LEAKAGE AFTER GIVING BIRTH – INCONTINENCE
After giving birth you may find controlling urine, wind or faeces very difficult. This will depend on a number of factors, some of which are generally agreed upon and some of which there is argument over. These factors include:
- previous history of incontinence (either during pregnancy or before)
- if you are overweight – the increased weight puts pressure on your pelvic floor
- having multiples (ie twins/triplets) again the increased weight puts extra pressure and stress onto the pelvic floor
- number of previous pregnancies, length of time between them & whether any rehabilitation was done in between pregnancies
- length of labour and push phase
- trauma to pelvic floor (ie tear or episiotomy)
- instrument assisted birth or not
- epidural usage or not
- size of baby
- vaginal or c-section birth.
Your pelvic floor has had to do a lot of work supporting your internal organs as your baby grew and got heavier. By the end of pregnancy the pelvic floor is under a lot of pressure. If you gave birth vaginally or attempted to give birth vaginally and have had any trauma to the pelvic floor it is injured. This injury to a muscle group can respond the same as any other, you will get pain and may get some muscle inhibition (limiting the working of a muscle). When you limit the capacity of the pelvic floor you can get leakage of urine and/or faeces and/or wind. Over time this should naturally improve. Over the course of the first week you should gain back some of the control and by your 6 week check up, you should have regained most of the control back. However there are many women who do not and while incontinence is common it is not normal & there are many things that can be done to help.
We strongly advise all women to get check by a pelvic physiotherapist at around 6-8 weeks postpartum to assess the individual and determine what is the best course of action for them. However as this is not possible in all parts of the world we are going to give some general advice and suggestions however this will not be the direct course of action for everyone.
Unfortunately pregnancy and giving birth are both considered risk factors for urinary incontinence. The first thing to determine is the cause for the leakage. There are different types of incontinence that have different approaches and requirements for treatment. A very common type of incontinence experienced after birth is stress incontinence. This is when leakage occurs due to pressure on the bladder. This pressure can come from an increase in the abdomen itself, for example during a cough or laugh or sneeze. It can also come from physical exertions like running, jumping, skipping; lifting a heavy object or having sex. It can be accompanied by an overactive bladder and/or urge incontinence – where you leak whenever you feel the urge to pass urine.
Treatments for incontinence vary depending on the type of incontinence and the severity. The treatments can include:
- Bladder diaries & retraining – this is where you keep a diary of things such as all fluids in & out as well as all episodes and amount of leakage; time of day & level of urgency. This helps to set a base line and starts you on a program to slowly increase interval time and frequency as well as urge issues.
- Pelvic floor muscle training – strengthening the pelvic floor muscles has been shown to help significantly when done correctly. See our video on how to engage correctly.
- Nerve stimulation – sacral (implanted in an outpatient setting) or tibial nerve stimulation where electrodes similar to that of the TENS are used to stimulate nerves that stimulate bladder control.
- Biofeedback tools – a probe is placed in the vagina to allow a visual feedback of the contraction/relaxation or tonicity of the pelvic floor muscles. This helps people better connect to the pelvic floor
- Reducing constipation – constipation has a huge impact on urinary incontinence so see our post on how to reduce constipation
- Stop smoking – cigarette smoking has been shown to be a bladder irritant
- Maintaining a healthy weight – the extra weight you carry is extra weight you put on your pelvic floor and increases the force downward during things like coughing and sneezing
- Medication if required – this is usually considered if conservative treatments are insufficient
- In the most severe cases more invasive options are considered eg botox to the bladder or surgeries
Compared to urinary incontinence, anal incontinence (stool: diarrhoea, constipation bloating & wind) is less common but the prevalence is higher than may be expected, up to 25% wind incontinence and 20% stool incontinence in women who have given birth. Some evidence suggests there is a higher association with a Grade III or Grade IV perineal tear. This is where the tear extends either into the anal sphincter (the ring of muscle that closes your anus) or all the way through it. It is quite a severe injury at birth that generally requires a surgical repair under anaesthesia in an operating theatre.
Anal incontinence can have a huge impact on a person’s mental & emotional wellbeing. There is often a lot of shame or embarrassment associated with it and often people are reluctant to share their problems even with healthcare providers. It is important to know that there are many different treatment options & a lot can be done to improve or cure it! If the anal incontinence has not resolved a few months after birth then seek out a pelvic physiotherapist who can assess and treat your individual issues.
Strengthening up the pelvic floor muscles has been shown in many cases to significantly improve the incidence of leakage but it needs to be done correctly. It is also important to ensure you’re taking in enough fluid as well as a fibre rich diet but not overloading on fibre supplements as this can contribute to constipation. In the short term wearing protective garments – pads and underwear designed to absorb faecal matter, ensuring you know where the toilets are & having clothes to change into can help. But these should only be considered short term aids to a longer term solution.
OUR PELVIC FLOOR & CORE WORKOUTS WILL MAKE A BIG DIFFERENCE