Pregnancy is all about pressure. It is very important you understand this before I carry on. Pressure on the pelvis, pressure on the abdominal muscles, pressure on the connective tissue, pressure on the diaphragm and pressure on the internal organs. Not to mention pressure on the pelvic floor, which is hugely affected both during pregnancy and giving birth. Your growing baby will also have an impact on your heart.
Regaining control over your core muscles (the pelvic floor is a part of your core – see image below) is the number one priority after you’ve given birth. In some circumstances surgery on the urethra might be necessary in order to prevent leakage, if exercises won’t help.
It is common to leak urine during exercise (or when you laugh or cough), but it is not normal.
Urine leakage is common, but few seek help. Some people feel embarrassed about it, don’t think it is a big deal or think it is ‘normal’ after childbirth. Around 30% of all women have experienced incontinence – that’s as far as we know, but the number is probably a lot higher than that.
There are different kinds of incontinence:
- Stress incontinence
- Urge incontinence
- Mixed incontinence
The underlying cause tends to be the tissue in the pelvis in and around the urethra, and the bladder, which is affected by pregnancy and childbirth. Incontinence is more common in women who have given birth, those who have weak pelvic floor muscles, and those who have suffered a prolapse.
What is the pelvic floor?
Imagine a hammock hanging from your pubic bone at the front to your tailbone at the back. The pelvic floor is meant to keep the internal organs, such as the womb and the bladder, in place. The pelvic floor is also affected by the position of the pelvis.
Incontinence is more common in women who also suffer from asthma, a chronic cough, women who smoke, are obese or suffer from chronic constipation (constipation is also about pressure).
Leaking of urine is a sign that the whole core is weak, and the pelvic floor happens to be the place where it becomes ‘obvious’. Urine leakage is just one of many signs and a weak pelvic floor just one way this manifests. Other symptoms indicative of a weak core are painful knees, pain in the lumbar area and pelvic pain.
There are many other factors which can lead to stress incontinence, including a weak pelvic floor, an overactive pelvic floor (there is such a thing!), which is unable to generate a good contraction. Since it can’t relax, the diaphragm, pelvic floor and deep back and abdominal muscles produce uncoordinated contractions. When these muscles work together, you have a strong and stable core – see image below.
Important to remember at this stage: If you’re leaking while running, jumping and doing burpees – stop doing these exercises immediately! If your core is weak, you won’t strengthen it by carrying on as you are doing. You may even get worse and suffer various injuries.
Just because you have given birth, doesn’t necessarily mean you will suffer from urine leakage, of course. It is often a combination of factors that lead to urine leakage: childbirth, constipation and excessive training.
Rest assured that help is at hand!
See a gynaecologist who can refer you to a physiotherapist. Even if the problem is dismissed with an ‘everyone who’s given birth wets themselves’, don’t give up, but seek a second opinion. And a third and a fourth one, if necessary. Your health is in your hands and it is your responsibility. You can’t just assume that the health service will take you seriously.
Pelvic floor exercises (or even more exercises) are not always the answer to the problem. An overly tight pelvic floor or a tendency to hold your breath can create more problems rather than solving them. Each muscle has a limit as to how much it can contract and how much it can stretch. We know that muscles need to relax in order to generate a strong contraction. No one would go round with a constantly contracted biceps or triceps and the same applies to the pelvic floor. Always tensing and isolating the pelvic floor muscles is not necessarily the way to go but might have the opposite effect – it may become impossible to relax. An overly strong pelvic floor can be just as problematic as a weak one.
Since incontinence is a lack of muscle interaction in the core, the problem needs to be addressed in its entirety – regaining control of your core should be a priority.
HOW TO TRY TO RELAX YOUR PELVIC FLOOR
Think of your pelvic area as a clock!
Lie on your back with your knees bent and relax your pelvic floor (an example of a relaxed pelvic floor is when you’re on the toilet). Avoid arching your back.
- Breathe in through your nose and relax.
- Breathe out strongly through your mouth (you should hear a ‘sss’ sound), pull your navel back towards your spine and activate your pelvic floor by doing the following:
How to think:
- The pubic bone is 12 o’clock
- The tailbone is 6 o’clock
- The left-hand side is 9 o’clock
- The right-hand side is 3 o’clock
Visualise pulling 12 and 6 together and 3 and 9 towards the middle of the clockface and now try to lift the pelvic floor (as if you were picking berries with your pelvic area, strange as it might sound). Next imagine going to the toilet and try to interrupt the wee. Keep the tension and lift a little further. When you lift the pelvic floor, you need to feel tension in your abdomen. Don’t tense your buttocks or arch your back, but keep a neutral position while doing the exercise.
Repeat until you feel a clear difference between relaxation and contraction in the pelvic floor. Now your core muscles are working together. You can also try this exercise in different positions: on your side, on all fours, sitting down or standing.
Squats with your body weight as resistance can also help with relaxing the pelvic floor. Hold on to something stable and go into a deep squat to a point that feels comfortable, where you are able to relax. Breathe in deeply. Relax the pelvic floor and let your belly expand. Breathe out through your mouth and lift your pelvic floor. Repeat a few times and learn to recognise a relaxed pelvic floor and a tense one.