Tips for treating post-partum incontinence
Q: "I had a baby almost a year ago, and my body is still just not feeling right. I have a lot of pain in my hips and back, and I feel like I'm always running to the bathroom. Is this normal?"
--Kelly from Hampton, 38
A: One of the best parts of my job is that I can often help patients in just one visit, which sometimes involves dispelling myths. Even if something is "normal," there may still be a way to improve it. For example, urine leakage can start in pregnancy, and that's seen as normal but you could be learning and treating the cause of it.
Because bad muscle patterns don't fix themselves – you have to correct them.
Make sure you tell your OB/GYN
The pelvic floor is a sling of muscles that support the organs in the abdomen, with opening and closing that impacts as well as sexual, bowel and bladder function. After birth (even with a C-section) muscles and ligaments are stretched or move out of place. If you have any kind of tears, especially second or third-degree tears, those need to be assessed by a therapist. But sometimes you might not even know if you had one, so it's important to talk about this with your obstetrician soon after giving birth.
A tight muscle is a weak muscle
In therapy, we work on improving the coordination of muscles and repairing some of the changes that happened during pregnancy, such as a common abdominal muscle gap called diastasis recti. Strengthening these muscles can help support your core and your posture and even decrease back pain. I often hear people guiltily admit that they haven't been doing their "Kegels" – pelvic floor muscle exercises that are often talked about but commonly misunderstood. Kegels can be great, but they don't work if your muscles are too tight. So, even if you do your Kegels, you might be having leakage because your pelvic floor is too tight. A tight muscle is a weak muscle. That's why we teach people to stretch before introducing Kegels!
Retrain your habits, retrain your muscles
We also often emphasize to women that it's not about how things look – it's about how they function. Control is important, and so is letting your body recover thoroughly.
Sometimes it's just a matter of retraining your habits. For example, some people will avoid drinking water to prevent urine leakage, but that's not good for your muscles either. Maybe your bladder habits need retraining. This is something I see with people who have jobs where they have to "hold it" for hours, like teachers, nurses and drivers. Other people go at the first urge and end up going far too often.
We often look for a few other common post-baby issues like bad posture, or uneven muscles on either side of the body -- remember to switch sides while holding baby, breastfeeding or carrying their car seat!
Listen to others your body
As a physical therapist specializing in pelvic floor rehab, I wish women wouldn't wait to see someone like me for help. Often, women have accepted that they will leak urine or be in pain. At my practice, I see pain and incontinence issues that are related to birth from as long ago as 30 years. I just want to tell them, "You can get help!"
Always listen to your body, because you know it best. There can be long-term effects from not recovering properly from pregnancy, but thankfully, there are solutions – and we are here to help.
Christie Lee Sapakoff is a physical therapist on the Peninsula specializing in pelvic floor rehab. She treats patients at the Sentara Therapy Center located on the campus of Sentara CarePlex Hospital in Hampton.