The pelvic floor, peeing yourself and incontinence: What no one tells you about having a baby
You might pee your pants. But don't despair
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When Laura Foster, 27, gave birth to her daughter Kinsley last September, no one warned her about the less dignified aspects of becoming a mother.
“A couple weeks after I had her, I sneezed when I was sitting on the couch feeding her and I peed myself. I was like, ‘Oh my goodness.’ Of course my husband starts laughing. I’m stuck in this position,” Foster said.
Giving birth can do serious damage to the pelvic floor — the supportive muscles and connective tissue surrounding the bladder, lower intestines, and in women, the uterus.
This can result in all sorts of issues, from back pain to organ prolapse to painful sex, but one of the most common and debilitating is urinary incontinence, which affects about a third of new mothers.
According to Marie-Josée Lord, physiotherapist and past chair of the Canadian Physiotherapy Association’s women’s health division, there’s been a surge of awareness about pelvic-floor issues. However, screening and treatment for them “is not part of standard care.”
Usually, Lord said, postpartum incontinence can be successfully treated with physiotherapy (and there’s some research to back this up). But physio is not covered by provincial health plans. Many women, Lord added, don’t seek treatment at all either because they’re embarrassed or because they don’t know anything can be done.
On the suggestion of her sister-in-law, Foster found a physiotherapist near her home in Belleville, Ont. who offers pelvic physiotherapy.
When she started treatment she had little control of any muscles “from the bellybutton down.”
Having physio on her internal vaginal muscles was uncomfortable, but it worked.
“Basically, after you’ve had a kid you have no shame. I told her just to do it if it’s going to help. She sort of put pressure on (the muscle) to release it. It hurts. It’s not a very pretty kind of physio, but it works.”
After half a dozen appointments, her incontinence all but disappeared, and she has been able to go back to work early. “I would have been terrified to go back if I hadn’t done this,” Foster said.
The extent of the information Foster received from her doctor about pelvic floor health was some pamphlets and encouragement to do kegel exercises.
With only a pamphlet for guidance, around 40 per cent of women do kegels incorrectly, Lord said.
At postpartum visits, busy family doctors and OB/GYNs tend to check on external healing and leave it at that unless women bring up specific issues, Lord said — though that’s starting to change.
“I started doing pelvic health 25 years ago. It’s a lot better now. There’s a lot more awareness among both physicians and women.
“But there’s still a long way to go,” she said.
She held up France as an example. There, 10 sessions of rééducation périnéale (lady-parts rehab, basically) are automatically prescribed free to every new mother.
Lord didn’t suggest Canada should follow suit, but said even one postpartum physio visit to check for any issues and teach the proper way to do pelvic floor exercises would make a huge difference for many women.
And, she added, it could save money by reducing the need for surgery later and, in the very long term, improve incontinence among elderly women whose pelvic issues were never addressed.
Dr. Lynn Stothers, a professor of female urology at the University of British Columbia, said pelvic muscle rehabilitation is effective, and that nurses and doctors can be trained to do it as well as physiotherapists. But, she cautioned, it’s not a “cure-all” because incontinence has many causes and can be lifelong.
Foster has been having the conversation with other women that she wishes someone had with her.
“Nobody really tells you this stuff,” she said. “I go to playgroups — a lot of the women out there are starting to talk about this, and you realize there is help.”
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