Still leaking urine weeks after giving birth? You are not alone and it is NOT “normal”. Many new moms are surprised to find that bladder leakage continues well past the 6-week checkup. The good news? You don’t have to live with it. Here’s why it happens, what can delay healing, and what you can do now to get better faster.
Today we will go over the causes of postpartum incontinence. We will go over:
- The causes of incontinence after birth
- Symptoms associated with different causes
- Treatment and tips for leakage
Pelvic Floor Nerve Stretch
There is a nerve, called the pudendal nerve, that goes through the pelvic floor. It weaves around ligaments, muscles and bony prominences. The pudendal nerve splits into different branches, like a tree, and one branch goes to the urethra. The nerve weaving in and out of the different structures contributes to an increased risk of being stretched during birth. During childbirth with a long pushing phase, the pudendal nerve is stretched. The stretched nerve has limited ability to signal the urethra muscle to contract.
The urethra is the external muscle of the bladder and is a part of the voiding system. There are multiple factors in urethra muscle strength. The tone of the urethra helps keep you dry.
Symptoms
A prolonged labor and pushing phase can contribute to pelvic floor nerve stretch. Symptoms in general are the typical leakage with coughing, and sneezing. However, chronic constipation can contribute to stretch of the nerve due to bearing down. Bearing down during bowel movements continues to strain the pelvic floor contributing to irritation of the pudendal nerve. Increase in leakage after a bowel movement which you had to bear down to pass stool is a sign of pudendal nerve stretch injury. Meaning there is an increase in leakage with a cough or sneeze after a bowel movement.
Treatment
If your urinary leakage continues beyond 6 weeks postpartum, it may be more then slow healing, it is a sign of pelvic floor dysfunction. A pelvic floor physical therapist trained in advanced assessment of urinary leakage will assess is a nerve injury is keeping your bladder from functioning properly. Pelvic floor physical therapy will focus on decreasing muscle tension and improving nerve recovery, and identifying your body’s specific core and pelvic floor needs to support bladder control.
One tip important tip: Avoid excessive straining of the pelvic floor which can lead to further irritation of the pudendal nerve. One factor to keep in mind is constipation. Constipation is a common postpartum and the extra bearing down will delay muscle and nerve healing. To support healing, continue to take magnesium and stool softeners until digestion returns to normal. A pelvic floor physical therapist can help identify and correct these contributing factors providing strategies to reduce straining, improve muscle coordination and restore your bladder function more effectively.
If you are experiencing leakage beyond the first 6 weeks of postpartum, schedule an appointment with a pelvic floor physical therapist with advance training in stress urinary incontinence.
Fascia Tear
There is a connective tissue between the pubic bone and the bladder called the pubocervical fascia. The fascia can be overly stretched or even torn during childbirth. This stretched or torn tissue decreases the support provided to the bladder. When there is an increase in force, the support is decreased which causes urinary leakage.
Symptoms
When it’s connective tissue integrity you may have progressive symptoms/end of day symptoms as the connective tissue stretches. The reason this occurs is because over the course of the day the connective tissue stretches due to gravity. The prolonged stretch over time limits the ability of the tissue to create firmness to support the bladder. This can cause urinary leakage.
Treatment
When there is a stretch, or even a tear, to the fascia, the best way to provide the support is using a pessary. A pessary is a device worn internally at the pelvic floor muscles to provide support for the fascia and bladder. This device will allow the fascia to rest and be supported against the downward pressures of gravity. A pessary specific for leakage has a “bump” to provide reinforcement to the urethra.
At this time, Optimize Pelvic Health is the only pelvic floor physical therapy clinic in the South Bay Area that offers pessary fittings. To learn more about pessary fittings.
Still leaking 6+ weeks postpartum? You don’t have to live with it. Schedule an evaluation with our pelvic floor physical therapy team in San Jose.
Estrogen
Estrogen is the new “buzzword” in women’s health. It’s usually discussed for it’s impact on perimenopause and menopause. However, in the postpartum state, the hormone levels you experience are similar to the hormone levels during perimenopause. This massive drop occurs in the first 24 hours after childbirth.
Causes
There are estrogen receptors in the urethra. With normal estrogen levels, the urethra muscle has bulk making it easier to close. However, with the drop in estrogen the urethral tissues are not getting enough estrogen needed to maintain healthy muscle mass. The urethra muscles thin making it more difficult to contract completely to close the urethra.
Treatment
This is a discussion with your OBGYN. The use of topical estrogen can be helpful to improve muscle bulk of the urethra. The use of topical estrogen needs to be managed due to it’s impact on the surrounding fascia. Estrogen can make our fascia more pliable and stretchy. ESTROGEN is the hormone which allows the body to stretch during pregnancy, not the widely known relaxin. The collagen type that is responsible for making up fascia CHANGES in the presence of estrogen. Adding topical estrogen can impact the surrounding fascia making it stretch which limits the connective tissue support for the bladder. In some women, topical estrogen can actually make leakage worse.
There is also controversy on how topical estrogen impacts breastfeeding. To date, there is no research to indicate topical estrogen will negatively impact breastfeeding.
Pelvic floor physical therapists with advance training in the management of stress urinary incontinence, like the therapist at Optimize Pelvic Health, will be able to guide the conversation with your OBGYN.
Summary of Urinary Leakage After Childbirth
There are multiple factors that play a role in urinary leakage after childbirth. Pelvic floor nerve stretch, fascia stretch or tear, and low estrogen are the major causes of urinary leakage after childbirth. I also want to remind you that there is usually more than one factor that impacts urinary leakage after childbirth.
At Optimize Pelvic Health, we figure out how much each cause plays a role in your urinary leakage so that you will have an individualized plan for long lasting symptom relief. When you go to pelvic floor physical therapy, they should be able to tell you how pudendal nerve stretch, fascia tear and estrogen plays a role in your leakage after birth.
Please share this article with anyone you know with urinary leakage after childbirth.
For more extensive reading on urinary leakage please head to the Causes of Urinary Leakage blog.
Ready to stop leaking and start healing? Our pelvic floor physical therapists in San Jose can help you recover to get you back to the life you want to live. <<Book Your First Visit>>
No responses yet