Updated 12/1/22
The body takes nine months to miraculously adjust to a growing baby and deliver a tiny human being into the world, yet there is an unrealistic expectation of a six-to-eight-week postpartum time to heal and restore.
Consider the living systems in your body that have taken on an enormous task including - connective tissue, muscle memory, and trauma from delivery - making a short time frame of recovery unrealistic.
Do any of these statements sound familiar to you?
“I have to cross my legs when I feel a sneeze coming on.”
“I’m going to just stand while you do the jumping jacks during this exercise class.”
“No kids, you jump on the trampoline, I’m going to just watch.”
“Let me go to the bathroom... just in case.”
“Get out of my way, I’ve got to go!”
After childbirth, four in ten women suffer from incontinence. So if you're crossing your legs when you cough for fear of wetting your pants a bit, you're not alone.
Let’s start with how the word "incontinence" is perceived.
Incontinence often paints a picture of someone wearing Depends with no bladder control.
Yes, this is considered incontinence, but so is leaking a few drops when you sneeze. Incontinence is the technical term for any amount of involuntary urine loss. What most women experience after childbirth is called stress incontinence. This is leaking urine any time there is an increase in intra-abdominal pressure.
Activities that increase this pressure include sneezing, coughing, laughing, jumping, running, bending, and lifting, to name a few. The pelvic floor muscles are not strong enough to keep the urethra closed in response to that increase in pressure, and leakage happens.
It may be common to leak, but it's certainly not normal.
Here are five reasons women have stress incontinence after childbirth:
#1 - Your pelvic floor muscles are weak from carrying a baby for 9 months and delivery.
Imagine a hammock that goes from your tailbone to your pubic bone. The hammock supports all of your pelvic contents, and that load increases considerably when you are pregnant. Vaginal delivery causes the hammock to stretch three times its normal resting length.
Of course, those muscles are going to be weak after pregnancy and delivery.
#2 - Scar tissue from tearing during delivery or cesarean section.
Imagine you tear a muscle in your shoulder. Do you think that muscle is going to have residual weakness even if the tear was stitched and healed? Yep, it is.
When you tear during delivery, the perineum is directly affected. This is where pelvic floor muscles attach.
When you have a C-section, the incision is a horizontal incision down low at the bikini line. A scar can appear to be healed beautifully on the outside, but on the inside scar tissue can adhere to pelvic floor muscles and bladder, and cause weakness. In fact, overactive bladder symptoms can also be tied to scar tissue.
#3 - Diastasis Rectus Abdominis
Diastasis Rectus Abdominis (DRA) happens when abdominal muscles do not fully come back together after childbirth. You can have residual weakness, feel frustrated like you can't get your stomach strength back, and may notice a "pooch" or coning when you lie down or get up out of bed.
Envision this: Your deep core muscles work the best when all four parts are synced up and help out in equal parts - the pelvic floor, deep stomach muscles (transverse abdominis), deep back muscles (multifidi), and your respiratory diaphragm. If your stomach muscles are not doing their part, everything else gets thrown off.
The result? Your pelvic floor is functioning on overdrive and will eventually experience burnout.
#4 - Poor posture and tight ribs
The thigh bone's connected to the hip bone 🎶the hip bone’s connected to the backbone🎶
Knowing how to have good posture is simply being aware of how to stack your body parts one on top of another.
Muscles are connected to bone. When your skeleton is in a good alignment, muscles are going to be in an optimal position and activate better.
Following pregnancy, the ribcage has been through some stress, and because we don't give our post-pregnancy body enough thought, no woman thinks, “I need to get my ribcage back into pre-pregnancy position" or "I need to stretch my ribs."
During pregnancy, the ribcage assumed a position to accommodate the baby. This shift in alignment along with stiffness in the ribcage can really increase intra-abdominal pressure. Then, walking around with that increased pressure can lead to... yep, stress incontinence.
#5 - Holding your breath
Earlier we talked about the pelvic floor and diaphragm being connected. Well, they are strongly connected. In fact, what one does, the other does.
Inhalation equals diaphragm dropping down, pelvic floor dropping down; exhalation equals diaphragm recoiling up and pelvic floor recoiling up. When the pelvic floor is weak and not properly supporting you, you lock out your diaphragm and use it for strength - by holding your breath.
Pay attention to your breathing the next time you need your core.
Do you hold your breath when you:
-> Lift a car seat?
-> Push open a heavy door?
-> Get up from the floor?
Continuing to hold your breath allows the pelvic floor to be "lazy" and not work any harder, contributing to overall weakness.
We've talked about 5 common reasons women have weakness in the pelvic floor muscles following childbirth. Now let's talk about a road map to helping yourself and healing.
Step #1 - Kegels are important but not the be-all-end-all
Kegels are synonymous with pregnancy and postpartum, and very important. However, they are often not the complete answer. Learning more about the root of the reason the pelvic floor is weak can help you to live free of accidents, enjoy jumping and playing with your kids, or laugh with your friends without worrying about leakage.
Kegels are tricky, but here are some tips.
A Kegel is a contraction of your pelvic floor muscles. Most commonly, when you shut off your flow of urine, you are doing a Kegel. It’s never going to feel like a strong contraction (like a bicep or gluteus). You only want to feel it in your pelvic floor, not in your butt or upper stomach muscles.
Also, when you do a Kegel, contract on the exhale. These strategies may make it feel weaker, but it is going to isolate better. Try Kegels in all sorts of positions – lying down, on your side, sitting, hands and knees, and standing. Compare which position you can feel your Kegel the best and go with that.
One-on-one training can help you identify what’s preventing your pelvic floor from getting strong again.
Step #2 - Consult an expert
It often feels like we're detectives of our own bodies after childbirth - resulting in a wild goose chase of analyzing symptoms and troubleshooting tips.
Whether you are leaking a few drops or have multiple daily wardrobe changes, you do not have to live with incontinence. Your body is simply notifying you of a weakness that should not be ignored.
Nervous about reaching out about pelvic health and incontinence? You're not alone.
This is a sensitive topic and it's crucial to feel comfortable talking to a practitioner about your pelvic health. With my patients, I make sure to get a complete understanding of where their body is by having a complimentary consultation over the phone (Zoom, Google chat, etc.) before we even meet in person.
Feeling safe is just as important as any medical treatment. Make sure you advocate with your comfort level in mind.
Therapists should answer any and all questions and explain procedures prior to any postpartum recovery plan.
With the right support and guidance, it's possible to feel stronger and more complete when it comes to pelvic health. The first step is to start listening to your body...
About the author:
Jamie Justice is a Board Certified Women's Health Specialist, Physical Therapist, and co-owner of Empower Women's Health & Wellness in St. Charles, Illinois. Committed to starting the conversation about postpartum recovery, Jamie feels adding the 4th trimester to women's health is crucial to moms everywhere.
For more information about Jamie and Empower Women's Health & Wellness, visit empowerwhw.com.
Don't forget to follow Jamie for tips and support on Instagram.
Disclaimer: Articles and advice from contributing writers are meant to provide information only. Resources, articles, and infographics should not be used as a substitute for professional diagnosis or treatment. Always seek the guidance a qualified health care provider for all healthcare and mental health related needs.
Lead image - Brooke Cagle on Unsplash