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:
- Help to close off the bladder, the vagina (birth canal) and the back passage (the anus).
- Help to hold the bladder, the uterus (womb) and bowel in their proper place.
The Muscles of the Pelvic Floor
What happens if my pelvic floor muscles are weak after the birth?
- You might leak urine when you cough, sneeze, lift, laugh or exercise.
- You might not be able to control your wind.
- You might feel a sense of urgency when you need to empty your bladder or your bowel.
- You might not have proper support for the bladder, your uterus or your bowel.
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:
- Squeeze, lift and hold as if you are trying not to pass wind.
- Feel the pelvic floor lift. At first the movement that you feel may be very small. If your muscles are weak, you may feel very little at all.
- Make sure that you do not have any downward movement of your pelvic floor when you try to do a squeeze and lift.
- The lower part of your tummy muscles should gently pull in as you squeeze and lift your pelvic floor muscles.
- You might like to use a hand mirror to see your pelvic floor working, if you feel comfortable doing this.
- Tighten, lift and squeeze your pelvic floor muscles before every cough, sneeze, and lift. You should try to do this for the rest of your life. This is called having “the knack”.
- Straight after the birth of your baby, you should follow the simple exercise plan below for about six weeks.
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.
- After you have finished going to the toilet.
- When you wash your hands.
- When you have a drink.
- When you change the baby.
- When you feed the baby.
- When you have a shower.
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:
- Near the toilet button or behind the toilet door.
- Near where you keep the tea or coffee.
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:
- Drink plenty of fluid (2 litres per day) especially if you are breast feeding.
- Drink fruit juices such as pear or prune juice.
- Eat high fibre breads and breakfast cereals.
- Eating fruit is a MUST. 2-3 pieces each day.
- Use a natural fibre supplement – Metamucil or Fybogel from the supermarket or pharmacy. Psyllium husks are much cheaper (get these from a health food shop or supermarket).
- Vegetables and lentils or pulses are all high in fibre. Try to eat 5 different vegetables every day.
- When you sit on the toilet, raise your heels.
- Relax your pelvic floor, bulge the lower part of your tummy forward.
- Gently push keeping your tummy bulged forward, hold the push, then relax.
- Repeat – push, hold and relax.
How can I be sure that I have good bladder habits?
It is normal to:
- Go to the toilet about 6-8 times each day. Try not to go “just in case”.
- You should pass about 300-400ml each time you go to the toilet.
- It is OK to get up once each night to pass urine. Try not to go just because you have to get up to the baby.
- Drink at least two litres of fluid each day.
- Avoid drinking coffee or cola drinks or too much tea.
Caffeine in these drinks might affect your bladder.
You should ask for help if you notice any of the following:
- Any leaking of urine.
- Needing to rush when you need to go to the toilet.
- Not being able to hold on when you want to.
- Leaking urine on your way to the toilet.
- Burning or stinging inside when you pass urine.
- Having to strain to start the flow of urine.
What can I do to prevent these things from happening?
- You can start some pelvic floor exercises.
- Make sure that you have good bladder and bowel habits.
- Keep your body weight within normal limits.
- Only do pelvic floor safe exercises when getting back into shape after having your baby
Here are some hints to help you:
- You should try to avoid downward movement of your pelvic floor. The only time you should have downward movement of your pelvic floor is when you are opening your bowels.
- Avoid constipation.
- When you need to open your bowels, you can support the front part of your pelvic floor with your hand to try to stop it from over-stretching as you bear down.
- Use ‘the knack’ for every cough, sneeze, or lift.
- If your pelvic floor muscles feel weak, try crossing your legs and squeezing them tightly together before each cough or sneeze.
- Try to avoid any heavy lifting (even at the gym) or bouncing exercises like jumping jacks for at least three months.
- Even if you have a problem with wetting yourself, you should keep on with gentle exercises, walking or swimming.
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.
To find out how to best manage your incontinence:
- Speak with your GP, the specialist or midwife who are helping you after the birth of your baby, a physiotherapist or a continence nurse advisor.
- The Australian Physiotherapy Association can give you the name of the physiotherapist nearest to you who has a special interest in helping women with pelvic floor problems.
- Call the National Continence Helpline Freecall™ 1800 33 00 66. The National Continence Helpline is staffed by professional continence nurse advisers who can provide advice and referral.
ONE IN THREE WOMEN WHO EVER HAD A BABY WET THEMSELVES
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
© 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 firstname.lastname@example.org.
© 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 email@example.com.
Written by: Pauline Chiarelli
University of Newcastle
The National Continence Program
ACTION PLAN 2011–2014
D0502 Sept 2011,
All information in this publication is correct as of September 2011