A few months after having a baby, you might want to get back in shape.
So, you put on your sweats and head out for a run.
Or maybe you sign up for a workout class.
Once your feet hit the ground or the instructor asks you to jump, you find yourself peeing your pants. You don’t quite see how working out is going to work out. Like at least one in three new moms, you have stress incontinence.
What is postpartum stress incontinence?
While it sounds like something caused by the mental and emotional stress of having a new baby, stress urinary incontinence is the term for the involuntary loss of urine caused by physical movement or activity. That can include coughing, sneezing, exercising, laughing, sex, or even just a brisk walk. It has nothing to do with psychological stress, although it can cause plenty of it. Stress incontinence is different from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting. When that happens, you usually feel like you really need to pee. Stress incontinence comes out of nowhere, without an urge.
Following pregnancy, changes to the tissue in the pelvis and the pelvic floor muscles can cause the urethra and the base of the bladder to be improperly supported. “The junction doesn’t hold tight, so if someone jumps, laughs, coughs, or sneezes, whatever is in the bladder comes out,” Dr. Lauren F. Streicher, MD told me. She’s a clinical professor of obstetrics and gynecology at Northwestern University and oversees the Northwestern Medicine Center for Sexual Medicine and Menopause.
There are multiple risk factors that can lead to this type of postpartum bladder leakage. Streicher outlined some of them, which include a genetic predisposition, long labor, a big baby, or forceps delivery. Streicher noted that there are some women who request C-Sections in order to avoid the pelvic floor becoming incontinent, although stress incontinence can still occur, even if you opt out of traditional delivery. “Having a C-Section and avoiding labor can be protective, but it is certainly no guarantee,” Streicher explained. And of course, long labor or large baby is also not a guarantee that you’ll end up with stress incontinence since, as Streicher told me, there are plenty of women who push out nine-pound babies and don’t have problems with incontinence.
How long does stress incontinence last?
Sometimes it’s temporary. “There are many women who are very distressed because after they deliver they find they are losing urine, but in many women, the problem gets better in time,” Streicher explained. For others, this is when the problem starts, and it does not go away by itself. Ann Kovack, a registered nurse who works at the Cleveland Clinic, pointed me to one study that found that as many as 42 percent of women still experienced stress incontinence 12 years after their first deliveries.
While she doesn’t give anyone a timeline, Streicher said if it’s temporary it likely should last from one week to up to a year. “Just because you have this now doesn’t mean you’re going to have this forever,” she explained. While it might resolve itself, there’s no harm in being proactive quickly. “If you’re losing urine two to three months postpartum, this is an appropriate time to talk about strategies to improve the situation,” she said.
How you can treat it — beyond kegels.
Most pregnant women have been told to do Kegels to prepare the pelvic floor for labor and to help it recover more quickly after. Unfortunately, it’s not that simple. Kegels involve tightening and relaxing your pelvic floor muscles, and women are instructed to do three sets of 10 to 15 reps about three times a day. It’s a lot.
“Whenever I give a talk to large groups of women, I say, ‘Raise your hand if you do your Kegels.’ Everyone raises their hands. Then I say, ‘Leave your hand up if your Kegels work.’ Everyone pretty much puts their hands down,” Streicher recounted. This is consistent with medical literature, which shows that the majority of women who do Kegels do not get the results, not because Kegels can’t theoretically work, but because most women don’t do them consistently or can’t do them correctly. Dr. Camille Moreno, D.O., who also works at the Cleveland Clinic as a clinical fellow in women’s health, agreed with Streicher’s assessment of Kegels: “Pelvic floor muscle training techniques are the noninvasive treatment approach considered to be first-line of treatment for female urinary incontinence. However, a majority of women have difficulty completing Kegel exercises correctly.”
Since DIY Kegels aren’t enough, here are steps you can take to address the problem:
You may want to assess any underlying health issues. “Some behavioral changes can treat incontinence, including lifestyle modifications such as decreasing overall consumption of liquids and avoiding drinking caffeinated beverages that may irritate the bladder,” Moreno told me. Like Streicher, she said quitting smoking could also help because smoking can cause a chronic cough that puts extra stress on the bladder. Finally, if you’re overweight, getting to a healthy weight can improve incontinence.
Pelvic floor rehabilitation.
There are physical therapists who have been trained to strengthen and coordinate pelvic floor muscles. “In a perfect world, everyone would go to a pelvic floor physical therapist,” Streicher said. Unfortunately, a lot of women either haven’t heard about pelvic floor therapy, don’t have access to it, don’t want to go, or their insurance won’t cover it. But according to Streicher, it works, and if your insurance covers physical therapy of any kind, it should cover this.
So how does it work? Pelvic floor rehabilitation is hands on. “Like any physical therapist, they are working with muscle, which means they are using their fingers in the vagina, almost like a pelvic exam,” Streicher explained. She continued: “A lot of people think they’re trying to strengthen the muscle, and while they are, they’re also trying to coordinate the muscle and help the muscle relax. They do a series of exercises and include biofeedback so women are able to contract and relax these muscles on their own and they can take it home and practice exercises at home.” Streicher said it’s highly successful at ending incontinence if women stick to the program and do what they’re supposed to do. “We usually sign people up for 12 treatments, once a week. Some people need less some people need more,” Streicher explained.
At home devices.
There are some devices available over the counter to help women attempt to treat stress incontinence in the privacy of their own homes. Streicher cautioned that many have not been studied, but she believes they could work well in conjunction with in-person physical therapy. These devices use electrical stimulation to the pelvic floor muscles to help women properly reproduce the Kegel. They also provide biofeedback and can pair with apps on your phone. Streicher, Moreno, and Kovack all recommended the Apex M device, which has been FDA approved.
If other options do not work, there is a surgical procedure that helps suspend the urethra using a piece of tape. “This works very nicely, but we don’t do this until someone has finished their childbearing, because otherwise, it’s going to get messed up with the next baby,” Streicher said. She also explained that is not the first or second preferred treatment: “It is the last treatment for someone who hasn’t responded to pelvic floor physical therapy or devices.” There have also been recent lawsuits from women who say gynecological mesh used to treat urinary incontinence has caused ongoing health problems, so you’ll want to be sure you’ve talked this option through with your provider.
Incontinence management products.
A little pee isn’t the only involuntary bodily fluid women have to deal with. And just like with our periods, there are products that can help us manage it. Cora makes Bladder Liners for incontinence. Just like other Cora products, they’re made with a 100% organic cotton topsheet.
Is it ever too late to treat stress incontinence?
Maybe you had a baby five years ago and have been dealing with a little pee when you sneeze thinking it’s just life. Well Streicher said it’s never too late to address it. “I’m the medical director for sexual medicine and menopause. Very often the people who come to see us for sexual dysfunction, like painful intercourse, have pelvic floor disorders that started with childbirth. It doesn’t matter how many years out they are, we start them with pelvic floor physical therapy, with the idea that it will help their sexual issues and it will help their incontinence.”
If urinary incontinence is not well-managed, the debilitating and distressing symptoms can affect a woman’s quality of life. “It can affect intimacy within relationships and a woman’s self-confidence,” Moreno pointed out. For these reasons alone, it’s important to start a conversation about postpartum incontinence and the solutions. In her practice, Streicher has seen the shame and embarrassment that surround the issue. “This goes under the list of taboo topics that people want information about, but just don’t want to talk about,” she said. Let’s change that.
FEATURED IMAGE BY JANA SABETH SCHULTZ
Looking for ways to manage urinary incontinence? Cora’s Bladder Liners were designed by women in the know, and made to eliminate the anxiety and fear that goes along with experiencing light bladder leaks.