Incontinence After Pregnancy

Incontinence is not a glamorous topic.

For anyone who has experienced incontinence, you will know that it can be embarrassing, inconvenient and at times demoralising. I am passionate about sharing as much information as I can on this topic, and not just because it is something that is affecting me. Incontinence affects so many women, but is still considered quite a taboo topic.

The Continence Foundation of Australia cites that as at 2010 there are over 1.7 million Australian women aged under 50 years living with some form of incontinence. So whilst it may seem like a problem for the elderly, the statistics clearly indicate that this is something affecting our generation of women.

Pregnancy is a major risk factor for urinary incontinence and the Continence Foundation cites that 1 in 3 women who have had a baby will wet themselves in the postpartum period.

I have learnt so much about urinary incontinence and the different forms of incontinence from Lyz Evans. Lyz is a Womens and Pelvic Health Physiotherapist with a Masters in Womens Health and Continence Physiotherapy
. She is the co-founder of the Empowered Motherhood Program. She's a total expert on this topic.

She is also a Mum who loves being active and healthy, so she combines her knowledge with very practical and realistic advice. I hope you will get a lot out of her tips below.

"What role does the pelvic floor play when it comes to incontinence?"

"When it comes to incontinence (or the maintenance of continence), the pelvic floor plays quite a complex role. Much more complex than most people realise.  The role of the pelvic floor will differ depending on the type of continence mechanism that is required at the time.If a woman suffers from Stress Urinary Incontinence (SUI), then the pelvic floor needs to play a supporting role.

It creates a rigid 'back-stop' to minimise excessive movement of the urethra that occurs with activities such as a sneeze or a jump. If the pelvic floor doesn’t activate at all or doesn't activate with enough speed or strength then the urethra or bladder will move excessively or open, and urine will leak out.

In the case of Urge Urinary Incontinence (UUI), which is the involuntary loss of urine associated with a sudden desire to pass urine, the pelvic floor functions just as one member of the team. It needs to work in conjunction with the detrusor (bladder muscle), bladder nerves and urethral sphincters. If any one member of the team isn’t working optimally then UUI will occur.Typically if the pelvic floor is weak, then women are more likely to get leaking, however clinically we often also find that a pelvic floor that has become too tight may also have that leaking as the pelvic floor muscle is unable to function optimally due to its spasmed state."

What are some active strategies that we can use to treat and prevent stress urinary incontinence?

Pelvic floor strengthening is with out doubt the most important thing we can do to treat and prevent SUI. The research shows this time and time again with a 70 – 95% cure rate when a structured pelvic floor program is followed. It is important that both the slow twitch and fast twitch muscle fibers are trained as both are required for the prevention of  urinary incontinence.

If a woman learns how to correctly activate her pelvic floor earlier in life before she has children this can be invaluable in preventing SUI occurring. Learning to engage the pelvic floor quickly whilst  under load (such as when you sneeze or lift a heavy weight) can protect it from excessive downward forces that may weaken the pelvic floor. Other lifestyle factors such as preventing constipation with a healthy diet full of fibre, adequate water consumption and avoiding excessive weight gain can also play a vital role in the prevention of SUI.If a woman embarks on a pelvic floor strengthening program and is struggling, there are a few little tricks that Women’s health physios will use to help speed up this process.

These include electrical stimulation probes or biofeedback probes that sit within the vagina and help to contract the pelvic floor for the woman so she can learn what it feels like (electrical stimulation) or which give her visual feedback when she is doing the correct squeeze to help her learn what correct pelvic floor engagement feels like (biofeedback).Strengthening the pelvic floor is usually a work in progress, so in some cases we will use intra-vaginal continence devices such as the contiform or a silicon pessary.

These act to provide support to the urethra and act like 'back-stop’ against the downward force of the urethra, which is what the pelvic floor should be doing. There is a huge increase in women using these in recent years as women are no longer happy to put up with incontinence as a reason not to be active. I love these devices as they help keep my women of all ages enjoying an active lifestyle. If women are interested in trying these I encourage them to chat with their women’s heath physio or Gynecologist as they can help wok out which device will be the best fit for the individual.If women have severe SUI and it is not responsive to conservative treatment then surgery may need to be considered.

What are some active strategies that we can use to treat and prevent urge incontinence?

The mechanism for UUI is multi factorial with variable contributing factors. In most cases it is not simply due to a weak pelvic floor. It may occur due an overly active bladder muscle (detrusor) that has such a strong pressure that no matter how strong the pelvic floor is leaking still occurs. It may also be due to a low capacity bladder where the bladder has reduced in size so very quickly gets full and leaks, or in some cases UUI occurs when the pelvic floor muscles are so tight, that they are not able to contract to hold in urine as they are already in spasm.In a healthy optimally functioning bladder, women should feel a gradual build in bladder sensation, be able to defer the urge till they are ready to pass the urine, then calmly and without leaking make it to the toilet. If this healthy bladder mechanism is disturbed, then treatment to address the bladder is required as is a detailed assessment to work out what the problem is for that individual.The treatment may be with pelvic floor exercises, bladder retraining or pelvic floor release. In some cases electrical stimulation can be used to calm the bladder down or medication can be used as an adjunct to the Physiotherapy program.If you want to keep your bladder healthy here are a few tips:

• Ensure you drink enough water each day to keep your bladder capacity up (approx. 2 liters)

• Minimise caffeinated, acidic, alcoholic and carbonated drinks as these are known to irritate the bladder

• Keep in control of your bladder and only let your yourself pass urine when you should i.e. don’t pass it in the shower or when swimming as this starts to tell your bladder ‘ its ok to wee when in water’ and make the bladder confused.

• Aim to go to the toilet 4-6 times per day (if drinking 2 liters) and each volume should be around 300 – 500 mls. Do a spot check on yourself from time to time with an old measuring jug to check how your bladder is functioning.

Any strategies you are using that have been successful in treating incontinence?

The strategy that is most effective is a detailed assessment and clear communication with a woman so she understands the mechanism behind her type of incontinence as an individual. Many women just think that by doing more pelvic floor exercises that their incontinence should improve, but in some cases it can actually make it worse.My other big tip is to think outside the box by looking beyond the pelvis to see what other factors could be contributing to increased bladder or pelvic floor stress, such as abdominal function, diaphragm tightness, thoracic and lumbar spine restrictions, or even ankle stiffness. These structures all have either a direct or indirect connection to bladder function and can dramatically improve urinary incontinence if addressed.