One in three woman who ever had a baby wet themselves

Bladder Control

Women who have one baby are nearly three times more likely to leak urine and wet themselves than women who have not had a baby.

Why does having a baby make you wet yourself?

When the baby moved down through the birth canal (the vagina), the canal was stretched. The nerves and muscles that keep the bladder shut (called the pelvic floor muscles) were also stretched.

This can leave the muscles weak so that they are not able to keep the bladder from leaking. This leaking happens mostly when you cough, sneeze, lift or exercise.

Is this leaking likely to go away by itself?

The leaking is not likely to go away unless you guard against further damage and exercise your pelvic floor muscles to help them to get their strength back, As you get older, you pelvic floor muscles will tend to get weaker.

If you don't get the muscle strength back after each baby you have, you are likely to start wetting yourself. Following the menopause, there is a higher risk that you will wet yourself.

How do my waterworks work?

The bladder itself is a hollow, muscular pump. The bladder fills slowly form the kidneys. You should be able to hold on until there is about 300-400ml inside the bladder. The bladder closing muscles are called pelvic floor muscles. When you are ready, the pelvic floor muscles relax and the bladder squeezes the urine out. Then the same cycle begins over again.

What do my pelvic muscles do?

See the diagram on the opposite page. It shows where the pelvic floor muscles are.

These muscles do a number of things such as:

• Help to close off the bladder, the vagina and the back passage (the anus).
• Help to hold the bladder, the uterus and bowel in their proper place.

What happens if my pelvic floor muscles are weak after the birth?

• You might leak urine when you cough, sneeze, lift, laugh or exercise.
• You might not be able to control your wind.
• You might feel a sense of urgency when you need to empty your bladder or your bowel.

When one or more of your pelvic organs sags down into your vagina, this is called pelvic organ prolapse. Prolapse is very common and happens to about one in ten New Zealand women. If you have a feeling of 'something coming down', you might have a prolapse. See your doctor if you are not sure about this.

How do I exercise my pelvic floor muscles properly?

To begin sit leaning against a back support (wall or bed). When you do a proper pelvic floor muscle squeeze you should:

• Squeeze. Lift and hold as if you are trying not to pass wind.
• Feel the pelvic floor lift. At first the movement that you feel may be very small. If your muscles are weak, you may feel very little at all.
• Make sure that you do not have any downward movement of your pelvic floor when you try to do a squeeze and lift.
• The lower part of your tummy muscles should gently pull in as you squeeze and lift your pelvic floor muscles.
• You might like to use a hand mirror to see you pelvic floor working, if you feel comfortable doing this.
• Tighten, lift and squeeze your pelvic floor muscles before every cough and sneeze and lift for the rest of you life, This is called having 'the knack'.
• Straight after the birth of your baby, you should follow the simple exercise plan below for about six weeks.

Pelvic floor exercises

A proper pelvic floor squeeze should lift up and hold hard. Pelvic floor exercises should be done quickly and slowly.

Every squeeze, whether quick or slow, should be done as strongly and tightly as you can!

Squeeze and lift three times quickly with no rests (THREE QUICK)

Squeeze, lift and hold for three seconds, three times (THREE SLOW)

Together, this is ONE SET

Try to do THREE SETS each day

Squeeze up hard, hold and cough (the knack) THREE TIMES a day

As pelvic floor muscles get stronger, you can hold your squeeze for longer. You should aim to hold a long squeeze up to the count of six. It may take some weeks before you can hold for the count of six. Start with whichever number you can manage to do. This might be any number from one to six.

Getting 'the knack'

You should squeeze up and hold before you cough, sneeze of blow your nose and before each time you lift anything. This braces your pelvic floor and protects it. The lower part of your tummy should squeeze, lift and hold as well.

When you feel that your vagina has recovered from the birth of your baby (some time after three weeks), you might like to place two clean fingers gently into your vagina. As you squeeze up hard, see how many seconds that you can hold the squeeze. Now see how may of these long squeezes you can do, one after the other. Filling in the table below might help you to watch your progress more easily.

Keeping track of your progress

Use the table below to keep track of your progress.

How can I remember to do my exercises?

The hardest thing about pelvic floor exercises is remembering to do them. Here is a list of some things that might help you to remember:

• It will be easier to remember if you do one set of exercises (or use the knack) each time that you do a certain thing. When you have a shower or a bath is a good time to practice 'the knack'. Choose from the list which times you think would work best for you
• When you are going to the toilet.
• When you wash your hands.
• When you have a drink.
• When you change the baby.
• When you feed the baby.
• When you have a shower.
• Red Sticker dots can help you to remember your exercises. You can get these at your bookshop. Stick these up in a couple of places around the house. They can remind you to do your exercises each time you see them. For example:
• Near the toilet button or behind the toilet door.
• Near where you keep the tea or coffee.

You could ask your partner of friend to help to remind you to do your floor exercises.

Remember to brace you pelvic floor every time you are going to couch, sneeze or lift. (This is 'the knack')

Remember - you need to do your pelvic floor exercises for the rest of your life!!!

Relationships

Your perception of a continence problem may affect your personal and/or intimate relationships and how you feel about yourself. Pelvic floor muscles play an important role in bladder and bowl control and also affect sexual function and sensation. If resuming sexual activity is concerning you, talk about it to someone who is knowledgeable and sensitive to this aspect eg, your GP or midwife. Unfortunately this issue is frequently overlooked or considered unimportant."

What can I do to help avoid constipation?

Constipation can lead to incontinence. To avoid constipation:

• Drink plenty of fluid (2 litres per day) especially if you are breast feeding.
• Drink fruit juices such as orange, apple or prune juice.
• Eat high fibre breads and breakfast cereals.
• Eating fruit is a MUST. Three pieces each day.
• Use a natural fibre supplement - Metamucil or Fybogel from the supermarket or pharmacy. Psyllium husks are much cheaper (get these from a health food shop).
• Vegetables and lentils or pulses are all high in fibre.
• When you sit on the toilet, raise your heels.
• Relax your pelvic floor, bulge the lower part of your tummy forward.
• Gently push keeping your tummy bulged forward, hold the push, then relax.
• Repeat - push, hold and relax.

How can I be sure that I have good bladder habits?

It is normal to:

• Go to the toilet about 6-8 times each day. Try not to go "just in case".
• You should pass about 300-400ml each time you go to the toilet.
• It is OK to get up once each night to pass urine. Try not to go just because you have to get up to the baby.

Try to:

• Drink at least two litres of fluid each day.
• Avoid drinking coffee of cola drinks or too much tea. Caffeine in these drinks might affect your bladder.

You should ask for help if you notice any of the following:

• Any leaking of urine.
• Needing to rush when you need to go to the toilet.
• Not being able to hold on when you want to.
• Leaking urine on your way to the toilet.
• Burning or stinging inside when you pass urine.
• Having to strain to start the flow or urine.

What can I do to prevent these things from happening?

• You can start some pelvic floor exercises.
• Make sure that you have good bladder and bowel habits.
• Keep your body weight within normal limits.

Here are some hints to help you:

• You should try to avoid downward movement of your pelvic floor. The only time you should have downward movement of your pelvic floor is when your are opening your bowels.
• Try to avoid constipation.
• When you need to open your bowels, you can support the front part of your pelvic floor with your hand to try to stop from over-stretching as you bear down.
• Use 'the knack' for every cough, sneeze, or lift.
• If your pelvic floor muscles feel weak, try crossing your les and squeezing them tightly together before each cough or sneeze.
• Try to avoid any heavy lifting (even at the gym) or bouncing exercises like jumping jacks for at least three months.
• Even if you have a problem with wetting yourself, you should keep on with gentle exercises, walking or swimming.

If you have trouble with your bladder or bowel do not despair! The chances for a cure for an incontinence problem are good if you seek the right advice, Enjoy your pregnancy and your baby. Both before and after your baby is born, remember that it is important to take care of yourself.

Need Help?

For information on managing incontinence:

• Speak with the healthcare professional who is helping you after the birth of your baby. This might be your GP, your specialist or your midwife.
• Many local hospitals have continence advisors. Please phone the Continence Help Line for a contact list. They can also provide you with the name of the physiotherapist nearest to you who has a special interest in helping women with pelvic floor problems.
• Receive free information leaftlets on a range on continence subjects.

For all of the above phone the National Continence Helpline on 0800 650 659

Discuss continence with your health professional. You should ask each of your health professionals how any aspect of care during your pregnancy, delivery or post-natal period could affect your bladder or bowel control (eg. Epidural, induction, repair of episiotomy or tears). Consider this information when making any decisions regarding your pregnancy, delivery and after-care.