Urinary incontinence, known as bladder leaks, is a common issue many women face after childbirth. It can be distressing and inconvenient, but understanding why it happens can help you take steps to manage and overcome it. Better understanding the anatomy of the pelvic floor muscles, the impact of perineal tears, and why urinary incontinence occurs, especially during high-impact activities like running and jumping can help you feel empowered to get the help you need
Anatomy of the Pelvic Floor Muscles
The pelvic floor is a group of muscles and connective tissues that span the bottom of the pelvis, forming a hammock-like support for the pelvic organs, including the bladder, uterus, and rectum. These muscles play a crucial role in maintaining continence, supporting pelvic organs, and providing stability to the core.
Key Components of the Pelvic Floor:
1. Superficial Pelvic Floor Muscles:
Compressor Urethrae: Provides tension and presses on the urethra to close in order to prevent leakage throughout the day, but relaxes and opens to allow urination.
Urethrovaginal Sphincter: Helps compress the urethra to prevent leakage
Bulbocavernosus: The most distal pelvic floor muscles surrounding the urethra creating that final prevention of leakage.
2. Deep Pelvic Floor Muscles:
Levator Ani Group: Includes the puborectalis, pubococcygeous, and iliococcygeus muscles and is critical for maintaining urinary and fecal continence and pelvic organ support. These muscles help with control the rises of intra-abdominal pressures to prevent leakage while working together to create pelvic floor stability and form a trampoline like muscle that also help with absorbing impact of the internal organs with walking, running, and jumping.
The Impact of Perineal Tears
Perineal tears are common during vaginal childbirth and can vary in severity. These tears occur in the perineum, the area between the vaginal opening and the anus, and can affect the pelvic floor muscles.
Types of Perineal Tears:
1. First-degree tears: Involve only the skin and are usually minor.
2. Second-degree tears: Affect the skin and muscle tissue of the perineum and often require stitches.
3. Third-degree tears: Extend through the perineum and into the muscles surrounding the anus (anal sphincter).
4. Fourth-degree tears: Involve the perineum, anal sphincter, and the lining of the rectum.
The more severe the tear, the greater the impact on the pelvic floor muscles and the longer the recovery period. Proper healing and rehabilitation are crucial for restoring pelvic floor function and preventing urinary incontinence after having perineal tears that directly affect your pelvic floor muscles.
Why Leaking During the First Month Postpartum is Normal
Leaking urine during the first month postpartum is relatively common and can be considered normal due to the significant changes the body undergoes during pregnancy and childbirth. Here are a few reasons why this happens:
Bladder Overflow: As you’re pregnant your blood volume goes significantly up and after giving birth you no longer need all that blood volume and your kidneys start to filter the plasma that’s not needed. Your kidneys create urine out of the plasma and excrete it out. This can cause bladder overflow and increased urinary frequency, especially in the first 2 weeks postpartum
Physical Strain: The weight of the baby and the process of childbirth put immense pressure on the pelvic floor muscles, leading to temporary weakness, making them unable to uphold the pressure from the bladder. Some women have a tear in their levator ani muscles which can also cause coordination issues and more difficulty with muscular engagement.
Nerve Trauma: The nerves controlling the bladder and pelvic floor muscles can be stretched or excessively compressed during childbirth, affecting muscle control of the pelvic floor and bladder muscles.
These factors often result in temporary urinary leakage that should improve within the first few weeks postpartum as the body begins to heal, your blood volume returns to normal, and hormones stabilize.
When Bladder Leakage Persists Beyond the First Month
While some urinary incontinence is expected in the immediate postpartum period, it should not persist beyond the first month. If leakage continues, it may indicate an underlying issue that needs attention. Persistent urinary leakage can be due to:
Pelvic Floor Dysfunction: The pelvic floor muscles may not have regained their strength, mobility, or coordination, leading to continued leakage.
Nerve Damage: Prolonged or difficult labor can cause lasting nerve damage, affecting bladder control secondary to affected communication between your pelvic floor, bladder, and brain.
Pelvic Organ Prolapse: The stretching of pelvic floor muscles and the impact that excessive pushing during birth or constipation during pregnancy or postpartum can lead to a prolapse, where the pelvic organs drop from their normal position, causing difficulty fully emptying the bladder, and placing more strain on the pelvic floor muscles so they can’t engage how they need to
Constipation: Pressure in your pelvis can cause pelvic floor muscles to not work how they need to and increase pressure on your bladder causing leakage.
Postural or Strength Deficits in Surrounding Pelvic Musculature: Limitations in these can cause poor length tension relationship in the pelvic floor muscles limiting pelvic floor control, coordination, and strength.
Why Leakage Happens More with Running and Jumping Postpartum
High-impact activities like running and jumping put additional stress on the pelvic floor muscles, which can lead to urinary leakage, especially in the postpartum period. Here’s why:
Increased Pressure: Running and jumping create more intra-abdominal pressure, which the weakened pelvic floor muscles may not be able to withstand.
Reduced Support: The pelvic floor muscles or pelvic nerves may still be recovering causing lack of power strength or reactive contraction speed of the pelvic floor muscles that support the bladder and urethra adequately during high-impact activities.
Weak Surrounding Musculature: Typically pregnant and postpartum women significantly reduce their running or high intensity training during their pregnancy and recovery period postpartum. Limiting any physical activity >3 weeks time can cause muscular weakness of all muscle groups that are not getting trained. If the calves, glutes, core, quads, or even trunk or shoulder muscles are weaker, then that places excessive strength and stability needs on the pelvic floor muscles that are also recovering from pregnancy and birth too. This perfect storm can lead to leakage
Managing and Preventing Postpartum Bladder Leaks
Understanding the causes of postpartum urinary incontinence is the first step towards managing and preventing it. Here are some strategies to help strengthen your pelvic floor and regain bladder control:
Pelvic Floor Exercises: Kegel exercises involve contracting and relaxing the pelvic floor muscles to build strength and endurance. These can be done anywhere and are crucial for postpartum recovery. Learning how to properly squeeze and lift through these muscles is critical in improving their ability to withstand intra-abdominal pressure increases. Working on building longer endurance holds to 10 seconds and repeated power contractions can be helpful in improving the pelvic floors impact needs in whatever sport you are returning back to.
Pelvic Floor Physical or Occupational Therapy: A pelvic floor therapist can provide personalized treatments to assess how your pelvic floor muscles, pelvic nerves, core, and overall body is recovering postpartum to create an individualized plan for you to return to your preferred exercise or life activity without leakage.
Proper Hydration and Diet: Maintaining proper hydration and a balanced diet can help prevent constipation, which can further weaken the pelvic floor muscles.
Gradual Return to Activity: Avoid high-impact activities until you have adequately strengthened your pelvic floor, core, and surrounding muscles. Start with low-impact exercises and gradually progress as your strength improves, taking into account your symptoms and not working past them. Urinary leakage can be a good guidance on when to slow your pace or decrease the intensity of the exercise or movement as your pelvic floor muscles may not be able to accommodate for that difficulty quite yet.
When to Seek Professional Help
If urinary incontinence persists beyond the first month postpartum or is significantly impacting your quality of life, it is essential to seek professional help. A pelvic floor therapist can assess your condition and provide appropriate treatment options.
Conclusion
Urinary incontinence after childbirth is a common but manageable condition. By understanding the anatomy of the pelvic floor muscles, the impact of perineal tears, and the reasons behind postpartum leakage, you can take proactive steps to strengthen your pelvic floor and other musculature to regain control. Implementing pelvic floor exercises/ mobility, finding a gradual training program, seeking professional help when needed, and gradually returning to high-impact activities will support your postpartum recovery and help you enjoy a more active, leak-free life.
For more guidance on exercises early postpartum recovery, you can join my 6 weeks early postpartum rehab program! Empower yourself with the tools and knowledge to regain your strength and confidence postpartum.
