in activities or hobbies they would usually enjoy, or perhaps not going to work.
• Changes in appetite or weight significant weight loss or gain, or changes in eating habits where someone might not be eating regular meals or eating more than usual.
• Alcohol and substance use drinking more alcohol or using illicit substances.
• Expressing thoughts of suicide if someone is expressing thoughts of not wanting to live anymore, it is important you seek immediate help by calling 000 or go to your local emergency department.
Starting the conversation. Make sure you have the time and privacy to have a compassionate and meaningful conversation about a friend or loved one’s mental health.
Start by expressing you care and are concerned about them and their wellbeing. This can be done by using statements like: “I’ve been thinking about you and wanted to check in".
Encourage them to express their feelings and ask them open ended questions that require more detail than a “yes” or “no” answer. You might ask:
“How are you feeling today?”
“What has been challenging for you lately?”
“How have you been coping with work and family life?”
“How have you been coping with your health lately?”
Listen closely. When you ask these kinds of questions, you need to actively listen and validate their feelings, without any judgement. Pay attention to what is being said verbally and nonverbally, for example notice facial expressions or their tone of voice. Validate any expressed feelings by acknowledging the reported experiences or challenges are valid and understandable, and that you are there to offer support.You might say:
“I can see this is really hard for you”
“It makes sense that you’re feeling like that with everything you are going through”
“I want you to know that I am here to listen”
“I am here to support you in whatever way I can”
Offer practical ways of supporting a friend or loved one such as offering to help with errands, supporting them at appointments, or even cooking a meal for them. However, just being there to listen without judgement can often be the most supportive thing to do.
If you are concerned about their mental health, you might gently suggest they talk to a health professional to help them access suitable support. You might say: “I am concerned about you and wonder if talking to a health professional would be helpful for you”. Remind them it’s okay to ask for help even if it feels hard, and that there is no shame in seeking help. We all experience challenges in various ways and will require support with life challenges.
Be patient, even if they don’t immediately open up or accept your support. Continue to check in with them regularly and remind them you are there for them.
SUPPORT NUMBERS FOR PEOPLE EXPERIENCING THOUGHTS OF SUICIDE
LIFELINE: 13 11 14
SUICIDE CALL BACK SERVICE: 1300 659 467
BEYOND BLUE: 1300 224 636
IF YOU ARE CONCERNED FOR YOUR SAFETY OR THE SAFETY OF OTHERS, SEEK IMMEDIATE ASSISTANCE BY CALLING 000
Alan had prostate cancer 14 years ago and has since been working tirelessly to educate others.
"I often talk to groups of men about their health. I started out using words like continence, but people weren't understanding," Alan tells Bridge. "You have to use plain language to explain to people what is normal and what they should be looking out for when it comes to their bladder and bowel control health"
"Women are often more health literate (understand health care options) because they have been going to the doctor since puberty. Blokes put off going to the doctor thinking the problem will go away or leave it for too long to get their symptoms checked out," says Alan.
"When I talk to these groups of men and explain how often they should be going to the toilet and what their wee and poo should look like they are often shocked. I will say to a bloke, if you are only doing a poo every 4-5 days, how does that feel? How does your body feel when that happens?"
"When I am planning a presentation for the general public who might not be that health literate, I always ask myself, 'What will stop this from working, what will stop people from understanding this topic?'," Alan explains. "Not only do we have to consider people who might not be that familiar with medical terms, we also have to consider all the people in Australia that don't have English as a first language."
SPEAK TO A NURSE CONTINENCE SPECIALIST FOR FREE CONFIDENTIAL ADVICE 1800 33 00 66 (8AM-8PM AEST MON-FRI)
AVERAGE WAIT TIME LESS THAN 60 SECONDS
44% of Australian adults don’t have the literacy skills to manage everyday reading tasks
AUSTRALIAN BUREAU OF STATISTICS PIAAC 2011-2012
Alan and his wife, Fiona, run a website called theprostatezone.com and Alan has also written a book about his experience. The website aims to give people practical information on living with prostate cancer including the parts that are sometimes difficult for people to talk about such as erectile dysfunction, sex and intimacy.
theprostatezone.com/prostate-book
If bladder control problems are new to you, you might not know exactly how to put into words the symptoms you have been experiencing. There are a lot of medical terms and complicated names that describe different ways your body can be impacted. The jargon buster below might help you decipher what you are experiencing to help you communicate with your health care provider.
SYMPTOMS: MAY INDICATE A MEDICAL CONDITION, DISEASE OR DISORDER IN THE BODY.
Stress incontinence leaking wee when you laugh, cough, sneeze, jump, run or lift something heavy.
Urinary urgency the strong and sudden feeling of needing to do a wee.
Urge incontinence the strong and sudden feeling of needing to do a wee which can't be controlled and results in leaking wee (urine).
Urinary frequency need to go to the toilet very regularly to pass urine (weeing more than 7 times a day and more than once at night).
Mixed incontinence leaking wee when you laugh, cough, sneeze, jump, run or lift something heavy as well as an urgent need to do a wee which can't be controlled and results in leaking.
Post-micturition incontinence (after dribble) involuntary or accidental leaking of wee when standing up after going to the toilet, pulling clothes up or when starting to walk away from the toilet.
Orgasm-associated urinary incontinence (climacturia) involuntarily leaking wee when you orgasm during sexual activity and can happen to both men and women.
Urinary retention not being able to fully empty the bladder, so some wee is left in the bladder after going to the toilet. It can be long-term (chronic urinary retention) or happen suddenly (acute urinary retention).
Nocturia waking up and needing to go to the toilet more than once at night.
SYNDROMES: GROUPS OF SYMPTOMS THAT CAN BE CAUSED BY A FEW DIFFERENT CONDITIONS.
Bladder dysfunction when your kidneys produce wee (urine) it is stored in the bladder until you go to the toilet. Symptoms of bladder dysfunction (your bladder not working as it should) can include difficulty filling, storing or emptying the wee.
Overactive bladder sudden unexplained bladder contractions, resulting in symptoms such as urinary urgency, urinary frequency and nocturia.
MOST OF THESE SYMPTOMS CAN BE TREATED, BETTER MANAGED OR EVEN CURED. VISIT OUR WEBSITE TO FIND OUT MORE CONTINENCE.ORG.AU
"Good bladder and bowel control health starts with what you eat."
Eat Well, Feel Strong: Nutrition for Continence
Health. Words by: Tris Alexandra Jarvis, BHSc Nutritional Medicine (ANTA Accredited Clinical Nutritionist®).
When it comes to continence health, nutrition often isn’t the first thing that comes to mind—but what we eat and drink can make a significant difference in supporting a healthy bladder, bowels and pelvic floor.
From the health of our gut microbiome, hydration, to specific foods that relieve constipation and fibre intake, a few small tweaks can go a long way to supporting continence.
THE GUT MICROBIOME
A strong foundation for bladder and bowel control health (continence) begins in the gut. The trillions of bacteria in our digestive system, known as the gut microbiome, don’t just aid digestion, they influence bowel regularity, bladder health, and even our risk for chronic conditions like type 2 diabetes, which can increase incontinence risk.
A balanced, diverse microbiome supports regular bowel movements and helps maintain a healthy urinary microbiome (potentially lowering urinary urgency). A 2022 study published in the International Urology and Nephrology journal (link.springer.com/article/10.1007/ s11255-021-03044-w) even links harmful gut bacteria with the progression of urinary urgency and urgency incontinence.
HOW TO SUPPORT A HEALTHY MICROBIOME
By embracing a wide range of plant foods to provide different types of fibre and polyphenols that nourish beneficial bacteria, you can create a more resilient gut ecosystem. Studies show that eating 30 or more different plant foods weekly—including fruits, vegetables, nuts, seeds, herbs, legumes, and whole grains—can boost microbial diversity.
Prebiotic-rich foods like garlic, onions, leeks, asparagus, bananas and rolled oats provide fibre that feeds good bacteria. Probiotic foods such as yogurt, kefir, sauerkraut, kimchi and miso introduce helpful bacteria into the gut.
Hydration is equally important. Dehydration leads to concentrated urine that can irritate the bladder lining, triggering urgency. But hydration isn’t just about drinking more water—it’s also about how well your body absorbs it.
Electrolytes like sodium, potassium and magnesium help pull water into your cells, ensuring fluids are effectively used. Without enough electrolytes, you might drink plenty yet still feel dehydrated or worsen urinary urgency symptoms.
Aim for around 1.5 to 2 litres of fluids daily (unless on fluid restriction), adjusting for activity levels, climate, or life stages like pregnancy and breastfeeding. Herbal teas, broths, and water-rich foods like cucumbers or watermelon also count toward your total. Adding natural flavours like lemon, mint, or berries can make hydration more enjoyable, while a small pinch of quality sea salt or a splash of coconut water adds electrolytes to support fluid balance.
Balancing blood sugar levels isn’t just about preventing type 2 diabetes—it’s also key for maintaining bowel regularity and supporting the gut microbiome. When blood sugar spikes and crashes, we tend to crave quick carbs and skip fibre-rich meals. This pattern can reduce stool bulk, slow digestion and contribute to constipation.
Building balanced meals with protein, healthy fats and fibre-rich carbohydrates helps keep blood sugar steady while boosting fibre intake. The target is 25–30 grams of fibre per day, yet most Australians only get on average 15–20 grams. To boost your fibre intake, try:
• Adding leafy greens to one meal each day
• Sprinkling chia or ground flaxseeds over breakfast
• Swapping white rice for quinoa or lentils
• Snacking on whole fruits like apples or pears with the skin on
"Constipation can increase pressure on the bladder and worsen incontinence symptoms," Tris tells Bridge Magazine. "Diet is one of the most effective tools for improving bowel regularity . Small, consistent dietary changes like adding the below foods can ease constipation and reduce strain on the pelvic floor. "
CHIA SEEDS
Absorb water, forming a gel-like consistency that bulks and softens stools.
Pears and prunes are high in fibre and sorbitol, they help soften stools and get things moving.
Just two kiwi fruit a day may improve bowel regularity and stool consistency.
Food and hydration are foundational—but lifestyle habits matter just as much when it comes to bladder and bowel control health.
Toilet posture: One of the easiest changes you can make is how you sit on the toilet. Using a small footstool to elevate your feet and leaning slightly forward helps relax the pelvic floor and makes bowel movements easier and more complete.
Stress management: Stress impacts gut motility and bladder sensitivity. Deep breathing, time in nature, or simply taking short breaks throughout your day can help regulate your nervous system and reduce symptom flare-ups.
Routine matters: Try to eat around the same time each day. Your body thrives on rhythm, and a predictable routine can help train your bowels and bladder into better patterns.
Nutrition is one of the most empowering and accessible ways to support your continence health. By feeding your gut with a variety of whole foods, hydrating strategically, managing blood sugar, and creating some healthy lifestyle habits, you lay a strong foundation for continence health at any age.
This year, the Australian and New Zealand Continence Journal celebrated 30 years of publishing research on all aspects of bladder and bowel control health.
The official journal of Continence Health Australia and Continence NZ, the Australian and New Zealand Continence Journal (ANZCJ) is a trusted open-access (free for anyone to read) publication for health professionals, people experiencing incontinence and their loved ones to use when researching their health condition and latest treatment options.
Podium Presentation Abstracts from the 33rd National Conference on Incontinence (NCOI)
Each year, Continence Health Australia runs the NCOI with presentations on the latest continence research, an exhibition of continence product suppliers, and workshops for both health professionals and people experiencing incontinence. The ANZCJ publishes a summary of each of the main presentations, called an abstract. Read them online: publish.csiro.au/cj.
The latest research in continence. Free to publish, free to read
Academic journals that publish research are run by an editorial committee of experts in their field. An author (or authors if multiple people contributed to the research) submits their findings in the form of a written article, usually supplemented by images, figures, and data tables. They back up any theories or ideas with research that has already been published, and indicate where they found the information using references. The idea behind a well-written research paper is that another person could repeat the experiment by following the instructions set out in the article and get the same result. Once submitted, the article is checked by the editorial committee who decide if it is relevant for the journal and would further the scientific knowledge in the field their journal specialises in. If the paper is relevant, it is sent to at least two experts who read the article and give feedback on whether it was a well-run experiment and if the results are valid. They do not know who wrote the research when they read it; this is called an anonymised peerreview. Any feedback is passed on to the editor of the journal (the big boss) for a final decision on whether the research was conducted in the correct manner and if the conclusions the authors have drawn from the results are backed up by the data they provided. At this point, the paper can be rejected if the research methods or ethics were not up to the standard expected, accepted for publication in the journal, or sent back to the author(s) with feedback from the peer reviewers and editorial committee. The authors are not told who the peer reviewers were; this is called a double-anonymised peer-review process, and is the gold standard in research. If only minor corrections are required, the author is invited to read the constructive feedback from reviewers, adjust the paper and resubmit it to the journal, with the hope that the reviewers and editors will now find it suitable for publication.
Your call will be answered by one of our nurse continence specialists who will listen to your story without judgement and offer confidential advice.
No question is too big or too small. The Nurse Continence Specialist is able to give you advice on how to improve and manage the continence problem, give details of local clinics, funding and product advice, including where to get product samples. The nurse can explain what to talk to your GP about and tests that may be needed. They can help you describe the problems you are having using medical terminology, which can be useful when explaining your symptoms to other health professionals.
Topics people call the helpline about include, but are not limited to:
1. Prevention and management of incontinence (loss of bladder and bowel control).
2. Women's health – bladder or bowel issues from pregnancy, childbirth, pelvic floor dysfunction, prolapse and/or menopause.
3. Men's health – prostate, pelvic floor, after dribble.
4. Children's health – toilet training, bedwetting, day wetting, soiling, constipation.
5. Bladder or bowel issues from medical conditions such as diabetes, dementia, and Parkinson's Disease.
6. Funding schemes including CAPS and NDIS.
7. Continence product advice.
Anyone! You can call the helpline if you are experiencing incontinence, are caring for someone living with incontinence, or you are a health professional calling for advice about a patient. Health professionals can also call and arrange for the helpline staff to contact one of their patients.
For free advice call the National Continence Helpline on 1800 33 00 66 (8am-8pm AEST) to speak to a nurse continence specialist.
If you have a story to share about your experience calling the helpline for advice on your bladder or bowel health, please get in touch. Readers value reading other people's lived experience.
Email Managing Editor, Sarah Tayler media@continence.org.au to share your journey.
1 in 4 Australians experience bladder or bowel leakage. Take
