Accidentally losing urine in the months and years after having a baby is either not talked about at all, or laughed off as normal. Approximately 1 in 3 women will experience urinary incontinence in their lifetime and two of the most significant risk factors for it are pregnancy and vaginal childbirth. Although common, leaking urine and bladder incontinence is not a normal part of being a mom.
The reason why bladder control issues are so common postpartum is because the pelvic floor muscles (who’s role it is to control urine, gas and stool) work incredibly hard during pregnancy, and are stretched out very significantly during birth.
The ability of these muscles to recover fully postpartum is affected by things like how strong they were going in to pregnancy and birth, whether or not they were damaged through episiotomy or perineal tearing, and other factors such as heredity, and a woman’s general level of health.
This isn’t a perfect analogy, but you can think of the muscles of the pelvic floor like the ones that purse your lips closed. Imagine your mouth started from a pursed position to passing a baby through it. Then, in the days and weeks after that, it has to return to its pursed position AND keep water inside without letting any dribble out. That’s hard work!
Of all the postpartum pelvic floor dysfunctions that can occur, bladder incontinence is the most common; and there are two main types.
The first is called stress urinary incontinence, which is leaking with activities such as coughing, sneezing, running or jumping. The second is called urge urinary incontinence, which is leakage accompanied by urgency and a fear of not making it to the bathroom in time. Many people have a combination of the two.
Stress Bladder Incontinence
When you contract your pelvic floor muscles, or do a “Kegel,” you’re tightening the muscles that clamp off the urethra: the tube that carries urine from the bladder to the outside world. In the case of a cough or sneeze, a strong and well timed contraction will kink-off this tube very well and keep you dry. If that contraction is not strong enough, or perfectly timed, then the pressure (or stress) that the sneeze exerts on the bladder will over-power the pelvic floor and urine will leak out.
In the case of running, the pelvic floor has to keep a woman dry for several minutes to several hours. In this case, not only does the pelvic floor have to be strong, but it has to have a significant amount of endurance, and an incredible amount of coordination to be able to respond to the forces placed on it with each land and push off of running.
The first line of treatment for stress bladder incontinence is to rehabilitate the pelvic floor muscles after pregnancy and childbirth.
You can try these basic pelvic floor exercises to see if they solve the problem:
- Squeeze the muscles that you would use to stop the flow of urine or stop gas coming out
- Lift your pelvic floor up like an elevator
- Hold that contraction for 10 seconds then relax fully. Repeat 10 times
- Contract and relax these muscles quickly 10 times. Repeat 10 times
If leaking persists, a Pelvic Physiotherapist is an excellent resource to address how to integrate your pelvic floor strength, endurance, and coordination into activities such as running and jumping. Beyond this, there are devices called pessaries that can help, and even surgery if all other avenues have been exhausted.
Urge Bladder Incontinence
Also known as overactive bladder, urge bladder incontinence is when you experience urgency to get to the bathroom and urine leaks out on the way. Unlike with stress incontinence, urge is associated more with the bladder muscle, itself (although there’s a pelvic floor component too). The bladder spent 9 months being very compressed by the uterus during pregnancy. Postpartum, its ability to fill and empty normally may have changed.
Sometimes, the bladder becomes anxious and gives you a sensation of urge before it reaches its full capacity.
When a person is going pee more than every 2-3 hours in the day, that’s called urinary frequency. This can often lead to urinary urgency and urge incontinence.
Other times, either the bladder doesn’t give the sensation of fullness postpartum, or moms develop the habit of ignoring bladder sensations until it’s too late, and then they are leaking on the way to the bathroom.
The first step of treatment for urge incontinence is adopting good bladder habits:
- Drink enough water to keep urine pale yellow
- Pee every 2-3 hours during the day (or 6-8 times while awake)
- A normal bladder capacity is about 500 mL of urine and takes at least 10 seconds to void
- Pee 0-1 time at night
- Don’t pee “just in case”
- Don’t hover over the toilet seat to pee. Sit down.
- Don’t push to pee
If adopting these bladder habits is not enough to get symptoms under control, the next step would be bladder re-training through Pelvic Physiotherapy. The bladder is a muscle and can be rehabilitated just like any others. Beyond this, there are medications that your Doctor can prescribe and even surgeries that can help.
About the author:
This post was authored by Jillian Palmer is a Pelvic Physiotherapist and a Mom of four wonderful children. She is passionate about improving the quality of care for women in pregnancy and postpartum. Her Pelvic Physiotherapy practice in Edmonton, Alberta, serves women throughout the lifespan struggling with pelvic dysfunction. You can find her @yeg_pelvicphysio and @pine_health_yeg
Canadian Continence Foundation