POST-PARTUM INCONTINENCE

Pregnant women mostly experience Soreness, depression, bleeding, fatigue, and constipation are just a few of the unpleasant outcomes women may experience after giving birth. One of the most common complaints from women is how to handle symptoms of incontinence in the weeks following childbirth. And yes this is something which is not known to all or not explored.

Postpartum incontinence is a serious condition that does affect almost 30-70 % of women after pregnancy, but it doesn’t have to derail their lives completely. You may have heard jokes about moms who wet their pants after giving birth, but is postpartum incontinence really something to laugh about? Of course no.

Many people mistakenly think that having postpartum incontinence is normal after pregnancy. While it is common for many women, it is not necessarily normal.

Postpartum incontinence comes in 3 form, either Urinary or fecal or both at once. Risk of post-partum incontinence increases with forceps deliveries, multiple births, obesity, previous history of incontinence, weak pelvic floor muscles, abruptly abnormal hormonal imbalance or any injury during the delivery. After giving birth woman’s body continues to experience hormonal changes that affect her bladder and as her uterus contracts, it places extra pressure on her bladder. All of this pressure and stretching means her weakened pelvic muscles, which may be unable to contract in
order to hold or stop urine/fecal leakage.

During the later stages of pregnancy, bladder is squashed by the baby. This
means that your bladder gets used to holding less. This muscle weakness may also cause pain, fever, discomfort & incontinence. For the delivery doctor can give anesthesia by mean of epidural or a spinal block, and due to its after affect one can numbness around your bladder may feel numb. If women had an epidural, the catheter that was inserted into your bladder may make it harder for you to control when you pee. But this should sort itself out within a few days.

Urinary incontinence is the involuntary partial or full release of a woman’s bladder after pregnancy and childbirth. For many women, this may look like leaking or dribbling a little urine if their bladder is full, when performing a physical activity like running and jumping, or with forceful movements like coughing and sneezing.

For the better understanding, most of the women without pregnancy also leaks the urine when they laugh or sneeze due to weak pelvic floor muscles
and thus French government gives out free 10 pelvic health classes. When we are talking about the scenario of developing countries, where most the women are not aware about the ante/post-natal rehabilitation neither they have the resource for the same, having high spectrum of incontinence is quite obvious.

Urinary incontinence is classifying in 3 ways. It could be stress incontinence, urgency or mixed type.

Stress incontinence is the commonest type which affects after pregnancy in younger women. Any stress put on the bladder like sneezing,
coughing, jumping can produce leakages. Having a strong pelvic floor muscles, one can prevent this and thus rehabilitation before & after pregnancy is quite vital. For some, the problem goes away within a few weeks of giving birth.

For others, it can linger for months, or become a long-term problem.
Fecal incontinence after pregnancy and delivery can also occur, but it is much less common. Fecal incontinence may occur if a woman has a 4th-degree tear into her anus, or if a fissure develops from the vagina to the anus. Unlike urinary incontinence which can be helped in some cases with physical therapy, fetal fecal incontinence usually requires surgical
intervention to correct if happened due to serious injuries. One can prevent or cure post-partum incontinence with exercises, changing lifestyle, asking the same early to the doctor, maintaining good core muscle control, avoiding high impact exercises and taking required amount of fluid, & follow good conduct of ante/post-natal care education.

Pelvic health during or after pregnancy involves breathing exercises, posture awareness & Control education, Core muscle balancing/strengthening exercises, pelvic floor muscle awareness & strengthening, partum health education to
parents, ergonomics and pelvic hygiene techniques. Many time women need to consult the doctor for their pelvic infection or other issues for which doctor can give medication for urine urgency, reduce frequency or to treat infection.

Sometime electrical stimulation is also needed to stimulate the nerve which supplies the muscle of pelvic floor. At worst case Surgery is needed to support the urethra to reduce leakage. Rehabilitation expert works in hand in hand as a core team with physician, gynecologist, nutritionist, maternal educators & nursing staffs to provide best care for women’s pelvic health.

Pregnant women need to do pelvic floor exercises at least three times a day, for at least three months. After a while, doing them should become second nature. Pelvic floor exercises are something that you should make part of your daily life, at least two or three times a week. If you stop doing the exercises, your muscles can weaken, and you may find that your
bladder control problems return. Doing the exercises will help your body to heal, so don’t worry that it’s too soon after the birth. Strengthening your pelvic floor will reduce some of the swelling caused by stitches and bruising. So the sooner you can begin your exercises, the better.

Many times changing behavioral habits & modifying few lifestyle measures can also help incontinence. Behavior modifications like urine diary, set times for urination/fecal, regularize sleeping timings can help to control incontinence problems. Lifestyle changes like avoiding alcohol, reduce intake of caffeine, timely fluid intake, eating healthy food, implementing good hygiene techniques can promote good health and also prevent or helps to cure incontinence.

Sample post-partum exercises:

Guidelines are as follows if one does not experience any vaginal heaviness (prolapse),
bladder leakage, pain or abdominal doming during or after any exercise-
– 0-6 weeks: Focus on pelvic floor and gentle core muscle exercises, postural exercises, gentle walking and
stretching, breathing & thoracic expansion exercises.
– 6-12 weeks: Postnatal posture correcting exercises, flexibility exercises, Pilates or yoga, low-impact cardio
exercise like walking, swimming and light strength training with breath control training
– 3-6 months: Progress core work, gradually increase intensity and duration of low-impact cardio & strength
training, introduce light jogging.
– 6+ months: Progress all of above, introduce higher-impact exercise like jumping, running if that is a goal of
yours.

Conclusively, Mindful movement, awareness& strengthening of pelvic floor, maintaining pelvic – self hygiene,
improve breathing flow – control, ergonomics of baby handling, improving overall body fitness, eating and
maintaining healthy food- water intake, are quite importance factors to deal with incontinence before/after
pregnancy.

Article Contributed by :
By – Dr.Bhavan Bhavsar (www.bhavanbhavsar.com)
MSPT, MIAP, FMT, CET, DFM – FIFA, Fellowship in stroke & neuro rehabilitation, LASCH (UK), ASNR (USA).
He is a globally trained specialized physical therapist working at M.P. Shah Hospital, Nairobi dealing with newest
evidenced based approaches of pain management.