Everything You Need to Know About Postpartum Incontinence
From "Why do I pee a little when I laugh?" to "Do Kegels actually work?", our friend and favorite gynaecologist Dr. Chimmy breaks down all the questions you've ever had about postpartum incontinence.
What's postpartum incontinence?
Incontinence, simply put, is "involuntary leakage". This can be involuntary leakage of urine, which we refer to as "urinary incontinence" or of stool, which we refer to as "fecal incontinence" (we'll get to that in a minute). Both can happen when you're postpartum.
In general, incontinence can happen for a variety of different reasons, and can affect your physical, psychological, and social wellbeing. It can even sometimes lead to significant lifestyle restrictions.
Postpartum urinary incontinence is experienced by up to 40% of postpartum people. Typically this type of incontinence is called Stress Urinary Incontinence (SUI) which is the involuntary leakage of urine due to increases in intra abdominal pressure. This can happen during activities like exercising, coughing, sneezing or laughing.
What causes it?
Postpartum SUI is a result of weak or injured pelvic floor muscles, ligaments and connective tissues— with the injuries usually occurring during pregnancy or childbirth. These injuries lead to weaker urethral support, and this further leads to an inability of the urethra remaining closed during events like coughing or sneezing.
What do a toddler, a preschooler and a pregnant lady all have in common?— full metal mommy (@FullMetalMommy) September 29, 2014
We all pee our pants in public.
Vaginal delivery can strain or injure the pelvic floor muscles as well as the pudendal nerve which is a nerve with many jobs— including helping the muscles of the pelvic floor. This injury ultimately leads to insufficient pelvic floor muscle support and an unsupported urethra. Vaginal deliveries carry the highest risk for SUI at a rate of 34%, however those that deliver via cesarean section have also been shown to have stress urinary incontinence at a rate of 17%.
Hold on, did you say fecal incontinence?
People at highest risk for postpartum fecal incontinence are those who sustain obstetric anal sphincter injuries (OASIS) during vaginal delivery. Studies have shown that about 26% of women with OASIS had fecal incontinence at about 6 weeks postpartum. And by 6 months after delivery, this prevalence dropped to 17%.
Long-term outcomes have been assessed by the Mothers’ Outcomes After Delivery study, which found that OASIS is significantly associated with fecal incontinence sometimes as long as 5 to 10 years postpartum. However, the study also showed the majority of women who are initially symptomatic will experience resolution of symptoms over the first 3 years postpartum.
Can postpartum urinary incontinence be treated?
Typically treatment of SUI includes exercises to strengthen pelvic floor muscles, devices inserted vaginally to provide urethral support or surgery to repair the pelvic floor. Your treatment is typically initiated by your OBGYN or pelvic floor physical therapist assessing your pelvic floor musical strength.
If you have a fairly good perception and awareness of that part of your body and you’re able to voluntarily contract your pelvic floor muscles, then you may be candidates for home pelvic floor exercises. Both the American Urogynecologic Society and the International Urogynecological Association have patient resources available, so you can do these exercises in the comfort of your own home.
If you don’t have a good perception and awareness of that part of your body or you’re unable to voluntarily contract your pelvic floor muscles, then you may not make great progress with these guided exercises. Instead, a definite referral to a Pelvic Floor Physical Therapist is required for individuals who have tried home exercises without significant improvement in SUI.
Certified Health Pelvic Floor Physical Therapists (PFPTs) are able to conduct a more thorough evaluation of your pelvic floor, create a guided plan and monitor your progress over time. Most postpartum individuals tend to feel satisfied with checking out a PFPT after they give birth, but some also begin during pregnancy as preparation.
What does incontinence treatment look like?
There are quite a few options for people with urinary incontinence. Anti-incontinence devices (bladder support devices like pessaries) are one of them. These devices are placed within the vagina to provide urethral support. There are also over-the-counter disposable "tampon-like" devices that can typically be worn for up to eight hours (within a 24-hour period) and can safely be trialed at home.
For symptom control in women with mild to moderate leakage, there are also Leakproof Underwear options that are absorbent and odor-resistant. These can be used instead of pads, panty liners or diapers to catch the leaking urine. You can check them out here!
If these measures are still not doing much to improve your quality of life, the next step is referral to a specialist in female pelvic medicine and reconstructive surgery for additional evaluation and surgical management.
One last question— what the heck are Kegels?
Kegels are pelvic floor muscle exercises typically performed to help decrease or stop involuntary leakage of urine.
In describing how to perform Kegels, you can equate it to the same technique used to stop urine mid-stream or trying to prevent gas from escaping the rectum.
Not sure if you’re doing them right? Time to grab a mirror. You can assess whether or not you are using the right muscles by holding a hand mirror in front of the vagina and looking to see if your perineum (the area between your anus and your vulva) lifts up when you contract.
Kegels are usually performed by squeezing for 3 seconds and then relaxing for an equal amount of time (3 seconds). This is repeated 10 times, 3 times a day with an eventual goal of 10 seconds per squeeze.
Typically Kegels can help with SUI due to weak pelvic floor muscles, and studies have shown that 50% of women are satisfied 1 year after starting pelvic floor muscle training.
However, there are 14 different causes or urinary incontinence (yes, 14!), so if you don’t have urinary incontinence due to weakened pelvic floor muscles, Kegels may not be helpful and in some cases, could actually worsen symptoms.
Although many people are hesitant to seek care or discuss their symptoms with a physician or medical provider, it’s an incredibly important and necessary step in ensuring the diagnosis is correct, and the treatment options are appropriate and healthy for you and your body.
Dr. Chimmy MD is our resident gynaecologist and vagina expert. You can follow her here for more educational posts covering all the ways our bodies work, and DM us over on @knixwear if you have any questions for Dr. Chimmy!
Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA. 2018
Diagnosis and Management of Postpartum Pelvic Floor Disorders; Ana Rebecca Meekins MD and Nazema Y. Siddiqui MD, MHS; Obstetrics and Gynecology Clinics, 2020