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Postpartum Pelvic Floor Tips for a Leaky Bladder

Postpartum Bladder Leak Tips and What to do About it

Your Bladder Can Do Better! 

We all know the body changes a lot with pregnancy but maybe you weren’t quite prepared for the changes that linger after having your baby. Maybe you expected to go to the bathroom more frequently during pregnancy due to hormonal changes and your growing baby, but your need to frequently or urgently visit the restroom now may be frustrating, not to mention the annoyance of bladder leakage that happens with lifting, coughing, or sneezing! Involuntary loss of urine (bladder leakage) that is bothersome is known as urinary incontinence.1

Thirty-three percent of women will experience bladder leakage three months postpartum.2 A whopping 29% will continue to have leakage at 4 years postpartum.3

There are three muscle layers within the pelvis called the pelvic floor muscles and they serve important roles, including:

  • supporting the bowel, bladder, and uterus
  • supporting the pelvis and spine
  • supporting posture and breathing
  • supporting comfortable and pleasurable sex
  • helping control bowel and bladder storage and emptying

These muscles attach to the inside of the pelvis and surround the openings of the urethra (where urine exits the body), vagina, and anus (where poop exits the body). We can voluntarily contract these muscles just like we can contract the muscles in our arms and legs. Tightening these muscles helps to close the openings of the pelvis (urethra, vagina, and anus) which can help with bowel and bladder control. These muscles (and the nerves that help them work) are stretched an incredible amount with labor and delivery of your baby and may need special attention to return to more normal function.

Different Types of Postpartum Incontinence

Pelvic floor muscle training is the first-choice recommendation for postpartum urinary incontinence.4 There is no one-size-fits-all treatment for bladder leakage. What will help you the most may depend on what kind of urinary incontinence you are experiencing. The most common types of postpartum urinary incontinence include:

  • Stress urinary incontinence: involuntary loss of urine on effort or physical exertion including sporting activity, or on coughing or sneezing
  • Urgency urinary incontinence: involuntary leakage of urine associated with sensation of sudden, compelling desire to void
  • Mixed urinary incontinence: having both stress and urge urinary incontinence5

Types of treatments with pelvic floor therapy:

  • Pelvic floor muscle exercises (more commonly known as Kegel’s) can strengthen the pelvic floor muscles that help close the urethra (opening from the bladder) to prevent urine loss with activities like coughing, sneezing, laughing, or with urges to empty your bladder.6 It is important to note that most women do not have an accurate awareness of how well they are able to do a pelvic floor muscle contraction.7
  • Bladder re-training helps learn bladder control and increases the time between bathroom trips back to normal frequency (2-5 hours)
  • Biofeedback is a training technique that helps you identify the proper muscles to use. One biofeedback technique uses sensors that fit inside or outside the vagina to measure how intense the muscle contraction is.

A specialty trained pelvic floor physical or occupational therapist can accurately assess your pelvic floor muscle contractions and provide guidance on the above treatments.

Some lifestyle modifications can also be helpful including the following:

  • Weight management - a 10% weight loss in overweight or obese individuals can improve bladder leakage6
  • Fluid modification - timing of when you drink can reduce how much you go to the bathroom at night 

More Options...

If these treatments do not achieve desired results, your physician may recommend certain medications, additional testing, or possibly surgery.

If you continue to have bladder control issues by three months after your baby is born, talk to your doctor about your symptoms or see a pelvic floor physical or occupational therapist for pelvic floor therapy to determine what will help you recover based on YOUR body’s situation.


References:

1. Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A., Petri, E., Rizk, D.E., Sand, P.K. and Schaer, G.N. (2010), An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn., 29: 4-20. https://doi.org/10.1002/nau.20798

2. Thom, D.H. and Rortveit, G. (2010), Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstetricia et Gynecologica Scandinavica, 89: 1511-1522. https://doi.org/10.3109/00016349.2010.526188

3. Gartland, D, MacArthur, C, Woolhouse, H, McDonald, E, Brown, SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG 2016; 123: 1203– 1211.

4. Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40.

5. https://www.ics.org/glossary?q=urge#F

6. Summaries for patients. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):I-34. doi:10.7326/P14-9034

7. Uechi, N, Fernandes, ACNL, Bø, K, et al. Do women have an accurate perception of their pelvic floor muscle contraction? A cross-sectional study. Neurourology and Urodynamics. 2020; 39: 361– 366. https://doi.org/10.1002/nau.24214

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