Are you struggling with bladder control after having your baby? The bladder can have a bit of a rough time during labour. It can be ignored and not emptied and subsequently overdistended or stretched. It can be pushed and squashed by the descending baby, it can be filled due to IV fluids, affected by hormones and medication and it can be irritated by a catheter or surgery. As a result of all this, some women present with a complete loss of bladder control after childbirth and this can cause a lot of distress at a time when emotions are already high and exhaustion is present.

Three main types of urinary incontinence

There are three main types of urinary incontinence that may occur immediately postnatally.

Stress urinary incontinence (where urine leaks due to the inability to compress and shut the urethra during an increase in abdominal pressure – such as with a cough), urgency urinary incontinence (where urine leaks in response to an overwhelming urge to reach the toilet) and overflow incontinence.

1. Stress urinary incontinence is very common in the postnatal population – it is thought around one third of postnatal women experience stress urinary incontinence. Often (but not always) it is due to a weakening of the pelvic floor and an inability of the pelvic floor muscles to generate the required, or timely, force closure of the urethra. Urine subsequently leaks during a raise in intra-abdominal pressure, such as with a cough, sneeze or jump.

2. Urgency urinary incontinence is also very common postnatally. This is where the urge to urinate overrides the ability to maintain control and urine escapes. The bladder lining has become more sensitive and overreacts to the filling bladder.

3. Overflow incontinence occurs when the bladder is not emptying properly. Postnatally this is called Postpartum Voiding Dysfunction (PPVD). This may happen due to an obstruction eg postnatally a swollen perineum following a tear or episiotomy or because of overdistension of the bladder which prevents complete emptying and results in regular urine loss.

Overflow Incontinence can occur postnatally and is a warning sign for Postpartum Voiding Dysfunction. This is when a postnatal woman is unable to fully empty her bladder. This may be very apparent – she just can’t wee, or less so – she is managing to pass urine but it is slow, hesitant, small in volume, she keeps having to go back to do more and there may be regular incontinence.

Either way, this is not good news for the bladder. With this condition the bladder is at risk of overdistention (overfilling and stretching) which can lead to a chronically dysfunctional bladder down the line.

PPVD is more likely in those women who have had an instrumental birth, such as forceps, an epidural, a prolonged labour, first-time mums, caesarean section and/or perineal trauma.

After delivery of a baby, the bladder is usually monitored to ensure the woman passes urine within 6 hours of delivery or 6 hours after catheter removal. The volume is measured to make sure it is an appropriate amount (normally over 150ml). If there is no urine or only a very small amount within 6 hours, the woman may require an in/out catheter to drain the urine and is then monitored further. Occasionally an indwelling catheter is required for 24 hours or longer to protect the bladder from overfilling and allow it to recover. The exact protocol is dependent on your local care provider.

What you need to do if you suffer from a complete loss of bladder control after childbirth

The good news is that the bladder, perineum and pelvic floor are normally all great at getting better. For PPVD it is important that you flag up any concerns to your Midwife or Doctor as soon as possible as you will need to be monitored and checked regularly. You may require timed voiding (going to the toilet at a set time) moving forwards and subsequent help and advice.

For stress urinary incontinence and urgency urinary incontinence there is much conservative treatment that can be accessed easily through the NHS or Privately. Ask for a referral to a Women’s Health Physiotherapist. Here you will be assessed and guided through the appropriate muscular rehabilitation, given advice about fluid and bladder control techniques, advised on how to move forwards with general exercise and taught perineal care as appropriate.

Although postnatal incontinence issues are common, they are not normal and as such should not be ignored. If you’re suffering with a complete loss of bladder control after childbirth, make sure you seek treatment. There is a lot that can be done with excellent success rates. If you have any questions, please do not hesitate to email me at erica@hertfordshirewomenshealth.co.uk.

You can also read our blog post on what you can do to improve your pelvic floor if you’re struggling with incontinence after childbirth.

It astounds us how incontinence after childbirth and leaking is often seen as a normal part of motherhood. We believe that it is time to put a stop to this archaic way of thinking.

We’re making it our mission to tell women everywhere:

YOU DO NOT HAVE TO PUT UP WITH THIS SHIT.

Sometimes, literally!

Urinary and faecal incontinence are, sadly, much more common than you would think, and it is so important to be aware of what you can do to support yourself.

The strength and function of your pelvic floor is hugely impacted by pregnancy and birth – from the weight of a growing child to the exertion, and potential tears and interventions, of a vaginal or caesarean delivery.

Once your baby has arrived, your pelvic floor may not be able to sufficiently support you. And when these muscles are struggling, there is more chance that you will experience leaking, pain and feelings of heaviness or dragging.

What is stress incontinence?

Stress incontinence is leaking when under pressure – such as sneezing, laughing or jumping, and around a third of new mums experience this during their first postnatal year. It could be just a few drops, or it may be enough to leak through clothing and cause severe embarrassment. Stress incontinence can have a real impact on women’s lives if it is not brought under control, in fact there is a clear link between continence and postnatal depression, so it is vital to seek help if this is something you are currently struggling with.

Why am I suffering from stress incontinence?

There are certain factors that mean that some people are more susceptible to stress incontinence than others. If you suffered with incontinence during your pregnancy, particularly earlier on in the first or second trimesters, you are more likely to experience it postnatally too. If you had a long pushing stage, a 3rd or 4th degree tear or an instrumental delivery, you are also more likely to experience postpartum incontinence issues.

How long will incontinence last after childbirth?

It really is different for everyone. Some people find that within a few days they don’t have any issues but, for some women, it can last months or even years. If you are still experiencing issues by the 6-week mark it is advisable to discuss this with your GP and ask for a referral to a Women’s Health Physio, if left untreated, it could cause you problems for the rest of your life. Please remember that this is not something that you simply have to live with and with the right support you can regain control.

What can I do to help prevent postnatal incontinence?

At the hospital when you have your baby you are likely to be given a leaflet that talks about pelvic floor exercises. Pelvic floor exercises or ‘kegels’ are proven to help reduce incontinence after childbirth and are a useful tool in restoring your pelvic floor postnatally. However, they are just one piece of the puzzle and you need all of the other pieces in order to build up a full picture of pelvic floor health.

Before we delve into the many other ways that you can improve your pelvic floor function, first let’s make sure that you can kegel properly.

Kegels aren’t everything, but they’re a good place to start…

How to kegel:

Pelvic floor health isn’t just about strength and it is very important to remember that the release of these muscles is just as important as the contraction. As with any muscle, in order to contract effectively, your pelvic floor needs to be able to release effectively too.

The way you breathe is also crucial to perfecting this exercise and your breathing should be relaxed throughout and not forced or restricted in any way. Your pelvic floor moves up and down with each breath you take – as you inhale, your belly should move outwards slightly, and as you exhale it should move slightly inwards. Your ribs should also move as you breathe, make sure you are not just breathing into your belly.

You can make your pelvic floor contraction more effective by coordinating the movement with your exhale. As you exhale, let your pelvic floor naturally lift and then add in a gentle contraction, like you are trying to pull a piece of spaghetti up your bum! Make sure you are not squeezing your bum muscles, tensing your shoulders or holding your breath. It might not feel like much is happening at first, especially if you have recently given birth, but as you gain strength you will get more sensation.

As you inhale visualise your pelvic floor releasing.

Be sure to release fully in between every single contraction.

The long-term aim is to hold the contraction for 10 seconds and repeat that 10 times.

You can do this exercise 3 times a day.

Is that all I need to do?

As mentioned before, this is only the beginning! How you use your body for the rest of the day is just as important as doing your pelvic floor exercises.

Here are some top tips for looking after your pelvic floor:

1. Consider your posture

When the rest of your body aligns well with your pelvis, your pelvic floor will function better. You want to have your rib cage stacked on top of your pelvis and your pelvis stacked above your ankles to allow everything to function as it should. Pelvic floor health is a full body issue. Everything is connected! Which means that your feet, legs, ribcage and head all have an impact on your pelvic floor. Tension and imbalance anywhere in your body can make a difference to what is happening in your pelvis, so you need to look carefully at your posture, your alignment and the way you are moving day to day.

2. Address your toilet habits

Constipation can cause straining which leads to a lot of problems for the pelvic floor. Make sure you are drinking enough water and eating enough fibre. The angle your legs are at when you poo can also help to reduce straining – think of a toddler squatting to poo in their nappy. Buy a squatty potty or similar so that when you are on the toilet your knees are higher than your hips and you are less likely to need to strain.

3. Move!

All low impact exercise is pelvic floor exercise. Going for a walk every day and being active in your life will ensure your pelvic floor switches on and does a better job of supporting you. When you sit too much, your pelvic floor tightens and then cannot contract as effectively.

4. Coordinate your breath with movement

As you’re aware, when you breathe out your pelvic floor lifts and contracts. Like with any muscle, we build strength by loading it and adding movement. The pelvic floor is not an isolated muscle, it works as part of your whole-body system and should be worked as such. Movements, like squats, can be coordinated with the breath to create a great pelvic floor work-out – simply inhale as you squat down, exhale as you push back up.

5. Exhale on the effort

This is a useful phrase to keep in your mind when you are picking up something heavy, like a baby! If you breathe out, it will help you to control the pressure that is created.

6. Release your pelvic floor

There is always a huge focus on the strengthening of your pelvic floor, but it is important to make sure you are releasing these muscles enough too, especially if you sit a lot.

Here are some helpful exercise suggestions to encourage release of your pelvic floor:

FASCIAL RELEASE

Take a fascia release ball, if you don’t have one, you can use a soft football, and sit on the ball, so your knees are facing forward and your legs are behind you. Sit for two minutes to give the tissue around your sit bones time to soften.

CAT COW

This is a gentle stretch for your pelvic floor. On all fours, in the position of the cat cow Yoga pose, consider the space between your sit bones. When you exhale, try to round your back into a cat position and imagine you are drawing your pubic bone towards your ribcage – notice how the space between your sit bones changes and gets smaller. As you inhale, release back into a flat back and notice again how your sit bones widen and create more space.

Repeat 10-times to really find the movement in your pelvic floor.

GLUT RELEASE

Standing up against a wall, take a spiky ball (you could also use a tennis ball) and massage it into your bum cheek. Your pelvic floor and gluts are really connected and releasing the gluts can help to reduce pelvic floor tension. Look for a tight spot at the top of your bum cheek, this is your piriformis which runs from your lower back to the inside of your hip and is often an area of tension.

We have a range of online and St Albans based classes (COVID restrictions permitting!) to help mums of any age with incontinence after childbirth. Get in touch for more information on our specialist Pilates classes, a great way to improve your pelvic floor health and reintroduce yourself to postnatal exercise.

Firstly, this is all new, and new can feel weird, odd, scary.  New can also feel amazing, fabulous and exciting.  That is the strange wonderful thing about becoming a parent, we can experience all this on both ends, moment to moment.  It’s normal for it to take some time to adjust, it is also normal to feel some worry, nervousness and anxiety day to day.  The key is to pace yourself, be honest with yourself and your loved ones and give yourself some grace!

We are bombarded as parents from the moment of conception with experts and opinions of how to be the best parent, what we need to buy, how to act, what to attend, what to believe.  What we need to avoid, take away and manage to be the optimal parent.  Being a parent is not a race, we don’t get a badge for making it first and contrary to often portrayed, it is not a competition.

Being a good enough parent.

There is no such thing as a perfect parent, we cannot and do not need to get it right all the time.  In fact, it is well documented that as children grow, they must see that their parents don’t always get it right.  It gives them permission as children to make mistakes, essential when learning new things. 

Things to be mindful of as a new mum:

• Everyone has an opinion, but no one truly knows your circumstances.  Choose who you respect, listen to and then check in with yourself.  Does this resonate with me?  Do I need this information?  Does it serve me, help me?  If not, let it go.  You don’t have to take on every idea, comment, or friendly advice put forward.
• Expectations cause anxiety.  Every minute doesn’t need to be filled, the Insta life is not a real one.  A task a day, a rest day, a day out, a day in,  you don’t need to do everything, every day. 
• Get a breath of fresh air.  Especially with regards to our mental health, being outside help can be a game changer in feeling well and capable.  To absorb some sunshine, breath, notice nature.  Sometimes the brief conversation with the server at the shop is enough to lift spirits.
• Seek help if you feel you need it.  Using a therapist gives you the space aside from the role of mother, worker, partner, friend to understand your feelings, needs and worries.

You are normal

• It’s normal to be tired.  Parenthood is hard work, you are allowed to feel tired, it is normal.  It is not ok however, to feel exhausted. When our reserves of energy are low, this is when low self-esteem, mental health struggle can kick in.  We tend as a community to normalise exhaustion, often worn as a badge of honour. 
• It’s normal for it to take a little time to get used to it.  New routines take time, being realistic can help with feeling anxious.  Asking too much of ourselves can escalate mental stress and feelings of anxiety.
• It’s normal to feel a little lonely, displaced a little.  Going on maternity leave can feel like a blessing and a curse.  We can feel that without work and the freedoms we had before that we feel a little lost.  Creating another network of a few new friends who have similar timetables, locality and circumstances as yourself can be so helpful in maintaining wellbeing. 
• It’s normal to need some support.  Not everyone has family, partners and a team of support.  So sometimes we have to look outside the box, support groups, neighbours, local friends.
• It’s normal that some of us need more support than others.  Everyone needs to support at some point in life.

Remember…..

• You don’t need to do everything
• You do need to eat, sleep, take a walk sometimes and get outside. 
• It changes, a lot, all the time.
• Everyone else does not know what they are doing.

What does anxiety feel like?

Anxiety feels different to each individual.  We can feel overwhelmed, a sense of mild panic brewing.  It can be felt in our chest, or throughout our bodies.  We can feel out of control, unable to make decisions, unable to relax or concentrate on tasks.  Often, we feel like we cannot be present, that we spend time forecasting the future in the hope of reducing our anxiety.

When to seek professional help

Anxiety and depression is not a black and white thing, it runs along a spectrum.  We can all feel anxious sometimes, but if it’s prolonged and intense then speaking to a professional for support can help.  You need not do this alone.

They can include:

• feeling down and teary
• an inability to concentrate
• low sex drive
• feeling worthless
• inability to feel happiness
• sleep problems
• anger
• finding it difficult to leave the house
• overeating
• problems bonding with your baby
• suicidal thoughts.

The NHS has a mood screening tool that you can use to help you identify your moods.

Finally, we all need support sometimes, talking to someone who isn’t a friend or connected to your circle can be an empowering and freeing experience.  To be able to talk freely without the worry of upsetting or saying the ‘wrong thing’ We spend time looking at what is troubling you.  So often the actual act of saying it aloud and hearing it, reduces the fear and anxiety.

When to call the GP.  Post natal psychosis can affect us after birth. 

More advanced symptoms can include:

• Delusions (possibly about the baby) – having thoughts or beliefs that are unlikely to be true, and that other people don’t share.
• Hallucinations – sensing smells, visions or voices that don’t exist outside the mind.
• Mania – talking quickly, disorganised thinking, restlessness, confusion, appearing ‘high’.
• Loss of inhibitions.
• Behaving out of character – more talkative, active, suspicious, fearful, giggly or sociable than usual.
• Depression – low mood, tearful, trouble sleeping.
• Severe mood swings.

How to help

Finding joy and happiness in your parenting journey can be a day to day navigation.  It is normal for it to be hard sometimes, and it can take time to adjust.  Often, we have times that we feel a sense of grief at our old life, this is normal too.   Please do not struggle alone in isolation, share with people your trust, you will probably find that they have had similar struggles too!

If you would like to talk with a therapist, please feel free to call me in the strictest confidence to see how I can support you.  I believe that we are all capable of living a life that is fulfilling, nourishing and content.  This takes time, effort and attention.  But the effort is worth it, you are worth it! 

We are all worthy of time to reflect, time to rest, time to connect with what our needs are.

Amy Engleman

Psychotherapist

www.AmyEngleman.com

T 07939 101 645

You might be interested in our Centred Sundays to give you some headspace if you are struggling

https://centredmums.com/introducing-centred-sundays-from-july/