FAQ: “Peeing a little” after pregnancy (and how you can stop the sudden go)

When I cough, sneeze, or run, a little pee comes out. But that’s normal after giving birth, right?

Not exactly. It’s incredibly common — 1 in 3 women will experience stress incontinence or “peeing a little” when there’s a sudden movement — but it’s not normal in the sense that you should just live with it. It’s a dysfunction of an area of the abdomen called the pelvic floor, a group of muscles that help support and regulate the bladder and bowels among other things. And there are things you can do to return the pelvic floor to its pre-baby strength.

What is the pelvic floor? Why isn’t mine working?

If you picture your skeleton, the hip and pelvic bones create an open ring at the bottom of your pelvis. The pelvic floor is a cradle of muscle that holds organs like the bladder, uterus, rectum (and prostate for men) inside the body and helps keep them in place.

Those muscles and ligaments can be affected by the additional weight resting on the pelvis during pregnancy and during vaginal delivery when all the pushing puts pressure and strain on top of the pelvic floor. Other things like injury during a car accident or changes in our bodies as we age can also affect the pelvic floor’s ability to do its job (this is true for men and women). When the pelvic floor muscles aren’t able to contract correctly, it becomes harder to control urine and stool, and leaks can happen. The pelvic floor muscles can also become tight or inflexible, which can cause pain during intercourse or pain/discomfort in that pelvic floor area.

What about Kegel exercises – do they help?

Many primary care physicians and OB-GYNs will recommend Kegel exercises — a specific set of muscle contractions — as a way to strengthen the pelvic floor. When done correctly, Kegels can be effective. The tricky thing is that the exercise is hard to do properly based on one-time verbal instructions or reading a pamphlet, and studies show that many women aren’t doing them the right way (which can actually make incontinence worse).  

Most women only contract the muscles in the front around the vagina, but that is only part of the muscles that make up the pelvic floor. The pelvic floor muscles extend back and loop around the rectum, so to do a proper Kegel, you need to close the rectum then lift the front (vaginal) tissues. Only these muscles around the rectum and vaginal tissues should be tightening, not the butt or leg muscles, and there is no need to hold your breath.

Are there other things I can do to stop the peeing?

Yes. This is such a common problem that there are physical therapists who specialize in rehabbing the pelvic floor. It’s a type of therapy that’s been around for almost 20 years in the United States and is fairly common in Germany and France, but still isn’t something most women have heard about. Pelvic floor physical therapists work with patients to evaluate and strengthen the pelvic floor muscles and get them back into shape — just like a regular physical therapist would do for a bicep or shoulder injury. Pelvic floor therapy is sometimes covered by health insurance; contact your insurance carrier to see if they’ll pay for some or all of the treatment.

What does pelvic floor physical therapy involve?

During your first visit, the therapist will start by evaluating your pelvic floor muscles to see what they’re doing (or not doing). This involves an internal and external exam to check muscle tone and function to see how well those muscles contract and relax. While the internal exam may sound daunting, it’s very quick and much less invasive than the OB-GYN exams most women have during pregnancy. Some patients aren’t able to contract their pelvic floor muscles at all in the beginning, so the therapist will use electrical stimulation to help the muscle contract (it doesn’t hurt). Sometimes women will need to work on flexibility of the muscles first before they can be strengthened for control.

You and the therapist might go over a diagram showing the anatomy of that region, since it’s helpful to see exactly what muscles you’ll be working to strengthen and how they’re all connected.

The therapist will show you how to isolate and contract the right pelvic floor muscles through a series of exercises (including true Kegels) that can be done at home. The therapist will work with you to make sure each exercise is being done properly and may use surface electrodes that show on a screen whether the right muscles are engaging for each one (since it can be hard to feel). Some exercises will work on endurance contractions to hold your bladder for a longer time (like during a run) and others work on quickly engaging those muscles (like when you feel a sneeze coming). The exercises don’t require any special equipment — just your body — and take just two to three minutes, three times a day to complete. You might start in an easy seated position to get a hang of the exercises, then advance to doing them in practical scenarios such as standing in line at the grocery store, lunging at the gym, or carrying a toddler and a laundry basket at the same time while going up the stairs.

The therapist may also cover healthy bladder habits that can help reduce leaks, like making sure you go when you get the urge (and not hold it for hours, which can be tricky for professions like nurses, teachers, and servers), sitting to urinate rather than squatting, and possibly avoiding certain bladder irritants found in food and drinks.

After the first visit for evaluation and learning the exercises, you’ll come to shorter therapy visits once a week to check in, make sure the exercises are being done effectively, and possibly learn some new ones as you progress. Some patients see improvement in as little as six weeks, and most will experience significantly fewer “accidents” after six to nine months of doing the exercises regularly and correctly.

I had my babies a while ago. Is it too late to fix this?

Whether you’ve had one baby or five, and whether you gave birth last year or a decade ago, you can still work on repairing your pelvic floor to help stop the leaks.

Is there any way to prevent this from happening?

Yes. Pelvic floor PT can be started during pregnancy to strengthen the pelvic floor ahead of delivery. To find a pelvic floor PT near you, search http://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx.


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