Do you remember Adam Sandler as Billy Madison trying to make his friend look cool after having an accident on the school field trip? I hear from a lot of moms that think it is normal to pee a little when laughing, sneezing, coughing, or jump roping. Incontinence at any point during pregnancy or post birth should not be considered normal. Many women experience urinary incontinence during pregnancy and/or postpartum, but it doesn’t have to be your normal. During pregnancy there is more pressure from above on the pelvic floor muscles, which help control urine and feces.
The pelvic floor muscles have 3 major functions. One is to provide support to the abdominal cavity and organs, as well as the lumbar and pelvis from the bottom. Another is to assist in control of bowel and bladder function. Sexual function is another function of the pelvic floor muscles.
Urinary incontinence associated with coughing, sneezing, laughing, jumping, burpees, etc. is called stress urinary incontinence (SUI). Urinary incontinence associated with an urge to go is called urge incontinence (UI). If you’re having urinary or fecal incontinence at any stage during pregnancy, see a pelvic floor therapist. If you’re reading this and you have had a baby and you are having incontinence, see a pelvic floor physical therapist to determine if you even need kegels or pelvic floor training, or if you need more relaxation exercises prior to strengthening the muscles. I meet a lot of women who have been doing kegels either the wrong way, wrong prescription (holding too long, not long enough, or the wrong number of repetitions throughout the day), or should not be doing kegels at all due to a hypertone pelvic floor. This means that the muscles are not staying at a rested state at neutral and then we are trying to strengthen a tight muscle. If you think of doing a bicep curl in only half motion you can see how you will never be able to build the strength as well as performing in full range of motion with your bicep curl. The same can be applied to the pelvic floor muscles. If you have tried kegels for more than four weeks and you are not seeing some improvement, you are probably doing it the wrong way. If you are experiencing difficulty starting the stream of urine, burning pain, or pain with intercourse then you are, most likely, doing too much exercise. This is another reason to see a pelvic floor physical therapist. According to the research, greater improvements in SUI occur when women receive a supervised exercise program of at least three months (1) by a pelvic floor physical therapist.
Women can also have incontinence after cesarean section as well as vaginal delivery. Diastasis recti is common in many women after pregnancy. This is the separation of the rectus abdominis muscle. Performing the correct core exercises after having a baby is very critical to not only decrease the diastasis recti but also ensure proper tension between the abdomen, pelvic floor, diaphragm, and multifidus. You can seek a referral for pelvic floor physical therapy from your Midwife or other medical provider.
Helping moms post childbirth with their pelvic floor, decrease urinary incontinence or fecal incontinence, and stabilizing the core and hip muscles to help them get back to their goals of returning to yoga, CrossFit, or just being able to pick up baby with less strain and pain is my passion.
Reference:
1. J Phys Ther Sci. 2014 Sep; 26(9): 1493–1499. Published online 2014 Sep 17. doi: 10.1589/jpts.26.1493
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