When Is It Time to Get Serious About Leaking After Pregnancy?

OT and Pelvic Floor Rehabilitation

When is it time to get serious about leaking after pregnancy. GettyImages

Leaking is a problem I would rather ignore. As dreadful as it is to leak urine when jumping, sneezing, running or lifting, I tell myself that it only happens occasionally. Well, unless I have a cold or want to exercise regularly.

It is a problem that is easy to normalize. There is always another mom to commiserate with.

It is also easy to justify. I remember the enormous pressure my body was under during pregnancy and the fact that leaking is the last remaining artifact seems like a small miracle.

But, now that my child is 2, I’m realizing that the “ignoring-it” strategy isn’t working. I’m left wondering how serious this problem is and if/how to address it.

A quick online search reveals that definitions of this problem, technically called “stress incontinence,” are plentiful. But, I found the advice about what to do is sparse and varied. Do Kegels. Don’t do Kegels. See a therapist after one month. Exercise and it should go away naturally.

I decided to reach out to Lindsey Vestal, a fellow occupational therapist who specializes in pelvic floor therapy. Lindsey makes house calls for pre and post-natal women in New York City.

Is Leaking the New Normal?

First, I wanted to know at which point it switches from being reasonable to hope the problem will go away naturally to being an indicator of your new normal.

The first question Lindsey asked me was if I was still breastfeeding. During breastfeeding your body releases significantly lower levels of estrogen and progesterone. This hormone drop mimics the effect menopause will have on your vaginal tissue– the tissue will thin and become drier. This can play a role in leaking.

After you have stopped breastfeeding for 3-9 months, hormone levels will return to normal. That is when you really get a chance to see what your new normal will be like. So for me, a year out from breastfeeding, this is likely a problem that will not naturally go away.

Lindsey made it plain that at any point after pregnancy, leaking does not need to be accepted as normal. “Leaking may be common, but it’s not normal, “she said. “When the pelvic floor is weakened and can’t support the structures above it (evident by leaking), it’s an opportunity to rebalance it. And the pelvic floor is just one part of your core. The lower abs, spinal muscles, and even the diaphragm are our core. All of these areas may become deconditioned after pregnancy. Pelvic floor rehabilitation is an opportunity to restore these areas.”

The Long-Term Consequences of a Weak Pelvic Floor

So, if this is my new normal, my second question was, is it that bad of a problem? If I chose to do nothing about it, will it keep getting worse?

Through our conversation, I quickly realized time and upcoming changes in my body are not on my side. If I have another pregnancy, the weight gain, birth process, and hormone fluctuation will again put increased stress on muscles that are already out of balance.

As menopause approaches, my estrogen levels will decrease again, possibly causing an exacerbation of symptoms.

When Is It Time to Seek Help?

A pelvic floor therapist can help at any point. However, sometimes other post-natal/life issues take precedence, and that’s OK.

Knowing the hormonal timeline, you may choose to wait and see if the leaking normalizes after breastfeeding has ended. Another approach would be to stick diligently to a core exercise program for a few months and see if you can correct the problem on your own.

The important thing to remember is that there are options out there for you. This is not a condition you have to live with. You can be proactive about halting its advance.

“In a perfect world,” said Vestal, “I would see my patients before they gave birth to provide coaching on relaxing the pelvic floor. The less trauma that occurs, the less restoration that will need to happen. When it comes to post-natal care, I admire the French model, which gives at least one session of general self-care principles and education as well as the chance to screen for whether further rehabilitation is needed.”

What to Expect from an Evaluation

One of my hang-ups about seeking evaluation was fear of discomfort. I dreaded the idea of stirrups and the speculum. Lindsey assured me that an evaluation with a pelvic floor rehab therapist is much more gentle.

“People can anticipate an in-depth conversation,” said Vestal. “I ask about their medical history, symptoms, their labor and delivery story, and their previous physical activity levels. I take a holistic view of their overall health. I want to get to know my client and put them at ease; there is vulnerability involved in discussing these sensitive topics.”

“A gentle internal and external exam is next. I am evaluating both the strength and endurance of the pelvic floor muscles. Just like rehabbing any other muscle in the body, you need to know its ability to contract and sustain that contraction so that you can restore it.”

What to Expect From Treatment

Lindsey has the opportunity to see patients in their home, so treatment can be integrated into a patient’s day-to-day life. The type of treatment varies with each individual case, but common techniques include the following:  

  • Biofeedback, which allows you to see on a computer screen what muscles are being recruited
  • Body Mechanics Training (picking up and carrying baby, crib mechanics, etc.)
  • Dietary Habits Education
  • Myofascial Release
  • Lifestyle Modifications
  • Scar Tissue Restoration
  • General Post-natal strengthening program, emphasizing postural factors such as scapular recruitment, hip, and glute strength

A Note on Post-Natal Exercising

Wrapped up in the issue of leaking is often the issue of exercise. People want to know if they can start exercising even when their pelvic floor is out of whack. For many, the drive to exercise is related to the desire to shed pregnancy pounds.

Vestal advises, "Take the time to address the pelvic floor first. When you are running, you pound 4x your body weight through the pelvic floor, which escalates the process of stretching and weakening your pelvic floor. If you take 6-8 weeks to rehab your pelvic floor, you will enjoy the process of working out much more.”

How to Find a Pelvic Floor Rehab Specialist

Both occupational and physical therapists can become pelvic floor specialists. But it is important to note that specific training regarding this type of treatment is often not given in grad school.

You will need to seek out at therapists who have undergone further training. A simple Google search may help you find one in your area. The Physical Therapist Locator is another resource.

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