Today’s guest post from Vicki Zumbragel is no laughing matter (pun intended)! Too many women suffer with postpartum incontinence on a long term basis. It’s an important topic that needs to be talked about. As a registered nurse and personal trainer who specializes in pelvic floor safe exercise programs, Vicki was the first person I went to for a request on this topic. I hope it helps you to heal your body and reclaim your confidence.
As another side note that isn’t mentioned in Vicki’s article, diastasis recti (abdominal separation) can also bring with it symptoms of pelvic floor dysfunction. If you have separated abdominals you can also check out my post about using a postpartum girdle to help close the gap – Elly xx
As a Registered Nurse and Personal Trainer specializing in pelvic floor safe exercise programs I see many women with signs of postpartum incontinence. I have found that pelvic floor weakness does not discriminate by age or stages of women’s lives. However, I do note that it is more common in women who have had babies or are in a state of menopause. Whilst many women focus on their weight and try to exercise on a regular basis they tend to forget to exercise their pelvic floor muscles.
Many, whom I have trained and consulted, have signs of postpartum incontinence. They are already incontinent and are wearing incontinent products or incontinence pants. This is either “just in case” or maybe they know that they will leak during the day. They either have light bladder leakage or for complete loss of bladder control after childbirth. Some require pelvic floor surgery or have already had surgery due to pelvic floor dysfunction symptoms.
- How are menopause and postpartum incontinence related?
- Signs that you may be experiencing Postpartum incontinence
- Emotional and physical aspects
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- Now what can you do about them?
You will have noted that I used the word menopause and wonder how this fits in with postpartum incontinence. I believe that women, no matter their age or how long ago their experience was, continue to be within the realm of being in a state of postpartum. During the birth process, there may be some fascia tears of the pelvic floor muscles. These usually heal but can weaken the connective tissue so it won’t be as strong as it was originally.
This weakness may not show up until menopause. It will be exacerbated with the aging process and hormone changes. Coupled with pelvic floor dysfunction symptoms and postpartum incontinence it becomes an issue that needs extensive care and expertise.
Signs that you may be experiencing Postpartum incontinence
Stress incontinence (leakage)
Sneeze! Cough! Laugh! Exercise! Jump! Dance! …and leak!
This is one of the most common symptoms of pelvic floor dysfunction. One in three women experience light bladder leakage or even complete loss of bladder control after childbirth. This is due to weakened pelvic floor muscles. Postpartum incontinence after childbirth has a huge impact on women’s lives and everyday living. It is usually caused by an increase in pressure during the pregnancy, with baby and organs pressing down on the pelvic floor, hormonal changes, and/or the birth process.
Urge incontinence (leakage)
Also known as: “the key in the keyhole dance.” If you find that you have a sudden urge to go to the toilet and there is usually quite the sense of urgency! It is also typically associated with not getting to the toilet in time and wetting your underwear or missing the toilet. This is where women also like to have the extra protection of incontinence product or special incontinence pants.
This is may also be likely due to having an overactive bladder*! Many women have a mix of stress and urge incontinence.
Postpartum incontinence also includes bowel incontinence.
You may find that you:
- Are unable to control wind
- Can’t make it to the toilet in time
- Are unable to empty your bowel properly and feel like there is still more there
- Soil your underwear with leakage
- Have to wipe your bottom copious times and on returning to the toilet find that you have remnants on the toilet tissue and you only did a wee!
Damage to the anal sphincter muscles (the opening which allows you to do poos) usually causes issues of being incontinent after birth. This is usually due to a tear of some degree, episiotomy or from pushing baby. Approximately one in five women experience this. It is common for women who have bowel incontinence to have bladder issues as well. This is most likely because the same tissues and nerves that affect both types of incontinence are interconnected.
On the flip side, you may have constipation or find that you strain to empty your bowel. This is not incontinence but it can influence your pelvic floor and continence. *
Do you feel like:
- Your bladder doesn’t completely empty
- You have poor/slow/intermittent urine flow/
- Getting up during the night to pee two or more times is the norm for you
- You pass urine frequently
These can all be part of having a pelvic floor weakness too*.
You have a prolapse or have a bulging or feeling of a heavy dragging sensation in the vagina or rectum. Some might say it feels like a small water balloon hanging down inside or outside (depending on the severity of the prolapse) their vagina.
A prolapse is the dropping down of one or more of either the uterus (womb), the bladder or the bowel. It adds more stress onto the already weakened pelvic floor muscles. Prolapse during pregnancy certainly can occur due to the load placed on the pelvic floor muscles and cause incontinence after pregnancy. Some women who have prolapses don’t feel any symptoms described but they may have these other signs of postpartum incontinence.
Some women may find doing prolapsed bowel exercises or prolapsed bladder exercise helpful by doing regular pelvic floor exercises daily. However, some do need prolapse surgery despite all efforts made as a form of pelvic floor dysfunction treatment.
To help you have the best surgical outcome from prolapse surgery it is important to strengthen your pelvic floor muscles before and after. Doing prolapse exercises (kegels) is important for your pelvic floor recovery and to support your pelvic floor in the long run. This may help prevent pelvic floor dysfunction symptoms and minimize the future risk of having a prolapse.
Having symptoms of pelvic floor dysfunction can also influence our sex lives and our sensuality. Going beyond this, it can also affect how we see ourselves as women. It affects our feelings of feeling joy and intimacy and being desirable. Thinking that you might wet everywhere when enjoying sexual pleasures should not be top of thoughts when you are with your loved one. This can be a symptom of having a prolapse and or weakened pelvic floor muscles. *
This brings me to the last sign of postpartum incontinence – the emotional and physical aspects.
Emotional and physical aspects
This is huge and all encompassing! This is where the pain points are right? Let’s do a dump right here!
- I feel annoyed, pissed off, angry that this is happening to me!
- I feel alone.
- I’m embarrassed!
- Am I the only one who wets themselves or soils themselves every time when working out?
- Not only do I have to buy tampons once a month I have to buy incontinence products for everyday!
- I really don’t want to go out for a walk with my friends – there are no toilets handy.
- I want to play with the kids and join in the school parent sack race but there is no way!
- Do I need to go check on my pad/underwear and change? Do i need to use incontinence pants?
- I swear I can smell myself!
- I will just wear my black pants today in case
Did you know that two out of three women who experience postpartum incontinence, including light bladder leakage, do not seek assistance? They think that incontinence is a normal problem for women to have and that nothing can be done.
- You might experience irritation in your vulva region due to being incontinent of urine or from wearing pads all the time.
- UTI’s (urinary tract infections) might be common due to soiling in your underwear and the bacteria making its way into your vagina/urethra.
- You may not drink as much fluid as you should per day so that you go to the toilet less often or have less postpartum incontinence.
- You’re not as active as you used to be and feel unfit and not as healthy as you want to feel.
- Every single public toilet near you is on your phone.
- You go to the toilet before doing anything even if you don’t need to go.
- It’s necessary for you to “pad up” before exercising or doing any activity – even food shopping!
- You don’t play with your children as much as you used to just in case you wet or soil yourself.
So, we have looked at seven signs of postpartum incontinence and have really just touched on some basic points.
Now what can you do about them?
Firstly, having a basic understanding of the pelvic floor muscles is important. You will have noted throughout the signs and symptoms that they have been mentioned a few times (at least).
The pelvic floor muscles are layers of muscles that are stretched out like a diamond shaped hammock. They are connected from the pubic bone to the tail bone and out to the sides of the pelvis. There are three openings through the pelvic floor; the urethra (where urine comes out), the vagina (the birth canal) and the anus (where poo comes out). The pelvic floor muscles support the bladder, uterus (womb) and rectum/bowel. They help with bladder and bowel control and sexual function.
Imagine if there is pelvic floor weakness or stretching for a moment. The openings will not be able to function properly like they should do. This will cause a great deal of the issues mentioned above such as experiencing complete loss of bladder control after childbirth. I recall complete devastation as I sneezed once and I had absolutely no control. I thought my world had come to an end!
There are many factors that may cause pelvic floor dysfunction symptoms. These include pregnancy and childbirth, being overweight, heavy lifting, being on your feet all day, pelvic floor surgery, hormonal changes, constipation, urinary tract infections, medications, diabetes, chronic coughs (smoking, asthma…), and even familial genetics.
For some women, postpartum incontinence lasts for a short time until all resumes back to a normal state for them, some a year or more or a lifetime.
Recommendations for postpartum incontinence
- See your health care professional or women’s health physiotherapist to complete a thorough assessment to ensure nothing else is underlying health wise. They will also discuss pelvic floor dysfunction treatment with you such as prolapsed bowel exercises and prolapsed bladder exercises.
Why miss out on the opportunity to reclaim your life and be active!?
Approximately 70% of women will become dry or experience substantial improvement with the appropriate treatment for them. Only a small number of women may require pelvic floor surgery.
- Learn how to do pelvic floor muscle exercises (Kegels) correctly.
Here is a basic regime you can follow to increase the strength of your pelvic floor muscles. Practice this a few times a day for a three to five months to build ideal strength. Later you can do it few times a week for maintenance. Once you’ve got your basic pelvic floor exercises sorted, consider combining them with these post-natal core exercises to strengthen your tummy.
To start with it is easier to lie on your back with knees up and feet on floor or bed or sit on edge of a firm upright chair. Imagine you are trying to stop passing urine or wind. You are lifting and squeezing up into your vagina. This is an internal feeling nothing else should feel like it is squeezing like your buttocks, thighs or abdomen and you should be able to breathe.
Try to begin with holding the lift for about three to five seconds.
If it is only one to two seconds that is ok too. This is your starting point to try to build up to six to eight seconds. You can later try following it with three to four quick lifts once you master the lift and hold.
Now relax this hold for about 5 seconds before you do another one.
Repeat this again. You want to build up to doing eight holds (building up to 10 or 12). If you can only do a few holds initially this is ok too. You have to start somewhere right? Quality over quantity. Don’t be too hard on yourself. Your pelvic floor muscles after birth are usually rather weak and the ability to do these can be trying. Do this a few times a day if you can.
If you are not noticing any improvement, find it difficult to do these exercises or have issues with incontinence or prolapse I do recommend that you engage with a Women’s Health Physiotherapist or your Professional Health Care Provider.
- Discover how to do strength training with resistance exercise (great for your bone density) by doing pelvic floor safe exercise programs and move with ease! Work with a certified Personal Trainer who can look out for you, strengthen your core and ensure good technique. Doing this and your recommended pelvic floor dysfunction treatment, such as prolapse exercises, may just be the ticket for your pelvic floor weakness and to decrease the need for pelvic floor surgery.
*Although we think symptoms of pelvic floor dysfunction are to do with weakened pelvic floor muscles it may also be due to having tight pelvic floor muscles. This is when the pelvic floor muscles are very tight and unable to relax or lengthen which makes the muscle ineffective. Therefore, symptoms like leaking or experiencing pain during or after sex can seem like weakness.
If you need help to strengthen your pelvic floor muscles, get in touch with Vicki on her facebook page. You can also read about how osteopathy can help with postpartum incontinence.
If you’re pregnant at the moment, find out all about the benefits and risks of yoga during pregnancy.
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