incontinence Archives - Moving Like A Mother

Hi ya’ll. Some of you may know that I recently began seeking further education in the area of women’s health. I especially have a strong interest in the pregnancy and postpartum population. Since having my two babies I have realized how much change women undergo physically. It’s actually quite amazing what our bodies are capable of. But unfortunately, our postpartum bodies are not perfect. Muscle weaknesses, posture changes, and healing tissues can lead to aches, pains, and impaired function. Luckily physical therapy is available to help women after pregnancy with many of these new and unanticipated challenges.

The need for physical therapy after pregnancy

In my recent postpartum course I discovered some staggering statistics on the number of women struggling with postpartum pain or issues who are not receiving any treatment. Some of the particularly noteworthy statistics include:

Pregnancy related lumbopelvic pain persists in 25-50% of women at 3 months postpartum. And if the pain is there at 3 months postpartum, then it will most likely still be there at one year postpartum.

Sometimes this back pain can become chronic. So what exactly does this mean? This tells us that postpartum women suffering from low back pain need therapeutic intervention. Unfortunately the pain will not just magically go away.

What’s more, only 32% of women who have PLBP (pregnancy low back pain) or PGP (pelvic girdle pain) report it to their care providers. And then of those who report pain to their providers only 25% of these women get a treatment recommendation. This means a huge number of women are not getting any treatment or professional help for their physical problems after having a baby.

Postpartum Care in Other Countries

So why aren’t more women in the U.S. getting physical therapy after pregnancy? I mean their body just went through a huge change, they potentially had surgery, and their physical demands just grew exponentially with a new tiny human on the scene.

Many other countries are leaps and bounds ahead of us in their postpartum care of mothers. In France, the Netherlands, and Australia every woman is automatically given several visits with a pelvic floor physical therapist to address healing issues, muscle imbalances, or any other concerns. Fox News published an article addressing the vast difference between France and the U.S in their care of the postpartum women. In fact, U.S. women are the least likely to get physical therapy treatment after pregnancy (only 24%) compared to Europeans.

Yet, of these women who do get treatment in the U.S. up to 87% reported positive effect, meaning that therapy works. Obviously. Therapy can help your body heal effectively in order to prevent chronic pain symptoms, incontinence, pain with future pregnancies, and safe return to exercise and regular activities.

Common Problems Postpartum

Below are some of the common problems women might experience postpartum.

Abdominal Separation/ Diastasis Recti

When we are pregnant our uterus and stomachs grow as the baby grows. This new growth can place extra pressure on the linea alba which is the tissue that runs down the middle of your 6 pack abs (also known as your rectus abdominis). The added pressure on your linea alba can lead to a separation of your abdominal muscles known as a diastasis recti. A diastasis recti is diagnosed postpartum if the distance between the abs is 2 finger widths or more when measured slightly above and below the belly button, or there is insufficient muscle tension. Around 4 weeks postpartum this separation naturally starts to come back together.

However, about 60% of women still have a diastasis recti 6 weeks after childbirth. In fact, if a diastasis recti is present at 8 weeks postpartum it will likely still be present at 1 year (Coldron, 2008) An untreated diastasis recti can contribute to low back pain, pelvic pain, urinary incontinence, and other pressure system issues in our body.

A physical therapist would be able to assess and provide proper treatment to help heal a diastasis recti. We do not have any specific exercise program supported in the scientific literature to heal a diastasis. What matters is the quality of your exercises and movement which would be assessed by a specially trained PT.

Incontinence

For many women pregnancy and postpartum is the starting point for urinary leakage and other bladder problems. There is no “normal” amount of leakage or pee with activity. A systematic review shows that 33% of women have urinary incontinence at 3 months postpartum. At 4 years postpartum about 29% women reported incontinence. Postpartum incontinence could be from weakness, poor coordination, pelvic floor muscle endurance or from overactivity and muscle trigger points. Again a pelvic floor therapist would be able to evaluate and determine to the best specific and individualized treatment for you.

Cesarean Section Scar Healing

One in three women have a cesarean section according to an article written by The Bump in 2017. A cesarean section is a major surgery in which several layers of the abdomen are cut open. Caesarean sections vary in the layers sutured or not suture as well as the depth and amount of scarring. There are several techniques for scar mobility and massage to help the healing process. A physical therapist can perform and educate a woman on these techniques to aid in optimal recovery.

Perineal Tearing

Tearing is the tissue damage that happens during labor and delivery. Greater than 85% of women have perineal trauma with vaginal birth (about 50% of women have episiotomy). Tissue healing of the pelvic floor is important for proper function and remaining pain free.

Low Back or Pelvic Pain

Pregnancy related low back pain or pelvic girdle pain is common during and after pregnancy. Due to changes in the body’s composition and posture during pregnancy many muscles and ligaments can become stressed out and irritable. And as previously mentioned, the core muscles are often quiet weak so there is a lack of stability which can further contribute to pain in the back and pelvis.

Upper Back and Neck Pain

Similarly upper back and neck pain is often present postpartum. Upper back pain is reported in about 43% of postpartum women. This again is due to muscle imbalances and forward posture preferences when holding baby, feeding baby, and more.

There are numerous other things a physical therapist can assist a new mom with after having a baby. Other impairments that often need to be addressed are posture, gait, breathing patterns, body mechanics, and potentially nerve pain.

How Can Physical Therapy Help New Moms After Pregnancy

No two women, pregnancies, or birth stories are the exact same so there is no one size fits all treatment for new moms. An individualized treatment session with a PT would allow a therapist to look at your specific impairments. There are numerous ways physical therapy could help a woman after pregnancy.

Examples include:

Help aid appropriate healing of perineal or C-section scars/incisions
Education on body mechanics and positioning techniques to improve function and prevent pain
Provide specific techniques and exercises to heal and strengthen the abdominal muscles (often through use of biofeedback, palpation, observation). They can help postpartum moms retrain the deep core muscles to work effectively and appropriately
Provide specific exercises to heal and strengthen the pelvic floor muscles
Assess posture, breathing patterns, and gait mechanics for correctness and efficiency
Evaluate and treat low back pain and pelvic pain. Possible techniques include massage, taping, manipulations, and appropriate exercises.
Provide an individualized treatment plan for safe return to exercise

What’s Next?

Ok, ok I’ll get off my soap box now. I just recently realized how little education is available to American women regarding their postpartum bodies. To be honest with you there is so much I have learned already that I was not aware of when I had my children. Luckily, I was able to use some of my prior knowledge of the human body to heal and get rid of the little pain and discomfort I did experience after having my babies. But most women do not have a background or education base on body biomechanics and exercise science.

So what can you do? I would love love love if you could share this info with all the mamas or mamas to be out there. I do believe there is a movement happening in the U.S. for postpartum care to be more common place. Do not be afraid to ask your doctor for a referral to a pelvic floor therapist or woman’s health specialist. I think there is a bit of a stigma around woman needing therapy after pregnancy. But you wouldn’t be embarrassed if someone told you your leg muscles were weak. Weakness of the core and pelvic floor shouldn’t be any different.

Keep following along as I embark on this journey of education regarding health and wellness for the pregnancy and postpartum woman. And I do believe the saying, once postpartum, always postpartum. Our bodies are fricken amazing. Let’s give them the love and respect they deserve.

–Monica

What is the pelvic floor?

So let’s start with a little anatomy lesson. Your pelvic floor is a group of muscles that hold the bladder and rectum in place. Think of your pelvic floor as a hammock. It lies on the bottom of your core supporting all your internal organs, and perhaps, a growing baby. The pelvic floor is made up of muscles, and therefore it can be stretched and/or strengthened.

Pelvic floor during pregnancy and postpartum

So now let’s think about pregnancy. For months you grow a baby in your uterus that sits on the pelvic floor. And the combined weight of the baby, the placenta, and extra fluid places quiet a bit of extra weight on these pelvic floor muscles. This causes the pelvic floor to stretch out and the muscles that close the urethra (where the pee comes out) to become weak.

What is normal?

As previously mentioned the pelvic floor is a group of muscles that supports our bladder and rectum. When they are strong and functioning properly we are able to contract and relax them in order to control when we go to the bathroom. Normal pelvic floor function means you should be able to run, jump, etc. without unexpected urine leakage.

What is not normal?

Urinary leakage in women (especially postpartum) is common, but not normal. You shouldn’t leak urine just like you shouldn’t need glasses for “normal” function. When we cough, laugh, sneeze, run, or jump there is increased pressure inside the core and excessive stress is placed on the pelvic floor. This can cause an involuntary leakage of urine and is referred to as stress incontinence.

Stress incontinence

Stress incontinence occurs when the muscles and connective tissue that surround the urethra become weak, which is common after pregnancy. When extra stress is placed upon the pelvic floor these muscles are unable to appropriately contract in order to keep the urethra closed. If left untreated the muscles can continue to get weaker making leakage more common.

Aging and weakness

New moms are not the only women to suffer from pelvic floor weakness and stress urinary incontinence. As we age our muscles and connective tissue can also get progressively weak. Again this can lead to unexpected urine leakage during times when the pelvic floor is unable to withstand extra pressure placed upon on it. Other signs of pelvic floor weakness or dysfunction include trouble having a bowl movement, low back pain, and pain with sex.

How can we fix it?

So what can be done if you believe you have pelvic floor problems? Start with talking to your doctor. Every pregnancy is different and every woman is different so you should always speak with the appropriate medical professional regarding your unique case.

Exercise:

Just like with any muscle, the best way to make it function properly is to make it strength and length. And one of the most common exercises for specifically strengthening the pelvic floor is a kegel. A kegel is a contraction of your pelvic floor muscles. Many describe a kegel as stopping the flow of urine while peeing. Personally my favorite cue for performing a kegel is to imagine drinking through a straw with your vagina. Go ahead and laugh but I bet you’re doing it right now.

But pelvic floor is not just about kegels. The body is a chain and the pelvic floor does not function solo. There are many other muscle groups that need to be considered if you are suffering from incontinence (refer to my “Pop- Can” core post). Some of these muscle groups include your core and your pelvic stabilizers.

Physical Therapy:

If you are peeing when you cough, sneeze, laugh etc. the best thing you can do is seek a referral for women’s health physical therapy. Depending on where you live in the U.S. you may need an script (order) from your doctor.

Physical therapists who specialize in the pelvic floor are are able to evaluate and treat your unique symptoms. No two pregnancies and no two women are the exact same. The muscles that are weak or too tight will not be the same for every woman.

Why do women in the U.S. think it is normal?

So why do so many women think it’s normal to pee after having a baby? The answer is because there is a significant lack of knowledge and discussion about pelvic floor function. Did you know in France women are required to go to a pelvic floor therapist at 6 weeks postpartum and each woman has on average 10 pelvic floor therapy appointments? In the U.S. we have one postpartum visit with our OB, and pelvic floor function is not readily discussed. Hopefully, that can change.

What’s next?

This post just scratches the surface about pelvic floor function and dysfunction. And while this might be longest post I have written to date I wanted to try and keep it fairly short and sweet for now. We could dive much deeper into pelvic floor function, treatment, and prevention but I will save that for another day. Feel free to leave a comment or send me a message with any questions you might have about pelvic floor therapy. Let’s open up about pelvic floor function!