Incontinence After Pregnancy

Incontinence is leaks or accidents of urine or fecal matter (even a small amount counts). Women are often too embarrassed to talk about it, even with their doctors. I hope I can give you some basic information and numbers so that you can understand what it looks like, just how common it is, and that with the right specialist and treatment, the vast majority of incontinence problems can resolve.

 

If you are experiencing pelvic floor problems, it can have a major impact on your way of life. And if you feel embarrassed bringing it up with a healthcare provider, please don’t feel embarrassed. Bring it up anyway. Remember that we healthcare providers are here because we want to help people. Often physical therapists who specialize in the pelvic floor became specialists in that field after struggling with pelvic floor issues themselves. Please don’t delay. Talk to your doctor or call a physical therapist who specializes in the pelvic floor as soon as possible. You’ll be so glad you did.

Incontinence is an obvious sign you’re likely experiencing a pelvic floor problem.

But it isn’t always as straightforward as you might think. Incontinence can look like:
• Leaking even a small amount of urine or fecal matter (that’s poop) when you cough, sneeze, laugh, or work out
• Having to get up in the middle of the night to urinate after you’ve had your baby
• Usually needing to urinate more than 7 times in a 24 hour period
• Struggling with a trigger that doesn’t have to do with urinating, like putting the key in the door, that suddenly causes you to feel like you have to urinate 1-3

Note: Incontinence is not the only potential cause of the above symptoms, so be sure to discuss any of these symptoms with your doctor.

Pelvic floor problems can also show up in other disconcerting ways.

Pelvic floor problems can be at the root of pain with sex (though there are many other potential causes as well, such as the vaginal dryness that’s common while breastfeeding). Uterine prolapse can be a serious manifestation of a pelvic floor problem.4

Less obvious, a pelvic floor problem can cause posterior pelvic pain, low back pain, and even pain in far away joints like your shoulder or knee. Since your pelvic floor is a key part of your core muscle system, if you aren’t firing your pelvic floor correctly or well, that can throw off your whole body mechanics.4

Here are some numbers.

Less than 1 percent of women who are not moms experience incontinence.5 Contrast that with moms. Of those who have a vaginal delivery, 58% have some kind of pelvic floor problem (including incontinence) after giving birth, as do 43% of those who have a C-section (I know, it doesn’t seem right, but the pelvic floor stretches during pregnancy too, not just delivery).1

Stress urinary incontinence is leaks or accidents with sneezing, lifting, coughing, etc. Urge urinary incontinence occurs when your body responds by feeling the urge to go after an unrelated trigger, like putting the key in the door. Taking stress urinary incontinence by itself, 34% of moms experience it.2

Risk factors include more than one vaginal delivery, even if you were A-OK after the first one, surgical delivery (they had to use a vacuum or forceps), a third or fourth degree tear (into the anus), or delivering a baby over 8 pounds.1,3,5,6

While 38-42% of women do experience a transient nerve injury during the birth process that self resolves in the first 6 months, many are still having problems long afterwards. The prognosis is good, though, if you are receiving evaluation and treatment from a physical therapist – 97% will see improvement, and 73% will experience complete resolution of incontinence.1,5,6

No matter how common it is, it doesn’t have to be that way. You should be able to run, exercise, laugh and sneeze without leaking. If you’re not, you need to see a physical therapist who specializes in the pelvic floor. Find one here. In many states you can see a pelvic floor specialist without a physician’s referral, and you can check with a quick call to the clinic.

References:

1. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s Health. 2013;9(3):265-277. doi:10.2217/whe.13.17.
2. Sahakian J, Woodward S. Stress incontinence and pelvic floor excercises in pregnancy. British Journal of Nursing. 2012;21(18):S10-S15.
3. Shelly B. Introduction to Rehabilitation of Pelvic Floor Dysfunction and Urinary Incontinence. In: Shelly B, ed.; 2014:1-36.
4. Weibe J. The Diaphragm-Pelvic Floor Piston for Rehab and Fitness Professionals. In:; 2012. https://www.juliewiebept.com/store-video/the-diaphragm-pelvic-floor-piston-for-rehab-and-fitness-protected/.
5. Romano M, Cacciatore A, Giordano R. Postpartum period: three distinct but continuous phases. Journal of Prenatal Medicine. 2010;4(2):22-25.
6. Whitehouse T. Managing stress incontinence in postnatal women. Nursing Times. 2012;108(18-19):16-18.
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