Part II of a guest blog series for Lokahi Acupuncture by Dr. Janet Yu. Read part I here.

Postpartum bladder challenges: urinary incontinence (UI) & a pelvic muscle primer

The most common postpartum bladder challenge I see in my clinic each day is urinary incontinence, which refers to when a person accidentally leaks urine. Many patients leak urine when performing everyday activities like jumping, sneezing, and coughing.

As far as postpartum maladies go, urinary incontinence is the most common. At three months postpartum, 33% of patients have urinary leakage; of those, 92% will continue to have UI at one year postpartum. Many people incorrectly believe that UI occurs when the pelvic floor muscles are weak. However, UI can occur when the pelvic floor muscles are tight.

Don’t know what your pelvic floor muscles are?

Most people don’t either until they experience dysfunction. The pelvic floor muscles encompass the muscles and connective tissues that support organs in your pelvis, such as your bladder, bowel (large intestine), and reproductive organs. Think of your pelvic floor like a sling; your muscles hold these organs in place while simultaneously supporting your bodily functions like peeing, pooping, and sex. If something isn’t working as it should – if it’s overly tight or weak, for example – you experience pelvic floor dysfunction.

Tips to rectify urinary incontinence

Many pelvic floor patients initially think they will leak urine for the rest of their lives after giving birth, but fortunately, that’s not true! Patients can rectify urinary incontinence through pelvic floor physical therapy, such as learning how to perform the knack, diaphragmatic breathing, and breath holding. I’ll walk you through these three options below.

The Knack:

The knack is a reflex that patients may need to retrain when they’re postpartum. It refers to when you lift your pelvic floor before you sneeze or cough. It’s a quick and simple technique that provides a strong and well-timed contraction of the pelvic floor muscles. When done correctly, the knack can help you prevent urinary incontinence episodes. As patients practice this over time, it will become a reflex again.

Diaphragmatic breathing:

The diaphragm and the pelvic floor mirror each other. Every time you inhale air, the diaphragm moves down, as does your pelvic floor. Similarly, when you exhale, the diaphragm moves up, as does your pelvic floor.

Here’s an easy-to-remember tip: when you’re doing a diaphragmatic breath, take a nice, long exhalation breath. When we pair a small inhale through the nose with a long exhale through the mouth, we can help restore our diaphragmatic breathing, which in turn can help to activate and relax the pelvic floor.

Breathing Properly

Eliminating the pressure in your abdomen by breathing out. Avoid holding your breath or squeezing your muscles as you lift your baby or stand up. Relax your abs and glutes to help you avoid putting pressure on your bladder and pelvic floor. Focus on exhaling as you lift your child and transition from sitting to standing.

When to see a pelvic floor physical therapist

So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.

I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.

Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary incontinence, fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.

Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.

Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS

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