Everything that’s helpful, honest, and practical that you need to know about your bladder, bowel, and pelvic health before, during, and after your pregnancy.
The pelvic floor muscles are a wonderful, hard-working part of the body that deserves a special kind of attention it often misses out on! Find out more about pelvic health, including pelvic health during and after pregnancy.
Bladder Control
Women who have one baby are nearly three times more likely to leak urine and wet themselves than women who have not had a baby.
Why does having a baby make you wet yourself?
When the baby moved down through the birth canal (the vagina), the canal was stretched.
The nerves and muscles (called the Pelvic Floor Muscles) that help keep the bladder closed were also stretched. Even if you had a caesarean to deliver your baby, pregnancy itself can lead to pelvic floor problems over time.
This can leave the muscles weak so that they are not able to keep the bladder from leaking. This leaking can happen when you cough, sneeze, lift or exercise.
Is this leaking likely to go away by itself?
The leaking is not likely to go away unless you take steps to prevent future damage and begin to exercise your pelvic floor muscles to help them regain your strength. As you get older, your pelvic floor muscles will tend to get weaker.
If you don’t get the muscle strength back after each baby you have, you are more likely to start wetting yourself. Following menopause, there is also a higher risk that you will wet yourself.
How do my waterworks work?
The bladder itself is a hollow structure surrounded by muscle. The bladder fills up slowly from the kidneys. You should be able to hold on until there is about 300-400ml inside the bladder.
The bladder closing muscles are called the pelvic floor muscles. When you are ready, the pelvic floor muscles relax and the bladder squeezes the urine out. Then the cycle begins again.
What do my pelvic muscles do?
When one or more of your pelvic organs (bladder, womb, bowel) sags down into your vagina, this is called pelvic organ prolapse. Prolapse is very common and happens to half of all New Zealand women. If you have a feeling of ‘something coming down’, you might have a prolapse.
NB: One in ten women in New Zealand have surgery for prolapse, but half of the women actually have a prolapse.
See your doctor if you are not sure about this.
Pelvic Floor Muscles
Pelvic Floor Exercise
1. A proper pelvic floor squeeze should lift up and hold hard. Pelvic floor exercises should be done slowly – you need to concentrate.
2. Every squeeze should be done as strongly and tightly as you can!
3. Squeeze, lift and hold for three seconds, three times.
4. This is ONE SET.
5. Try to do THREE SETS each day.
As pelvic floor muscles get stronger, you can hold your squeeze for longer. You should aim to hold a long squeeze up to the count of ten. It may take some weeks before you can hold for the count of ten. Start with whichever number you can manage to do. This might be any number from one to ten.
Once you can hold on for longer and are more confident you can add in some quick short holds – squeeze as hard and as quickly as you can.
If you are unsure about whether or not you are using your muscles correctly, see a pelvic floor physiotherapist.
Getting ‘The Knack’
You should squeeze up and hold before you cough, sneeze or blow your nose and before each time you lift anything. This braces your pelvic floor and protects it. The lower part of your tummy should squeeze, lift and hold as well.
When you feel that your vagina has recovered from the birth of your baby (some time after three weeks), you might like to place a clean finger gently into your vagina. As you squeeze up hard, see how many seconds that you can hold the squeeze. Now see how many of these long squeezes you can do, one after each other with a short rest between each. Filling in the table on page 7 might help you to watch your progress more easily.
Keeping track of your progress
Use the table to keep track of your progress:
You could ask your partner or a friend to help remind you to do your pelvic floor exercises.
Remember to brace your pelvic floor every time you are going to cough, sneeze or lift (this is called ‘The Knack’).
Remember – you need to do your pelvic floor exercises for the rest of your life!!
Back to sex after the baby
Your pelvic floor muscles not only play a part in bladder and bowel control, they also help with sexual function. They will help you feel your partner and help with sexual responses. Hormone changes during breastfeeding can cause the vagina to be dry, even if you are aroused, causing discomfort. The use of vaginal lubricant can help. If you had stitches after the birth of your baby, this may cause pain when you first try to have sex. If you are worried about getting back to sex or would like advice about any of these problems, see yourG.P.or pelvic floor physiotherapist. This is an important part of getting back to normal after the baby that is often missed - but you should not feel embarrassed asking for advice.
What can I do to avoid constipation?
Constipation can lead to pelvic floor stretching.
How can I be sure that I have good bladder habits?
Summary
Discuss continence with your health professional. You should ask each of your health professionals how any aspect of your care during your pregnancy, delivery or post-natal period could affect your bladder and bowel control (e.g. epidural, induction, repair of episiotomy or tears). Consider this information when making any decisions regarding your pregnancy, delivery and after-care.
Written by: Pauline Chiarelli
University of Newcastle
For all enquiries
Continence NZ: Continence Helpline: Call 0800 650 659
Email: info@continence.org.nz
The content of this booklet has been provided by the Commonwealth of Australia, © 2011
