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Bladder Leaks are not normal.

5/10/2019

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:

Find what triggers your leaks: Is it a mechanical reason like coughing, laughing, sneezing, or the enemy of many women - the trampoline 😱? Or, is it more related to times you experience a strong urge to pee, such as seeing a bathroom, hearing water, or turning your key in the door when you get home? Maybe you leak in both types of situations? Knowing these triggers helps decide treatment.
Log how frequently you actually go to the bathroom: For overwhelmed postpartum women, you may be forgetting to pee! If you’re drinking a lot of extra water for breastfeeding and forgetting to go to the bathroom regularly, this may be a big part of your problem. Make sure you’re going to the bathroom every 2-3 hours. Conversely, if you’ve been leaking for a while, you may have overcompensated by going to the bathroom too frequently. Your bladder may have learned not to hold. Getting a clearer picture of how frequently you pee and when you leak helps us make smart changes.
You’re doing kegels but they aren’t working: Research estimates 15-25% of women do kegels incorrectly with only verbal instruction. Many women compensate with other muscle groups instead of the pelvic floor, or they overuse the posterior pelvic floor muscles (the ones closer to the anus). The muscles that help with bladder leaks are up front (around the urethra), so overusing the back pelvic floor won’t help! An internal pelvic floor exam will determine if you’re using the correct muscles at the correct time.
Kegels aren’t always the answer: A tight and overactive pelvic floor can also lead to leakage. If your muscles are overworked, they may give out when you really need them and not be there to prevent leaks, especially at the end of the day.

If you experience bladder leaks, please seek treatment!

Sources:
1. https://www.nafc.org/
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.

Let's get intimate...talking sex after baby

5/1/2019

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...

It’s ok if you don’t feel ready. You and your body have been through A LOT. It is absolutely fine to wait longer. If your partner is mad about it, you can tell them I said so :). I’ll take the blame. Maybe you experienced a tear, have pain or prolapse, or you’re just EXHAUSTED. Wait until you’re ready. Please. Pushing through sex because you think you should can cause more pain.
Start with something less...invasive. Your body is different and the way you feel about it is different too. Start with lower pressure sexuality and intimacy. Have an orgasm! Get creative with your partner, get to know your body again, and have a good, intimate experience externally first. Sexuality is not just about vaginal intercourse.
USE LUBRICANT. I cannot stress this enough. Postpartum, your estrogen level drops significantly. Especially if you’re breastfeeding, but even if you’re not. This drop in estrogen leads to more vaginal dryness, so lubricate! Lubricants are not created equal, so try a few options to find your favorite. Check reviews online or visit the very knowledgeable folks at Good Vibrations to get some advice. Many people love a good water based lubricant, like Slippery Stuff, which I use for exams. If a water based lube doesn’t last long enough for you and you have to keep reapplying, you may prefer a hybrid or silicone lubricant. Sliquid is a good quality brand with water based, hybrid, and silicone options.
Scar tissue massage is your friend! I know touching your scar, or even looking at it, may feel scary but getting it moving better can make a world of difference to comfort with intercourse. This goes for perineal OR c-section scars! Try working on your scar in the shower! It’s a great time to do it because your hands are already clean and your body is warm with good blood flow to your skin. If it’s your perineal scar you’re working on, put one foot up on the side of the tub to reach better. Put your fingers on either side of your scar and wiggle it gently, sliding it side to side, up/down, in circles etc. The point is not to push into heavy pain, you want gentle stretching only. No more than 4/10 on a discomfort scale. If it hurts too much, you won’t be able to relax, which defeats the purpose. Don’t forget to breathe!
Breastfeeding is not birth control!! There is a misconception (pun intended) out there that you can’t get pregnant if you’re breastfeeding. Some women don’t get their periods the entire time they’re breastfeeding, but others will. Because you ovulate before you get your period, and periods during this time can be irregular, you need to use a form of birth control! Unless your dream was always to have kids one year apart…
Don’t be surprised if you lactate during sex. I know...that’s something you didn’t expect. Arousal can lead to lactation, so you may get some leakage of milk during intercourse. Some women choose to wear a bra and nursing pads during sex if this bothers them.
See a pelvic floor PT! (That’s always my answer, right?) You might not have known we can help with this, but a pelvic floor exam can give you a better picture of what’s causing the problem with intercourse. Is it tight or sore muscles? Prolapse? Scar tissue? Let’s find out and give you recommendations tailored specifically for you!

At Home With Your Pelvis

Bladder Leaks are not normal.

Let's get intimate...talking sex after baby

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