Post Partum Problems: Leaking, is This Normal?

Stress incontinence is defined as involuntary leaking of urine upon physical exertion or activities such as sneezing, coughing, jumping, or running. Did you know that 15 million American US women suffer from stress incontinence? It is twice as common for women than men. In women between the ages of 18-44, 24% experience urinary incontinence.

It is a topic that often goes unspoken about. On average, a person will wait 6.5 years from the first time they experience symptoms until they seek help from their health care provider. Let’s face it, having a leaking problem is embarrassing. Many women do not want to bring it up to their provider. If they do, sometimes they are given medication or surgical options. Those who do not want to take this route end up doing nothing, and the issue continues.

Why does stress incontinence happen? Stress incontinence is usually due to weakness or dysfunction in the pelvic floor. What is the pelvic floor? The pelvic floor consists of 3 layers of muscle than run from your tail bone to your pubic bone. They create a sling to help support our internal organs, provide bowel, bladder and sexual function, and aid in posture. They work hand in hand with our deep core muscles. All of these muscles have to be strong as well as flexible in order to maintain continence, prevent low back pain, and work efficiently.

During pregnancy, the weight of the baby puts pressure on our pelvic floor, this leads to over stretching and weakness in this area. Child birth can cause vaginal tearing and perineal trauma that can also lead to disruption in the pelvic floor musculature. Thus, pregnancy, child birth and menopause (due to lack of estrogen causing weakening tissues) are factors in why urinary incontinence is so prevalent in women.
Putting a pad in becomes a part of many women’s “new normal” after having a baby. However, did you know that incontinence can be treated by conservative measures? A pelvic floor physical therapist can help you return to your pre baby activities without leaking.

Many women ask, should I just do kegels? Kegels are a great way to exercise the pelvic floor and can be used to strengthen these muscles. However, if you are someone that is also performing pain with intercourse, you may want to hold off on kegels and seek out an evaluation from a PT first. This may mean that you have a tight pelvic floor and need to work on relaxation strategies before strengthening.

To perform a kegel: Inhale, then exhale as you lift the pelvic floor away from your seat , or as if trying to stop the flow of urine or gas. Try holding for a count of 5 seconds. It is important to make sure that these exercises are performed correctly. Often times, when asked to perform a “kegel,” compensations are made with the glut muscles or adductors. You want to isolate only the pelvic floor. Place one hand on the inner thigh and one on the buttocks to make sure these muscles are not contracting. A hand held mirror can also be used to see if the pelvic floor is contracting. You should see a lift and not a drop of this area while performing the exercise.

A physical therapist can use a tool in the clinic called biofeedback (which measures electrical activity in the muscle) to determine if the right muscles are indeed being activated. A PT can help progress the “kegel” with a series of other exercises in order to get you to performing functional and higher level activities, with decreased symptoms. It can be helpful to begin this treatment at around 6 weeks postpartum; however the simple kegel exercise above can be performed right after child birth to aid in blood flow and healing. This exercise should not cause any pain, but if for any reason it does then hold off and let your provider know.