Postpartum incontinence: What to expect

After childbirth, you may experience postpartum incontinence. Read on to learn how to restore your pelvic floor so you can sneeze safely.

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Pre-pregnancy, you’d probably never thought much about your pelvic floor (you know, that network of muscles that keeps your uterus, bladder and bowels in place). But now you may be noticing that things down under haven’t been the same since you had kids. The biggest sign things have gone south? Leakage — when you laugh, sneeze or, heaven forbid, jump.

“One in three women experience urinary incontinence and three-quarters of the time, it’s giving birth that’s to blame,” says Scott Farrell, chief of gynaecology at IWK Health Centre in Halifax. But before you resign yourself to a lifetime of stifling your sneezes, here’s what you should know:

All stretched out
During pregnancy, your uterus balloons from a couple of ounces to about two pounds and, along with your baby, puts extra pressure on your pelvic floor. Plus, pregnancy hormones, not to mention the birth process, stretch out your pelvic floor muscles and increase your risk of urinary incontinence.

“After delivery, about 30 to 40 percent of women experience some degree of leaking,” says Farrell. “And while it usually improves within a year, each subsequent pregnancy makes a permanent problem more likely.”

Powering up your pelvic floor
So what’s the best way to whip your pelvic floor muscles back into shape? You guessed it — Kegels. Bonus: Toning these small but mighty muscles also improves your sex life.

To do a basic Kegel, start by identifying the muscles involved. The next time you’re in the loo, try stopping your urine mid-flow — those are the muscles you need. Once you’ve got the move, practice makes perfect. Try contracting your muscles and holding for five seconds, then relax for five seconds.

The key to perfecting the Kegel is consistency and frequency, says Farrell. “The more intense the program, the better.” Think in terms of sets and reps, aiming for two sets of 15 reps every day. It also helps to mix up your routine. Instead of always squeezing and holding, try squeezing the muscles for a count of five, relax, then do four contractions in rapid succession.

If your leakage problems are more severe, you can also try a pessary device — a stiff cone fitted by your doctor and inserted into your vagina every day to help support the urethra and prevent your bladder from leaking. “Depending on how much incontinence is affecting your daily activities, surgery is another option,” Farrell says. For women who prefer less drastic measures, there are also several products on the market:

Incontinence pads
Though similar to menstrual pads, these pads are designed specifically for urinary incontinence. Tenais a popular brand.

Protective panties
Stride Everyday even offers lacy thongs with protection sewn into gusset.

Biofeedback devices
Not sure you’ve mastered Kegels? Biofeedback devices, such as the Epi-No, help you monitor your progress and perfect your technique.

Satisfaction guaranteed
Painful sex is a common side effect of childbirth. If you had any trauma to the perineum (whether through tearing or episiotomy), you’ll probably want to hold off until you heal. Hormonal changes also make your vaginal wall dry and tender. “If you’re nursing, your vaginal wall probably won’t return to normal until you stop and your estrogen levels increase,” says Scott Farrell, chief of gynaecology at IWK Health Centre in Halifax. But there’s no need to abstain altogether. The key is to take it slow, use a lubricating cream, and try different positions (woman on top is a safe bet) to take the pressure off sore areas. And, once again, Kegels can help by increasing muscle tone and making sex more pleasurable for both partners — giving your man a “friendly squeeze” not only feels good for him, it also boosts blood flow to the vagina, increasing your chances of orgasm.

Originally published in October 2011. 

Read more: 
Postpartum sex: Why it sometimes hurts
Your period after baby
Post-traumatic (childbirth) stress disorder

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