Third GP appointment and I have been told again that leaking is just what happens after babies

I have now had this conversation three times with two different GPs and I came out of today's one so angry I sat in the car park for a quarter of an hour.

Second baby is fourteen months old. I leak when I cough, when I sneeze, when I laugh properly, and every single time I run for a bus. Today I said all of that out loud in the right order and got: "it is extremely common after two babies, most women have some of this, try not to worry".

And the thing is, I believe her that it is common. That is not the bit I am arguing with. What I cannot work out is how common turned into nothing can be done, because those are obviously two different sentences and somehow the appointment ended after the first one. I did not ask for anything specific because I did not know what to ask for. I just said it was bothering me and then apologised, which I have now done three times.

Is there a magic phrase? What do you actually say?

There is basically a magic phrase and it is not the one you think. Stop saying "is this normal" and start saying "am I eligible for a referral". Completely different conversation, I promise.

Four appointments over two years here, and the reason I got nowhere for the first three was that I kept describing how I felt about it rather than what it had stopped me doing.

Fourth time I went in with a list. Stopped the Thursday class in the January. Stopped taking the kids on the big trampoline in the March, hence the username. Started planning the school run around whether I would need to cough. Three things, with months attached. She read the list, did not say the word normal once, and referred me. Same symptoms, same GP surgery, different information.

I am not saying that is a trick that always works. I am saying the appointment goes differently when the person opposite you has something specific to write down.

I want to answer the question you actually asked, which is how common turned into nothing can be done, because that step is where most of the harm on this subject happens.

Common is a statement about how many people have something. It is not a statement about whether it responds to treatment. Those are separate claims and the second one does not follow from the first. In this case the treatment claim is unusually well supported: the NICE guideline on pelvic floor dysfunction, NG210, says at recommendation 1.6.14 to offer a programme of supervised pelvic floor muscle training of at least three months to women with stress or mixed urinary incontinence, and NG123 puts the same thing as first line treatment for those symptoms. First line means before surgery in the pathway, not after everything else has been tried.

On the numbers, and I am going to give you the definitions with them because a prevalence figure without its definition can be made to mean almost anything. A systematic review of postpartum incontinence found any leakage in about 33 percent of women in the first three months after birth, with a confidence interval of 32 to 36, but weekly leakage in about 12 percent and daily leakage in about 3 percent. Population studies of women generally report any urinary incontinence somewhere in the range of 25 to 45 percent. So when somebody says most women have some of this, they are usually reaching for the widest definition available, and the person sitting opposite them who is planning her day around a cough is not in that group.

What the trials found, kept separate from what I see in a room. The Cochrane review of pelvic floor muscle training against no treatment or an inactive control reported cure in 56 percent of women with stress incontinence against 6 percent of controls, a risk ratio of 8.38 with a 95 percent confidence interval of 3.68 to 19.07, and that is graded high certainty, which is rare in this field. It also rests on four trials and 165 women, which is a small foundation for a famous number, and cure meant whatever each of those trials defined it to mean. Turned over, 44 percent were not cured. In a clinic what I see is closer to that second sentence than the first: substantial change is common, complete resolution is not universal, and people who are told to expect a cure and get an improvement often think they have failed.

The practical part. The question that produces movement is not "is this normal" and it is not an argument. It is: I understand this is common, I would like to know whether I meet the criteria for a referral to pelvic health physiotherapy, and if I do not, I would like to know which criterion I fail. That asks for a reason rather than a verdict, and asking for the reason to go in the notes is a reasonable request and not an adversarial one. Take a three day bladder diary, take the list of things you have stopped doing with the dates on it, and say whether anyone has ever told you to do pelvic floor exercises without checking what your muscle was doing. Why symptoms get dismissed sets out the mechanism properly and stress urinary incontinence covers what the treatment is and what it is not.

What I cannot do from here is tell you what is causing your symptoms or which treatment suits you, because that needs somebody to assess you rather than read you. Nothing in this post is a view on your pelvic floor.

The thing that kept me quiet for two years was assuming it only counted if it happened every day. Mine was a few times a week and I genuinely thought that put me below the threshold for being allowed to complain about it. Nobody ever told me there was no such threshold.

Went back a fortnight ago with the diary and the list and the sentence about criteria, and I have a referral. She actually said "that is a much clearer picture" while she was reading the diary, which after three appointments of trying not to cry was quite something.

No appointment date yet, and reading the other thread on here about waiting lists I have set my expectations accordingly and asked which list I am on. But I wanted to come back and say the sentence worked, and that the diary did more of the work than anything I said out loud.