I just caught a commercial for a new brand of tampons and pads. The gist of the commercial was natural products and female empowerment and I’m all for it! Until the part where they proudly said “We bleed, We leak…” and I was throwing my shoe, cursing: “$*&% Noooooo!! WE DON’T NEED TO LEAK!”
Yes, it is extremely common for women to have bladder leaks. 26% of women between the ages of 18-59 experience involuntary urinary leakage and this problem affects more than 25 million people in the US overall. But COMMON does not mean NORMAL. Normalizing bladder leakage adds to the problem. Our medical system often waves people away if they complain of urinary incontinence (bladder leaks), especially if the person voicing their concern happens to be older or postpartum.
I’m all for products that will help people be more comfortable and confident on their path to recovery, but the cynical side of me recognizes that these companies have a lot to gain from this normalization and lack of treatment. Especially since the incontinence industry was estimated at $65.9 billion in 2007, with projected costs up to $82.6 billion in 2020 and some women spend as much as $900 per year on leakage products and costs related to incontinence.
It doesn’t need to be this way. There’s a lot we can do to treat bladder leaks! Some thoughts to consider:
2. Koyne KS, et al. (2014). Economic burden of urinary urge incontinence in the United States: A systematic review. Journal of Managed Care Pharmacy. 20(2). 130-140.
3. Subak, L, et al. (2006). The “Costs” of urinary incontinence for women. Obstetric Gynecology. 107(4). 908-916.
4. Bump, R., et al (1991). Assessment of kegel pelvic muscle exercise performance after brief verbal instruction. American Obstetrics and Gynecology. 165(2). 323-329.
5. Henderson, JW., et al. (2014). Can women correctly contract their pelvic floor muscles without formal instruction? Female Pelvic Medicine & Reconstructive Surgery. 19(1). 8-12.
As a pelvic floor PT, I find my clients feel really unprepared for returning to intercourse after birth. Many women go to their 6 week postpartum visit, are told they can have sex, and feel COMPLETELY overwhelmed by this prospect. “You think I can do what?? Already?!” Though you’re often given the go ahead at 6 weeks, you may receive little advice about how to return to sex and it may feel taboo to ask your doctor about it. So let’s get into it! There’s basically nothing I won’t talk about...
Dear New Mom,
Like many women, you may have waited a full six weeks before seeing your OB after giving birth. You struggled and pushed and stayed up all hours, and maybe had major abdominal surgery (hi, c-section), and then a few days later you were waved out the door with an infant and no instruction manual. Six weeks of a whole new life: crying, rocking, pain, joy, struggle, love, and drama. Then, you get to your six week postpartum visit, sleep deprived and overwhelmed, and your OB says that you’re “healed” and “good to go” back to exercise, sex, and work. And you were probably thinking, “What?!?!”
I want you to know that no woman has ever told me they felt back to normal at six weeks postpartum. You are not alone. The six week visit can be traumatic because of the vast chasm between how you feel now and what you knew as normal before. You may look at your OB and wonder if they really recognize you, do they really see you?
To give your OB the benefit of the doubt, they likely mean you are progressing normally through this recovery process. Their time with you is so limited, they really only have the opportunity to check on healing of your uterus, any perineal tears or c-section scars, and talk to you about birth control. It is relatively rare the OB will check for prolapse or diatasis recti and they almost never assess your pelvic floor muscle awareness or strength. This brief visit and the recommendation to return to all activities can result in the unrealistic expectation that you should feel back to normal after 6 weeks.
This interaction may make you feel behind the curve or ashamed of your current body and how different it is. You may worry your OB is saying this is your “new normal”, and that this is all the recovery you can hope to achieve. This shame or worry may stop you from sharing how you really feel with others. You look around at other postpartum women, who seem to be happily coping and focused on their babies, and wonder, “Is this just me?” No, it’s not just you, and we need to talk about this together!
I want you to know that we’re here to help. Your body took nine months to prepare for this and will need time to recover. Fun fact: just the uterus shrinking back down to normal size takes about 11-12 weeks! There will be so many changes and you need knowledgeable, caring providers supporting you through this process.
In some other countries (bonjour, France!), this is standard care. Every postpartum woman gets referred to pelvic floor physical therapy after every birth. This makes sense! Your whole body changes during pregnancy and the delivery process can be very physically (and emotionally) traumatic. In the US, if someone tears their ACL, they often receive up to 6 months of rehab. Well, a lot more than your knee is affected during pregnancy and birth...
Postpartum women need support here in the United States AND we need to talk openly about our bodies and how we really feel.
Things are slowly changing in the US and the American College of Obstetrics and Gynecology has revised their recommendations for the postpartum period, to offer earlier postpartum visits and extend care through 12 weeks. Until more of these changes take effect though, you will need to continue to self advocate and seek out support. You do not have to get used to incontinence, painful sex, feeling weak in your core, or pelvic pain. Please reach out to pelvic floor PTs, The Lotus Method, postpartum doulas, lactation consultants, and support groups to help you on this journey.
Jessica Abele, PT, DPT, NCS
Therapy Roo Physical Therapy
Stay Tuned.... (No, that's not my house. Or my cat.)