Incontinence during & after pregnancy… Should it happen??
with Dr. Whitney Haase
Short answer: NO. Urinary incontinence (AKA unintentional urine loss) should not occur and is not normal.
Long answer: Here we go!
Figure 1. Abdomen and pelvic floor anatomy
Healthy pelvic floor muscles should be able to support your abdominal and reproductive organs, assist in generating intra-abdominal pressure (IAP for short, which we need to safely brace and protect the spine during movement), and allow for normal bladder, bowel, and sexual function. If the pelvic floor and abdominal muscles are working as they should, we can do all of those things; when the pelvic floor loses normal function, we start to have problems.
While it may not be “normal” to have trouble with the pelvic floor, it is surprisingly common, especially in pregnant and postpartum women.
Some researchers estimate that up to 3 in 4 women have stress incontinence during pregnancy, which often resolves spontaneously postpartum, but for many women, it continues for months or years after delivery. Sometimes women are told it’s just something they need to expect (I heard this from a few friends during my first pregnancy). But why?
Let’s start with a little anatomy.
Figure 2A. Ideal position. Figure 2B. Compensated position.
Muscles don’t operate in isolation. The pelvic floor works with the diaphragm and abdominal muscles (see Figure 1) to perform the functions I mentioned at the beginning, but they can only do those things well if they’re in the right positions. In Figure 2A, the diaphragm and pelvic floor are stacked, which is a good position. In Figure 2B, they lose that position and aren’t able to function optimally.
Most women learned from an early age to “suck it in,” and that be-skinny-at-all-costs posture leads to a position like the one in Figure 2B and non-ideal pelvic floor and core function. When we spend day after day sucking in our bellies, we end up carrying too much tension in our abdominal and pelvic floor muscles. In addition to good positioning, these muscles also need to be able to FULLY relax to work how they’re supposed to.
This problem (bad positioning and too much tension) has affected so many women, including me.
When I was pregnant with my daughter, Anna, a friend of mine who was also a mother told me to “get ready to pee yourself every time you sneeze.” Excuse me? Aside from the fact that the advice was unsolicited, it also seemed unreasonable and pessimistic. Our bodies were designed to handle stress. For example, you wouldn’t expect healthy bones to fracture from the stress of normal running or muscles to tear from the stress of a pull-up. Pregnancy and delivery are incredibly physically demanding, but they are also NORMAL stresses that the pelvic floor was made to undergo. It didn’t make sense to me a few years ago that a woman’s pelvic floor (normal muscles) would be “damaged” for months or even years after pregnancy and delivery (normal stress).
But then it happened.
I sneezed in the shower and peed. I desperately didn’t want that friend to be right, or more importantly, deal with incontinence. I was in chiropractic school at the time and thankfully had already learned about good pelvic floor and core function. Peeing myself after sneezing was an amazing motivator for me, and from that day forward, I focused on good abdominal breathing, strengthening, and started to incorporate daily pelvic floor rehab. I noticed after a few weeks of persistent training that sneezing was no longer a problem, running became easier for me, and my low back pain eased.
At Midwest Movement, we use Dynamic Neuromuscular Stabilization (DNS) as our primary method for rehab. It is excellent for helping patients establish ideal movement and control of the body, especially the abdomen and pelvic floor.
We believe human bodies are strong, resilient, and made for movement. Our goal is to help all of our patients achieve optimal movement and function of all body systems, including the pelvic floor! We take a natural approach to healthcare and work to get patients out of pain and back to active lifestyles without medications, surgeries, or unnecessary bracing. If you have any questions about the pelvic floor, strengthening, women’s chiropractic, movement, or would like to schedule an evaluation with Dr. Whitney Haase, contact our office at (402) 256 6683 or clinic@midwestmovementelkhorn.com.
Update: I’m now two babies in, and still no leaking when I sneeze, laugh, jump, or run.
References:
Sangsawang, B. & Sangsawang, N. Int Urogynecol J (2013) 24: 901. https://doi.org/10.1007/s00192-013-2061-7