We love our children, and wouldn’t trade them for anything (well, most of the time), but there sure are some physical results of childbirth we would trade away in a second. Dr. Fareesa Khan with Urogynecology Consultants explains that many pelvic floor disorders originate with pregnancy and delivery. Just being pregnant can cause problems. “As the baby grows, it puts pressure on nerves, and stretches muscles and ligaments” she says. ”Vaginal delivery adds additional stress to nerves and supporting structures. While the body will usually return to normal over time, 25 percent of women will have some type of pelvic floor disorder.”
Khan says that six weeks after delivery, about 35 percent of women will have stress incontinence—urine leakage upon exertion, exercise or sneezing. By the end of a year, that rate falls to 8 to 10 percent. “If women have stress incontinence three to six months after delivery, they are more likely to have it in 10 or 20 years, because the effects of aging have been added,” explains Khan. “Women who are 45 are shocked that they leak urine. They often leak during exercise, so they don’t exercise, and their health declines.”
The problem is often fixable. She suggests they work with a physical therapist to learn how to do pelvic floor strengthening exercises, called Kegel exercises. Manual support devices called pessaries are also helpful in supporting pelvic structures. If conservative measures fail, sling surgery is 85 percent successful in correcting stress incontinence.
Other pelvic floor disorders include fecal incontinence, a prolapsed uterus and episiotomy scar pain. Prolapse, where the uterus comes down into the vagina, is usually due to multiple deliveries and family history. “All these are quality-of-life issues, not life threatening, but if it is disturbing, you should get help,” advises Khan. “Prevention through lifestyle is a big part of warding off pelvic floor issues.” Smoking and excess weight put more stress on the pelvic floor, she notes.
Dr. Lewis Wall, professor of obstetrics and gynecology at Washington University School of Medicine, says the take-home message is, “Loss of urine is not a normal or inevitable part of aging. There are many different reasons and treatments for stress incontinence.” He says treating incontinence does not necessarily mean surgery. There are many alternative therapies, and anyone with pelvic floor problems should have a thorough evaluation. “Women put up with it for too long, probably because they are used to dealing with fluid issues,,” Wall says. “At least one-third of menstrual pad sales are for bladder leakage.”
He advises women not to allow themselves to be brushed off when they raise the issue. They should see a urologist or urogynecologist who is willing to do a good history and discuss a variety of options, not just a favorite procedure, Wall says. “The pelvic floor is a complex neuromuscular system influenced by the back, spine, posture, gait and childbearing. For non-surgical therapy to be effective requires a physical therapist with specialized knowledge of the pelvic floor. Washington University has a nationally ranked group of physical therapists, several of whom specialize in pelvic floor work.”
Dr. Octavio Chirino, chairman of obstetrics and gynecology at St. John’s Mercy Medical Center, says that stress urinary incontinence is the most frequent thing women notice after childbirth and with aging. Other symptoms include low back pain, uterus prolapse or even hernias. “What happens to women at this point in life is a combination of things: genetics and the strength of their collagen, stress caused by pregnancy and childbirth, and weight gain, particularly around the abdomen and pelvis, that puts pressure on the pelvic floor,” he says.
“There is a misconception that having a cesarean section avoids all the pelvic floor problems,” Chirino says. “That’s not necessarily true, although vaginal birth seems to exacerbate them.” He says women can head off later problems by being in the best shape possible before childbirth , and by staying active and well-nourished after afterward.