Conquering Bladder Leakage POstpartum
I remember as a kid, seeing my mom use a liner in her underwear daily. I remember thinking, if she’s not on her cycle why does she need a liner? Postpartum urinary leakage is one of those things that I feel was normalized growing up. It wasn’t talked about, but it also wasn’t mentioned that it’s not normal and that you could receive treatment for it.
During my orthopedic clinical rotation, my clinical instructor had a planned vacation, so during that week, I followed another therapist who was a Certified Woman’s Health Specialist. One of the days, she had a presentation at the local hospital in which she spoke to some doctors and other health care providers about the importance of physical therapy to help with pelvic floor issues. At the end of the presentation, she had a picture of a gravestone and underneath it, she said “No woman should ever pee their pants from laughing”, or something like that. It stuck with me. Leaking while sneezing, laughing, jumping, walking, running, standing up from sitting, playing with your kids, is not normal. It is common, lots of women experience it, especially after childbirth.
Why do women experience increased leaking after childbirth? Let’s look at the anatomy of the pelvic floor and the physiology of how urine is held and released. Our pelvis is a bowl with the bottom cut out. The portion that is cut out, is filled in with lots of ligaments and fascia, and beneath that, our pelvic floor muscles. The fascia’s primary goal is to support the organs that sit in our bowl (pelvis), bladder, uterus, rectum. With increased stress and pressure, the fascia can become lax and not give as much support, so the muscles are there to help re-enforce that support. Around our urethra is a muscle called the compressor urethrae, it is a part of our pelvic floor muscles, and helps give support to hold urine inside. Our urethrae also has an internal and external sphincter that holds urine in. Our brain tells our bladder to contract to squeeze the urine out and the sphincters and muscle around our urethrae have to relax in order to allow urine to flow out.
What happens when the sphincters relax when they’re supposed to be engaged… well, if the pelvic floor muscles are not engaged as well, it causes urinary leakage. Why would the sphincters relax at inopportune times? Increase in pressure downwards. A big cause of increased downward pressure is the 10 months of pregnancy, where you are growing a baby, a placenta, and producing increased fluids that are all sitting in your uterus, which sits on top of your bladder. Other short burst of increased downward pressure, come from sneezing, coughing, laughing, jumping, etc.. When that increased downwards pressure is too much for the sphincters, they become lax, and when it is too much for the muscles ontop of that, you leak.
“Well, I’m just going to drink less fluids or go to the bathroom more often, so that my bladder is empty, so I don’t leak”. Unfortunately, our bodies don’t work that way. Drinking less fluid, can lead to dehydration and other problems. Using the bathroom even when you don’t have to, is a bad bladder habit, that tricks your brain into thinking your bladder is not as large as it actually is, over time, you decrease the capacity available. Also, your bladder is NEVER completely empty, because your kidneys are constantly filtering your blood which then gets turned into urine.
The best bet, is to learn how to manage increased downward pressure!
Our pelvic floor is a part of our core system, so when we inhale, our pelvic floor should lengthen or relax. When we exhale it should contract a little bit. If we purposefully contract our pelvic floor and our deep abdominal muscles at the same time, as we exhale, that’s called bracing our core. When you know a big sneeze, or cough is coming; or that you’re going to laugh or vomit; you’re going to pick up your kid from a squat position; this is a good time to exhale and brace your core to help prevent leaks. This is not something you should think about doing ALL the time, but rather when you know there is a chance you may leak with these activities, like if you have a cold and repeated downward pressure from coughing or sneezing. OR, if you’re newly postpartum and noticing leaking with activities. During this time, you’re giving your pelvic floor a little extra support to help prevent leakage.
The next key, is to seek out a pelvic floor therapist, what is the state of your pelvic floor muscles? Are they too tight? Which can cause weakness over time. Are they weak? Which allows for decreased sphincter contraction. Is there a combination of both? A pelvic floor therapist, can help you understand the state of your muscles, so that you can see how to best train your muscles to restore them to a healthy balance.
