Many bladder and bowel problems, particularly during pregnancy, can be due to weak pelvic floor muscles. If you have weak pelvic floor muscles you may:
- leak urine when you cough, sneeze, lift, laugh or do exercise (stress incontinence)
- not be able to control passing wind
- feel an urgent need to empty your bladder or bowel (urge incontinence)
- leak bowel motion after you have been to the toilet
- have trouble cleaning yourself after a bowel motion
- find it hard to pass a bowel motion (constipation)
- feel a lump in your vagina or a sensation of dragging (mostly at the end of the day), which could mean that one or more of your pelvic organs might be sagging down into your vagina (pelvic organ prolapse).
Some women seem more likely to have bladder and bowel problems, even if they have had quite an easy birth. We can't yet tell who these women will be.
Women who already have bladder or bowel symptoms, such as irritable bowel syndrome or an urgent need to pass urine (also called overactive bladder) may be more likely to have this problem worsen or to gain new problems.
Certain things about the birth that can make a woman more likely to have bladder and bowel problems including:
- having a large baby
- having a long labour, particularly during the second (pushing) stage of labour
- having a difficult vaginal delivery, when you have stitches or a tear just outside your vagina.
Choosing a caesarean birth might seem like a way to avoid these problems, but it is not that simple. A caesarean birth might reduce the risk of severe bladder control problems from 10% to 5% for a first baby, but after the third caesarean there may be no benefit at all.
The birth of your baby might have stretched your pelvic floor muscles. Any 'pushing down' action in the first weeks after the baby's birth might stretch the pelvic floor again. You can help to protect your pelvic floor muscles by not pushing down on your pelvic floor. Here are a few ideas to help you:
- try to squeeze, lift and hold your pelvic floor muscles before you sneeze, cough, blow your nose or lift
- cross your legs and squeeze them tightly together before each cough or sneeze
- share the lifting of heavy loads
- don't do bouncing exercises, and
- do pelvic floor muscle training to strengthen your pelvic floor muscles.
Bladder or bowel control problems just after giving birth will often improve in the first six months, as the pelvic floor tissues, muscles and nerves recover.
Regular pelvic floor muscle training kept up over the long term, as well as the right advice will help.
Don't forget to look after yourself at a time when it is easy to neglect your own needs.
The Continence Foundation of Australia has written The Pregnancy Guide for women who are pregnant, planning to become pregnant or have recently had a baby. Health professionals may also find this guide useful.
The booklet contains information about bladder and bowel control during pregnancy and after childbirth, and explains the role of the pelvic floor muscles and how to exercise them. It provides information about a range of topics, including abdominal muscle bracing, sex during and after pregnancy, pregnancy and exercise, haemorrhoids, prolapse, and pelvic floor problems after birth. The booklet also provides information on where to get help if you experience bladder or bowel control problems.
The National Continence Helpline is staffed by continence nurse specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.