2/3 of women suffer from urinary incontinence although it actually affects both men and women. It’s a common problem but not a normal function of the body. So what is incontinence and how can we reverse the changes?
Urinary incontinence comes in two forms: stress incontinence and urge incontinence.
Stress incontinence occurs when pressure is put on the bladder through sudden movements such as sneezing, coughing, jumping, running or even during sexual intercourse. In turn the bladder puts pressure on the pelvic floor muscles via the connective tissues.
Urge incontinence is when you get a sudden urge for a wee with no warning. It happens when the bladder sends signals to the brain that it is full when it isn’t. In response, the brain sends a message back to the bladder to contract and empty.
For the purposes of this blog, I am going to talk about stress incontinence and its prevalence in post natal women.
There’s this common assumption that once you’ve had kids, your pelvic floor is wrecked and you can never expect to jump on a trampoline again or sneeze without having to cross your legs. Sound familiar? It was definitely my mindset when I had my daughter because no one told me otherwise. I just accepted it as a foregone conclusion and counted myself lucky I had my beautiful little girl. Luckily I learnt that it wasn’t a normal path of being a mum and that although common, mishaps and a weakened pelvic floor could be rectified.
But first we have to understand why the role of the pelvic floor pelvic floor and how it becomes compromised - and it’s not just because we have pushed a baby out through it.
The Anatomy bit
The pelvic floor muscles are the sling of muscles that create a plug for out insides – in short, they stop our lower organs from falling out (bladder, rectus and uterus) They also play a huge part in contributing to the body’s stability system, the core. The pelvic floor muscles are anatagonist muscles (opposite) to the diaphragm (our big breathing muscles) and are synergist muscles (work together) to our deep abdominal muscles, the Transverse Abdominus (TVA).
The strength of the pelvic floor muscles actually lie in their ability to co ordinate with the rest of the intrinsic core muscles so that they work as a team and a unit.
So when it comes to pregnancy, there are a lot of compromises in the structure of the core muscles. The ribcage expands and pulls the oblique abdominal muscles and the muscles of the 6 pack (the rectus abdominus) into a lengthened state, creating diastasis rectus (weakened tissues through the midline of your six pack which can lead to a tummy gap). The TVA also gets stretched by the growing bump compromising its ability to contract; the diaphragm gets squashed up into the rib cage compromising its ability to contract downwards on inhalation and the pelvic floor has the growing weight of a baby , increasing in size over 9 months and bearing down on it. The pelvis tips forwards under the weight of the baby and puts a lot of work on the lower back muscles and stretches the lower abdominal muscles which are attached to the pelvis downwards.
If the diaphragm and TVA are compromised, they will have a knock on affect to the pelvic floor. Likewise the weakened pelvic floor will also cause a chain of knock on effects to the TVA and diaphragm. The position of the pelvis will also place the pelvic floor muscles in a sub optimal position so they cannot contract and relax effectively.
Birth and scars
Although the core is compromised by the growing weight and size of the baby during pregnancy, it can undergo some big shifts during birth itself by way of scars.
Scars can create some of the biggest neurological disruptions in the body. When a scar interrupts the signal from the brain to a muscle, it creates a white noise akin to tuning in on an old style dial radio. This white noise means that the brain cannot recruit the desired muscles and consequently, the body has to create compensatory patterns using other, less efficient muscles, to create the movement. If the main muscles are taken out of the equation, it has a knock on effect to the other muscles that they team up with.
The c section scar is made through 7 layers of tissue, right in the spot where our core is strongest. The surgery and the scar itself can create an inhibitory effect on the muscles of the TVA resulting in the pelvic floor muscles losing their main partner. The pelvic floor muscles then have to step up and do a bigger share of the work which can weaken them. A weakened pelvic floor is unable to respond to the high impact of sneezing, coughing and jumping – and hence we have stress incontinence.
A tear or episiotomy scar can create issues in the pelvic floor muscles so that they become over-active or underactive and hence muck up the sequencing in the rest of the core. An overactive pelvic floor and an underactive floor can prevent the pelvic floor muscles from contracting and relaxing properly and they consequently cannot respond to the demands of the organs putting pressure on them – and, you’ve guessed it – we have stress incontinence.
Even an epidural (inserted into the stabilizing muscles of the spine) is a scar. Albeit tiny, these scars can also create a disconnect in the motor control patterning from the brain to the pelvic floor and other core muscles.
What can I do to help my urinary incontinence?
Now although we can’t stop ourselves from sneezing and coughing, we can definitely help the rehab of the core by minimizing High impact physical activity whilst the pelvic floor recovers from its 9 month marathon. The body can take up to a year (or even more) to heal from this incredible journey, so help it along the way by choosing low impact activities that help it rest and digest whilst mending. If you are running and leaking then your body is certainly not ready for running.
But most importantly get your diaphragmatic breathing back. The diaphragm is the driver of the core and what the diaphragm does, the pelvic floor responds to. In fact most pelvic floor rehab focuses around learning to breathe properly, rather than the old thought of doing kegels.
Strengthening the pelvic floor is a big focus after child birth and many a kegel has been given over the years to new mums. BUT NOT EVERY PERSON NEEDS KEGELS. Sometimes, the pelvic floor is overactive and the last thing an overactive, tightly switched on pelvic floor needs is to contract further as this can create further problems with incontinence issues.
If you are in any doubt of how to proceed with your pelvic health recovery, please contact me or visit a Women’s Health Physio for an assessment.
I have nothing against incontinence pads as a short term help for preventing wet knickers – no one wants wet knickers - but let’s face it, that’s the only use of an incontinence pad. I do however have a real problem with selling and using them as a long term solution. And those new incontinence pants that have reared their ugly head …………… I’m totally speechless! We should be helping women to feel whole and strong again after birth, not advocating them wearing a nappy. What happened to empowerment and education?
So before you go grabbing for a pad as a long term solution to incontinence, please ask yourself these questions first:
- Do I have a diastasis rectus?
- Did I have a c- section?
- Did I have an episiotomy or tear?
- How is my breathing?
- How optimal is my posture?
And if any of these points resonate with you, or you would like your diastasis, c section scar, breathing or posture assessed, please do not hesitate to contact me and we can book you in for your Restoration Mummy Post Natal Assessment
EMPOWERING YOU TO MAKE BETTER DECISIONS FOR YOUR BODY