After an afternoon of pumpkin picking at a farm in their hometown of Raleigh, North Carolina, Kerrie’s kids, ages 4 and 6, had one activity in mind: riding a giant tunnel slide with their mom. “I sat on my piece of burlap and enjoyed the trip down,” Kerrie recalls. But the sudden stop at the end was too much for her to handle. With urine soaking the front of her pants, Kerrie dashed to the restroom, where she stood under the hand dryer, then resorted to the old wrap-your-coat-around your-waist-trick. “The wet spot was still noticeable to me, but I hope not to anyone else,” she says.
Kerrie’s story is far from rare. About half of women in the U.S. experience incontinence, and both pregnancy and childbirth can bring it on and worsen it. Hormonal fluctuations during pregnancy and breastfeeding weaken the pelvic-floor muscles (the ones that support and control the bladder), and giving birth can stretch or tear them. At two months postpartum, 30 to 40 percent of women who delivered vaginally also leak, says Kimberly Ferrante, M.D., assistant professor of obstetrics and gynecology and urology at NYU Langone Health, in New York City.
The problem will usually resolve within six months, but for some moms it persists when they laugh, cough, jump, or sneeze. Sex can spur leaks, and frequent “just in case” trips to the bathroom can also train the body to release urine at the slightest provocation. But with know-how and diligence, incontinence is preventable and treatable. The following strategies can help you get back to dry.
Pretty much any mom who’s pushed out a baby could benefit from an assessment by a pelvic-floor therapist, who can determine whether your Kegels are effective, chart your progress, and tailor a workout routine to your particular problems, says Stein. This kind of care is standard in France and other European nations, but here in the U.S., it’s typically only recommended to women who complain of pelvic pain, incontinence, or sexual dysfunction to their doctor. (Your gynecologist may also notice pelvic-floor weakness during an internal exam, says Benjamin Brucker, M.D., assistant professor of urology and ob-gyn at NYU Langone Health.) Getting the services covered by your insurance usually requires a prescription, just like any other form of PT. To find a physical therapist in your area, check the website of the American Physical Therapy Association.
Too nervous to get started? Don’t be! Here’s what to expect at your first appointment:
There’s a good chance you first learned how to do Kegels at a slumber party while huddled over directions from Cosmo or Glamour, so it makes sense that you may need a refresher on proper form. “Most women squeeze their glutes, inner thigh muscles, or abs, which doesn’t help,” says Amy Stein, a pelvic-floor physical therapist and founder of Beyond Basics Physical Therapy, in New York City. To perform Kegels correctly, first locate the right muscles. While on the toilet, stop the flow of urine. Note how this feels; these are the muscles to clench and unclench during Kegels. (Once you’ve got it, there’s no need to do this test again, says Stein. Repeatedly stopping while urinating can send a confusing signal to the brain that may eventually make you unable to fully empty your bladder.) When you’re ready to do a Kegel, locate the muscles, clench them, hold the contraction for three to ten seconds, then fully relax for the same amount of time. The exercise is easiest to do correctly when you’re lying down on a flat surface (like a yoga mat), so try to do it this way most of the time in the beginning. Aim for ten repetitions three times a day.
Once you’ve mastered a basic Kegel—meaning you can do it throughout the day without thinking too hard—try these advanced moves:
It can take up to six months for a woman with straightforward incontinence to notice significant improvements through Kegels and pelvic-floor therapy. (About 50 percent of women are satisfied after three months.) These products will help you stay dry in the meantime.
having kids and still regularly leak through pads after trying Kegel exercises or physical therapy, you may want to ask your doctor whether or not he would recommend midurethral sling surgery. In this 20-minute outpatient procedure, a urologist or a urogynecologist inserts a thin polypropylene sling under the urethra, creating a permanent supportive backstop that helps stop the unwanted flow of urine—putting an end to leaks. Patients tend to be very satisfied with the results, with reported success rates ranging from 86 to 99 percent.
The midurethral sling is considered safe by the FDA and has been backed by more than 2,000 scientific articles. But like any surgery, this one comes with a long list of possible risks, including organ perforation. Before you decide to go under the knife, be sure to discuss with your doctor any potential downsides that could particularly affect your health.