Alexandra Gatti, PT, DPT
Incontinence Post Baby
Pre-pregnancy, many women don’t worry about their pelvic floor or bladder. However, soon after giving birth, a laugh, sneeze or sudden movement can cause surprise urine leakage. During pregnancy, many women experience some form of urinary incontinence, a loss of urine control. Unfortunately, incontinence can linger after pregnancy. Studies show that women who give birth vaginally are more likely to experience urinary incontinence a year postpartum compared to women who have cesarean sections.
The most common type of incontinence among women is stress incontinence. Stress incontinence involves involuntary leakage of urine that occurs when a woman stresses her abdomen, such as in jumping, sneezing, laughing or coughing. In stress incontinence, the bladder sphincter is unable to hold in urine. Studies show about two-thirds of women with stress incontinence also experience urge incontinence, which is caused by an overactive bladder. Urge incontinence is when the need to urinate comes on very quickly or leakage occurs when the bladder is full. The muscles surrounding the urethra may be affected.
Urinary incontinence can range from a slight loss of urine to severe, frequent leakage. Urinary incontinence can be treated, and treatment depends on the severity of symptoms and the type of incontinence. Here are a few treatment methods for this condition:
Kegels: Kegel exercises are a method that can be used to help control urinary incontinence. It can help to strengthen and tighten the pelvic muscles. To perform Kegels, you want to work on both coordination and endurance of your pelvic floor muscles. This means contracting and relaxing the muscles quickly and also working on the holding ability of the muscles. To find the right muscles to squeeze, think about the sensation of holding back gas or stopping the flow of urine mid-stream. That feeling is your pelvic floor muscles contracting. Squeeze those muscles up and in for just a second and then release. Repeat this 10 times. Then you can tighten the muscles and hold for 10 seconds. Relax and repeat again for 10 seconds. If you can’t maintain that squeeze for 10 seconds yet, you can work up to 10 seconds over time. The easiest position to do this exercise in is lying down as your muscles get stronger you can transition to doing the exercises sitting then standing to challenge the muscles and help strengthen them further.
Biofeedback: A specially trained physical therapist (PT) places electrodes on your skin or a small sensor can be placed inside the vagina while you perform a series of pelvic floor exercises. The sensors provide visual and auditory feedback to show you and your PT if you are contracting the right muscles. Biofeedback helps you to gain awareness and control of your pelvic muscles.
Vaginal Weight Training: Small weights are held within the vagina by tightening the vaginal muscles. This may be done for 15 minutes, twice daily, for 4 to 6 weeks.
Pelvic Floor Electrical Stimulation: Mild electrical pulses stimulate muscle contractions, which can be done along with Kegel exercises.
Bladder Training. In bladder training, you resist the urge to go to the bathroom by waiting a little longer before you go. You follow this pattern for a period of time. You consistently extend the schedule and continue to lengthen the time until you are up to three or four hours between bathroom visits.
Schedule Toileting. You use a chart or diary to record the times that you urinate, your fluid intake and any leakage. This will allow you to create a schedule so you can avoid leaking in the future by going to the bathroom at scheduled times.
Medicines. This includes specific drugs for incontinence as well as estrogen therapy. The medicine can help control muscle spasms in the bladder or strengthen the muscles in the urethra. Other medicine can help to relax an overactive bladder. This may be helpful along with other treatments for women with urinary incontinence who are past menopause.
Surgery. This is an option if the incontinence is related to problems such as an abnormally positioned bladder or a prolapse. It may be used if other treatments don’t work or incontinence is severe.
Adult diapers. Modern diapers are more comfortable and no longer bulky. You can wear them under everyday clothing without visibility.
Pessary Device. This device is used if your leakage is more severe or if a pelvic organ prolapse is present. A stiff cone is sized, fitted and inserted into your vagina to help support the urethra and prevent your bladder from leaking.
There are plenty of other devices and products that can help with urinary incontinence. The most important step in diagnosing a urinary incontinence is talking your health care provider. Urinary incontinence should not be ignored or it can become a long-term problem. A pelvic floor physical therapist may be able to help strengthen your pelvic floor muscles to treat your incontinence.
Visit touro.com/findadoc to find a physician or urologist.
Alexandra Gatti received her Doctorate degree in Physical Therapy from Northeastern University in 2010. She started her physical therapy career as an inpatient acute care physical therapist at Saint Mary’s Medical Center in San Francisco, CA and then ventured to Beth Israel Deaconess Medical Center in Boston, MA where she specialized in pelvic floor physical therapy for both men and women. She has successfully completed the Herman and Wallace Pelvic Floor Rehabilitation Institute’s Pelvic Floor level one and level two courses and the American Physical Therapy Association (APTA) course on managing chronic pelvic pain. She is a member of the APTA and Women’s Health Section of the APTA. She is conversational in Spanish and has worked with a diverse patient population both at home and abroad. She started at Touro Infirmary in New Orleans, LA in early 2016 focusing on the pelvic floor physical therapy and cancer rehabilitation programs.