Did you happen to read the book “Girl, Wash Your Face” by Rachel Hollis? Such a great book wasn’t it?! As a pelvic floor physical therapist, you know what struck me…when she told the story about jumping on the trampoline with her boys and peed her pants! You guys…even Rachel Hollis struggles with postpartum incontinence! Rachel…dear friend…give me a call let’s address that!
You see gals, just because incontinence postpartum is common, it is not normal! The Good News…we can fix it and we don’t need Bob the Builder to do it! Grab a cup of tea and let’s get a little nerdy!
Now, what happens if this system is a bit off-kilter?
All of these symptoms are signs that there is something up!
Let’s dive a little deeper into the two most common types of incontinence postpartum, urge incontinence and stress incontinence. Let’s dig in!
Urge Incontinence is defined as an involuntary loss of urine or a strong desire to urinate that cannot be postponed. If you struggle with this type of incontinence you may find that you have a trigger that causes you to have the urge to pee such as running water, the key turning in the front door, or the sensation of cold.
A bladder diary can be helpful to look at your daily voiding habits. Things to monitor are: how often are you using the restroom, how much urine did you void (counting the number of seconds), what was your urge, and how much liquid (and what kind) are you taking in throughout the day. You should be voiding typically around 5-8 times a day with intervals of 2-4 hours. If you find yourself using the restroom every 45 minutes to an hour, try to increase your time by 15 minutes and work up to 2-4 hours in between voids.
If you do get the sudden urge to pee, try doing quick pelvic floor contractions (Kegels) until your urge is gone or change up what the trigger is. For example, if your keys in the front door cause you to have an urge, try going in the back door instead.
It may seem a bit counter-intuitive that drinking more water would help with bladder health but if you are dehydrated the uric acid in the urine can be very irritating to the bladder. How much water do you ask? Drink ½ your body weight in ounces of water each day. This is good for your bladder but also all things health.
Constipation can lead to a lot of straining and pressure down on the pelvic floor. Avoid constipation by drinking your water and getting enough fiber in your diet, roughly around 35 grams each day. Fiber can be found in foods such as avocados, pears, berries, beans, and nuts. Also, don’t forget to MOVE throughout the day. Being physical active can help with motility through the digestive tract.
When you hover over the toilet (I am guilty of this in my earlier years due to the fear of catching something disgusting in public restrooms) your pelvic floor cannot relax, therefore it is giving your brain (and bladder) confused information. If you have too, cover the seat with a toilet seat liner and sit down and relax.
This bad habit all started back in the 20th century when your mom told you to go to the bathroom “just in case!” I completely sympathize with the reasoning due to my little one’s confirming a pee break just 5 minutes after leaving the house. The problem is, if you start to use the bathroom before your bladder is full, you may be training your bladder (and brain) that it is full when it isn’t. You physically can hold the extra volume but you have convinced yourself that there is no way in heck you can wait any longer! Understandably, you can pee before leaving on a big trip but don’t make it an everyday habit. For example, you pee right before a run despite just going 15 minutes ago.
Let’s switch gears to stress incontinence. I want to make note that you can have a mix of urge and stress incontinence. Read on dear friends!
A study performed on elite female endurance athletes showed that out of 112 elite x-country skiers and runners, 50% experienced urinary leakage: 28% urge, 46% stress, and 19% mixed (Poswiata et al., 2014).
Stress incontinence is the involuntary loss of urine (maybe just a dribble) with physical exertion. This physical exertion could be a cough, sneeze, laugh, exercise or anything else that requires effort.
Leaking is a signal that our body isn’t managing pressure or impact well. Our intra-abdominal system is like a closed pop-can with our glottis on the top, our abdominal muscles on the front, our deepest back muscle on the back, and our pelvic floor that sits on the bottom. If we sneeze, our intra-abdominal pressure increases and if we have a “dysfunction” somewhere in the system, we will manage the pressure somehow and a lot of times that is leaking urine or maybe even “toot.”
Our pelvic floor may play a role in this dysfunction, maybe it is weak, uncoordinated, or overly recruited. A pelvic floor physical therapist can help you assess your pelvic floor and find the right treatment for you.
Although the pelvic floor can play a huge role so can other factors. Maybe you have a diastasis recti or your transverse abdominis muscle isn’t firing correctly. It could be your form during the activity you have leaking with. For example, if you are running and experience leaking, you may have a more upright posture, ribs flared, and a hefty heel strike that is causing a lot of impact on the system. It could be your respiratory endurance that is causing you to leak. If you are exercising and you don’t have the stamina built up quite yet, you may use a shallow breathing pattern that can put pressure down on the system.
It is not always just about the Kegels. Maybe your pelvic floor is too tense and needs help learning to relax. Maybe you feel like you are performing a Kegel but in reality, your pelvic floor just isn’t getting it. That was totally me after kids! My eyeballs would roll back into my head while I was trying to perform a Kegel because things just weren’t working quite right. With a little retraining, the pelvic floor will snap back to it.
If you suffer from no butt syndrome, this may be a sign that you have adapted some movement patterns that aren’t accessing your gluts. Our gluts and pelvic floor work very closely together, so if your gluts aren’t working your pelvic floor may be struggling.
One of the easiest ways to address stress incontinence is your form. If you are a runner, look at leaning forward and landing underneath your body instead of out in front. If you are a CrossFitter or lift weights, how does your form look? Are you tucking your butt under mid-way through the lift? Do something different and see if it changes your symptoms!
An excellent women’s health physical therapist, Julie Wiebe, coined the term “Blow Before You Go.” If you know you experience symptoms before you get up out of a chair or before you hit the ground when you jump rope, exhale first. Our pelvic floor (and the rest of our core) work with our breath, and on the exhale, we get a nice recoil of our pelvic floor which can help prevent leaking.
Other things that can help are very similar to the Urge Incontinence strategies. Making sure you are not constipated, drinking enough fluids, and developing good voiding strategies.
If you would like some more information on how to treat your incontinence you can check out my E-book!
Or… if you feel you may need a little extra assistance, I am always down for a good ol’ chat! I would love to get on a Zoom Call with you and help you figure out the best plan of action for you!