During pregnancy, the muscles that support a woman's bowel, bladder and uterus (called the pelvic muscles) become stretchier as a result of hormonal changes. These muscles also have to support the weight of the baby, which can weaken them. When women give birth, the pelvic muscles are put under enormous strain, as the muscles, tendons and ligaments that form the pelvic floor muscles are used to push the baby out. The stress that these muscles go through during delivery can cause postpartum incontinence, an extremely common condition which affects up to 70% of women after giving birth.
Why Do I Leak?
Postpartum incontinence, also known as stress incontinence, typically comprises of leaking urine during reflexes such as sneezing, coughing, and laughing or during exercise. In some cases, women can feel a sudden urge to go to the toilet, and it can feel like they only just got there in time. Women who suffer tears or who underwent episiotomies are even more likely to suffer from incontinence. Mothers who have had caesareans can also suffer post-birth incontinence, as if the caesarean was performed as an emergency, they may already have been through the pushing stage, where damage can be done to the pelvic muscles. Some women who experience stress incontinence also suffer from diminished pleasure during sex afterwards. In some extreme cases where a woman has had a very deep tear or cut, fecal incontinence can be experienced after delivery, although this is rare. For some women who suffer post birth incontinence, the problem goes away after a few weeks, for others it can be a long term problem.
Although this sounds like rather bleak for pregnant women, the upside is that in the majority of cases, these muscles can be repaired after delivery by doing exercises to repair your pelvic muscles, commonly called kegel exercises. The importance of doing kegel exercises is demonstrated by the French, who have a system where every new mother is automatically enrolled onto a 10 session course, funded by the state, which focuses on repairing the pelvic and abdominal muscles. Many women suffer in silence about their incontinence, but it's important to seek help if you suffer from this as there is lots of help and support available.
What Can I Do To Help?
You need to do kegel exercises to regain muscle tone, which will prevent leaking and help your bladder go back to its pre-pregnancy state. To do kegel exercises, squeeze your pelvic muscles as if you are trying to stop peeing or passing wind. It's best to do this when your bladder is empty. Squeeze your pelvic muscles towards your belly button in a 'lift and squeeze' motion, and hold them for 5 seconds, and then relax. Repeat this 5 times. Then do the same as before, but do it more quickly, and hold it for 2 seconds instead of 5. Do this 5 times. Then alternate between holding for 5 seconds, and holding for 2 seconds. Do this for 5 minutes, at least 3 times a day.
Incorporate these exercises into your daily life so that they become part of your daily routine. You can work them into your day quite easily as they can be done any time, anywhere! Do some while watching TV, doing the washing up, in the shower, or waiting for the bus! It will take a while before you notice any difference, but you should start to notice an improvement between 8-20 weeks. If you stop doing them, your muscle weakness may return so make sure you keep them up. Kegel exercises can be done soon after delivery, don't be put off you're feeling sore down there, they actually speed up the healing process. Post birth incontinence is likely to get worse if the problem isn't treated, as subsequent births and age exacerbate incontinence, which makes it harder to fix, so don't delay doing kegel exercises.
You can also help gain your pre-pregnancy bladder back by training it to hold more water. During pregnancy, hormones and the weight of your baby on your bladder make you pee more often. By waiting until your bladder is full before going to the toilet it will actually help it get used to holding more water and lessen the symptoms of stress incontinence.
Is There Any Way To Prevent This Happening?
Expectant mothers can also strengthen their pelvic floor muscles during pregnancy, as the stronger the muscles are, the easier it will be to push, which results in less damage being inflicted on the muscles during delivery. Doing kegel exercise at least 3 times a day will help prepare your muscles. There are certain types of pregnancy pilates and yoga that specialise in strengthening the pelvic muscles, so look around for a class which covers pelvic floor exercises.
If kegel exercises don't seem to be helping, seek professional help from your doctor, who can refer you to a women's health physiotherapist.