Why do we new mums find it easy to discuss the graphic details of our labours, yet not our leaky bladders? Bladder problems, or incontinence, are as prevalent as one in every three new mums.
Raising awareness and encouraging conversation about pelvic floor troubles is essential. It is important that health professionals do this, in particular, women’s health physiotherapists, midwives and doctors. It’s also important for women to not feel afraid to ask for help when visiting a health care professional.
What is Incontinence?
Urinary incontinence is a loss of bladder control which results in leaks of urine. This can occur when coughing, sneezing, laughing, exercising, or even during sex. Incontinence can also occur when there is a strong overwhelming desire to urinate and losing control before reaching the bathroom.
Why Am I Having Accidents Now that I’m Pregnant?
It is very common for women to develop some form of incontinence during pregnancy, especially in the third trimester. There are many reasons for this, most of which are unavoidable and just one of those pregnancy things! These can include:
- The weight of the unborn baby and the pressure of the uterus on the bladder and pelvic floor muscles.
- Constipation, a common side-effect of pregnancy, adding further pressure of a full bowel on the bladder.
- Pregnancy hormonal changes, making the ligaments that support the bladder very soft and lax, resting on a pelvic floor muscle sling which is already exhausted.
If bladder control and pelvic floor muscle strength is not great heading into a pregnancy, then it will be more likely to become more problematic as the pregnancy progresses. Also it is more common in women with a high BMI, or who are overweight.
Can I Lower the Risks of Wetting Myself in Pregnancy?
Keep in mind that a lot of the causes of incontinence are unavoidable when a woman is pregnant. However, if having a second or third baby, working hard on restoring good pelvic floor muscle strength between babies is imperative. Making sure that pelvic floor muscle activations are appropriate and proper is also crucial as we find that many women are not engaging or strengthening these muscles correctly. Seeking assessment and advice by a specially trained women’s health physiotherapist can give a clearer idea of how well a woman is practicing her exercises.
If planning a pregnancy and BMI is very high, reducing body weight through an appropriate routine of good eating and exercise will reduce the risks of pregnancy incontinence later on. It will also optimise mental and physical wellbeing moving into the most incredible journey a woman and her body will take.
I’ve Had My Baby. Why Am I Still Having Bladder Problems?
Leaking is common in one in three women after childbirth. Sometimes women lose their connection to their pelvic floor muscles after childbirth and the muscles weaken. As with incontinence in pregnancy, there are common causes or risk factors, including:
- Assisted vaginal births with forceps and vacuum, or tears and episiotomies, all of which can cause injury to the pelvic nerves and muscles.
- A very long second stage of labour.
- Having a first baby, or large baby over four kilograms.
- Early prolapse where the bladder, uterus or bowel can sag and put pressure on the pelvic floor.
- Weakness of the pelvic floor muscles, or bladder problems before pregnancy.
For those women having a C-section, post-natal incontinence is still a risk due to the tiredness and weakness of the pelvic floor muscles from the weight of the uterus throughout pregnancy.
Isn’t a Leaky Bladder Something I Should Just Put up With?
The health and strength of a woman’s pelvic floor for bladder control can always be improved. It is not to be put up with, especially when quality of life or worry over having accidents gets in the way of a full life. Proper pelvic floor muscle exercises during pregnancy and after childbirth are essential.
Those first few weeks as a new mum may also see a lot of women with poor bladder control, which is very normal. However, ongoing issues require further assessment and management. It is advised to see a women’s health physiotherapist to make sure the correct therapy is prescribed – it may not be as simple as a few pelvic floor ‘squeezes and lifts’ for these women. Women’s health physiotherapists are highly skilled in assessing pelvic floor function and can help manage any incontinence, as well as treat any prolapse or scar tissue which is common post-birth.
Tips for Beating Pregnancy and Postnatal Incontinence
- Get to know your pelvic floor muscles before or during pregnancy – how to properly engage them, how to relax them, how they control your toilet urges. This will not only assist with your labour, but you will know how to start your pelvic floor exercises as a new mum.
- Find a way to remember to do your pelvic floor muscle exercises each day. Perhaps with every drink of water in your day, or with nappy changes when you have your new little one.
- Talk openly about bladder and bowel control with your fellow new mums at mothers’ groups, or with your GP at your regular visits.
- When your baby is three months old, stop and have a think about your bladder and bowel control at this point in time. If you are still having troubles, seek help.
- Women’s health physiotherapists are the best at assessing the cause of any ongoing bladder control issues. They will guide you through the best exercises and management that are right for you. We see it all and know that every woman is different.
- Know that you do not have to put up with a leaky bladder – there is help out there and you deserve that.
To read more about women’s health and pregnancy physiotherapy, visit The Fix Program.
Katrina Tarrant is the Owner and Principal Physiotherapist of The Fix Program in Sydney’s CBD. The Fix Program, helping many since 2005, is a clinic and Pilates studio designed to heal, strengthen and protect bodies from injury and pain. Katrina is also a mother of 2 and is passionate about achieving the physical and mental best in a woman throughout her child bearing years.