When people talk about after-the-baby recovery, common ailments such as fatigue, pain from episiotomy stitches, and general aches and swelling from labor and delivery figure high on the list. But few new moms are prepared for urinary incontinence.
In fact, urinary incontinence affects at least 7 million women in the U.S. Women who've just had a baby usually suffer from the most common type of incontinence, called stress incontinence.
Why It Happens
The bladder is like a balloon, with a stubby knob at the end called the urethra. Normally, the bladder relaxes to accommodate urine as it fills. The fuller it gets, the more the sphincter muscle around the urethra squeezes to keep the urine contained, explains Margaret Roberts, MD, PhD, director of the neurophysiology lab at Schwab Rehabilitation Hospital in Chicago. During delivery, the ligaments and muscles that support the bladder and urethra are stretched. In addition, there is a change in some of the enzymes and hormones that make ligaments elastic. Because the muscles and ligaments are weakened, urine may leak out, especially when a woman coughs, laughs, exercises, sneezes, or lifts something. These are all activities that physically stress the bladder, hence the name stress incontinence.
The good news is that urinary incontinence is usually temporary and definitely treatable, most often with simple exercises and lifestyle changes. After a first baby, more than 70 percent of women fully recover from stress incontinence.
Kegel Exercises increase the strength and elasticity of your pelvic floor muscles. Here's a primer:
Lie down, knees bent and legs parted. Tighten the muscles around your vagina and urethra as if you're trying to prevent urine or gas from leaking out. Place one hand on your lower abdomen and make sure you're not pushing or contracting your abdominal muscles. (If you're pushing down on your abdominal muscles or squeezing your thighs or buttocks, you're not doing the Kegels correctly.)
While breathing, tighten your vaginal muscles. Think of the pelvic floor as an elevator: Contract muscles in stages, rising to successive levels slowly, in intervals of five to ten seconds. Aim to accomplish sets of ten, three to four times a day, every other day.
Once you've got the hang of Kegels, try doing them while walking or exercising, to help you stay dry during the activities that are most likely to bring about an accident.
In the first three to four weeks postpartum, however, don't be alarmed if the mere thought of doing a pelvic exercise leaves you exhausted. If you had a catheter or an episiotomy during delivery, you may not be able to contract the necessary muscles, due to pain and swelling. Kegels may also be difficult to do correctly if you had significant muscle and nerve damage during delivery. In this case, biofeedback can help identify and isolate the proper pelvic muscles.
Electrical stimulation therapy is another option. In this technique, a gentle electric current is used to make the muscles in the pelvic floor contract like a Kegel, says Dr. Roberts.
The NeoControl is a comfortable chair that produces highly focused, pulsating magnetic fields. The pelvic floor muscles contract and relax with each pulse, strengthening in the process. The procedure requires going to the doctor's office twice a week for eight weeks for a 20-minute session. More than 20,000 women throughout the U.S. have used the chair, with impressive success rates.
Lifestyle changes can also help new moms regain bladder control.
- Ease up on caffeine, alcohol, carbonated beverages, and spicy foods -- they can irritate your bladder and make it contract more easily, says Dr. Roberts.
- Stop smoking. Nicotine acts directly on the muscles of the bladder, causing it to spasm. Women who smoke also often have a chronic cough, which brings about more episodes of urine loss if you're incontinent.
- Lose excess weight. Extra weight puts constant pressure on your pelvic floor muscles.
When It's More Complicated
If these approaches don't work, your doctor may conduct further testing to identify the problem. While stress incontinence is the most likely scenario in postpartum women, there are other possible causes, such as nerve damage, loss of muscular support, sphincter muscle problems, or injury to the bladder.
There are surgical procedures available to correct persistent urinary incontinence, though they're usually not advised for women who want to have more children. Here are the most common surgeries:
Vaginal Sling: A sling is created from the patient's own tissue (or donor tissue) and is passed underneath the bladder and urethra for support.
Abdominal Suspension: Stitches are placed on both sides of the urethra through a horizontal skin incision on the bikini line. The stitches are then attached to a strong ligament that lies on the pubic bone, thus resupporting the bladder or lifting it back up into a normal position.
Collagen Injections: These can bulk up and strengthen the tissue around the urethra. (This procedure is not ideal for young, active women, because the collagen eventually dissolves -- the results aren't permanent.)
Urinary incontinence is a problem millions of women will face. But usually, with a few lifestyle changes and lots of Kegels, the problem will not persist.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your won health or the health of others.