Peeing in pants after giving birth

After giving birth, most women experience soreness, depression, bleeding, fatigue, and constipation.

Quite a number experience urinary incontinence, where urine leaks involuntarily, for instance when one coughs or laughs in the weeks following childbirth.

Known as postpartum incontinence, this condition affects almost 30 to 70 percent of women after pregnancy.

Some people think that having postpartum incontinence is normal after pregnancy. But it is not normal.

Types of incontinence

Postpartum incontinence comes in three forms; urinary (where the bladder is loose and urine leaks or is fully released) or faecal (where stool leaks) or both.

For many women, this may look like leaking or dribbling a little urine if their bladder is full or when running and jumping, or doing forceful movements like coughing and sneezing.

Who is at risk?

Risk of post-partum incontinence increases in women who have:

a) forceps deliveries. This is where a doctor uses forceps to guide a baby struggling to make way through the birth canal.

b) multiple births

c) obesity

d) previous history of incontinence

e) weak pelvic floor muscles. The pressure and stretching during childbirth weaken pelvic muscles, which may be unable to contract to hold or stop urine or faeces leakage. Muscle weakness may also cause pain, fever and discomfort.

e) abrupt abnormal hormonal imbalance. After giving birth woman’s body continues to experience hormonal changes that affect the bladder and as the uterus contracts, it places extra pressure on the bladder.

f) injury during childbirth.

g) anaesthesia. Epidural or a spinal block may cause numbness around the bladder. The catheter inserted during surgery into the bladder may also make it hard for a woman to control pee afterward. But this should sort itself out within a few days.

In non-pregnant women

Most women who are not pregnant also leak urine when they laugh or sneeze due to weak pelvic floor muscles. In developed countries, the government gives out free 10 pelvic health classes to avoid these embarrassing cases. In Kenya, a majority of women are not aware of ante/post-natal rehabilitation, hence many suffer in silence.

How long does it last?

For some, the problem goes away within a few weeks of giving birth. For others, it can linger for months, or become a long-term problem.

Leaking faeces after pregnancy and delivery can also occur, but it is much less common. It is common in women who have has 4th-degree tear into her anus, or if a fissure develops from the vagina to the anus.

Unlike urinary incontinence which can be corrected with physical therapy, foetal faecal incontinence requires surgery to correct it.

What's the solution?

—Having strong pelvic floor muscles prevents the leakages thus rehabilitation before and after pregnancy is important.

—One can prevent or cure post-partum incontinence with exercises, changing lifestyle, maintaining good core muscle control, avoiding high impact exercises and taking the required amount of fluid.

—Doing breathing and strengthening exercises, having a proper posture and pelvic hygiene, and core muscle balancing, also help.

-Pelvic infections or other issues should be treated.

—Electric stimulation can be used to stimulate the pelvic floor nerves.

—In severe cases, surgery is done.

—Rehabilitation experts work with physicians, gynaecologists, nutritionists, maternal educators and nurses to provide the best care for women's pelvic health.

Pelvic Floor Exercises

Pregnant women should do pelvic floor exercises three times a day, for at least three months. If you stop doing the exercises, your muscles can weaken, and you may find that your bladder control problems return.

Strengthening the pelvic floor will also reduce the swelling caused by stitches and bruising. So the sooner you can begin your exercises, the better.

Lifestyle changes

Many times, lifestyle changes can also help incontinence.

—Keep a urine diary. Set times for going for long and short calls.

—Have a regular sleeping time.

—Avoid alcohol

— Reduce the intake of caffeine

—Eat healthy food

— Implementing good hygiene techniques.

Sample exercises

If you do not experience vaginal heaviness (prolapse), bladder leakage, pain, or abdominal doming (have diastasis recti) during or after any exercise do these:

From 0 to 6 weeks: Do gentle core muscle and posture-improving exercises. Walk and stretch. Do breathing and thoracic expansion exercises.

From 6-12 weeks: Do postnatal posture correcting exercises, flexibility exercises, Pilates or yoga, low-impact cardio exercise like walking, swimming and light strength training with breath control training

From 3-6 months: Progress to core workouts, gradually increasing intensity and duration of low-impact cardio and strength training, and introduce light jogging.

From 6+ months: Progress all of the above, introduce higher-impact exercises like jumping or running.

Long-term: Do mindful movement awareness and strengthening of the pelvic floor, maintain pelvic hygiene, improve breathing flow and control, handle the baby with proper posture, improve overall body fitness, eat healthy foods and increase water intake.

Dr Bhavan Bhavsar is a physical therapist working at M.P Shah Hospital, Nairobi dealing with the newest evidenced-based approaches of pain management.