You’ve probably heard pregnant mamas, new mamas, and maybe even not-so-new mamas joke about peeing their pants when they sneeze or exercise. And while it’s easy to brush it off with a joke, urinary incontinence is a real issue. Here’s more about why women experience urinary incontinence after pregnancy, how the pelvic floor works, and steps you can take to manage it.
What Is Urinary Incontinence?
To be blunt, it’s the inability to control the passage of urine. Some women leak urine without reason, while others may experience “stress incontinence” when coughing, sneezing or doing certain physical movements (hello, jumping jacks). Many also experience incontinence as an urgent need to use the bathroom more than usual—meaning taking frequent bathroom breaks.
Why Does Urinary Incontinence Happen During Pregnancy?
Your bladder is located above the pelvic bone, and is held in place by your pelvic muscles, sometimes called the “pelvic floor.” When you’re pregnant, your growing uterus starts to put pressure on the bladder, which naturally makes less space for urine. All of this compression, along with increased urine production as a result of pregnancy, can make you feel like you need pee constantly. Your pelvic floor muscles can also weaken as a result of this pressure, leading to problems holding your urine in.
Does Urinary Incontinence Stop after Pregnancy?
For some women, incontinence issues go away within a few weeks of giving birth. However, there are many who continue to experience urinary incontinence in the months—or even years—following pregnancy.
There can be several factors at play for those who experience incontinence postpartum, including your pregnancy history, how you delivered your babies, and the number of children you have. Specific conditions that can contribute to increased incontinence issues include:
- Pelvic organ prolapse: Pregnant people’s pelvic muscles stretch and may become weaker during pregnancy itself, as well as during a vaginal birth. As a result, the pelvic floor can’t provide enough support which can cause your bladder to sag, and the urethra opening to stretch.
- Pelvic nerve damage: The pelvic nerves are responsible for sending signals to the brain to control your bladder function. These nerves can be damaged during intense vaginal deliveries, leading to leaking issues.
- Other injuries during delivery: Events during the birthing process can cause injury to your pelvic floor, too. For instance, delivery with forceps can cause injuries to the pelvic floor and anal sphincter muscles, while prolonged pushing can increase the likelihood of pelvic floor injuries.
How Can Urinary Incontinence Be Treated after Pregnancy?
The great news about urinary incontinence is that there are physical therapists that specialize in strengthening the pelvic floor. In fact, there’s no need to wait until after birthing your baby to take action. Pregnant and postpartum women alike can do pelvic floor physical therapy to help retain, or regain control of the pelvic floor muscles.
While many pregnant and postpartum women are advised to “do Kegel exercises,” there’s more to pelvic floor physical therapy than that. There are other specific ways to train the muscles in your pelvic floor, helping to strengthen them enough to successfully support your uterus, bladder and bowels.
How Does Pelvic Floor Physical Therapy Work?
Typically, a pelvic floor physical therapist will begin by assessing your posture, core and hip strength, as well as your pelvic floor muscles (all pelvic therapy takes place in a private treatment room for privacy). Often they will examine the pelvic floor muscles through an internal vaginal examination. However, if this is not comfortable, your therapist can do their best to assess the muscles from the outside of your body or over clothes. They’ll also speak with you about your health history, birth or pregnancy experiences, as well as any bowel, bladder or sexual issues that you have experienced.
After examination, your therapist will put together a plan to help improve your pelvic floor function. Different therapies may include:
- Exercises to strengthen the core and pelvic floor muscles
- Massage of targeted muscles
- Changes to the diet to help with urinary symptoms
- Relaxation and deep breathing techniques
Another tool that a therapist may utilize is called biofeedback. Biofeedback measures the electrical activity of your muscles (using external stickers or internal probes) and displays the readings on a computer screen. This gives you and your therapist a better visual of how your muscles working, which helps as a guide to strengthen them and improve your control.
If you are experiencing any pelvic pain, back pain, urinary leakage, or other pelvic floor issues, bring them up with your provider and request a referral to physical therapy. While pelvic floor physical therapy isn’t standard in the United States during or after childbirth, it’s a wonderful treatment option that can help alleviate painful or embarrassing pelvic floor issues.
Our experienced therapists at Penn Medicine Lancaster General Health are specially trained to help women manage pelvic floor disorders, including pre- and post-partum issues, pelvic pain, and urinary incontinence. Remember—you don’t have to live with these issues. There’s help!