The Pelvic Floor.

By Janet Thackray
Jun 2018

Many women accept incontinence as part of being female and giving birth, and do not seek help when the problem arises. This can be due to lack of knowledge, shame or embarrassment, and normalisation of incontinence as an aging process. Just wearing a pad will not fix the issue, and it is not a normal part of aging, nor an acceptable consequence of childbirth. There is plenty of help available for incontinence, through many different providers such as specialist physiotherapist, Continence Nurse, GP, and Specialist Doctors. Continence NZ is a not for profit organisation, set up to raise awareness about bowel and bladder incontinence issues. Incontinence, leaks, accidents, dribbles are all words used to describe the involuntary leakage of urine or bowel, and any involuntary leakage is considered abnormal. Incontinence is a debilitating, distressing and embarrassing problem affecting a quarter of the population and a third of women who have given birth. This can range from leaking a tablespoon of urine with coughing, laughing, sneezing to losing a whole bladder full, or being incontinent of a bowel motion.

What do I do if I have a leakage problem?

There are many options open to you if you have a problem with your bowel or bladder. Ideally your first port of call should be your GP, who should assess you and start your initial treatment. If this initial therapy does not bring about relief, do not give up hope. Your GP can direct you to the appropriate bowel or bladder continence service, if the initial therapy was unsuccessful. Your GP can also refer you to your local Continence Nursing Service, who can complete a comprehensive continence assessment. You may require a further referral to a Gynaecologist or a Urologist for a specialist doctors’ opinion, on medical or surgical options for management of urinary leakage, or a Colorectal surgeon with regards to bowel incontinence, or it may be more appropriate to be reviewed by a Pelvic Floor Specialist Physiotherapist. These are specialists in pelvic floor issues such as leakage, prolapse or pelvic pain, who can also assess and begin management of urinary and bowel incontinence.

The most common incontinence conditions that women suffer from are stress urinary incontinence and/or an overactive bladder. I will be discussing these conditions in subsequent issues of Homebirth, followed by bowel issues and urinary tract infections.

Why does having a baby make you wet yourself?

Pregnancy causes the muscles of the pelvic floor to stretch, due to the weight of the pregnancy and the softening of ligaments by pregnancy hormones in preparation for the birth. This is why ladies who have a caesarean section can still experience leakage. Further damage is caused when the baby moves down the vagina, when the muscles and nerves become even more stretched. Muscles can also be cut with an episiotomy or torn at the actual delivery.

Some ladies have leakage following giving birth, but for others the leakage may not arise until later on in life, after subsequent births or after the menopause. Often, we have no idea of the damage incurred until leakage arises in our 50’s or 60’s. That is why it is so important to know how to look after your pelvic floor during and after pregnancy.

Pelvic floor exercises and preventing weight gain are the most important things you can do to prevent incontinence. We need to do pelvic floor exercises before and during pregnancy, and after delivery for the rest of our lives to prevent leakage and further damage. The good news is that seven out of 10 women with stress incontinence, can become dry or significantly improve doing pelvic floor exercises.

We have downloadable information on our website, to teach you how to do these correctly. If these exercises are not working for you, please consult your GP, Practice Nurse, Continence Nurse Specialist or a Physiotherapist for more help and advice.

Exercise and the pelvic floor

It is important to exercise during and after pregnancy, but this needs to be done in a safe way to prevent further damage. Some exercises can cause a lot of stress to the pelvic floor, such as deep lunges, star jumps, trampolining, sit ups and high impact exercise classes. It is important to check with your maternity provider during pregnancy regarding what is an appropriate exercise for you. They will consider your current health, how the pregnancy is progressing, and what to look out for as you start exercising. At Continence NZ we run education courses to train Personal Trainers in safe exercise for women in pregnancy and after giving birth, so ask your personal trainer what is safe for you.

We also have information on safe exercise on our website under Pelvic Floor Focus, for you to download. It may just mean sitting on a swiss ball to support your pelvic floor, whilst lifting hand held weights.

How can I find out more?

Look on our website for pelvic floor safe exercises and ones to avoid. Talk to your personal trainer and get a personalised exercise program just for you. Check out our list of continence professionals and give them a call.

Please also feel free to give us a call on any incontinence issue you may be experiencing, no matter how small, on our Helpline 0800 650 659

My name is Janet Thackray, the Continence Educator for Continence NZ. My role is to educate community groups and individuals on managing incontinence issues. I speak both to the public and professionals and encounter people who have problems, or just want more information about what help is available.

Continence NZ has an extensive website: containing a large amount of information for managing adults’ and children’s incontinence. It contains details on pelvic floor exercises, how to access help, videos, and information on education days. There is a free confidential helpline for asking questions that you may not want to ask your GP initially; 0800 650 659. There is also information on all Continence Nurse Specialists and Pelvic Floor Specialist Physiotherapists who are members of Continence NZ, and we are able to direct you to people in your region who are passionate about helping you with your continence issues.

The website also contains extensive information regarding children’s bowel and bladder continence issues. When children are struggling with bowel or bladder issues, home, school and any socialising can become very difficult. We have information leaflets about children’s bladder and bowel issues which are free to download and some excellent books such as “Poo Hoo” and “Wee Secret”.

We also have a new Facebook page, with up to date information and a question and answer facility. Please have a look and send to your family and friends, a like would be really appreciated!