One In Three Women Who Ever Had A Baby Wet Themselves in Karen

Women who have even just one baby are nearly three times more likely to leak urine and wet themselves, than women who have not had a baby. The more babies you have, the more chance there is that you will leak urine and wet yourself.

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Why do you leak urine after having a baby?

When the baby moves down through the birth canal, it stretches the nerves and muscles that keep the bladder shut. These are called the pelvic floor muscles, and they can sometimes be left weak, and not able to keep the bladder from leak ing. Leaking happens mostly when you cough, sneeze, lift or do exercise. It is rare for the bladder to be hurt during birth, but the muscles and nerves often are, and you need to do pelvic floor muscle training to help the muscles get strong again.

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Will this leaking go away by itself?

If you have any leaking, it will not go away if you just ignore it. Leaking is likely to stop if you train your pelvic floor muscles, to help get their strength back. If you don’t get pelvic floor muscle strength back after each baby you have, you may start wetting yourself, as the pelvic floor muscles get weaker with age.

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How does my bladder work?

The bladder is a hollow muscle pump. It fills slowly from the kidneys, and can hold at least one and a half to two cups of urine (300 to 400mls). The bladder outlet tube is kept closed by the pelvic floor muscles. When the bladder is full and you decide to pass urine, the pelvic floor muscles relax when you sit on the toilet, and the bladder squeezes the urine out. Then the same “fill and empty” cycle begins again.

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What do my pelvic floor muscles do?

See the picture of the pelvic floor. The pelvic floor muscles do a number of things, they:

• help to close off the bladder, the vagina (front passage) and the rectum back passage); and
• help to hold the bladder, the uterus (womb) and bowel in their proper place.

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What happens if my pelvic floor muscles are weak after having my baby?

• You might leak urine when you cough, sneeze, lift, laugh or do exercise.
• You might not be able to control passing wind.
• You might feel an urgent need to empty your bladder or your bowel.
• You might not have good support for your bladder, your uterus or your bowel. Without good support one or more of your pelvic organs might sag down into your vagina. This is called pelvic organ prolapse. Prolapse is very common and happens to about one in ten women in Australia.

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What can I do to stop these things from happening?

• Train your pelvic floor muscles (we tell you how later).
• Keep good bladder and bowel habits:
  - eat fruit and vegetables;
  - drink 1.5 - 2 litres of fluid per day;
  - do not go to the toilet ‘just in case’ as this might cut down how much your bladder can hold; and
• Protect your pelvic floor muscles when opening your bowels. A good way to sit on the toilet is to put your forearms onto your thighs and, with your feet close to the toilet, raise your heels. Relax your pelvic floor muscles and gently push.
• Keep your weight within the right range for your height and age.

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How can I care for my weak pelvic floor muscles?

The birth of a baby might have stretched your pelvic floor muscles. Any ‘pushing down’ actions in the first weeks after the baby’s birth might stretch the pelvic floor muscles again. You can help to protect your pelvic floor muscles by not pushing down on your pelvic floor. Here are a few ideas to help you.

• Try to squeeze, lift and hold your pelvic floor muscles before you sneeze, cough, blow your nose or lift.
• Cross your legs and squeeze them tightly together before each cough or sneeze.
• Share the lifting of heavy loads.
• Don’t strain when using your bowels.
• Do not do bouncing exercises.
• It’s alright to get up once a night to pass urine—don’t go to the toilet just because you had to get up to baby.
• Strengthen your pelvic floor muscles through training.

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Where are my pelvic floor muscles?

The first thing to do is to find out which muscles you need to train.

1. Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
2. Squeeze the ring of muscle around the back passage as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Try not to squeeze your buttocks together.
3. When sitting on the toilet to empty your bladder, try to stop the stream of urine, and then start it again. Only do this to learn which muscles are the right ones to use—and only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.

If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t stop your stream of urine as talked about in Point 3, ask for help from your doctor, physiotherapist, or continence nurse advisor. They will help you to get your pelvic floor muscles working right. Even women with very weak pelvic floor muscles can gain from pelvic floor muscle training.

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How do I do pelvic floor muscle training?

Now that you can feel the muscles working—

1. Squeeze and draw in the muscles around your back passage, your birth canal and your front passage all at the same time. Lift them UP inside. You should have a sense of “lift” each time you squeeze your pelvic floor muscles. Try to hold them strong and tight as you count to 8. Now, let them go and relax. You should have a distinct feeling of “letting go”.
2. Repeat (squeeze and lift) and let go. It is best to rest for about 8 seconds in between each lift up of the muscles. If you can’t hold for 8, just hold for as long as you can.
3. Repeat this “squeeze and lift” as many times as you can, up to a limit of 8 to 12 squeezes. When you first start after having your baby you might like to begin with 3 squeezes only, and work up to more over a few weeks.
4. As you get stronger, try to do three sets of 8 to 12 squeezes each, with a rest in between.
5. Do this whole training plan (three sets of 8 to 12 squeezes) each day while lying down, sitting or standing.

While doing pelvic floor muscle training—

• Do NOT hold your breath;
• Do NOT push down, only squeeze and lift; and
• Do NOT tighten your buttocks or thighs.

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Do your pelvic floor muscle training well

Fewer good squeezes are better than a lot of half hearted ones! If you are not sure that you are doing the squeezes right ask for help from your doctor, physiotherapist, or continence nurse advisor.

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Make the training part of your daily life

Once you have learnt how to do pelvic floor muscle squeezes, you should do them often. Every day is best, giving each set of squeezes your full focus. Make a regular time to do your pelvic floor muscle squeezes. This might be when you:

• go to the toilet;
• wash your hands;
• have a drink;
• change the baby;
• feed the baby; or
• have a shower.

It’s a good idea to get into the lifelong habit of doing one set of pelvic floor muscle exercises every time you go to the toilet, after passing urine or opening your bowels.

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What if things don’t improve?

Pelvic floor muscle damage may take up to six months to get better. If things are not getting better after six months, speak to your doctor, physiotherapist or continence nurse advisor.

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Also ask your doctor for help if you notice any of the following:

• any leaking of urine;
• having to rush to get to the toilet, to pass urine or open your bowels;
• not being able to hold on when you want to;
• not being able to control passing wind;
• burning or stinging inside when you pass urine; or
• having to strain to start the flow of urine.

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Seek help

Qualified nurses are available if you call the National Continence Helpline on 1800 33 00 66* (Monday to Friday, between 8.00am to 8.00pm Australian Eastern Standard Time) for free:

• Information;
• Advice; and
• Leaflets.

If you have difficulty speaking or understanding English you can access the Helpline through the free Telephone Interpreter Service on 13 14 50. The phone will be answered in English, so please name the language you speak and wait on the phone. You will be connected to an interpreter who speaks your language. Tell the interpreter you wish to call the National Continence Helpline on 1800 33 00 66. Wait on the phone to be connected and the interpreter will assist you to speak with a continence nurse advisor. All calls are confidential.

* Calls from mobile telephones are charged at applicable rates.

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