How to Manage Postpartum Incontinence

Trampolines. Belly laughs with a friend. Allergy season. Jumping jacks. 

What do all these things have in common? They place a large amount of stress on the pelvic floor, and many postpartum women report leaking urine with these activities. 

Stress urinary incontinence, or “bladder leakage” with coughing, sneezing, laughing, jumping, or heavy lifting is one of the most common postpartum concerns, with approximately one-third of women reporting some degree of postpartum urinary incontinence. Also, many postpartum women experience urinary urgency (feeling the need to suddenly rush to the bathroom) with or without leakage.

Previous generations have laughed these women's health issues off as an inevitable consequence of having babies, but today’s mothers have more resources at their disposal. You may need to advocate for yourself, if you’re more than 3 months postpartum and still noticing incontinence symptoms or loss of bladder control, it’s a great time to look into some strategies and treatment tools to help get these systems back in order after birth. Incontinence can be treated months, years, or decades after vaginal delivery or c-section birth, so it’s never too late to find support and make improvements. 

Let’s take a look at the types of incontinence, and go over a few strategies to help keep you dry. Keep in mind that even a small amount of urine leakage is the result of some kind of pelvic floor issue, and there are no one-size-fits-all solutions, but there are treatment options. An individualized evaluation and treatment plan with a pelvic floor physical therapist is always your best approach if you’re experiencing leakage of any kind.

• Stress urinary incontinence occurs when the pressure inside your body that’s moving down on the bladder (also known as intra-abdominal pressure) is greater than the pressure that the pelvic floor is able to manage. Things like jumping, sneezing, coughing, and even lifting something really heavy all fit the description for increased intra-abdominal pressure. This type of incontinence is super common among postpartum moms, simply because the pelvic floor muscles may be weaker than usual. Unfortunately, stress urinary incontinence can linger for decades after birth if it’s not addressed. The good news? We absolutely can do something about it at any point after birth. 
• So what’s the big picture for addressing postpartum stress urinary incontinence? Take the pressure off the pelvic floor, and/or strengthen the pelvic floor to be able to handle the pressure placed on it. 
• Taking pressure OFF the pelvic floor might look like adjusting your posture when you run or jump. It might also involve switching up your breathing strategy with heavy lifting or strenuous activities. The phrase “exhale on exertion," or breathing out when you stand up from a low couch or lift something heavy might be helpful to limit the extra pressure on the pelvic floor, and thus reduce how much work your pelvic floor has to do to keep you from leaking. 
• Pelvic floor muscle exercise is the first line of treatment for stress urinary incontinence. Since stress urinary incontinence can occur as a result of a weak, underactive pelvic floor or a tight, restricted pelvic floor “just do your Kegel exercises” is not necessarily the right answer for everyone! The best way to move forward is to meet with a pelvic physical therapist for a thorough evaluation and treatment plan. 
• If a visit with a pelvic floor physical therapist is not available to you, ask your OB/Gyn or birth healthcare provider to make sure you’re using the muscles appropriately. You can also practice pelvic floor coordination and exercise (aka Kegels) with an emphasis on full contraction AND relaxation with each one. At the end of the day, we all need to be able to move through the full range of motion with the muscles of the pelvic floor. 
• If you find you have good control over the muscles but you’re still noticing leakage, you can try breaking up your pelvic floor exercises into two categories: endurance and speed. Endurance exercises will involve longer holds (5-10 seconds) and speed exercises will require quick coordination with your contractions. Just be sure to fully release the muscles after each repetition.

• Urgency is another common concern among postpartum moms. Growing babies sit right on top of pregnant women's bladders, so it’s no wonder new moms have bladder concerns after birth! 
• Urge urinary incontinence occurs when someone has an intense urge to urinate, and sometimes can’t quite make it to the bathroom before they begin to leak. When the bladder gets full, it starts to contract and sends signals that it’s time to find a bathroom. With urgency, sometimes the bladder starts sending those signals too early before it’s really full, and it can overwhelm the pelvic floor muscle’s ability to keep from leaking. Often, there is an element of bladder irritation or stress and anxiety that goes along with urge urinary incontinence. The good news is once we take back control and show the bladder who’s boss, this issue can improve pretty quickly! 
• First, we’ll want to look at bladder irritants. These are any foods or liquids that irritate the lining of the bladder and cause it to spasm, or squeeze before it’s really full. Caffeine is a big one, and so is carbonation. Seltzers, sodas, artificial sweeteners, citrus fruits or flavors, chocolate, and alcohol are all common bladder irritants, among others. If you don’t want to give up your morning coffee, you can try adding some plain water before and after to dilute the effect of the caffeine on your bladder. You also may want to cut down a little on the amount you’re drinking until you know exactly how it’s contributing to your symptoms. The goal is not to take away everything you love - just to better understand how it makes you feel so that you can make informed decisions along the way! 
• Once we have bladder irritation calmed down, we can try adding a little “urge deferral” strategy. This is where we really take back control and show the bladder who’s boss. Next time you feel an urge, try these tips: 
• Sit down. Pressure on the pelvic floor can help calm the bladder down. 
• Take deep breaths. Calming the nervous system brings down the intensity of bladder spasms. 
• Distract yourself. Think about something else for a moment. Or what about 100 minus 7? Minus 7 again? Minus 7 again? Got you thinking about something else, right? 
• Wait until the urge has passed, then walk calmly to the bathroom. Sit down again and repeat the strategies if you need to along the way! Urination urgency usually comes in waves, so if you can wait until the urge has passed you’re more likely to make it to the bathroom and stay dry along the way.

• If you’re noticing all of the above symptoms and you’re not sure where to start, you’re a perfect candidate for pelvic floor physical therapy.
• There is so much more that might go into a personalized treatment plan beyond what's listed in this blog post. Your program might include general exercise or hip strengthening, breathing drills, emphasis on posture and alignment, or specific pelvic floor exercises. You might benefit from some biofeedback in the clinic, or a biofeedback device for home like the Elvie or the Perifit. You may also need some manual therapy to help reduce tension in the pelvic floor. Your body, your experience, and your postpartum recovery plan is unique, and your pelvic floor physical therapy plan will be, too.