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The National Continence Program
ONE IN THREE
WOMEN WHO EVER HAD A BABY
WET THEMSELVES

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 that keep the bladder shut (called the pelvic floor muscles) were also stretched. Even if you had a caesarian 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 happens mostly 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 to get their strength back. 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 likely to start wetting yourself. Following menopause, there is a higher risk that you will wet yourself.

How do my waterworks work?

The bladder itself is a hollow, muscular pump. The bladder fills 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 pelvic floor muscles.

When you are ready, the pelvic floor muscles relax and the bladder squeezes the urine out. Then the cycle begins over again.

What do my pelvic muscles do?

The diagram below shows where the pelvic floor muscles are. These muscles do a number of things such as:

The Muscles of the Pelvic Floor

The Muscles of the Pelvic Floor

What happens if my pelvic floor muscles are weak after the birth?

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 about one in ten Australian women. If you have a feeling of ‘something coming down’, you might have a prolapse.

See your doctor if you are not sure about this

Pelvic floor muscles

How do I exercise my pelvic floor muscles properly?

To begin, sit leaning against a back support (wall or bed).

When you do a proper pelvic floor muscle squeeze you should:

Pelvic floor exercises

A proper pelvic floor squeeze should lift up and hold hard. Pelvic floor exercises should be done quickly and slowly.

Every squeeze, whether quick or slow, should be done as strongly and tightly as you can!

Squeeze and lift three times quickly with no rests (THREE QUICK)

Squeeze, lift and hold for three seconds, three times (THREE SLOW)

Together, this is ONE SET.

Try to do THREE SETS each day.

Squeeze up hard, hold and cough (the knack) THREE TIMES a 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 six. It may take some weeks before you can hold for the count of six. Start with whichever number you can manage to do. This might be any number from one to six.

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 two clean fingers 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 the other with a short rest between each. Filling in the table on page 7 might help you to watch your progress more easily.

ACTIONS Birth to one month 1–3 months 3–6 months 8–12 months
I can hold for how many seconds?
How many squeezes in a row can I do now?

Keeping track of your progress

Use the table above to keep track of your progress.

How can I remember to do my exercises?

The hardest thing about pelvic floor exercises is remembering to do them. It will be easier to remember if you do one set of exercises (or use the knack) each time that you do a certain thing. When you have a shower or a bath is a good time to practice ‘the knack’. Choose from the list which times you think would work best for you.

Red stick–up dots can help you to remember your exercises. You can get these at your newsagency. Stick these up in a couple of places around the house. They can remind you to do your exercises each time you see them. For example:

You could ask your partner or friend to help to 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 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 you feel your partner and be able to respond during sex. You may have pain during sex and if you are breastfeeding you may notice your vagina stays dry even after you are aroused and ready for sex. If you have a problem with leaking urine or you feel your pelvic floor muscles are not as strong after the baby, you might worry about getting back to sex with your partner. If you do have concerns like this your GP or health carer are well able to give you advice about any of these problems. 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 help avoid constipation?

Constipation can lead to incontinence. To avoid constipation:

How can I be sure that I have good bladder habits?

It is normal to:

Try to:

You should ask for help if you notice any of the following:

Summary

What can I do to prevent these things from happening?

Here are some hints to help you:

If you have trouble with your bladder or bowel do not despair! The chances for a cure for an incontinence problem are good if you seek the right advice. Enjoy your pregnancy and your baby. Both before and after your baby is born, remember that it is important to take care of yourself.

Need help?

To find out how to best manage your incontinence:


ONE IN THREE WOMEN WHO EVER HAD A BABY WET THEMSELVES

ISBN: 978-1-74241-598-7
Online ISBN: 978-1-74241-598-7
Publications Approval Number: D0593

Developed by the National Continence Program, an Australian Government Initiative. For more information on the National Continence Program visit the Australian Government’s Bladder and Bowel Health website at www.bladderbowel.gov.au

For information on the location of public toilets nationally, visit the Australian Government’s National Public Toilet Map at www.toiletmap.gov.au

Copyright Statements:

Paper-based publications
© Commonwealth of Australia 2011

This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Communications Branch, Department of Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

Internet sites
© Commonwealth of Australia 2011.

This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Communications Branch, Department of Health and Ageing, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

Written by: Pauline Chiarelli
University of Newcastle


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The National Continence Program
ACTION PLAN 2011–2014
D0502 Sept 2011,
www.health.gov.au
All information in this publication is correct as of September 2011