1 in 3 women who have had a baby wet themselves! – but it doesn’t have to be this way, 85% of people are cured of incontinence within a few months of doing their exercises.  If you have any symptoms, purchase Women’s Waterworks (Book section) to find out the simple steps you can take to cure this condition!

Pregnancy and childbirth places a great strain on the pelvic floor, so it is important to commence these exercises straight away if you are not already doing them.  Weakness of the pelvic floor may cause stress incontinence (wetting your pants when you sneeze, cough, lift etc). This is very common in pregnancy due to the strain on the pelvic floor and hormonal changes – it can get worse over time and will not fix itself, so start your exercises now. 

 Why does having a baby weaken the pelvic floor?

·         Complicated vaginal delivery: use of forceps or vacuum, episiotomy or tearing

can damage or stretch the muscles, nerves and connective tissue.

·         High birth weight:  the bigger the baby the more stretch and strain on the pelvic floor both during the pregnancy and delivery.

·         Long second stage labour – the more pushing you do, the more strain on the pelvic floor.

·         3+ vaginal deliveries, each time you have a baby, the pelvic floor gets a little weaker (especially if you haven’t been doing your pelvic floor exercises).

 

 

What does the pelvic floor do?

·         Supports the bladder, vagina, uterus and bowel to prevent prolapse

·         Contributes to the closing pressure of the urethra, vagina and anus

·         Is important for bladder and bowel control and sexual function

·         Withstands abdominal pressure which is increased during coughing, sneezing, vomiting, lifting, laughing etc

·         Works with abdominal and spinal muscles to support your spine

·         Assists with pregnancy and childbirth

 

Signs of a weak Pelvic Floor

• Urine loss when you cough, sneeze, lift or exercise
• Frequency – passing urine more then 6-8 times a day
• Urgency –
  •  an urgent need to pass urine
  • Unable to hold until you find a toilet
• Prolapse – you may feel a bulging, dragging or heavy sensation
• Poor control of wind
• Decreased sensation and tone in the vagina during intercourse
• Difficulty evacuating bowel motions
• Unable to completely empty when you pass urine
• Frequent urinary tract infections due to poor bladder emptying

 

Things you can do if you have a damaged pelvic floor from child birth:

·         Ice packs (do not apply directly to skin) 10 min every couple of hours (pain relief section)

·         Rest lying on your side or flat on your back with your head down (1 pillow) to help with swelling for at least 30 minutes twice a day

·         Lean forward as you sit to empty your bladder

·         To empty your bowel, lean forward keeping your spine straight and use a wad of toilet paper to support your perineum

·         Do not lift anything heavier than your baby

·         Keep up your fluid intake

·         Eat a high fibre diet to keep your bowel motions soft

·         Avoid heavy lifting

·         Start gentle pelvic floor contractions

·         Do not use ring cushions for pelvic floor damage

·         Avoid high impact exercises for 12 weeks or while you are still having incontinence or feelings of heaviness

·         Watch your posture 

Things you can do if you have a weak pelvic floor:

·         Do your pelvic floor exercises regularly

·         Cross your legs and squeeze them tightly before coughing

·         Do not lift heavy loads

·         Don’t strain when using your bowels

·         Do not do any bouncing or jumping exercises

·         Don’t go to the toilet just because you get up to your baby – only go if you have an urge

 

How to do your pelvic floor exercises!

There are 2 muscle types in the pelvic floor (fast twitch and slow twitch), so you need to do 2 different exercises.

Start exercises in a lying position, as they become easier progress to sitting and standing.

   

1.       Gently draw up and in around the vagina, urethra and anus (as though you are trying to stop weeing) – you should feel a lift and squeeze.  Try to hold this contraction strongly for 5-10 sec, relax for 10 sec then repeat up to 10 times. To do this sequence at least three times per day.  Be sure that you do not hold your breath or clench your buttocks.  You should continue this program throughout your pregnancy and for a minimum of 4 months after your baby is born.  It is a good idea to make them part of your daily routine forever.  As your muscles get stronger you can build up the length of hold and number of repetitions.  Start doing your exercises as soon as possible after having a baby to assist with the healing process.

2.       Strongly squeeze and lift your pelvic floor muscles, then relax – there is no need to hold this (fast twitch) exercise.  Do 10 repetitions, three times a day.

 

You should not return to sport until you can control your pelvic floor.

 Read Women’s Waterworks (Book section) for more information

If your muscles are very weak and you are unable to do your exercises, commence your strengthening program with electrical stimulation or vaginal cones (see the exercise and functional section)

If you cannot feel your pelvic floor muscles working or have any concerns make an appointment with your women’s health Physiotherapist.

By 12 weeks after having a baby you should be able to:

·         cough without leaking

·         completely stop your urine flowing (midstream) – please do this once only as a test, doing this often could lead to urinary tract infections

***if you cannot do this please see your Women’s Health Physiotherapist***

Episiotomy or Tearing Pain

This is when the doctor needs to cut the area between the vagina and the anus (perineum) to assist delivery of your baby, this area may also tear during childbirth.  In both cases you will need stitches and the area will be swollen and painful for up to a few weeks.  You will find that your pelvic floor muscles will be weak due to the pain and trauma.

What can you do?

·         Rest

·         Gentle Pelvic floor exercises will help to accelerate the healing process

·         Ice Packs (SEE PAIN RELIEF SECTION)

·         U shape pillows

·         Cool salt baths

·         Compress with disposable or cotton underwear (see functional section) and sanitary pads

·         Elevate lower limbs

·         Commence scar tissue massage after a couple of weeks and before 14 weeks to encourage tissues to become more elastic and prevent painful intercourse.  Use the tip of your thumb or middle finger and feel for lumps in the scar – hold gentle pressure for 30 seconds and slowly release.

 Healthy Habits for the Pelvic Floor

• Do pelvic floor exercises everyday as a lifelong habit
• Drink 1.5 – 2 litres of water a day, more if it is hot or you are exercising – restricting your fluid intake will make things worse by irritating the bladder
• Avoid just in case visits to the toilet – go only when you have an urge

·         Aim for normal frequency of voiding (passing urine) 4 – 6 times a day  (every 2-3 hours) and perhaps once at night, you should pass between 250 – 500 ml each time

• Always sit on the toilet seat to urinate.  Hovering over the toilet can prevent the bladder from emptying properly.  The best position is to sit with a straight back, leaning forward with your elbows resting on your thighs.
• Limit caffeine intake (coffee, tea, cola, and chocolate)
• Limit alcohol intake
• Avoid constipation or straining
• Eat lots of fruit, vegetables and fibre to stay regular
• Be a non smoker
• Do regular general low weight bearing exercise e.g.- walking
• Stay in the healthy weight range
• Avoid lifting heavy objects – never lift more than your pelvic floor can control
• Exercise – Cycling, Pilates and Fit ball are great.
• Lose weight
• Teach your daughters to commence pelvic floor training at a young age
• Tension your pelvic floor before you lift, sneeze, cough or exercise
• Tension your pelvic floor following toileting

 

Working with the Abdominal muscles

 

The deep core muscles and pelvic floor muscles work together to support our pelvic organs and lower back, especially if there is increased intra-abdominal pressure, e.g.-when we cough, sneeze, lift or exercise. Learning to co-activate these muscles will help your pelvic floor stay fit and strong.

 

Abdominal Drawing in exercises

 

1. Lie on your back with your knees bent.
2. As you breath out gently draw in your lower abdomen as if you are trying to flatten your stomach across your spine.
3. Breathe normally – Do not suck in your upper abdomen or hold your breath.
4. Try to feel your pelvic floor muscles working at the same time.
5. Practice combining abdominal drawing in and a gentle pelvic floor exercise together.

 

Aim for 10 repetitions of 10 seconds 3 times a day

 

Physiotherapy Pilates DVD’s will assist you with both pelvic floor and core muscle strengthening (see the DVD section)

Urinary Incontinence

Stress incontinence (S.I.) is the loss of urine associated with coughing, sneezing, lifting and straining. 1 in 3 women who have had a baby suffer from incontinence.

It is caused by a lack of support to the bladder outlet; this is due to both pelvic floor and connective tissue weakness. 

Risk Factors:

• Childbirth – SI is more frequent in women who have had a number of children, with larger birth weight increasing the risk.
• Race – Caucasian women are at a greater risk.
• Obesity
• Smoking (chronic cough)
• Chronic constipation 
• Connective tissue – women who are prone to stretch marks, hernias and flexible joints

 

Treatment

• Pelvic floor strengthening (purchase women’s waterworks and exercises DVD’s).
• Deep abdominal strengthening
• Learning the knack – this is when you contract your pelvic floor and deep abdominal muscles prior to coughing (or whatever triggers your incontinence)
• Lifestyle changes
  • posture
  • adjusting activities e.g.- avoid jumping until your symptoms improve
  • avoid heavy lifting 

• Weight loss if necessary
• Dietary changes to prevent constipation

 

 

Studies show 85% of women with S.I. are cured with Physiotherapy treatment

  

Urge incontinence is when you suddenly and urgently need to urinate and are unable to get to the toilet in time. This urgent need to urinate may occur frequently during the day and often at night as well. It is worse in pregnancy due to hormonal changes and the pressure of the growing baby on the bladder.

Bladder retraining is the technique used to try to increase the capacity of the bladder and decrease the sensitivity of the bladder.  By teaching your bladder how to store more urine without leaking or giving uncomfortable spasms, you will have more time between voids, less discomfort and more freedom to go out. This is a disciplined program to suppress an overactive bladder. Expect the program to take at least 3 months to have a positive effect.

How to retrain your bladder

The first step is to fill in a frequency / volume chart (or bladder chart) – this gives you an indication of how your bladder is functioning. Your physiotherapist will give you these charts.

Once you start your bladder retraining program you must:

1. Avoid just in case visits to the toilet.  Only go when you have a full bladder, not out of convenience. You may need to void to a timetable.  Start with a minimum of 1 hour and increase by 15 – 30 min each week.
2. When you get the urge to go to the toilet – defer your visit.  Start by holding for 10 seconds and slowly build up.  Often the urge will disappear as it was a false alarm. If the bladder fullness feeling persists then allow yourself to go after this waiting period.  This is a game of mind play as well as sheer physical strength and determination.  YOU MUST LEARN TO ONLY GO TO THE TOILET WHEN THE BLEADDER IS FULL!!
3. Become aware of your triggers e.g. - running water, key in the door and use the techniques below to defer, do not give in to known triggers e.g. - urinating in the shower.

 

Urge control techniques

1.  
   • Stay still, rushing to the toilet only makes it more likely that you will leak
   • Firm perineal hand pressure
   • Sit pressure – by sitting on the edge of a chair or corner of a desk, you can substitute hand pressure
   • Sit on a rolled up towel - this is especially good if you get urgency first thing in the morning, as your feet hit the floor
   • Toe pressure – press firmly with your toes into the floor
   • Cross your thighs
   • Squeeze your buttocks
   • Walking
   • Strong sustained pelvic floor or deep abdominal drawing in until the urge subsides

 

Once the urge has passed make a decision – is the bladder full? If not, defer going to the toilet.  If the bladder is full use the following techniques to get to the toilet dry:

• Stand carefully
• Breathe easily
• Walk quietly and calmly to the toilet, do not rush
• Count your steps and use distraction techniques e.g. – counting backwards in threes, making up a shopping list, reciting a recipe remembering all the details of your favourite holiday or?

 

Other advice

• Maintain a normal fluid intake – this is VERY important.  We need to fully extend the bladder to retrain it properly.
• Reduce your caffeine intake (coffee, tea, cola, chocolate and sports drinks)

 

* You are bound to have some accidents while you retrain your bladder.  Hang in there, it will be worth it.  If you are diligent with the program you should see some improvement by week 3*

* see your women’s health Physiotherapist for assessment and treatment specific to your condition*

 

 

Painful Intercourse (Dyspareunia)

What causes it?

·         Spasm in the pelvic floor muscles

·         scar  tissue following tearing or episiotomy from childbirth

·         anxiety

What can you do?

·         Pelvic floor exercises

·         Massage to the pelvic floor  - you can gently massage the tight area with your finger using a vegetable oil as a lubricant or make an appointment with a Women’s health Physiotherapist.

·         As a self management technique, while you are attempting intercourse, instruct your partner to stop penetration if there is burning pain, but not pull out. He should maintain constant steady pressure with the head of his penis as you do several lengthening pelvic floor contractions. This will reverse your protective guarding response and desensitize the tissues by direct stress loading. This can also be accomplished with a dilator or your own finger.

 *** see your women’s health Physiotherapist for  assessment and treatment specific to your condition***

 Faecal incontinence after childbirth

Can be caused by:  third-degree perineal tears associated with delivery, or nerve damage of the pelvic floor and external anal sphincter associated with childbirth or excessive straining with defecation.

 What can you do?

·         strengthening of the pelvic floor muscles  (See the books section for women’s waterworks)

·         Use of barrier creams to protect skin

·         Appropriate absorptive pads.

·         Surgery for severe cases

 *** see your women’s health Physiotherapist for  assessment and treatment specific to your condition***

Prolapse

What causes prolapse?

·         connective tissue laxity due to hormonal changes and stretching during delivery

·         weight gain during  pregnancy

·         multiple pregnancies

·         complicated delivery

·          obesity

·          smoking

·          Chronic cough

·         Chronic constipation

·         Lifestyle activities such as frequent or heavy lifting

What can you do?

·         Avoid activities that will further weaken the pelvic floor

1. Straining to move your bowels
2. Heavy lifting, pushing or pulling
3. Smoking (as it causes chronic coughing)
4. Sneezing (you may need to seek allergy treatment)

·      Learn to use your pelvic floor and deep abdominal muscles for support.  Avoid straining to move your bowel as this will stretch and   weaken the pelvic support structures and worsen your prolapse

·         Improve your general fitness with

·         Maintain your weight within a healthy range

·         Wear supportive underwear

*** see your women’s health Physiotherapist for  assessment and treatment specific to your condition***

  Disclaimer

Tummies, Mummies and Bubbies have provided these articles for general information only and they should in no way be considered as a substitute for the advice and information your physiotherapist and or doctor will supply about your particular condition. It is recommended that you always seek professional advice.

While every effort has been made to ensure that the information is accurate, Tummies, Mummies and Bubbies accept no responsibility and cannot guarantee the consequences if you choose to rely upon these contents as your sole source of information.