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Sneezing, coughing, laughing, lifting heavy objects, and exercise are the most likely activities to cause stress incontinence and urine leakage.
Many mothers think it’s normal to leak after having a baby, but it’s not. You shouldn’t have to suffer from it. We reached out to a local expert, Women’s Health Physical Therapist, Marci Silverberg, to tell us more about why women leak and what to do about it.
MYTHS ABOUT URINARY INCONTINENCE
While there are many myths that percolate about women’s health and recovery after childbirth, one of the most prevalent is that of leaking. As a Physical Therapist with a specialization in treating women during and after pregnancy, I have heard everything from women keeping this a most guarded secret, to laughing about it with others as a sort of bonding, an acceptance of what her postpartum body has become. While it is true that a postpartum body is a different body than the pre-pregnancy one, leaking is not something women should need to accept, is not normal, and is treatable. Furthermore, treating and preventing leaking, or UI (urinary incontinence) has far-reaching effects in improving a woman's confidence, core strength, and overall health and wellbeing.
HOW COMMON IS IT?
The first myth around UI is that because it is common, it is therefore normal. How common is it? Research states that up to 55% of women experience leaking after a vaginal delivery, and up to 40% leak after cesarean delivery. Many women find it surprising that this issue is so common, yet so rarely discussed. Shame and embarrassment, I believe, play a big role in this. And when a mother confides in a friend about this issue, and the other one has it as well, it is easy to conclude that leaking is simply what happens after childbirth.
WHAT HAPPENS AFTER CHILDBIRTH?
What happens after childbirth is this- the muscles of the deep core system are affected by the process of growing and birthing a baby. This deep core system includes the muscles of both the abdominal wall and the pelvic floor, which are the muscles at the bottom of the pelvis. This deep core system has many roles, including continence of the bowel and bladder. The deep core also provides stability of the spine, support of the pelvic organs, and plays a role in sexual satisfaction. These muscles get stretched, loaded, or sometimes cut or scarred- all affecting the ability of these muscles to do their main job.
DO KEGELS HELP?
Another common myth about UI is that the solution is to do Kegels. It’s often not that simple, for many reasons. First of all, some women do not perform a kegel, or contraction of the pelvic floor muscles, correctly with verbal input alone. That means many women require feedback from a professional to know if they are in fact contracting the correct muscles. Additionally, sometimes the muscles are not simply weak, but are actually tight or have a high tone, and performing more muscle contractions can actually make the issue worse. I find that this is surprisingly common. Imagine, if your neck muscles were stiff and tight, and so you tried to make the pain go away by exercising them- it wouldn’t help, right? The same process can happen with the muscles of the pelvic floor. In this case, the treatment is to first address the tightness with manual release and relaxation work before starting any individual muscle contractions.
SO HOW DO YOU KNOW WHAT YOU NEED?
Similar to me trying to fix my own kitchen sink, my advice would be to consult with a professional. In the United States, the best person to address issues with UI would be a Women’s Health or Pelvic Floor Physical Therapist. She will be able to tell you if your muscles are tight, or weak, and develop an individualized plan to address your unique needs and goals.
My last word on the topic is this- Please do address this issue. If leaking does not resolve by 6-8 weeks after childbirth, get assessed by a PT with advanced training in working with women and the pelvic floor muscles. In many cases, UI is not one of those issues that just “goes away.” I vividly remember one woman I treated for leaking who was 3 years postpartum before she showed up for therapy. By the time I saw her, she was distraught and unhappy, as the leaking had started her on a downward emotional spiral. She had stopped exercising due to it, then gained weight, which then affected her self image and even her relationship with her spouse. Within just a few sessions with me, she was jumping and squatting without leaking, and resuming an exercise program. Her only regret was that she did not know the resources available to her, including seeking the help of a trained Women’s Health Physical Therapist to get treated sooner. Those emotional conversations with her gave me the drive to communicate to women that we CAN live unencumbered by issues that are readily treatable. Most importantly, my patients have taught me that we all can be advocates for one another, and feel proud, healthy, and comfortable in our bodies.
Written by Marci Silverberg, MPT - Women's Physical Therapist
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