Did you know that one in three women who have ever had a baby experience bladder leakage? Incontinence is a common problem after childbirth, but the good news is that it can be helped. It’s usually caused by a weak pelvic floor, and understanding how this muscle group works allows you to see how damage can be prevented and improved.
What is the pelvic floor?
The pelvic floor is a group of muscles and ligaments which support the bladder, uterus (womb) and bowel. The openings from these organs – the urethra from the bladder, the vagina from the uterus and the anus from the bowel – pass through the pelvic floor. It can help to imagine them as a sling of muscles, like a hammock.
Pelvic floor muscles help you control bladder and bowel function. These are what let you ‘hold on’ to go to the toilet at the appropriate time and place.
What causes a weak pelvic floor?
Some of the common causes of pelvic floor muscle weakness are:
- pregnancy and childbirth
- being overweight
- constipation (excessive straining to empty your bowel)
- persistent heavy lifting
- excessive coughing, causing repetitive straining
- changes in hormonal levels at menopause.
You should get into the habit of lifting and squeezing every time you cough, sneeze or lift
Pregnancy, childbirth and your pelvic floor
Pelvic floor damage can occur during delivery of a large baby or multiple babies, or by prolonged pushing during delivery. Just as the vagina stretches during birth, the pelvic floor muscles also stretch as a result of the extra pressure of pregnancy and labour.
Even if you have a caesarean to deliver your baby, pregnancy itself can lead to pelvic floor problems over time. This can leave the muscles weak so they’re not able to keep the bladder from leaking. This leaking happens mostly when you cough, sneeze, lift or exercise.
What's a prolapse?
When one or more of your pelvic organs (bladder, womb or bowel) sags down into your vagina, it’s called pelvic organ prolapse. Prolapse is very common and happens to about one in 10 Australian women. If you have a feeling of ‘something coming down’, you might have a prolapse – see your doctor as soon as possible.
Repairing and strengthening pelvic muscles
Ideally, all women exercise their pelvic floor muscles everyday, to help prevent weakness and improve strength. Regular non strenuous exercise, such as walking, can also help.
Specific postnatal pelvic floor muscle exercises have been shown to help in the recovery of pelvic floor muscle function, and to reduce or cure the chance of urinary stress incontinence in women..
The 'lift and squeeze'
Pelvic Floor First recommends this exercise to help discover your pelvic muscles and learn how to lift and squeeze. You can do this exercise sitting or standing.
- Relax the muscles of your thighs, bottom and tummy.
- Lift and tighten the muscles around the front passage, as if trying to stop the flow of urine.
- Lift and tighten the muscles around the vagina so they move upwards inside the pelvis.
- Lift and squeeze in the muscles around the back passage, as if trying to stop passing wind.
- The muscles around the front and back passages should lift and squeeze up and inside the pelvis.
- Identify the muscles that contract when you do all these things together. Then relax and loosen them.
- Put this together so the muscles around the front and back passages lift, and then you should feel them squeeze up inside the pelvis.
- Women who are familiar with using tampons can imagine lifting and squeezing in the vagina as if drawing a tampon up higher in the vagina.
The National Continence Program recommends doing this 'lift and squeeze' (also known as 'the knack') 10 to 20 times in one set, and doing between one and three sets a day, after you have a baby.
So you remember to do them, try to do the set of exercises at the same time you do a certain action, such as when washing your hands, when you feed the baby or when you have a shower.
You should also get into the habit of lifting and squeezing every time you cough, sneeze or lift.
If wetness is a regular problem for you, it may help to speak to your GP or women's physiotherapist.
The National Continence Helpline Freecall™ is an Australian Government Initiative, and can be accessed on 1800 330 066. This helpline is staffed by professional continence nurse advisers who can provide advice and referral.
Some women find wearing a liner or pad for incontinence needs can help them feel dry and secure. Another way you can ensure you aren’t 'caught out' is by being aware of public toilets in areas you travel to. It can help to plan ahead with this map.