Urinary incontinence can affect anyone with weak pelvic floor muscles, at any time. According to the NHS, between 3 and 6 million people in the UK are affected to various degrees. The causes are just as varied for there are many reasons why a person’s pelvic floor can be weakened, but the most common of these are pregnancy, vaginal birth, obesity and old age. As such, urinary incontinence is more often a problem for women than it is for men.
The pelvic floor forms the base of the group of muscles that make up the body’s “core”, stretching like a hammock from the pubic bone to the tail bone (coccyx) and from side to side. As well as providing support and stability to your abdominal muscles, spine, and diaphragm, these muscles wrap around the passages that allow entry and exit to the body. For women, these are the urethra, vagina, and anus. If the pelvic floor muscles are working well they can provide equal amounts of resistance or give when faced with pressure from these passages according to the needs of the person, rather like a trampoline.
Having a baby puts pressure on your pelvic floor muscles. Your muscles are attuned to dealing with the pressure of your bladder, but when they have to cope with the added stress of a growing baby - as with the extra weight of obesity - they often lose control and pass urine unexpectedly. This is why incontinence can occur during the pregnancy, but why does it happen after?
There have been many studies that confirm vaginal delivery during birth is far more damaging to the pelvic floor muscles than having a caesarean. As the baby passes through the vagina it stretches the muscles, sometimes to the point of tearing, increasing the woman’s chances of suffering from urinary incontinence after pregnancy. A study of 330 women in Obstetrics and Gynecology found that those who gave birth vaginally had a distinctively higher prevalence of urinary incontinence after pregnancy than those who had a caesarean, the numbers reading 29.1%-40.2% for vaginal, and 14.2%-25.5% for caesarean.
However, having a C-section is not by a long way the safest or the most effective way of avoiding urinary incontinence. There are many exercises and practices that you can do to help protect you from leakages postpartum – whether you delivered vaginally, by caesarean or are hereditarily encumbered.
Whilst your pelvic floor muscles will do much healing by themselves, you can help speed along the process by exercising them regularly. These exercises can be done anywhere, without any special requirements. The Pregnancy Guide, published by www.continence.org.uk, instructs as follows:
1. Sit up tall and relax your shoulders. Focusing on your back passage, lift and squeeze upwards and inwards as though you are trying to avoid passing wind. Now, bring the pelvic floor lift forward to the front as though you are also trying to stop the flow of urine.
2. Lift and squeeze your pelvic floor. Aim to hold for 3 seconds initially, building up to 10 seconds over time. Your shoulders, buttocks, thighs, hands and feet should remain relaxed. You should not hold your breath while you hold your pelvic lift.
3. Rest for the same amount of time as you held the lift, before repeating.
4. Aim for 3 to 5 holds in one set, building up to 10. Repeat 3 sets a day.
If you cannot feel your muscles hold or relax or if you are not making any progress you should seek further help. Things that will not help your muscles improve are tightening and relaxing your muscles quickly, including stopping and starting your urine flow, for this can cause your muscles to become stiff, tired and painful. Also, strengthening the muscles around the pelvic area, whilst beneficial to you nonetheless, will not combat urinary incontinence.
As with any muscle, putting strain on it whilst it is healing will only impede the regeneration process. You should avoid energetic sports or lifting heavy objects, at least until you feel more confident in your muscle strength. Another practice that is essential, yet can seem contradictory, is to drink lots of fluids, as mentioned on this infographic portraying the NHS’s recommendations for dealing with incontinence. Starving your bladder of liquid weakens your bladder’s capacity and encourages what is called urge continence, which means you get the urge to pass urine at the slightest drop in the bladder. You should drink 8 glasses of non-caffeinated liquid daily, and don’t give in to your bladder at the first sign of weakness. You need to retrain your muscles to withstand your bladder’s growing capacity.
If you follow these steps rigidly you should see some improvement over time, but these are just some of the most basic ways of dealing with incontinence after pregnancy. For more help and advice, contact your GP.