Postpartum Stress Incontinence
One of the most common complaints I hear from women postpartum is that they are struggling with incontinence, or uncontrolled urinary leakage. While there are multiple types, the most frequently diagnosed for women after childbirth is stress urinary incontinence. Think about it. You just put an enormous amount of strain on your pelvic floor muscles to push your baby into this world.
Now, when smaller stresses (hence the name stress incontinence) like sneezing or jumping put pressure on those muscles, they have a hard time contracting strongly enough to keep urine in. This often presents itself as a woman trying to do a jumping jack at the gym and suddenly feeling a bit of leakage. Other times though, it may be a less obvious leak that happens throughout the day, and you may not notice it until you go to change your pad or go to the bathroom.
Is it Normal to Have Incontinence?
Yes and No. It is normal to have incontinence within the first few weeks after having a baby. In that time, the muscles will begin to repair any stretching or tearing that occured (sometimes with the assistance of sutures from your delivering provider). These muscle are just like any other skeletal muscles in the body and take time to heal. Think about how your muscles feel after a big workout, like doing a bunch of biceps curls; you may notice for days after that it is hard to lift your arms, because those muscles will demand some rest from you while new muscle fibers are created.
Delivering a baby is basically a pretty intense workout for your pelvic floor! So we expect that it will take a few weeks for those muscles to engage easily again. But after that, it is not normal to have urinary leakage. However, it is very common.
Many women will continue to experience leakage long past their 6 week postpartum check up with their doctor. While evidence shows that doctors should be referring women with incontinence to a physical therapist for conservative treatment, let’s be real, not a lot of women end up going. So many self-care items for mommas take a back seat to baby’s needs in the beginning. While self-care is super important (see my post here on its benefits), it can seem like a really big commitment to follow up on a referral to pelvic health physical therapy (PT). Don’t fall into this trap! The problem will rarely go away on its own. And while you may know some exercise to do at home, just know that therapy is a lot more than kegels!
So What Can Be Done?
Pelvic Floor Contractions
There are actually a lot of ways that you can help rehabilitate your pelvic floor to regain continence. You can start with kegels, though I teasingly give them little credit. A great way to work this into your daily postpartum routine is to do a few sets of kegels each day when you take a sitz bath. As I share in my post here about inflammation and healing after your delivery, it is typically recommended to spend some time soaking in warm water each day. While soaking, practice tightening your pelvic floor muscles, like you would if you were trying to stop yourself from peeing. (Another way to think of contracting your pelvic floor is to imagine pulling something up and into your vagina with your muscles.)
You can do sets of kegels where you focus on contracting and relaxing as quickly as possible, and you can also work on contracting and holding for as long as possible. Over time, this can help tone your pelvic floor muscles. After all, you want them to turn on very aggressively when a large stress is put on them, like a big sneeze, but also to be able to hold a less intense contraction for long bouts of time, like when on a run.
Strengthening the Core
In addition to toning your pelvic floor through kegel exercises, focus on regaining strength and stability in your “core.” Most people think of the core as the 6-pack muscles. But the core includes a few other muscles groups. Your multifidi are in your back and help to stabilize your spine. Your transversus abdominis are on your tummy (the muscles that help you corset when squeezing into tight pants). And you can probably guess, your pelvic floor muscles are also a big part of your core stability!
If any of these muscles get stretched and weak, the others have to work a bit harder to manage your day-to-day movements. So it is important to regain strength in your entire core after it typically gets weakened during pregnancy and delivery. I address the value of the “core” more in this post here and give you some ideas on how to begin strengthening it after a baby.
Pelvic Health Physical Therapy
Another way to help with stress incontinence is to go see a pelvic health PT, as I mentioned above. Many women struggle with knowing how to properly perform a pelvic floor contraction. Your therapist may use biofeedback to help you learn how and when to tighten it well. She may also prescribe you a routine of using pelvic weights or cones at home. While pelvic weights may sound weird, I promise you that it should be a very professional and medically focused intervention. You will not be pulling surfboards around with your weights like this woman you may have seen on YouTube! See my post about what to expect with pelvic health physical therapy.
What Else Should I Keep in Mind?
Another word to the wise — if you are continuing to have leakage, do NOT use menstrual pads. Use incontinence pads (you don’t even have to do a “walk of shame” in the grocery store thanks to the wonderful world of Amazon shopping). They are specifically designed to absorb urine, whereas menstrual pads are meant for, you guessed it, menstrual bleeding and will not work as well for you.
Constipation can be another factor that wreaks havoc on your healing perineum. I wrote more about that here. Many women benefit from taking an over-the-counter stool softener to avoid needing to bear down too aggressively for bowel movements. Gentle and comfortable bowel movements will help to minimize continued overstretching of your pelvic floor muscles.
My last piece of advice for managing stress urinary incontinence during your postpartum recovery is to avoid doing activities that put large amounts of stress on your pelvic floor while you are still trying to get stronger. You wouldn’t “max out” on a bunch of lifts like squatting or bench pressing your first day in the gym, so why would you think you can hop out of bed at the hospital and go for a run? Be patient with the healing process, seek additional help if needed, and you should be back to your normal activities in no time.