As I’ve grown older, many of my female friends and family members have entered the next stage of their lives—motherhood. Time and again, I’ve heard them express frustration about urinary leaks that occur when they laugh, jump, or even attempt to carry their babies. These leaks often leave them feeling embarrassed, and it got me thinking: what can I do to help?
To better understand this issue, I enrolled in courses focused on women’s pelvic health. What shocked me most was how little attention this topic is given in our society. Pelvic health, particularly postpartum, is something that must be brought into the mainstream. During childbirth, the pelvic floor experiences significant trauma, and restoring these muscles to their optimal strength is an essential part of my work as a physiotherapist.
Pregnancy and childbirth are transformative experiences for a woman's body, affecting it in many ways. One critical area of change is the pelvic floor, the diaphragm of the pelvis. These muscles support vital organs, such as the uterus, bladder, large intestine, and rectum. Unfortunately, these muscles are often compromised during pregnancy and childbirth, leading to changes in their functions, including urinary and fecal continence. Weakened pelvic floor muscles may cause prolapse, where organs shift within the pelvis. Additionally, trauma to the pelvic floor muscles and nerves can lead to pelvic pain, which may occur with or without sexual intercourse (Smith, 2023).
As pelvic floor muscles are a specialized group of muscles, they fall under the domain of physiotherapists like myself. I help patients with pelvic floor issues by assessing, diagnosing, and treating conditions that affect these muscles. When these muscles weaken, urinary leakage may occur.
The most common types of postpartum urinary incontinence include:
Stress Urinary Incontinence
This occurs during activities that increase abdominal pressure, such as jumping, coughing, laughing, or carrying heavy objects.
Urge Urinary Incontinence
This happens when there is a sudden urge to urinate, but you cannot hold it.
Mixed Incontinence
A combination of both stress and urge urinary incontinence.
Assessment
During the initial appointment, I begin by conducting a thorough history assessment. This can be done in person at the clinic or virtually. Once I gather all the necessary information, I ask my patients to keep a bladder diary for at least three days. This gives me a comprehensive understanding of their symptoms and triggers.
On the second appointment, patients come in for a physical examination. I perform a digital examination to palpate the pelvic floor muscles intravaginally, which helps assess muscle strength. Understanding the condition of the pelvic floor muscles is essential to determine the appropriate treatment. I also teach my patients how to correctly perform pelvic floor muscle training (Kegels). Sometimes, we may use a perinometer to measure the contraction pressure of these muscles.
For patients who are not comfortable with a digital examination, alternative assessment methods are available, such as observing or gently touching the perineum. While these approaches may not be as precise, they can still guide patients to ensure they are performing the exercises correctly. Research indicates that about 40% of individuals don’t perform Kegels correctly the first time. As a physiotherapist, I help patients identify the correct muscles and techniques, ensuring effective training.
Treatment
Of course, pelvic floor muscle training (Kegels) is not the only treatment. Studies have shown that combining pelvic floor exercises with selected abdominal and lower limb exercises is the most effective method to activate and strengthen the pelvic floor muscles (CP Ojukwu, 2022). For patients who have little to no pelvic floor muscle contraction, electrical stimulation may be used to help them get started.
I have made it a habit to ask my friends who are mothers whether they experience urinary leakage, and surprisingly, 80% of them answer "yes." One friend, who gave birth 10 years ago, is still experiencing incontinence and doesn’t know where to seek help, or feels too embarrassed to do so.
It’s important to note that women can begin performing Kegel exercises as soon as they are comfortable after childbirth. Studies have shown that regular pelvic floor exercises significantly reduce the development of urinary and fecal incontinence during the transition from pregnancy to postpartum (Stoppler, 2017). Pelvic floor physiotherapy can also begin as early as six weeks postpartum or when a doctor clears the patient for sexual activity.
Let me assure you that in our practice, we provide a non-judgmental space. You can share anything with me, and I will do my best to provide the care you need. If you are experiencing similar issues, please feel free to reach out. Together, we can work towards better health.
Thank you for reading.
References
Mayo Clinic Q&A: Pelvic Floor During and After Pregnancy Abby Smith, 2023. Retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-pelvic-floor-during-and-after-pregnancy-what-to-expect/
Comparative Effects of Selected Abdominal and Lower Limb Exercises in the Recruitment of the Pelvic Floor Muscles Chidiebele Petronilla Ojukwu, 2022. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1360859221002126
Urinary Incontinence in Women: Types, Causes, and Treatments Melissa Conrad Stöppler, MD, 2017. Retrieved from https://www.emedicinehealth.com/slideshow_urinary_incontinence_in_women/article_em.htm
Photo credit: https://www.continence.org.au/about-continence/continence-health/pelvic-floor
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