Updated: Apr 22, 2021
While there are many myths that percolate about women’s health and recovery after childbirth, one of the most prevalent is that of leaking. As a Physical Therapist with a specialization in treating women during and after pregnancy, I have heard everything from women keeping this a most guarded secret, to laughing about it with others as a sort of bonding, an acceptance of what her postpartum body has become. While it is true that a postpartum body is a different body than the pre-pregnancy one, leaking is not something women should or need to accept, is not normal, and is treatable. Furthermore, treating and preventing leaking, or UI (urinary incontinence) has far reaching effects in improving a women’s confidence, core strength, and overall health and wellbeing.
The first myth around UI is that because it is common, it is therefore normal. How common is it? Research states that up to 55% of women experience leaking after a vaginal delivery, and up to 40% after a cesarian delivery. Many women find it surprising that this issue is so common, yet so rarely discussed. Shame and embarassment, I believe, play a big role in this. And when a mother confides in a friend about this issue, and the other one has it as well, it is easy to conclude that leaking is simply what happens after childbirth.
What does happen after childbirth is this- the muscles of the deep core system are effected by the process of growing and birthing a baby. This deep core system includes the muscles of both the abdominal wall and the pelvic floor, which are the muscles at the bottom of the pelvis. This deep core system has many roles, including continence of the bowel and bladder. The deep core also provides stability of the spine, support of the pelvic organs, and plays a role in sexual satisfaction. These muscles get stretched, loaded, sometimes cut or scarred- all effecting the ability of these muscles to do their many jobs.
Another common myth about UI is that the solution is to do kegels. Well- it’s often not that simple, for many reasons. First of all, studies indicate that about 40-50% of women do not perform a kegel, or contraction of the pelvic floor muscles, correctly, with verbal input alone. That means, many women require feedback from a professional to know if they are in fact contracting the correct muscles. Additionally, sometimes the muscles are not simply weak, but are actually tight or have high tone, and contractions can actually make the issue worse. I find that this is surprisingly common. Imagine, if your neck muscles were stiff and tight, and so you tried to make the pain go away by exercising them- it wouldn’t help, right? The same process can happen with muscles of the pelvic floor. In this case, the treatment is to first address the tightness with manual release and relaxation work before starting any individual muscle contractions.
So how do you know what you need? Similar to me trying to fix my kitchen sink, my advice would be to consult with a professional. In the United States, the best person to address issues with UI would be a Women’s Health or Pelvic Floor Physical Therapist. She will be able to tell you if your muscles are tight, or weak, and develop an individual plan to address the unique needs and goals of each client.
My last word on the topic is this- Please do address this issue. If leaking does not resolve by 6-8 weeks after childbirth, get assessed by a PT with advanced training in working with women and the pelvic floor muscles. UI is not one of those issues that just “goes away.” The first women I treated for leaking was 3 years postpartum before she showed up for therapy. By the time I saw her, she was distraught and unhappy, as the leaking had started her on a downward spiral. She had stopped exercising due to it, then gained weight, which then effected her self image and even her relationship. Within just a few sessions, she was jumping and squatting without leaking, and resuming an exercise program. Her only regret was that she did not know to come and get treated sooner. Let us be advocates for one another to fully heal our bodies, and to live unemcumbered by issues which are treatable by conservative measures.
