One in three women who have
had a baby wet themselves.
Bladder control
Women who have one baby are nearly three times more likely to leak urine
thans than women who have not had a baby.
Why does having a baby cause
urine leakage?
When the baby moves down through the birth canal (the vagina), the canal
is stretched. The nerves, ligaments and pelvic floor muscles that control the
bladder opening (urethra), are also stretched.
This can lead to weakened muscles and less structural support around the
bladder opening, resulting in less bladder control. The symptoms? Leaking urine
with coughing, sneezing, lifting, 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, your pelvic floor muscles will tend to get
weaker.
If you do not get the muscle strength back after each baby you have, you
are more likely to leak urine. Following menopause, there is a higher risk of
having problems with urine leakage also.
How does my bladder work?
The bladder itself is a hollow, muscular pump. The bladder fills slowly
from 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?
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 (flatulence)
-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?
Position: Sit upright on a chair with your back supported. Relax your abdomen
and thighs. Breathe normally – your abdomen should gently rise and fall as you
breathe.
Pelvic Floor Muscle
contraction: Imagine – ‘squeezing around the vagina entrance and lifting the vagina
up inside’ or ‘squeezing around the bladder outlet and lifting the bladder up ’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 you
keep breathing. If you draw your abdomen in strongly or hold your breath, this
will hinder your ability to contract your pelvic floor muscles.
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 your pelvic floor muscles working,
if you feel comfortable doing this. You will see an inward movement of the
perineal body (the area between the vagina opening and the anal opening).
If you have difficulty isolating a pelvic floor muscle contraction, try
lying on your side. In this position it is easier to relax your abdominal
muscles and therefore easier to feel your pelvic floor muscles tighten.
Pelvic Floor Muscles exercise
programme.
Step One: Isolation.
It is important that you are correctly contracting your muscles. (see
the steps above on how to exercise your pelvic floor muscles) It does not
matter if you cannot hold your muscles for long or if they feel weak. The
technique is the most important first step.
Step Two: Strengthen – gentle
lifts
Positions: lying down or sitting
Begin by gently lifting and
squeezing. See if you can hold for 1-2 seconds then build up to 5-10 seconds.
This is a gentle lift not a ‘hard/strong lift’. Once you can hold for longer,
see if you can keep breathing while lifting your pelvic floor muscles.
Step Three: Strengthen –
strong lifts
Positions; lying down, sitting, standing leaning forwards, straight back
and with hands on a bench or table.
Once you are able to control gentle lifts, aim to lift your muscles more
strongly. Focus on a quick and strong
lift. You will not be able to hold as long as a gentle lift.
Aim to hold for 2-3 seconds then build up to 5 seconds. This will take
time and remember to keep your technique correct. Watch that your abdomen does
not ‘suck in’ strongly, however the more strongly you contract your pelvic
floor muscles the more you will feel your abdomen tighten but it should remain
flat (not suck in or bulge out).
The following is a suggested
guide for exercising your pelvic floor muscles.
Lift and hold strongly: 1-5
seconds
Let go completely and rest:
2-5-seconds
Repeat: 8-12 times
Do this routine 3 times per
day, daily for up to 5-6 months or until you have reached your goal which could
take more or less time.
Step Four: Maintenance
To maintain the good strength and function of your pelvic floor muscles,
keep exercising them often by following the above routine 3 times per week
aiming for strong lifts.
Throughout the day, think of doing gentle sustained lifts when you are
feeding your baby, driving your car or when exercising. Balance type exercise
is good for this. For example, sitting on an exercise ball or standing on one
leg. Aim to feel your pelvic floor muscles automatically tighten as you keep
your balance.
It is also recognised that general exercise is good for improving pelvic
floor muscle function. Walking swimming or doing low impact exercise at the gym
are beneficial. See the NZCA website for ‘pelvic floor safe exercises’.
Aim to control your weight to a
level that suits you height and build. Being overweight can lead to decreased
control over your bladder and/or bowel and may also weaken your pelvic floor
muscles.
Step Five: Functional
This means to use your pelvic floor muscles during activities of each
day especially those activities which may cause urine leakage.
For example:
Lift strongly before you cough, sneeze, laugh or lift your child. This
is sometimes called ‘the knack’.
Keeping track of your progress
You may like to keep a track of your progress to keep you motivated to
reach your goal.
Make up a table like the one below.
ACTIONS
|
Birth to One month |
1-3 months |
3-6 months |
6-12 months |
|
I can hold for how many seconds? |
|
|
|
|
|
How many lifts in a row can I do now? |
|
|
|
|
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 bowel 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 e.g., your GP or midwife.
Unfortunately this issue is frequently overlooked or considered unimportant.
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, which is 6-8 cups at
250mls per cup. If you are breast feeding you may need a few more cups per day.
You should have mostly water in your total daily fluid intake. E.g 4-6 cups of
water and 2-4 other drinks
- Avoid too much caffeine or carbonated drinks, limit to 2-3 cups per
day. That is coffee, tea, coke, other fizzy drinks. Try a herbal or fruit
infusion tea.
You should ask
for help if you notice any of the following:
- Any leaking of urine that is not improving
- Needing to go urgently to the toilet. Sometimes you may not be able
to hold on and leak before you reach
the toilet.
- Burning or stinging as you pass urine.
- Having to strain to start the flow or urine.
- Blood in the urine.
Can constipation cause urine
leakage?
Yes! Excessive straining to pass a bowel motion can weaken and damage
the pelvic floor muscles and supporting ligaments of your pelvic organs. This includes
the bladder and bladder outlet. With strong straining the bladder is also
forced downwards leading to an increased risk of urine leakage problems.
Constipation can also give the sensation of needing to go frequently or
urgently to pass urine. In severe constipation, the bladder outlet can get
obstructed causing difficulty in passing urine. The urine flow may be ‘stop/start’,
‘slow and trickly’ or ‘hard to start’.
How can I avoid constipation?
- Drink plenty of fluid (at least 2 litres per day) especially if you
are breast feeding.
- Eat high fibre breads and breakfast cereals.
- Eat fruit, three pieces each day. Include kiwifruit
- Use a natural fibre supplement – E.g Metamucil,Benefibrel or
Fibresure. You can get these 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.
- Sit correctly on the toilet to pass a bowel motion. Follow the
instructions below.
Correct sitting position to
pass a bowel motion.
- When you sit on the
toilet, raise your heels or put your feet on a low stool.
- Keep your back straight as
you lean forwards slightly
- Relax your pelvic floor,
and gently bulge your tummy. It feels like the beginning of when you bear
down. You will feel the sides of your tummy bulge and the lower part of
your tummy will bulge forwards slightly. (If you overstrain, you will feel
your pelvis and back move backwards. That is – round your back. This is
incorrect.)
- Do not rush. Work with
the natural urge to pass a motion. If you try and push and strain too
much, this hinders effective and complete emptying.
- When you have finished,
tighten your pelvic floor muscles a few times while still sitting on the
toilet.
Special notes:
- Always use this sitting
position. This is not just for when you have had a baby.
- Normal frequency to pass
a bowel motion is 3 times per day to once every three days and your bowel
motion should be soft but formed like a sausage, not too hard and not too
soft!!
- If you have some
swelling and/or stitches in your pelvic floor area after having your baby,
you may need to support your perineum while passing a bowel motion. With
some toilet paper around your hand, place it over the area between the
vagina opening and back passage as you pass a bowel motion.
- If you having problems
passing a bowel motion or with faecal leakage or uncontrolled wind (flatulence),
let your GP or midwife know. They can advise you on what to do or refer
you to a health professional.
CHECK LIST TO KEEP YOUR PELVIC FLOOR IN CHECK
§ Maintain good bladder and bowel habits.
§ Learn how to exercise your pelvic floor muscles correctly
and aim to strengthen them. When they are stronger, lift your pelvic floor
muscles before you lift, cough, sneeze etc
§ Start some general low-impact exercise like walking. As
time and energy allows try some other types of exercise. See the NZCA website
for ‘Pelvic Floor Safe’ exercises. ***
§ Aim for a healthy body weight. It is normal to have put on
weight after having a baby but don’t allow it to ‘hang around’ Set goals of
healthy eating and exercising to reach your ideal weight. To find what your ideal
weight range is see www.pickthetick.org.nz/bmi/
§ Avoid heavy lifting, straining and high-impact exercise.
§ Avoid prolonged periods standing or being upright
especially in the early weeks and months post-partum. Have some rest periods
for yourself and for your pelvic floor.
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
Many local hospitals have
continence advisors. Please phone the
Bladder 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
leaflets on a range on continence subjects.
For all of the above phone
the National Bladder 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 (e.g. Epidural,
induction, repair of episiotomy or tears). Consider this information when
making any decisions regarding your pregnancy, delivery and after-care.
