Preventing Urinary Incontinence During Labor and Delivery

Frequent trips to the bathroom? You’re not alone. But, what if your ability to control your bladder after pregnancy was greatly reduced? It happens to many women, and unfortunately, it’s just not discussed enough to embarrassment and misinformation. Today, we’re breaking down those barriers and taking an honest look on how pregnancy and labor and delivery can impact urinary incontinence.

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Preggie Pals
Preventing Urinary Incontinence During Labor and Delivery

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

Destiny Bochinski: If you have been pregnant before, you are no stranger to frequent visits to the bathroom to pee, but what if the ability to control your urge was greatly affected after giving birth to your child. Are there ways to prevent this from happening or reduce your odds? I am Destiny Bochinski, a physical therapist specializing in the pelvic floor an area that can be greatly impacted during labor and delivery. This is Preggie Pals’ episode 74.

[Theme Music/ Intro]

Sunny Gault: Welcome to Preggie Pals’, Broadcasting from the Birth Education Center of San Diego. Preggie Pals’ is your weekly online-on-the-go support group for expecting parents and those hoping to become pregnant. I am your host Sunny Gault and I am joined here by Stephanie, she is our Preggie Pals’ produce. Stephanie before we get started lets tell all of our listeners about our new Virtual Panelist program.

Stephanie Saalfeld: Hi listeners, so we want you to be a virtual panelist, no matter where you are if you are in the San Diego area and the United States or in the world, we would like you to like our Preggie Pals’ facebook page and follow us on twitter. If you are on twitter it’s the #preggiepalsVP. Before we record our show, we are going to be releasing sneak preview questions and we want your input, we want your comments, questions for our expert and we talk about them on the show. So if you want more information, you can go to www.preggiepals.com , under the community tab and be a virtual panelist.

Sunny Gault: Thanks Stephanie! Have you guys joined our Preggie Pals’ Club? Our members get bonus content after each new show plus special give aways and discounts and you will also get a free subscription to pregnancy magazine. For more information visit our website, www.preggiepals.com and thanks to everyone who is listening to this episode through our awesome Preggie Pals Apps, we have so many of them now, I think there is 4 total. They are available in the Apple and Android market place and in my opinion it is the easiest way, most convenient way to listen to the show especially if you are an “on the go parent” who are always out and about…you feel like I am always out and about doing something with my kids and another great thing, it is absolutely free. Our Apps are free. So download our Apps today!

Let’s meet everyone that is joining us here in the studio, you guys know me. I am the current host of Preggie Pals’. I am 35 year-old and I am the owner of New Mummy Media which produces Preggie Pals’, Parent Savers, The Boob Group and coming in January Twin Talks. My due date is…well I will just call my C-Section date. I am having a C-Section and it is scheduled for December 2nd. I am pregnant with identical twin girls and I have two little boys at home already, Sayer who is 3 years-old and Urban who is about 17 months-old and Stephanie why don’t you introduce yourself?

Stephanie Saalfeld: Hi I’m Stephanie. I’m 30. I have a little girl at home, her name is Savannah and she is 8 and a half month… time goes so fast. And, what do I do? I’m a producer for Preggie Pals’.

Sunny Gault: Taking my place as host of Preggie Pals’ is going to be Annie Laird, Annie is, she’s been a panelist on the show for a long time and some of our other shows as well, and we are really excited to have her join our team as a host. So we’re going to be trading episodes back and forth for the next few months, but Annie tell us a little bit more about yourself?

Annie Laird: My name is Annie. I’m 35. During the day I’m a government contractor and then on the weekends my fun job is going to be hosting Preggie Pals’. So, I really have enjoyed being a panelist on this show and I already have hosted a couple of episodes. So looking forward to continuing that more after my 3rd baby is born, which is going to be next month in October. We are not sure about the baby’s gender but we are planning a home birth. I have 2 children already and my 8 year-old Clara and my 1 year-old Lucy.

Sunny Gault: Alright! I want to introduce Destiny real quick here, even as part of our panelist because she’s been a panelist on the show. She’s been an expert a couple of times, and she’s pregnant. So Destiny, tell us a little bit more about yourself.

Destiny Bochinski: I’m Destiny. I’m 34. I’m pregnant with my 2nd. My son Talan, he will be 3 next month on October 20th. My due date for this little girl is November 2nd, we had a home birth with Talan and we’re planning a homebirth with the same midwife again. I’m a physical therapist I specialize in pelvic floor but I also see orthopedic, general orthopedic patients as well. So I have a pretty good mix of the two and I’ve been doing that for a little over 5 years now.

Sunny Gault: Very good! Thanks ladies for joining us today.

Destiny Bochinski: Thank you!

[Theme Music]

Sunny Gault: Before we begin with today’s show, here is some prenatal fitness tips from Lisa Druxman of Stroller Strides.

Lisa Druxman: Hi Preggie Pals’, I’m Lisa Druxman, fitness expert and chief founding mom of Stroller Strides, a fitness program for moms and their babies. I’m here to answer some of your most common questions when it comes to exercise and pregnancy. Today I’m going to give you some good ideas to improve labor and delivery. Now there are some mixed reports on the effects of exercise during pregnancy and on the course of outcome of your labor and delivery. Some studies honestly have shown that it has no effect, yet others shows that exercise has shorter labors and less painful labors and to me that sounds like a pretty good incentive.

Overall I’m going to tell you that the best thing you can do for a better labor is going to be just to exercise consistently throughout your pregnancy. Make sure you’re getting cardiovascular training, make sure you’re getting strength training, but also think about what are some of the positions that you’re going to be in during pregnancy. I want to see you doing a lot of squat so that your legs don’t fatigue during pregnancy and thinking about hip opening exercises; so a Plie squat and actually mimicking some of the positions that you’ll be in. I hope you during labor that you are actually not going to be on your back and you are going to be in a lot of standing positions. It will definitely, definitely help you getting ready.

The other thing is that you can work your abdominals during pregnancy; you just can’t do a lot of exercises lying on your back. So whether you are doing abdominal bracing or some standing core exercises: the stronger your abs are, the easier it’s going be to move that baby down. Certainly it’s important to be Kegeling throughout your pregnancy, and honestly, you should be Kegeling every single day for the rest of your life even after baby is born.

Those strong pelvic floor muscles will help you get the baby out but it’s also controlling your body, so you know how to relax your pelvic floor and it will help you greatly. So overall, I want to see you exercising throughout your pregnancy, focusing on core strength, focusing on some hip openers and again your pelvic floor and I do hope you have a wonderful fit pregnancy. Do visit www.strollerstrides.com for more great information on how to stay fit through pregnancy and parenthood and be sure to listen to Preggie Pals’ for more great prenatal fitness tips.

[Theme Music]

Sunny Gault: Today we are exploring a topic that I unfortunately know quite a bit about because it has impacted my life tremendously. We are talking about experiencing Urinary Incontinence after labor and delivery. Our special expert today is Destiny Bochinski, a physical therapist specializing in the pelvic floor area, and Destiny, welcome back to Peggie Pals’. Nice to have you!

Destiny Bochinski: Thank you!

Sunny Gault: Destiny was our expert for Preggie Pals’ episode 19, “Protecting your pelvic floor” and she’s also going to be an expert coming up for a new series we are launching about “Managing pregnancy discomfort”, and we will be focusing in one of those episodes on physical therapy.

So, I thought I would start off today’s show telling you guys a little bit more about my personal experience and there is a couple of disclaimers I think I should say off the top of the shelf . And the first is that urinary incontinence does not impact everyone the same way. Some women may not be impacted by this at all. And then there are women like me where it has drastically changed their lives and I don’t want to scare anybody through this episode, that’s not the intent.

I also don’t want you to use it as medical advice and think just because it’s happened to me you’ve got to do the same thing or you can’t do something. I believe women should be able to birth their babies exactly the way they want to and they need as much information as possible in order to make informed decisions. So today I thought it was really important for me to share my story. I have not done this on the show before and I have not done this because there was an on-going lawsuit regarding my incontinence and how it happened, and should my medical provider have been included into this issue that it could have happened to me and was there negligence involved.

I have to o say that after about 2 - 2 and a half year battle with this in preparing and a week long of arbitration, that the arbitrator sided in favor of my medical provider. So I did lose my case. The arbitrator basically said, there wasn’t enough information out there that my medical provider could have access to or that there wasn’t enough training out there to clue them in that what happened to me could have happened. So there was no way to prevent it.

So, unfortunately, they chalked it up as, “Sunny was injured!” greatly, I don’t think anyone who disputed that because of all the treatment that I have to had and surgeries but they couldn’t possibly have prevented that. So, in releasing this episode today, it’s not about blaming providers. I don’t want to get down that path because I think this could happen to anyone. I don’t think this has anything to do with where you’re delivering your baby and how good the care is. I mean, I think the issue more is how do we educate people, how do we educate mothers that this kind of thing can happen and how do we get the message out there to the medical community so training starts to happen. Because the more people are trained on this and realized that you can’t just chalked up Urinary Incontinence to having a big baby. Everyone loves to say, “Oh, you have a big baby!”, but they were other issues that can contribute to this and the more information we have out there, the more we can better prepare.

Anyways, that’s my disclaimer and why we are doing this episode and why I’m going to be sharing my story and as great of detail that I’m going to share because dealing with Urinary Incontinence is very embarrassing.

Today on the show, we’re supposed to have a couple of other panelist in addition to myself who had experienced extreme Urinary Incontinence and unfortunately, it didn’t quite work out. I think the reason that they backed off is because “who wants to really talk about this, who wants to admit that you can’t control your urine”, like it’s a very embarrassing topic. I think a lot of women kind of sweep these issues under the rug.

The problem is when you do that, you’re not only hurting yourself but you’re hurting other women out there.

Annie Laird: Well, it’s interesting that you say that, Sunny, because all the ads that you see in TV are all these women in their 60’s running around playing tennis.

Sunny Gault: Right!

Annie Laird: They don’t show what the real problems and undefinitely have not had the major problems that you have had but I’m still 35 weeks pregnant with my 3rd baby and I still cross my legs when I sneeze, I pee; I laugh. I can’t run anymore which I really enjoyed doing because of again minor Urinary Incontinence and that something that happens to so many young women of child bearing age, we just don’t talk about it because of the embarrassment associated with it.

Sunny Gault: Yeah!

Destiny Bochinski: I think that problem is too, that the less we talk about it, the less it gets because you can start out with minor issues like you’re talking about it at a young age and it snowballs and it gets to the point when you are in your 60’s or 70’s and you have watered pants and because you’re having major issues. Even if it doesn’t start off like a major issue like Sunny had, it can lead up to that area and up being like that if it doesn’t get addressed early on and if we don’t talk about it now, than talk about the early starting and start treating people early and addressing the problem early then it absolutely is going to continue to be a bigger problem later on.

Sunny Gault: So, for those of you that are listening, hopefully this hasn’t happened to you but if it has, please be vocal about it. Please ask questions and please inform other people about it because that’s how change is going to happen. So, to tell you a little bit about my story, I have two little boys now. I’m pregnant with identical twin girls. Prior to being pregnant, prior to having my first child I had absolutely no problems with Urinary Incontinence, no background in it, whatsoever, fully able to control my bladder. I was pregnant with my son, my total labor in delivery lasted maybe 14 and a half hours.
Destiny Bochinski: Not bad for your first baby.

Sunny Gault: It really wasn’t too bad and I knew going into this labor and delivery experience I knew I wanted an epidural. I am not big on pain but it was important to me to have a vaginal birth, that’s always been important to me to have that.

Annie Laird: Well, it sounds like you’re really the very typical pregnant mom. Most moms go into a birth, planning to have an epidural but they do want the vaginal birth.

Sunny Gault: Everything was going super well and my body was progressing very naturally. I didn’t need any Pitocin or anything like that to speed everything up. My little boy was just progressing the way he should have. I knew again I was going to have an epidural. That was not even a question, the question was, “How quickly can you administer this thing?” So shortly after being admitted they gave me an epidural. It is standard procedure for them to insert a Foley Catheter. Now, Foley Catheter is a Catheter that basically has a little bulb at the end of it and it secures the Catheter within your bladder. There are different types of Catheter, you can be catheterized just for an instant and then they can pull it out. This is something for a more prolonged period and they want that balloon in there to secure it. They also taped the Catheter to your leg to help prevent it from being tugged out and things like that so there are some precautions that are put into place.

Annie Laird: That make sense with making sure that the bladder is empty because the – if the bladder is full then that can prevent the baby from…your labor from progressing and the baby from moving down. So, that’s a good thing to have an empty bladder.

Sunny Gault: Obviously when you have an epidural they want you to have a Catheter because then you don’t have the sensation in your legs that you normally would so you can’t get up…

Annie Laird: To go to the bathroom.

Sunny Gault: Yes!

Annie Laird: Exactly!

Sunny Gault: I had a great epidural. I could still feel stuff but I was not in pain so I knew in contractions were coming for the most part but again I didn’t have the pain that was associated with it. So, everything was progressing wonderfully I was very happy, I was in a very good mood that I wasn’t having pain, and my baby was coming, and we knew he was healthy, and everything was progressing well. When it got to the second stage, second stage is known as the pushing stage. I ended up pushing for two and a half hours. At the start of that, though, as you guys know…who, those of you who’ve had babies already, usually…I gave birth in a typical hospital environment – there was a labor and delivery nurse that was pretty much there by my side most of the night, coming in and out, checking on me. The OB came in and out. Occasionally, I think I’d had one other prior meeting with her; she was not the person that saw me primarily for my prenatal care, so mainly it was the labor and delivery nurse taking care of me.

I did some practice pushes before the OB came in the room; according to what the labor and delivery nurse had instructed me to do. Then, at some point, probably a handful of minutes later, the OB comes into the room; she instructs me to do some pushes and these were guided pushes. The labor and delivery nurse was there, the OB was right there; and at one point she told me to stop because the Foley catheter – that little bulb that I was telling you guys about – that little bulb had made its way into the urethra opening. So, if you can imagine, this bulb – you know how tiny a urethra opening is

Annie Laird: To say, could you feel this, Sunny?

Sunny Gault: No! Well, I had an epidural, and you feel a lot of pressure – I mean I’m trying to push out a baby, so there’s a lot of pressure down there. I did not feel a bulb at all.

Annie Laird: Even if you didn’t have an epidural, I don’t know if you would be able to feel it…like you said, there’s so much pressure and so much sensation, I don’t know if you can really discern; I wouldn’t know if I would be able to discern is there something in my urethra versus my vagina, at this point, even unmediated. So it’s…there’s just so much.

Destiny Bochinski: Well, and that’s a good point. A lot of women, when they describe the urge to push, as having to take a bowel movement, so it’s all kind of pressured down in that region.

Sunny Gault: And, the OB actually saw it – so it wasn’t that she just felt it, but she actually gave me a sign of “I see the bulb”, and she gestured with her hand with about how big it was in approximation. She told me to stop pushing. And then from that point, the labor and delivery nurse asked if she wanted to remove the Catheter, and she said yes. At this point, I…this is my first baby, I really don’t know what’s going on – is it normal to push something like this out, I have no idea. I’m focused on my baby.

To my knowledge this wasn’t an unusual occurrence, it wasn’t until later that I found out that it was highly unusual. My labor and delivery progressed – again, I was pushing for two and a half hours, with no Foley Catheter in, and my baby was born. To my knowledge, everything turned out swimmingly, my baby was perfectly healthy, they didn’t have to use forceps or anything like that. I know that sometimes contributes to Urinary Incontinence, he came out naturally.

The epidural started to wear off, and at one point the, it was a new labor and delivery nurse, they had changed shifts, had asked me to get up and try to void. I stood up to go to the bathroom, and I was supposed to have full control, over everything and be able to physically walk there by myself. I stood up and my bladder just emptied on to the floor. I didn't even know it was going to happen, I didn't feel num, I didn't feel anything, I felt like I do right know, like I thought I could just walk to the bathroom. I was in shock, I just didn't know what to do, I didn't know what was happening.

Annie Laird: You mentioned that Sunny and it's interesting, because right know a light bulb went in, and the same thing happened to me. I had a 10lb 4oz baby, and the nurse was so mean about it. She was like, well if you can't control, the epidural had worn off, and she tells you that you have to get up, and you're under your own control, and under your own power and get to the bathroom. I just didn't have control and it just went all over the bathroom floor, and she was like if you can't control your bladder then we have to catheterize you again. I was like, Lady I just pushed out over a 10lb baby here an hour ago. I'm sorry you don't like cleaning up pee, but that's part of your job. When you go into nursing that is part of your job.

Destiny Bochinski: That's the easiest part of their job, I can think of a lot worse.

Sunny Gault: So, by the time I went to the bathroom I wasn't even sure if anything actually came out, because it was all on the floor. In my mind I just chalked it up to, well my body is just still recovering, I just gave birth to a baby, whatever. No one was really acting like it was a huge, huge deal, so I really wasn't on alert.

Annie Laird: So, you're saying that you didn't nurse ratchet like I?

Sunny Gault: No, I really didn't.

Annie Laird: Awesome for you!

Sunny Gault: I mean I thought it was weird, I was like well why did she have me stand up if she knew it was just going to happen on the floor, right? But a lot of questions… it is still… you're on a fog after you have a baby, there's a lot going on, and so eventually they moved me to a postpartum room, and I was there for a couple of days, the problem never went away. I never had any control over my bladder. The moment gravity took over, it was on the floor. My bed was I remember right next to the bathroom, I thought I can get there, I can make it, because I kept thinking come on body, what's going on, everyone's telling me this is normal, why you don't start bouncing back to the way you were, and it just didn't.

I remember talking to my mom, and eventually my mom said, there's something wrong here, your body should be reacting differently now, and you need to ask to see an urologist. In the hospital you have to see a urologist.

Annie Laird: Awesome! Good advice from your mom there. I mean like you were

Saying, I mean, I that happened one time but eventually.

Sunny Gault: It started to come back!

Annie Laird: Exactly! It was within a day.

Sunny Gault: So when I was in the hospital for a couple of days and still had nothing. I asked to see a urologist, they told me that I wouldn’t fall under urologist care because I was so soon postpartum that I had to see an OB. So they brought an OB in the room and I explained my problem, she didn’t examine me and she just chalked it up to that you just gave birth. Women have Incontinence issues after giving birth. Again she didn’t examine me and I was saying I think this is different, I can make it at all, like nothing is staying in my body. So anyways I ended up going home, still having this problem, still hoping it would just figure itself out. About a week later I was in major pain. I had a 2nd degree tear which is somewhat normal I guess and the problem is that I was having to wear Depends because that was the only way…I had to wear adult diapers, there was no other ways to catch the urine. The pads where not working, whatever.

So if you can imagine a 2nd degree tear, pretty much sitting in urine all day long, like I was trying to change out those Depends as much as possible. But my only real relief was sitting like in a bath like with Epsom salt and the moment I got out of the bath, it would start to hurt again. Whether there was urine on it or not, it would start to trout, it could not heal.

Eventually I went in, I saw a different OB, anyone that would see me, about a week after they agreed that I could come in and they could look me over because they kept saying “Oh you are 6 week postpartum up women…no…no…no…I was not going to make it 6 weeks…you know I could barely make it 1 week”.

What ended up happening as I went in to see the OB and she referred me to urogynecologist, which is a gynecologist that has additional training in this area, kind of a urologist and a gynecologist put together. I had to get treatment for it, I had some physical therapy, Destiny, that was one of the first things because they don’t want o jump right into surgery or anything, plus you already just had a baby, so they can’t do anything right away.
Destiny Bochinski: Plus most of the time…most instances conservative management of Incontinence mild to moderate cases is successful. Your case is out of the norm. Completely out of the norm.

Sunny Gault: It is totally different. But it kept getting classified as that you know well is it really as bad as she says it is. I mean who makes those stuffs up, right. It got to the point where I saw physical therapist, I worked on Kegels, I got my Kegels up to about a 5. So it was this highest I could go…

Destiny Bochinski: Super strong!

Sunny Gault: Super Strong!

Destiny Bochinski: Great for postpartum!

Sunny Gault: And I wasn’t noticing any change in the Incontinence and they had fitted me for a continence or incontinence ring whatever you want to call it. Basically it is suppose to support the urethra a little bit so you have more functionality over it and I saw a little bit of change not much. My mind was just step on having surgery because I thought there is just no way I’m trying to do all this other non-invasive things and their saying that we can’t do surgery for six months. So fast-forward I just kind of had to granine-bare it for several months. I got to the sixth month mark, I had to have all the necessary task done to ensure that I was a good candidate and I was well more than a good candidate. I was like testing crazy on this task. It was even hard to measure how much strength I had over my continence because I had no control.

So I eventually ended up having two different surgeries. They want to schedule a third for me but then I got pregnant with my second son, so that had to be postponed. Basically the way the situation is now, it is tough because I’m pregnant again with baby three and four and when you are pregnant, you already had a continence issue, you’re going to leak; it’s going to be worse. I haven’t been able to take additional steps that I’d probably would have had if I was done having kids. Like there’s medication you can get on, they don’t want to do that if you are breastfeeding, if you’re planning to get pregnant.

There are other types of more invasive procedure surgeries, things that can actually physically insert into your body to help control continence. I have not explored any of those.

The issue for me was not only that this happened but again I think it should have been prevented. Getting the word out there for me personally about women who choose to have epidurals and have Foley Catheters. That Foley Catheters can come out of your urethra, it is happened. There’s not enough information out there, again which is one of the reasons why we’re doing this show.

There are many other reasons and we’re going to explore that in a second-half of this episode as to what can cause Urinary Incontinence. We definitely want to go over all of that but my personal message is that be vocal about this. This happens to you or has happen to you. Tell as many people as possible because that’s the issue right now, is that there’s not enough information out there. Not that it doesn’t happen, I think most of the people involved in my lawsuit, if their being completely honest would admit that it was a Foley Catheter coming through my urethra that cause this. The question is, “Should my medical provider have known about it?” and the decision was that they couldn’t possibly because there wasn’t information out there.

So please help people about this, please be vocal about this, because the more vocal we are, the more information that will be out there and the more people we can help. So with that being said, that is my story about incontinence. But in part two of this episode, we’re going to talk about more about the pelvic floor in general, what are some other reasons women develop what can we do about it. So that is my mamma log.
We will be right back!!!

[Theme Music]

Sunny Gault: Welcome back, today we’re talking about Urinary Incontinence after labor and delivery. Destiny Bochinski is our expert; she is a physical therapist who specializes in the pelvic floor area. So Destiny, now that you’ve heard my lovely story…

Destiny Bochinski: And let me just chime in the little disclaimer on my part: I’m here as an expert on the pelvic floor area, not as a birth expert and in procedures during birth. Any opinions that I have are strictly opinions on that, and not from an expert’s point of view.

Sunny Gault: Thank you! Thank you for that distinction. Let’s talk about the pelvic floor and how it relates to Urinary Incontinence, what needs to happen to have full control over the areas that control our urinary continence.

Destiny Bochinski: When I think of urinary control, the best, the simplest way to put it is the balance of pressures: the pressure downward on your bladder pushing urine out needs to be matched or resisted by pressure upward and support upward to prevent it from coming out in order to have control. Then when you want to pee, the opposite happens: you have to release the pressure from below to allow urine to come out and the pressure from above has to be greater. So, when we’re talking about pressures downward forcing urine out, we’re talking about intra-abdominal pressure, the pressure within the abdomen, pressure of all the abdominal contents themselves, weight, all of those have to contribute to downward force on the bladder and on urine.

Pressure resisting that is not just the muscle, so the pelvic floor, I think a lot of people think Urinary Incontinence, they automatically think, “I do my Kegels, and I still leak. What’s up with that?” It’s not just the muscles, there’s muscular, there certainly is a big roll of muscles in the pelvic floor in controlling incontinence, especially the type of incontinence called stress urinary incontinence, which is not what you have, yours is just gravity-dependent.
Sunny Gault: They did try to lump it into that stress category though.

Destiny Bochinski: Right! Because yours was kind of unclassifiable, you didn’t even have the urge to go, and you would just go. So there are different causes of different classifications, but stress incontinence is usually when pressure is increased, like with a cough or a sneeze or a laugh, then you leak, and oftentimes strengthening the muscles in the pelvic floor will, it’s very successful with that, 80-90% of the people respond really well to strengthening.
Your case is different because the other upward resistive supports are your ligaments, the ligaments that support the bladder and the urethra itself, there’s like a hammock-sling type system that supports, that lies underneath the bladder, it’s called fascia, supportive connective tissue and ligaments that helps hold the bladder in place or prevent it from dropping down, and there’s also ligaments, supportive ligaments and fascia around the urethra itself that holds it, and it kind of holds it against the pubic bone and along the front of the vagina and if those ligaments are torn or damaged or over stretched, then you have got a floppy urethra or a floppy bladder and there is only so much that the muscles underneath can do that to support that- depending on the degree of tearing.

When you have something large essentially ramming through your urethra, it’s going to just wipe out all of those ligaments and over-stretch things and then your urethra is unsupported and your muscles, like you said, you got the strongest you can get, it’s not a matter of strength or working out, you just didn’t have the passive support of those ligaments to keep you in place and that’s pretty much the balance that we are looking at.

Sunny Gault: So when postpartum patients come to you, fairly quickly after having the baby, what typically has happened in this area to reduce their ability to control urine? What are some of the issues that you commonly see?

Destiny Bochinski: So usually what I see is weakened muscles, muscles that have been stretched or torn, you mentioned 2nd degree tear, the tear does go into the pelvic floor muscles a little bit and with that comes a weakness. It’s like anytime, like you tear your quadriceps you are going to have a weakness there and it’s going to affect your ability to control your knee. The same thing happens if you have a tear that extends in to the muscle- it’s going to affect your ability to be strong and control things.

Not everyone who has a 2nddegree tear will have incontinence; it’s not like one absolutely leads to the other, but typically that’s what I see, is at least a 2nd degree tear, or some extended prolonged pushing phase that has over stretched things or put a lot of pressure on the pelvic floor and it hasn’t recovered yet. Honestly, I would like to see more women earlier postpartum than I do but they usually isn’t until a few years after and a lot of women say “Oh yeah after my first kid, definitely after the second or the third, but after my first kid I had leaking for a while” and it usually comes back later on without being treated.
Sunny Gault: Is leaking urine after having a baby, and I am talking about pretty immediately, is that ever normal? Because one of the things people kept saying to me in the hospital was “Oh it’s normal, you just had a baby”. I mean is it ever really normal? I feel like we kind of put up with this. Like you said, women are coming in their menopause years or whatever, saying “Oh yeah I had that right after having a baby”. I think we sometimes chalk it up; it’s a very embarrassing thing to talk about right? We don’t like to talk about it but we just chalk it up as being normal but it is? Is it normal?

Destiny Bochinski: Not the kind that you are describing. I mean like full complete bladder loss like that, and if your epidural’s fully warn off and you have full sensation, full ability, well not, you are not going to have full ability to contract your muscles for a while, but ability to contract your muscles and control, it shouldn’t happen, that is not what I would classify as normal. Even a small amounts of leaking can definitely happen within the postpartum period and resolve pretty quickly. But I wouldn’t say it's normal, that it's supposed to happen.

Sunny Gault: At what point would you advise people, even if they're just leaking a little bit, because I'm the first to admit I'm a different case, I had a complication that happened that was beyond having a big baby, beyond the pushing phase, right? So for the women that have just maybe experienced a long pushing phase or big baby or whatever and they experience a little bit of it, when would you expect that to wear off versus, Annie was talking about earlier "Oh, within a day or so it kind of wore off and my body returned to normal", what would you say is as far as someone who may need treatment, what was the cutoff point, really?

Destiny Bochinski: Well, I would definitely say within the first couple months it should resolve. If everything physiologically is healing and returning back to… well, not back to, it's never the same… but…

Sunny Gault: You're never the same after you have a baby. It doesn’t work that way.

Destiny Bochinski: If things are healing and progressing normally, then I would definitely say within a couple of months. But if you have any degree of tearing 6-8 weeks you should be fully healed from that tearing, your scar tissue's going to continue changing, your muscles will continue changing and everything, but the pain and limitation from the tear and that injury should be resolved, largely resolved within that first couple of months and you should have full continence. There's really no reason that you shouldn’t, from a normal perspective. You can absolutely have treatment, pelvic floor treatment after that time.

Sunny Gault: Can a woman be genetically predisposed to leakage after having a baby?

Destiny Bochinski: Well, I don’t know about genetically predispose, there's different body types. There's people who have stronger legs than others, there's people who are really built up top in their arms than others, there's people who have really strong abs, there's people who have really strong pelvic floors, there's people who have really weak pelvic floors.

So definitely with body type variation that can predispose you to some leaking if you're just really weak in that area and then you have a baby that stretches things and it's harder for you to get back even that little bit of strength that you had before. So I would say that that can predispose, but I don’t know about genetic predisposition.

Sunny Gault: What are some other ways that we can try to prevent Urinary Incontinence? Are there some key things that you could give us to kind of work on?

Destiny Bochinski: Like I said the majority of people are having stress incontinence issues and that responds really well to strengthening, so doing your Kegel exercises is important and if you're pregnant doing Kegels as well as relaxing the pelvic floor is really important, getting to control the pelvic floor. Because some women go into labor and delivery having a really tight pelvic floor, especially with first babies, and that can cause complications as well. So being able to relax and elongate and lengthen those muscles is just as important as being able to contract them. Nobody would walk around with their biceps contracted all day long. You know, who’s going to walk around like that? You can’t use your arm. So you want to have good control of those muscles. Having good bladder habits is also really important.

Sunny Gault: Like not holding your yearn for too long?

Destiny Bochinski: Not holding it for too long, not going just in case, not putting things into your bladder that aren't good for it, a lot of carbonated beverages, a lot of artificial sweeteners, caffeine, things that are really acidic, those kind of things can really irritate the bladder, and cause you to leak more, or cause you to have more bladder issues.

Sunny Gault: There are so many things that impact it!

Destiny Bochinski: There are a lot of things! But if you’re mainly concerned about pregnancy, and what you can do now to help your pelvic floor to be healthy afterwards, just exercise, general exercises is important and doing your Kegels and relaxing your pelvic floor as well, opening up your pelvis.

Sunny Gault: Sounds good! Well thank you Destiny for joining us today and being part of our conversation, Our conversation continues for members of the Preggie Pals’ Club. After the show Destiny will discuss some treatment options, available for women dealing with moderate to severe Urinary Incontinence. For more information on our club you can visit www.preggiepals.com

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Sunny Gault: We have a question from one of our listeners, this come from Jared. I love hearing from the partners, from the dads. He says “My wife is due in less than 2 months, she is so excited about her baby showers and has invited me to the parties, but honestly it doesn't interest me”. I think that’s how most guys feel, Jared. But thank you for your honesty, I appreciate that. He says “I know our lives are going to drastically change shortly, but I would prefer to have a little party of my own, with some of my guy friends. Is this completely out of line? Since I’m not the one that’s physically pregnant and how can I approach this with my wife?”

Dr Singley: Hi Jared, this is Dr Jean Singley, a clinical psychologist specialized in men’s issues with an emphasis and new fatherhood, and the period that you wait out where you've got limited tolerance for baby showers is definitely a common one, but I hear it quite a lot about both professionally as well as personally from couples, friends of ours that are having showers. And of-course it has come out the issue of a number of different ways, one of which is to how mom and dad to be collaborate on exactly what the structure of it is going to be. Do you want to have a deal where everybody is around while you’re opening the gift or not? You don’t have to do this.

Do you want to have games, you do not want to have games? I think what’s most important is that you and mom get together, and you’re on the same page on what you’re looking for. Because it’s not just important for you, it is important for other people to be able to honor your transition into parenthood but you can do all that in keeping with what your own interest does as an individual than as a couple. The way some folks do that is they basically have the man on how the so called couple’s shower and to be sort of stereo typical here, there will be you know poker and cigars and folks generally the guys will go out take part in that.

Another way is to actually exclude it out and to do something that is not online with a typical show but is just good like another way for a guy to get together with other friends and honor the transition into fatherhood, you know just to gather and all go golfing or you know take part in some other kinds of activity together and have parts that we just talking about. Men that already have the transition and I think most importantly is just for you and mom to be to get together and to have straight forward discussion about exactly what your ideal way of involving your friends and family in honoring your transitioning into motherhood and into fatherhood.

That can look really different or it will be a very productive conversation to have even if you don’t agree to be able to do it together but because may be just doing it separately would be the best way for the two of you.

So good luck with your shower and party planning, hope this information is been helpful.

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Sunny Gault: That wraps up our show for today. We appreciate you listening to Preggie Pals’. Don’t forget to check out our sister shows, Parent Savers for Parents with Newborns, Infants and Toddlers and our show The Boob Group for Moms Who Breastfeed their Babies.

Next week it is another tough topic to discuss, October is National Pregnancy and Infant Loss Awareness Month and we will be talking about ways to find support, should this happen to you or someone that you cared deeply about.

This is Preggie Pals: Your Pregnancy, Your Way.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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