1. Do your pelvic floor exercises
Pregnancy and birth create a lot of stress on your pelvic floor muscles, which can leave them weakened and overstretched. To find your pelvic floor muscles, think about the muscles that squeeze and lift when you try to stop the flow of your urine, and engage those.
Many mothers experience stress incontinence, which is bladder accidents when coughing, sneezing, laughing or lifting. It is important to squeeze the pelvic floor muscles just before these stress-inducing activities. Coordination of your pelvic floor muscles with breathing is key - try this pelvic floor coordination exercise.
- Breathe in.
- Squeeze and lift your pelvic floor. Hold as you breathe out.
- Relax your pelvic floor and breathe in.
- Repeat 10 times.
For some women basic pelvic floor exercises are not enough. The pelvic floor muscles need to be integrated into other exercise regimes and into your daily acts of living. A pelvic floor program with functional exercise is essential for long-term control of your bladder and bowels.
2. Fix constipation
One of the biggest complaints pregnant women have is constipation, and unfortunately this can linger after birth in some women. If a woman has had significant tearing at birth, this can worsen constipation, and in some cases bring on bowel control problems.
Addressing constipation means less pressure on the pelvic organs and pelvic floor muscles. Women with constipation should drink plenty of fluids, eat more leafy green and colourful vegetables, identify and remove food sensitivities such as FODMAPs and perform regular exercise. Sitting on the toilet with the feet elevated on a stool can also help to relax the pelvic floor muscles and allow for easier bowel emptying.
3. Check for pelvic organ prolapse
30-50% of first-time mums will develop a prolapse, which is when one or more of your pelvic organs sag down lower in your pelvis. This can be one of the root causes of postnatal incontinence. Symptoms of prolapse include bladder or bowel control problems, heaviness or dragging sensations, lower back or lower abdominal pain, incomplete emptying or a visible bulge down there.
See a women’s health physiotherapist who can check if you have a prolapse, which prolapse you have, the severity of the prolapse, and can even fit you for a support device called a pessary to help lift your organs back up, so that it doesn’t worsen over time. Mums who have given birth vaginally and who have had a c-section can develop prolapse.
4. Keep away from bladder irritants
If you feel like you’re always busting to go to the bathroom, and sometimes not making it in time, then you may have an overactive bladder or urge urinary incontinence. In these cases, keeping away from common bladder irritants can help. These include things like caffeine, artificial sweeteners and carbonated drinks - so that’s a huge no on the Diet Coke!
Seeing a women’s health physiotherapist can also be helpful to identify your urgency triggers, teach you urge suppression strategies and get you on a bladder drill program to eliminate the urgency and incontinence. Sometimes the urgency can be due to a prolapse, so identifying this early is crucial.
5. Speak to a doctor about vaginal oestrogen
In the postpartum period, pregnancy and breastfeeding hormones are surging in your body. The breastfeeding hormone, prolactin, inhibits the production of oestrogen, which contributes to the loose and dry feelings down there. If you notice pain, dryness or skin tears down there, especially with sex, consider speaking to your GP about vaginal oestrogen cream. This can help create more tautness vaginally, and can help improve incontinence.
While postnatal incontinence is extremely common, it is not normal. With a few exercise, diet and lifestyle changes, women can be cured. You don’t have to put up with it, and you can get back control.
Heba Shaheed is co-founder and CEO of The Pelvic Expert, a digital wellbeing platform specialising in maternal, menstrual and hormone health. Heba is the host of the World’s Largest Online Pregnancy & Motherhood Summit, taking place in September. The Pelvic Expert provides holistic and research-based, women-focussed, online wellbeing programs to corporates, private health insurers, workplaces and individuals.