What’s wrong with me?
Leaks of urine occurring after childbirth should not be considered normal, and nor are they a natural consequence of ageing. In both situations, and so long as there are involuntary losses of urine, you should visit an experienced professional; there is no need to hide it or feel ashamed, nor should you allow the problem to restrict your daily activities.
The muscles and other anatomical structures that form the pelvic floor, which support and promote correct function of the bladder, vagina and rectum, are all overloaded during pregnancy. These muscles are strained during childbirth and sometimes stretched to the maximum. In some women these muscles and the tissues around them never fully recover their tightness and the structures are weakened; this could favour the appearance of the symptoms of urinary incontinence and other problems associated with the pelvic floor.
During pregnancy and the first few months after childbirth, it is important for women to complete pelvic floor muscle strengthening exercises and also avoid any activities that could imply an excessive strain on this muscle group. Women should ensure that there pelvic floor muscles are well toned and present a good contraction and relaxation capacity, during both voluntary and reflex movements.
What tests will I undergo?
This is the key test for identifying the exact type of urinary incontinence and diagnosing other urinary dysfunctions. The purpose is to measure the bladder’s function while it fills with fluid and when urinating.
Cystocopy is a test used by urologists to obtain a view inside the bladder and urethra (passageway through which urine is discharged).
What treatments are available?
While the operation may have resolved your urinary incontinence, you are still advised to maintain good muscular tone and continue practising the exercises regularly.
Patients are advised to rest for a period of 4–6 weeks after the operation. However, ideally you should avoid any activities that require significant physical strain for 3 months. To ensure the operation has a successful, long-lasting outcome, patients should avoid constipation and physical efforts involving the pelvic floor muscles.
Every case is different. Treatment options can range from assimilating some lifestyle changes, completing pelvic floor muscle exercises, taking medicines or undergoing surgery. The latter option is only indicated in women with urinary incontinence due to strain.
It is worth remembering that a high percentage of women with urinary incontinence manage to cure or significantly improve their symptoms after receiving treatment.
Living with Urinary Incontinence
The volume of fluids you drink is directly proportional to the volume of urine you produce. The correct volume is approximately 1.5 litres per day, taking into account that all the foods in a suitable diet also contain a variable amount of water.
If you have stress incontinence, then it is a good idea to empty the bladder before any planned activity involving physical strain (a session in the gym, walking, etc.).
You should moderate your consumption of alcoholic and fizzy drinks, coffee, tea, citrus fruits or chocolate. A decreased intake of these foods can help limit the number of incontinence episodes, especially in the case of women with urinary urgency or who have to urinate very frequently (overactive bladder).
Overweight and obesity are significant risk factors for incontinence as they translate into an excessive load on the pelvic floor structures causing them to be progressively stretched and weakened.
You should not attempt pelvic floor muscle exercises without first being assessed by the relevant professionals who shall confirm you can contract these muscles correctly.
Before starting the training programme, the therapist will assess your muscle tone and ability to perform the pelvic floor muscle contraction exercises correctly. They shall then use this initial evaluation to plan a personalised exercise programme for you.
Individuals who learn with a leaflet usually do the exercises incorrectly; this can aggravate the problem.
They do not require any special time period; you can train the muscles at any time of the day and incorporate the exercises into your daily routine. For example, on the bus to work, in the shower, while you are cooking, watching television, etc.
No. The best way of doing the exercises is to close the anal opening, as if you were trying to stop gases from escaping, and at the same time close the vaginal opening. Stopping the flow of urine while on the toilet is a good way of identifying the pelvic floor muscles, but you should not practise the exercises while urinating.
The pelvic floor muscles can be exercised in different positions (sat down, stood up, in the foetal position, etc.); each individual should find their most comfortable position.