Having a baby is a miraculous thing! However your body goes through a LOT to grow your little bundle and birth them, whichever birth route you took. Therefore there is no surprise that our bodies can feel different afterwards.
One of the symptoms that I hear a lot from my clients is stress incontinence after birth. Stress incontinence is the technical term for a leakage of urine when putting the pelvic floor under stress so for example sneezing, running, jumping, standing up from sitting down etc. Depending on the level of reduced control of the pelvic floor will depend on what types of activity that will cause leakage. It's a topic that many women feel embarrassed to talk about and can really affect quality of life.
So is it normal after child birth to have stress incontinence?
Yes, during pregnancy our pelvic floor is constantly put under strain from the increasing weight of our unborn baby and all the extra fluid we have in our body (did you know its normal to put on up to 2 stone/12kg during pregnancy), especially in the last 6 weeks when we increase our fluid levels extraordinarily! So regardless of how your baby is delivered, that pelvic floor has had to work very hard over the last 9 months.
If you have had a vaginal delivery, your pelvic floor has had to stretch THREE TIMES its own length! And any tears from childbirth that are a grade 2 or beyond have affected that pelvic floor in which it needs to heal - like any hamstring strain or calf strain you may have experienced before.
Once your baby is born the pelvic floor doesn't get a break! It now has to work hard whilst you do much more squatting, lifting, carrying your new baby, prams etc. (Did you know even when you stand up from sitting you are working your pelvic floor 150% harder than doing a Kegel!) So you can understand why after all that hard work the pelvic floor may not be working at its optimum - causing leakages.
Is it just a side effect of becoming a mum that I have to live with?
NOOOO! I find it heart breaking how stress incontinence along with other pelvic issues are so shrugged off as just 'a part of being a mother'. For the majority of women this problem can be solved! Yes...COMPLETELY GONE! No more big pads for running, standing on the side lines whilst your kids play on a trampoline or anxiously awaiting a sneeze at work in case of an embarrassing moment.
What can I do about it?
There is no 'one size fits all' solutions to this and it completely depends on the type of pregnancy and births you have had. However these are the most common treatments for it listed below:
Get checked out by a women's health physiotherapist.
Seeing a specialist pelvic health physiotherapist that is trained to work with post natal women (like myself) would be a great starting point! We complete a thorough assessment of your body (including internal assessments of your pelvic floor if indicated) and create a programme for you to get back to whatever activity it is! They can also help with discomfort during intimacy, increased urgency, scar work, prolapse concerns and more! Have a look at my antenatal and postnatal services for more information. If you're not sure what you need then the Mummy MOT is a great place to start!
If you are unsure which service would be best or how to go about finding a women's health physiotherapist in your area please get in touch with me and I will happily point you in the right direction.
2. Pelvic floor CONTROL exercises
Now I say control and not 'strengthening' as there is a big misconception that the pelvic floor needs to be strengthened all the time and Kegels are the answer to all problems! If that was the case my job would be super boring haha! Think of your pelvic floor like any other muscle. Lets take the calf for example (the muscle at the back of the lower leg). If we only every did strength training on that calf and never ever stretched it - how uncomfortable would that be! We may limp, we may alter our running style or reduce the height of our squat because it simply doesn't have the length. The pelvic floor is EXACTLY the same! It needs to have both strength and relaxation/stretch in order to be a happy, healthy functioning muscle.
So on that note start off with some simple 'squeeze and relax' exercises. Utilising apps like the NHS Squeezy app is fantastic, squeezing along to your favourite songs or adding it into a regular daily activity to make it easier to complete regularly. The research suggests that we need daily pelvic floor lifts for AT LEAST 3 months in order to notice a considerable difference.
If you enjoy classes then a local postnatal pilates or yoga class would be a great place to start too! You're looking for small groups with more time for the instructor to ensure you are doing the exercises correctly and at your own pace.
* Did you know at Emily the Physio Ltd we offer the New Mum New Core class? A small class for new mums or mums that haven't exercised yet to come along and learn all of this and more plus exercise PLUS TEA! what could be better?!
3. Don't run before you can walk
It is so common after having a baby to want to 'get rid of the baby weight', get back to exercises you couldn't do during pregnancy (more about that in a future blog post) or start new mumma-baby exercise activities during the day whilst on maternity leave. Just because a class is suitable 'from 6 weeks' doesn't mean it's suitable for you yet. Everybody's pregnancy and birth is different, as is our post natal recovery...so why would everyone automatically be at the same point in their recovery at 6 weeks? Imagine you and a friend had run a marathon - you hurt yourself during the marathon and they didn't - would you expect you both to be recovered and back to training at the same time afterwards? Of course not! Its the same for your body after childbirth. If you've come away from birth with a birth injury then I'd highly recommend speaking to your women's health physio and work out what exercise classes would be best for you and when.
So what type of classes can I do and when? Low impact classes such as yoga, pilates, tai chi are a great place to start! Progressing upwards to customised circuits, weights work (with guidance and supervision) and eventually running, aerobics, jumping exercises (usually around 12-14 weeks post partum for vaginal birthing mothers and 16 weeks for caesarean birthing mothers ). If you start a class that is too hard for your pelvic floor you'll do more harm than good so make sure you pick an activity that is right for you! Again, just because a class is made for mothers and babies, it still may not be appropriate for you yet, depending upon your own rehab journey.
4. The 'knack'
The knack technique is a great tool to reduce those embarrassing moments! Simply tighten up your pelvic floor when you are about to sneeze or do anything strenuous will help to reduce the leakage! The more you do it the more effective it will be and eventually an automatic response.
5. SQUEEZE!
There is a reason why squeezing your legs together helps to stop you from peeing! Your inner thigh muscles are intrinsically linked to your pelvic floor. So if we work our inner thighs - it will help to support our pelvic floor.
So have a try at putting a pillow or a ball between the knees and practice doing doing squeezes. This can be done on their own or as part of your usual exercise routine like during squats or hip thrusts.
I would like to comment though that this wouldn't be instead of pelvic floor exercises as mentioned above - but as a really helpful addition.
I had a baby 20 years ago...is there any chance I can regain my pelvic floor control?
ABSOLUTELY! Muscles are amazing things and will continue to adapt and build for the whole of our lives! Speak to a specialist physiotherapist for more information of how to do this successfully.
If you would like to learn more about your pelvic floor and how to improve your symptoms why not get in touch!