Pregnant and wearing a panty liner all the time because you can`t

Pregnant and wearing a panty liner
all the time because you can’t help
but wee a little when you sneeze?
Urinary incontinence is common,
but you don’t have to just put up
with it, says Lisa Yates.
L
et’s face it: Leaking urine is
not sexy. Yet, if we’re honest,
we all know someone who’s
terrified her kids will ask her
to jump on the trampoline,
or is scared of sneezing in
case of a small accident. This often “secret”
problem is actually incredibly common,
with up to 64% of pregnant women
suffering urinary leakage and over
30% of women post-birth having
regular “Eek! A leak!” moments.
Interestingly, this once-taboo
topic does seems to becoming
a more acceptable discussion
point. Take a look back five
years ago and urinary
eek! a
leak!
incontinence was rarely mentioned in
the media, or on TV, yet last year, it was
a regular topic on morning chat shows and
viewer interest was extremely high. So why
the sudden turnaround? With an estimated
one million New Zealanders suffering bladder
and/or bowel leakage, perhaps we can no
longer ignore the issue? However, my feeling
is that women are finally beginning to realise
that they don’t have to continue suffering
urinary leakage as a “normal” consequence
of childbirth. Let’s face it, who would really
want to wear a pad for the rest of their life,
when in most cases something can be done
to help?
But it’s normal, right?
Let’s get one thing straight. Urinary
leakage, while quite common, should not
be considered “normal”. It is a sign of
a dysfunction within the body, and ignoring
it (or hoping it will just go away of its own
accord) is extremely unlikely. In fact, if
ignored, the symptoms are likely to worsen,
especially if you are overweight, do highimpact exercise, or suffer from constipation.
And many women who escape problems
during the “child-bearing” years, find that
when menopause approaches (and their
oestrogen levels dip) that things start to
go wrong then.
20 / www.littlies.co.nz June 2013
LitJun13_20-22_PregnancyLeak.indd 20
17/5/13 10:38:53 AM
pregnancy | incontinence
64%
of pregnant women suffer
urinary leakage and 30%
of women post-birth do too.
Too stressed?
The most common form of urinary leakage
in child-bearing women is stress incontinence.
This doesn’t occur because of stress or
anxiety, but because the muscles and
ligaments that form the pelvic floor are put
under stress by activities that cause and
increased pressure within the abdominal
cavity. This could include coughing, laughing,
sneezing, jumping, or even yelling at the kids.
Sporting pursuits that may worsen symptoms
include boot-camp style exercise, cross-fit
classes, netball or anything that involves
a lot of high impact repetition, bouncing
or external force.
The second most common type of urinary
incontinence involves a real sense of urgency
to get to the toilet immediately. If you don’t
get there on time, you might leak a little bit
of urine. Some women suffer a combination
of the first and second types.
“hole” at the bottom of your pelvis, and your
bladder, bowel and uterus wouldn’t stay where
they should for long!
But my pelvic floor
keeps me dry, right?
Yes, a well-functioning pelvic floor should
be able to withstand any changes in intraabdominal pressure, such as a sneeze, and
react immediately keeping you from leaking
urine. There are three holes running through
the pelvic floor. In a woman, just behind your
front pelvic bone (the pubic symphysis) is the
urethra (where you urinate from), then the
vagina is in the middle and at the back you
find the rectum or bowel. The pelvic floor
muscles (PFM) normally wrap around these
muscles and when you decide to jump on the
trampoline, or go for a run, the PFM muscles
should close nice and tightly around the
urethra and keep you dry.
So what goes wrong?
Incontinence is more
likely with larger babies,
an instrumental delivery,
prolonged pushing,
a tear or episiotomy.
So where exactly is
my pelvic floor?
Off the trampoline,
on to the doctor!
If, like many mums, you dread the kids
asking you to jump on the trampoline,
June 2013 www.littlies.co.nz
LitJun13_20-22_PregnancyLeak.indd 21
▲
As we can’t easily see it, many women have
a hard time understanding where exactly
their pelvic floor is. Imagine the bony female
pelvis and the big opening at the base of it
(called the pelvic outlet – which is where
babies usually come out). The pelvic floor
muscles span this space and act a little like
a trampoline that rests just below the pelvic
organs; the bladder, uterus (+/- baby!) and
bowel. So the main role of these very
important muscles is to support all these
organs suspended on top of it. If they weren’t
there, there would quite literally be a big
During pregnancy, there are a lot of hormonal
changes taking place, some of which soften
the muscles and ligaments of the pelvic floor,
in order to make vaginal birth a little easier.
This is a great mechanism, ensuring the best
chance of fitting babies with proportionally
large heads out of a rather snug pelvic outlet.
In addition, constipation is common during
pregnancy and this regular straining on the
toilet, combined with the increased weight
(of the baby and placenta) on the pelvic floor,
can lead to urinary leakage.
For some women, problems don’t start
until after the baby is born. A vaginal delivery
stretches and weakens the muscles of the
pelvic floor, sometimes causing incontinence.
This is more likely to occur with larger babies,
an instrumental delivery (ventouse/forceps),
prolonged pushing, or if there was any trauma
(a tear or an episiotomy).
/ 21
17/5/13 10:39:36 AM
pregnancy | incontinence
World
Continence Week
24-30 June 2013
For free information pamphlets
on a range of continence topics
and list of free continence services
phone 0800 650 659 or visit
www.continence.org.nz.
or panic when they do star jumps at boot
camp, don’t despair, because something can
be done to help! Stop ignoring the problem.
The sooner you do something about it, the
sooner you’ll be dry and able to jump back
on the trampoline.
The first thing you should do is go and see
your GP. Tell them what’s been happening
and that you would like a referral to a local
pelvic floor physiotherapist or a continence
service. Your GP will most likely do a urine
test to rule out and infection, and may ask
you a few questions, but it won’t be anything
too stressful. Many GPs can refer you to
a local hospital service, which is usually free.
Sometimes they have waiting lists, so your
other option is to see a private women’s
health or pelvic floor physiotherapist (see
below how to find one in your area).
In the meantime, if you need to, wear
a panty liner or pad to keep you comfortable.
Remember, this is not a long-term solution,
but it will help you feel more confident while
you are addressing the cause of the problem.
Next ensure you have a high-fibre diet, with
at least 1.5-2 litres of fluid per day, to lessen
constipation which can further weaken your
pelvic floor. Then start doing your pelvic floor
exercises! Ideally these should be started
during pregnancy, but it is never too late.
Do pelvic floor exercises
actually work?
The short answer is yes. Large studies
have shown up to an 84% cure rate with
physiotherapy-taught pelvic floor exercise
programme. The important thing is that the
technique must be correct and these exercises
need to be done regularly. Just like you won’t
lose weight eating right for just one day, you
won’t cure your leakage with one attempt at
pelvic floor exercises.
One of the biggest difficulties in learning
these exercises is that you can’t easily see the
muscles you are exercising. Start by sitting
upright in a chair (not slouched on the couch)
or lying on your side. Next relax your tummy
and your breathing. Then, imagine that you
are trying to stop a wee, or that you’re having
lunch with your mother-in-law and you have
wind and you’re trying to hold it in! The action
is a gentle lift and squeeze, inwards and upwards.
Hold for a few seconds and then let go.
The action is all internal. If you find that
your buttocks or inner thighs are squeezing,
then you’re cheating a little and will not be
getting the most effective pelvic floor
contraction. Relax and try again, this time
only squeezing the muscles inside your pelvis.
You may notice that your lower tummy
flattens a little and this is fine. But make
sure you aren’t pulling your tummy in tightly
or holding your breath.
How can I be sure I’ve
got the right muscles?
A good test to see if you can locate the correct
muscles is to try and stop a wee mid-stream.
If you can’t or can only slow the flow, it
shows that either your muscles are weak
or that you’re not locating them correctly.
Ideally, it is easiest to learn these exercises
from a women’s health physiotherapist or
a continence nurse, both with special training
in continence assessment and management.
They will be able to ensure that your diagnosis
is correct and will be able to help you identify
the correct muscles. They will also be able
to grade the strength of your muscles,
prescribe a suitable programme and then
progress your exercises as needed, ensuring
the best outcome.
You need to do PFM exercises regularly to
find an improvement in symptoms, which can
take anywhere from six to 12 weeks depending
on your particular circumstances. Some
women notice an immediate improvement
once they can locate and activate the muscles
during activities like coughing and sneezing.
Remember, PFM training doesn’t cost much,
the exercises can be done almost anywhere
(while feeding baby or during sex!), and have
no adverse side effects. You might also be
interested to know that strengthening your
PFM can also help make sex more pleasurable
for both you and your partner. In some cases
it can even increase the quality of orgasm.
And that is one benefit that you won’t get
from surgery!
Unfortunately, many women delay seeking
help, sometimes for years. Once they have
finally sought help, the majority of patients
are so relieved; they wish they had done
it sooner.
Isn’t surgery just easier?
The International Consultation on
Incontinence recommends that pelvic
floor muscle training should be first-line
management in women with urinary
incontinence. It is considered to have
very high effectiveness and is a grade-A
recommendation. Yes, there are also many
surgical procedures that can help to alleviate
symptoms of stress incontinence; however,
all surgeries carry risks which need to be
carefully considered. While the procedures
for stress incontinence often decrease or stop
the leaking, they can cause other side effects
and do nothing to actually strengthen your
pelvic floor. It is always sensible to give pelvic
floor muscle training a good attempt before
considering this option.
leaking urine?
get help now
✔ Go to the Physiotherapy
New Zealand website (www.
physiotherapy.org.nz) to find
a women’s heath practitioner in
your area. Click on “Find a physio or
physio practice”, then “Business or
service directory” and then add your
location and choose “Continence
& women’s health”. You don’t need
a GP referral to see a private
women’s health physiotherapist.
✔ Alternatively, the New Zealand
Continence Association (www.
continence.org.nz) should have a list
of private and public physiotherapists
and continence services in your area.
You usually need a GP referral to
access a public (free) service.
✔ For more free information about
pelvic floor exercises, visit www.filifit.
com and click on “Pelvic floor”.
Lisa Yates is a registered physiotherapist with a special
interest in continence and women’s health. She is also
a women’s personal trainer and wellness coach. To find
out more, visit www.filifit.com.
22 / www.littlies.co.nz June 2013
LitJun13_20-22_PregnancyLeak.indd 22
17/5/13 11:23:09 AM