Natural childbirth is the first and biggest cause of urinary incontinence in women.
One third of new mothers become incontinent after childbirth because of the weight of the baby baring down on the pelvic floor, pushing the baby out during childbirth and even more minor complaints of constipation can have an effect.
Knowing what a profound affect that pregnancy and childbirth can have on a women's continence, pelvic floor exercises are promoted and encouraged regularly by midwives, health visitors and GP's.
Urinary incontinence is under diagnosed and considered a taboo subject however, it is important to keep the pelvic floor muscles strong for the rest of your life as multiple pregnancies, the menopause and natural ageing can cause the uterus to sag and push down on the pelvic floor which helps support your bladder, bowel and uterus.
Urinary incontinence: a taboo subject?
Urinary incontinence has been a taboo subject for many women., as they are often embarrassed to talk about it and will put up with their symptoms resorting to wearing sanitary towels to protect themselves and even carrying spare underwear as the leaking when coughing, laughing and sneezing etc, can be too much. As a result, healthcare professionals are much more aware of the problem and encourage their patients to seek help, but most importantly try to prevent the problems form occurring by educating women at risk, especially those going through child birth.
Research has revealed that pelvic floor training is effective in the management of stress incontinence and reduces incontinence episodes by 50%.
Stress Incontinence - Risk factors
- Pregnancy and childbirth
- Being overweight or obese .
Effects of pregnancy and natural childbirth on the perineum
The perineum is made of several layers of muscles, ligaments and membranes.
The perineum includes the vulva and the anus and supports the bladder, the uterus and the rectum.
The contraction of the perineum avoids both an urinary and a faecal incontinence.
Factors that weaken the pelvic floor during pregnancy and labour or worsen existing symptoms are:
- A big heavy baby .
- The crown of the babies head is larger than 35,5 cm in diameter.
- Abdominal pressure exerted during childbirth.
- The use of forceps during delivery .
- Problems from previous pregnancies.
- Trauma to the perineum during birth ie tears and episiotomy ...
Pelvic Floor Exercises before childbirth
To help keep your pelvic floor strong and prevent urinary incontinence, pelvic floor exercises are encouraged and taught before childbirth.
During your antenatal classes your midwife will teach you how to perform theses exercises and some maternity units use physiotherapists to teach them.
Pelvic Floor Exercises after childbirth
Following childbirth care you will find that you are constantly being reminded to perform your pelvic floor exercises and it is recommended that you continue to do them indefinitely on a regular basis to prevent problems throughout your life as incontinence may reappear at the time of another pregnancy or after menopause.
For some women referral to a physiotherapist for a more formal assessment and structured individual teaching is necessary.
Problems associated with a weak pelvic floor
- Sexual intercourse may not be a enjoyable.
- A weak pelvic floor can be a risk factor for a prolapse of the rectum, the uterus or bladder.
Avoid doing abdominal exercises, lifting too heavy loads, running and jumping for the first 6 weeks. These can put pressure and stress on the bladder. It is better to start exercising slowly and strengthen the pelvic floor first.
There are physiotherapists that have been especially trained in assessing the pelvic floor and use specialist equipment to help them. A probe is placed into the vagina and an electrical recording is taken measuring the contraction and relaxation of the muscles. The use of such equipment helps the visualisation of the effects of pelvic floor contraction and helps mothers better understand how their perineum functions and how to be more aware of its role.
Persisting symptoms should not be ignored and seeking help is important