Why Doctors Should Educate Women on Postnatal Incontinence

Childbirth is not always a smooth process. Many first-time mothers find themselves unprepared for complications after childbirth.

Hemorrhage, infection, pelvic organ prolapse and more, are common complications that women can be left with after pregnancy. Among these possible problems, is incontinence.  Urogynaecology expert, Roger Goldberg, MD, states, “even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50 percent of women”.

Postnatal Incontinence: The Statistics

• According to Continence Foundation of Australia, 37 per cent of pregnant women report urinary incontinence, and up to 47 per cent are still affected six months after birth.
• And as many as one in four women also have faecal incontinence in late pregnancy, with one in five still suffering one year after childbirth.
• Bladder problems are thought to affect 1 in 3 women in the year after childbirth
• 10 percent to 20 percent of women report having stress incontinence leakage that they consider “socially bothersome”

Most women do not know what to expect with bladder and bowel control issues, until the problems crop up. Many women even go years without telling their partner about the problem, which could be solved by more open communication from Doctors and specialists. The 4^th Trimester Project, a study led by Doctors and researchers, gained insight into the experiences of postpartum women. Researchers found that the majority of women in the cohort weren’t aware of treatments that could help them. They also claimed they were too embarrassed to discuss symptoms they were experiencing. Kristin Tully, a Doctor involved in the study, states, “women don’t know about serious complications because their providers don’t always tell them.”

This lack of education leads many women to keep the problem to themselves, even buying sanitary pads instead of proper incontinence products.

Encouraging Discussion

If the communication between patients and specialists improves, new mothers will feel less ashamed and embarrassed about stress incontinence. Doctors and midwives should be encouraged to brief new mothers on the possibility and management of incontinence. Studies have shown that new mothers are likely to benefit from early discussion of healthy bladder habits as part of their postpartum care. The lack of postpartum incontinence education in the UK was highlighted by new mother Gillian Harvey, who compared the support in England in the support in France. She asserts, “at each of my eight week checks following the birth of my children I have been prescribed 20 sessions of physio, to re-educate my pelvic floor”. She goes on to question, “so, why in the UK are we encouraged by adverts to accept incontinence pads as inevitable?” The prevalence of incontinence in women shows that we as a nation should demand more from Nurses and health advisers. Being provided with education and management tips for incontinence is a good starting point.

Stress Incontinence and Pregnancy: The Explanation

Stress incontinence is leakage that takes place when pressure is placed on the bladder. This is often due to weak pelvic floor muscles. Pregnancy and childbirth play a huge role in the weakening of pelvic floor muscles. The weight of a baby can press down on the bladder or pelvic floor muscles, applying extra pressure and weakening the muscles. Additionally, a change in hormones can even cause incontinence. Several hormones that are produced during pregnancy cause relaxation in pelvic tissues and organs. This occurs so the pelvis is more flexible and makes room for a baby, however the bladder and ureters are also affected.

During childbirth itself, the forces on a woman’s body can also cause damage to the pelvic tissues. Forces of the baby can tear the ligaments that anchor the pelvic supporting muscles to the pelvic bones. For some women, this damage does not completely heal.

Why New Mothers Shouldn’t Suffer in Silence

There is actually lots of treatment methods available for stress incontinence. If you are a new mother with incontinence, don’t keep it to yourself. The following options are available:

• A Pessary- pessaries are a popular solution. A pessary is a device that block the urethra or strengthens the pelvic muscles. This can be provided to you by your hospital, GP or incontinence specialist.
• Medications- If natural methods do not work, Doctors often prescribe effective medications to control muscle spasms in the bladder
• Practicing Kegel Exercises- the most popular treatment method for postnatal incontinence is practicing kegel exercises. These are often preferred, as the method is non-invasive and incredibly effective. You can read about how to do these here.
• Surgery- Surgery is often used when other methods have been proven to be ineffective.

Bladder Sling Surgery has a 90 percent success rate. This is often the best surgery option for frequent leakage.

Another surgery option is abdominal suspension, where stitches are placed on both sides of the urethra through a skin incision. The stitches are then attached to a strong ligament that lies on the pubic bone, supporting the bladder or lifting it back to a normal position.

Collagen Injections are another option, which bulk up and strengthen the tissue around the urethra.