Everybody has seen the adverts….the middle aged women sitting on the couch laughing with their friends before they look away, looking ashamed or worried because they’ve leaked a little bit of wee, only to smile and continue laughing because they’re wearing some kind of incontinence pad that keeps them nice and dry.
The problem with this kind of ad is not the incontinence itself (well, ok that is the problem but stick with me…) the problem is the normalisation of this situation where a grown woman wets herself doing something as mundane as laughing or sneezing or coughing or any other action that can happen a hundred times a day and the problem is fixed with a pad.
One in three women experience incontinence after giving birth[1]. The more babies you have, the more likely you are to experience some level of incontinence. And if you think having a cesarean means you won’t have issues, think again. According to the Continence Foundation of Australia ‘A cesarean birth might reduce the risk of severe bladder control problems from 10% to 5% for a first baby, but after the third cesarean there may be no benefit at all.[2]’ It’s not just mums who can be affected. The problem can extend to women who’ve never had children and men. As one of my gorgeous clients likes to remind people, as a physio, she’s treated nuns before!
The reason for stress incontinence is weakness in the pelvic floor muscles that support the bladder, bowels and uterus. As you can imagine, the weight of a growing baby and uterus coupled with hormones designed to make your bits stretchy can weaken those muscles over the course of your pregnancy and if this weakness isn’t addressed by restrengthening the pelvic floor muscles, stress incontinence can follow or even worse, prolapse where the muscles don’t work to keep internal organs where they belong and they effectively fall out of your vagina or rectum. I’m not joking.
The good news is that in most cases (although not all) stress incontinence can be prevented or fixed by strengthening the pelvic floor, observing healthy toilet habits and easing back into exercise slowly post-natally. Pads are not the only solution to leaking, thank goodness (although it is wonderful that we do have these options when all else fails).
The BEST weapon in your fight to avoid and fix stress incontinence and prevent prolapse is – hands down – your local women’s health physio. These wonderful people are specifically trained to work with the pelvic floor and will arm you with the skills and knowledge you need to address any issues you have.
I just recently went to see my women’s health physio to check out how things were going down there after having my third baby six months ago. I have been lucky in that I’ve never experienced any leakage or pressure in my pelvic floor region and have successfully returned to running and weight training between and after my first two babies. As a post-natal trainer, I’m all too aware of how exercise can exacerbate an existing issue or help to create an issue (think heavy weight training, running, incorrect form, plyometric exercises that put pressure on the pelvic floor causing weakness) so I knew it was important to have it checked even if I wasn’t having any issues. To be honest, I expected that I would get a big tick in the box and I could continue on my way.
What we discovered however, is that some of my pelvic floor muscles weren’t firing the way they were supposed to, most likely from my first labour where my son was vacuumed out, and if I didn’t take any preventative measures (pelvic floor exercises to strengthen and get them firing again), then it was very likely I would end up with an organ prolapse sometime down the track. Given I had planned to return to running in the near future, I would likely have sped up this process by placing additional pressure on the muscles as I pounded the pavement repetitively. At my follow up appointment three weeks later, the physio found that my pelvic floor strength had increased significantly with the targeted exercises she gave me, and they only take about 5 minutes to do each day. I set a reminder in my phone for 10pm and do them as I climb in to bed.
I’ll be honest, the examination can be a little confronting. It requires gloves and lubricant so that should give you a pretty good idea of what’s involved. But I’ve also given birth three times, and after you’ve had a 24-year-old trainee obstetrician poke around down there to learn about the stages of dilation, this is a walk in the park!! According to my physio, up to 70% of people do their pelvic floor exercises wrong, so having the correctly trained person check not only the strength of your muscles, but whether you’re doing your exercises right is truly the best way forward!
So, you may be thinking ‘didn’t my obstetrician check this already at my six-week check up’ and the answer is probably not. In most cases, your doc will check that you’re healing well, you don’t have any infections and that you’re not showing signs of post-natal depression. They’ll ask how bubs is doing and then refer you on to a paediatrician, if they feel it’s warranted. My gorgeous, brilliant doctor did ask if I had any leakage to which I replied in the negative, as at the time it was true, but we didn’t discuss what I would need to do if I did start to exhibit symptoms (to be fair to my OB, he knows what I do for a living, so he could have rightly assumed that I would know what steps to take). Unless someone is actually testing the strength of your pelvic floor by getting you to squeeze their finger internally – yes, internally – then your pelvic floor hasn’t been properly checked!
A 2011 report by Deloitte for the Continence Foundation of Australia projected that by 2020, the Australian Health Care system expenditure on incontinence would be around $420 million.[3] This figure doesn’t include the cost of productivity losses, formal care and aids. What we don’t measure in dollars is the pain, stress and shame that women can suffer when they have stress incontinence or have a prolapse. Preventing those things alone are worth the price of admission to see your local women’s health physio…it really is a very wise investment!
In a perfect world, every woman would have their pelvic floor health checked in tandem with their 6-week post-natal check-up and it would be common practice to have it done every few years, like a pap smear or a tetanus booster but until we get to that point, keep up the flow of information! Any time one of your friends jokes that their pelvic floor isn’t what it used to be since they had babies and they can’t even jump on the trampoline with their kids, tell them to get themselves to a women’s health physio ASAP!
[1] https://www.continence.org.au/pages/pregnancy.html
[2] ibid
[3] Pg V, The economic impact of incontinence in Australia by Deloitte Access Economics https://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf
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