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Embarrassingly, 1 in 3 women who have had a baby wet themselves. Women who have one baby are nearly three times more likely to leak urine than women who have not had a baby.
When the baby moves down through the birth canal (the vagina), the canal is stretched. The nerves, ligaments and pelvic floor muscles that control the bladder opening (urethra), are also stretched.
This can lead to weakened muscles and less structural support around the bladder opening, resulting in less bladder control. The symptoms? Leaking urine with coughing, sneezing, lifting, exercise.
The leaking is not likely to go away unless you guard against further damage and exercise your pelvic floor muscles to help them to get their strength back. As you get older, your pelvic floor muscles will tend to get weaker.
If you do not get the muscle strength back after each baby you have, you are more likely to leak urine. Following menopause, there is a higher risk of having problems with urine leakage also.
The bladder itself is a hollow, muscular pump. The bladder fills slowly from the kidneys. You should be able to hold on until there is about 300-400ml inside the bladder. The bladder closing muscles are called pelvic floor muscles. When you are ready, the pelvic floor muscles relax and the bladder squeezes the urine out. Then the same cycle begins over again.
These muscles do a number of things such as:
When one or more of your pelvic organs sag down into your vagina, this is called pelvic organ prolapse. Prolapse is very common and happens to about one in ten New Zealand women. If you have a feeling of ‘something coming down’, you might have a prolapse. See your doctor if you are not sure about this.
Position: Sit upright on a chair with your back supported. Relax your abdomen and thighs. Breathe normally – your abdomen should gently rise and fall as you breathe.
Pelvic Floor Muscle contraction: Imagine – ‘squeezing around the vagina entrance and lifting the vagina up inside’ or ‘squeezing around the bladder outlet and lifting the bladder up ’Feel the pelvic floor lift.
At first, the movement that you feel may be very small.
If your muscles are weak, you may feel very little at all. Make sure you keep breathing. If you draw your abdomen in strongly or hold your breath, this will hinder your ability to contract your pelvic floor muscles. Make sure that you do not have any downward movement of your pelvic floor when you try to do a squeeze and lift. The lower part of your tummy muscles should gently pull in as you squeeze and lift your pelvic floor muscles. You might like to use a hand mirror to see your pelvic floor muscles working if you feel comfortable doing this. You will see an inward movement of the perineal body (the area between the vagina opening and the anal opening).
If you have difficulty isolating a pelvic floor muscle contraction, try lying on your side. In this position, it is easier to relax your abdominal muscles and therefore easier to feel your pelvic floor muscles tighten.
Step One: Isolation.
It is important that you are correctly contracting your muscles. (see the steps above on how to exercise your pelvic floor muscles) it does not matter if you cannot hold your muscles for long or if they feel weak. The technique is the most important first step.
Step Two: Strengthen – gentle lifts
Positions: lying down or sitting
Begin by gently lifting and squeezing. See if you can hold for 1-2 seconds then build up to 5-10 seconds. This is a gentle lift, not a ‘hard/strong lift’. Once you can hold for longer, see if you can keep breathing while lifting your pelvic floor muscles.
Step Three: Strengthen – strong lifts
Positions; lying down, sitting, standing leaning forwards, straight back and with hands on a bench or table.
Once you are able to control gentle lifts, aim to lift your muscles more strongly. Focus on a quick and strong lift. You will not be able to hold as long as a gentle lift.
Aim to hold for 2-3 seconds then build up to 5 seconds. This will take time and remember to keep your technique correct. Watch that your abdomen does not ‘suck in’ strongly, however, the more strongly you contract your pelvic floor muscles the more you will feel your abdomen tighten but it should remain flat (not suck in or bulge out).
The following is a suggested guide for exercising your pelvic floor muscles.
Lift and hold strongly: 1-5 seconds
Let go completely and rest: 2-5-seconds
Repeat: 8-12 times
Do this routine 3 times per day, daily for up to 5-6 months or until you have reached your goal which could take more or less time.
Step Four: Maintenance
To maintain the good strength and function of your pelvic floor muscles, keep exercising them often by following the above routine 3 times per week aiming for strong lifts.
Throughout the day, think of doing gentle sustained lifts when you are feeding your baby, driving your car or when exercising. Balance type exercise is good for this. For example, sitting on an exercise ball or standing on one leg. Aim to feel your pelvic floor muscles automatically tighten as you keep your balance.
It is also recognised that general exercise is good for improving pelvic floor muscle function. Walking swimming or doing low impact exercise at the gym are beneficial.
Aim to control your weight to a level that suits your height and build. Being overweight can lead to decreased control over your bladder and/or bowel and may also weaken your pelvic floor muscles.
Step Five: Functional
This means to use your pelvic floor muscles during activities of each day especially those activities which may cause urine leakage.
For example: Lift strongly before you cough, sneeze, laugh or lift your child. This is sometimes called ‘the knack’.
Your perception of a continence problem may affect your personal and/or intimate relationships and how you feel about yourself. Pelvic floor muscles play an important role in bladder and bowel control and also affect sexual function and sensation. If resuming sexual activity is concerning you, talk about it to someone who is knowledgeable and sensitive to this aspect e.g., your GP or midwife. Unfortunately, this issue is frequently overlooked or considered unimportant.
It is normal to:
You should ask for help if you notice any of the following:
Yes! Excessive straining to pass a bowel motion can weaken and damage the pelvic floor muscles and supporting ligaments of your pelvic organs. This includes the bladder and bladder outlet. With strong straining, the bladder is also forced downwards leading to an increased risk of urine leakage problems. Constipation can also give the sensation of needing to go frequently or urgently to pass urine. In severe constipation, the bladder outlet can get obstructed causing difficulty in passing urine. The urine flow may be ‘stop/start’, ‘slow and trickly’ or ‘hard to start’.
If you have trouble with your bladder or bowel do not despair! The chances for a cure for an incontinence problem are good if you seek the right advice. Enjoy your pregnancy and your baby. Both before and after your baby is born, remember that it is important to take care of yourself.
For information on managing incontinence:
They can also provide you with the name of the physiotherapist nearest to you who has a special interest in helping women with pelvic floor problems.
Discuss continence with your health professional. You should ask each of your health professionals how any aspect of care during your pregnancy, delivery or post-natal period could affect your bladder or bowel control (e.g. epidural, induction, repair of episiotomy or tears). Consider this information when making any decisions regarding your pregnancy, delivery and after-care.