I thought urinary incontinence was something that happened to older women! Why didn’t I know that I could develop long term urinary incontinence after having a baby? Why wasn’t I warned of the risk factors? What could I have done differently during my pregnancy? Why haven’t I ever heard of a pelvic floor physiotherapist?!
As a continence and women’s health physiotherapist, these questions are all too familiar.
This week is World Continence Week, and here at Eve Health we are raising awareness of the alarming statistic that 1 in 3 women who have ever had a baby will be affected by incontinence (Continence Foundation of Australia, 2017).
To ensure the best holistic care during pregnancy and beyond, our obstetricians work very closely with our women’s health physiotherapists and all women have the option of seeing a physio during early pregnancy, at 35 weeks, and at 6 weeks post-birth. Of course many women do choose to see a physio throughout their pregnancy as required.
Pregnancy is physically demanding and the pelvic floor tissues are placed under great strain from the mother’s increasing body weight along with the weight of the growing fetus. Certain pregnancy hormones further contribute to significant stretching of the pelvic floor muscles and connective tissue supports that provide physical support to the pelvic organs (including bladder, bowel, and uterus).
Just after your baby is born, you will be very tired and preoccupied with your baby. Vaginal birth can cause over-stretching of the muscles and nerves of the pelvic floor, leading to weakness and reduced sensation around the vagina/bladder/bowels. Vaginal and perineal tears, along with surgical trauma from caesarean deliveries can lead to pain inhibition of the pelvic floor and abdominal wall muscles. Furthermore, while breast feeding, oestrogen levels are always low, which further contributes to vaginal laxity and dryness.
Pregnancy and childbirth are therefore significant risk factors in the development of incontinence. There are two main types of urinary incontinence, ‘urge urinary incontinence’ (UUI) and ‘stress urinary incontinence’ (SUI). UUI is the loss of urine as a result of the sudden need to urinate. SUI is the loss of urine during activities such as coughing, sneezing, laughing, and other activities causing downward pressure on the bladder and pelvic floor.
Physiotherapy is recommended as first-line management for both types of incontinence by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Continence Foundation of Australia (Dumoulin et al., 2014).
Whilst bladder and bowel control will often improve in the first six months after giving birth, having good pelvic floor muscle function will dramatically reduce your risk of developing urinary incontinence during or after pregnancy and can assist with recovery after birth.
Studies have shown that up to half of all women perform pelvic floor muscle exercises incorrectly. So before you start a pelvic floor muscle training program, make sure you can identify, contract, relax, and coordinate these muscles correctly. An assessment with one of our women’s health physiotherapists will help you find and isolate these muscles and develop an individualised program for you.
So, if you ever have to rush to the toilet and don’t quite make it, leak when you run, jump, cough or sneeze, or are contemplating/currently pregnant then we can help you!
Blog post by Angie Vienne, Physiotherapist