Postnatal Incontinence – not just muscle weakness

Postnatal Incontinence – not just muscle weakness

Whenever I talk to mothers (and fathers) about toilet training toddlers I always start with the suggestion that learning how to go to the toilet is a REALLY big task! Sure, we now do it on autopilot (most of us at least), but let’s look at all the steps involved in being able to successfully do a wee in the toilet:

  1. You have to be aware of the urge to urinate
  2. You have to recognise that urge in enough time to allow you to make it to the toilet
  3. You have to find your way to the nearest bathroom
  4. You have to be able to remove your clothing and underwear
  5. You have to be able to shift your body weight onto and off of the toilet
  6. You have to have the neural control required to release the urine from your bladder
  7. You have to have the ability to sense when your bladder is fully empty
  8. You have to have the manual handling skills to tear the toilet paper from the roll and wipe your perineum
  9. You have to be able to stand up from a seated position
  10. You have to be able to re-dress yourself
  11. You have to be able to remember to flush the toilet and wash your hands.

Phew! It’s no wonder toddlers take a while to get the hang of it! Ask my three-year old – she’ll tell you!

No, this isn't my three year old, and it's not my house. It's way too clean.

Learning to wee? There’s more to it than you think.

So what’s my point here? Well, toileting is a really complicated task. There are several body systems and processes at play in mastering the cognitive and physical elements within it, and it also requires us to integrate those systems and processes to work together. Which is why it takes us so long to learn how to do it as toddlers – and why we tend to have so many accidents.

Frequently, I come across parents who are frustrated at how long it’s taking their child to toilet train. I find encouraging them to remember the enormity of this task – all 11 points listed above – helps shift their mindset around their child’s toilet training.

Which brings me to the topic of postnatal incontinence and pelvic floor dysfunction.

This is a common issue impacting on many postnatal women. Most recently given the less confronting title of “leakage”, postnatal incontinence has the potential to dramatically impact on a woman’s life. It can lead to issues with embarrassment, low confidence and self esteem, it can lead to women ceasing or reducing their favourite social, recreational and sporting activities, it change how they see themselves as a woman. At the extreme end, it can lead to serious mental health conditions such as depression or social anxiety. It’s difficult to feel free, spontaneous, athletic or sexy when you’re worried your pelvic floor is going to let you down. There’s such a stigma about incontinence in our society that it’s rarely spoken about out loud, and when it is, it’s almost always spoken on in diminished terms “leakage”, “light bladder leakage”, “LBL”.

Just like toilet training a toddler, dealing with adult incontinence also requires us to step back and look at a range of body systems and processes. Unfortunately the common understanding by the general public is that this issue is just related to weak pelvic floor muscles, which is not entirely true. Certainly the functional capacity of the pelvic floor musculature has a huge role in regaining and maintaining continence. But what else is there to consider?

Our overall posture: How we stand or sit throughout the day impacts on the length and function of our body’s postural muscles – many of which have connections with the pelvis and the pelvic floor muscles. Imbalanced postural muscles can impact the way our pelvic floor muscles function.

How we breathe: did you know the diaphragm (the muscle under your lungs) is designed to work in unison with the pelvic floor? To maintain good ‘intra-abdominal pressure’ they should work together – when the diaphragm contracts downwards the pelvic floor should relax downwards. When the diaphragm relaxes up, the pelvic floor should lift up. By the time we reach adulthood so many of us have developed poor breathing patterns, and we’ve lost our ability to breathe properly, or connect our breath with our pelvic floor.

What we eat and drink: A common tactic used by many women to address incontinence is to simply reduce their fluid intake. This is a huge no-no as it means the bladder becomes used to only holding small amounts of urine. Over time, it can lose it’s capacity to stretch to it’s previous size. To maintain good continence, we want the bladder musculature as functional as possible. Also, were you aware that caffeine is a stimulant for the bladder? Sometimes eliminating coffee from our diet can be a big piece of the puzzle.

Our habits: Going to the loo ‘just in case’, or because your friends are; ‘holding on’ because you want to avoid public toilets while away from the house; how about running the tap while you pee to avoid the embarrassment of someone hearing your stream on urine? We women have terrible habits when it comes to toileting – but honestly, it’s probably not our fault, it’s something we have drilled into us from an early age as young girls. The problem is, when our toilet habits become habitual or situational, it means we lose that important mind-body connection between our brain and our bladder. When we lose that connection, we lose the trust in our own bodies, and that has a huge impact on continence.

Poor toileting habits early in life can lead to continence issues down the track.

Poor toileting habits early in life can lead to continence issues down the track.

Our mental health: It’s a two way street – continence issues can increase the likelihood of mental health problems, such as depression and anxiety, but these conditions can also impact the prevalence of continence issues. When we experience depression, anxiety or social phobia, our habits and lifestyles change – which means that every one of those four areas listed above can be impacted. It changes our posture, our breathing, our nutrition and our habits. All of which can lead to pelvic floor difficulties.

Did someone say vicious cycle?

So you can see that treating pelvic floor issues is about so much more than just strengthening those pelvic floor muscles. The list above is by no means exhaustive either. But it’s enough evidence to be able to say that addressing incontinence and pelvic floor dysfunction requires a truly holistic view of the individual involved.

The good news is there’s so many wonderful health practitioners out there who can support you if you need help with this area. incontinence is not something you have to live with. It can be treated, but for best treatment, you need someone who is going to look at the whole you – not just your pelvic floor. Search around for a Women’s Health OT (like me), or a Women’s Health physiotherapist, those of us who specialise in this area know that taking an integrated approach is the best, and only, answer.

Until next time, be well.

Cheers, Sarah xx

ps. If you want to know more about how to restore your pelvic floor function after having a baby, make sure you check out my Body Mind Baby postnatal wellbeing program. This 10 week online program covers a wide range of physical and emotional challenges faced by new mothers – with information and simple, practical strategies you can implement in your everyday life to positively impact your wellbeing – you can check it out here.

 

Is Pilates the reason I don’t wet my knickers when I run anymore?

Is Pilates the reason I don’t wet my knickers when I run anymore?

Women ask me the BEST questions!

Since I moved into this field of pregnancy and postnatal wellbeing, the funniest thing has been happening – I now get asked all manner of questions I never thought I’d be asked when I started my OT career.

In one-to-one appointments, group Pilates classes, Facebook forums and even at fancy-pants awards dinners, women start asking me the most awesome questions whenever I tell them what it is that I do.

Here’s a few of the questions I’ve had in just the past week – and my answers.

Q: “I just realised that since I started Pilates, I haven’t needed to wear a Tena-lady anymore when I go running – could that be due to the Pilates?”
A: Yes!! Pilates is awesome! (ps, this lady was talking about Pilates with another instructor – who is clearly awesome – so I’m not blowing my own trumpet here!)

No Tena Lady required!

No Tena Lady required!

Q: “If I had a pelvic organ prolapse, would I know about it?”
A: Not necessarily, there are different stages of prolapse, and in the early stages the prolapse is still contained within your body – it’s not until the late stages that “things pop out” of your body – so if something doesn’t seem quite right with your lady parts – get it checked out by your gynaecologist or women’s health physio.

Keep those pelvic organs right where they should be!

Keep those pelvic organs right where they should be!

Q: I had a C-section, do I still need to worry about pelvic floor rehab?
A: Yes, definitely. It’s not just birth that puts strain on the pelvic floor. Nine months of your little baby bouncing up and down on that collection of muscles will definitely stretch and strain the pelvic floor. Rehab is always recommended after pregnancy – no matter what type of delivery, it may just be a different level of rehab.

Pelvic floor rehab is for all women, no matter what type of birth you had.

Pelvic floor rehab is for all women, no matter what type of birth you had.

Q: What’s the minimum amount of time to wait between pregnancies, from a physical recovery perspective?
This is a tricky one, and we really need to look at it from a functional perspective, rather than on a timeline. It would definitely be advised to wait until any diastasis recti (abdominal separation) is healed and core strength is restored, ditto for pelvic floor difficulties. So you need to be physically “put back together” in order to give your body the best chance of staying strong during your next pregnancy and recovering again post-pregnancy. But women also need to consider how well their hormonal levels have rebalanced, and how well their nutritional stores have recovered. If women are still nutritionally and hormonally depleted when they conceive again, then this will put an added strain on their body during that subsequent pregnancy. This would differ for every woman. I dare say many women don’t get back to being fully functional and balanced before getting pregnant again, even if a year or two has passed since they gave birth, and this can lead to increased risk of further and more pronounced dysfunction through the second pregnancy.

Ready for baby number two?

Ready for baby number two?

So there you have it – just a few of the conversations I have with women every day! I truly have an awesome job.

Now over to you. Do you have a burning question? Feel free to shoot me an email and I’ll do my best to respond anonymously on my Facebook page in a Q&A post.

Alternatively, you could always join my Body Mind Baby program, which begins in Adelaide on Thursday, March 17. Find out more about it here, or call me on 0432 420 846 if you want to chat about it in person.

Until next time,

Be well and live your best life.

Cheers, Sarah xx