Presented by Lisa Rogo-Gupta, MD
Clinical Assistant Professor of Female Pelvic Medicine & Reconstructive Surgery
January 17, 2019
Giving birth can be a wondrous accomplishment for many women. It’s also one of the riskiest. The hard work of labor and delivery can leave a new mother with pelvic injuries that go unrecognized and – all too often – untreated.
“Delivering a baby is the most magical thing I’ve ever done,” said Lisa Rogo-Gupta, MD, a clinical assistant professor of pelvic medicine and reconstructive surgery. “It is a wonderful blessing.”
But delivery has a tremendous impact on a woman’s body. Giving birth leaves about 10% of women with injuries or problems, according to a study cited by Dr. Rogo-Gupta. The overall prevalence of all pelvic floor disorders is about 24%, or about one-quarter of adult women.
Doctors now are helping more women with lingering pelvic problems. Leaky urination or bowel movements can be an issue. So can internal organs that sink through a weakened pelvic floor.
‘Like a bowl’
The pelvic floor is made of muscles that connect to bones in the pelvic area and help stabilize joints, Dr. Rogo-Gupta said. “It’s like a bowl in the bottom of your pelvis. It’s the floor that holds your organs in.”
Sometimes pelvic problems start to develop during pregnancy. “You have to grow a whole new human being. It’s a huge workload on your pelvic floor, your spine, your abdomen, and all parts related to your core,” Dr. Rogo-Gupta said at a lecture at Stanford Health Library.
Women can potentially reduce the risk of these problems when they pregnant. They can strengthen their muscles by walking and by learning Kegel exercises before giving birth. It also helps to maintain a healthy weight and to learn what to expect from their rapidly changing bodies.
She outlined the factors that raise the risk of pelvic problems after childbirth:
- A long labor: The longer the labor, the higher the risk of a “stretch” injury involving pelvic muscles.
- A “helped” delivery: If forceps or suction vacuum is necessary, there is a much higher risk of later vaginal problems.
- Genetics: If other women in your family have had a difficult labor and delivery, you may also have a higher risk.
Having a C-section doesn’t eliminate the risk of pelvic floor problems, Dr. Rogo-Gupta said, though it does lower the risk of some.
Pelvic floor injuries can also occur from other strenuous activities, such as heavy lifting jobs or other chronic physical stress.
What are the most common problems linked to pelvic floor injuries?
- Incontinence: This condition means you aren’t able to control urination, or have leaky urination. It can be serious enough to cause people to change the way they live. Some always sit in the back row of a movie theater so they can rush to the bathroom. Others start to isolate themselves because they worry about odor. Some even avoid sexual intimacy, especially when meeting a potential new partner.
- Bowel control: This means not being able to control bowel movement. Some can’t control their bowel movements at all, though others get a warning early enough that they can get to a bathroom in time. The risk of bowel or urinary problems after childbirth is higher than many other common medical problems for women, Dr. Rogo-Gupta said. “This happens to more women than high blood pressure, more than depression, more than diabetes,” she said.
- Prolapsed organs: This means internal organs sink in the abdomen, sometimes showing from the vagina. Prolapse can happen when the pelvic floor is so weakened that the organs above sink and collapse through the floor. Women may feel a heaviness, and some see “something sticking out” when they go to wipe themselves clean after urinating, Dr. Rogo-Gupta said. Prolapsed organs may occur later in life, long after a woman gives birth. Prolapse is present in more than 40% of women over age 50. But only 4% to 10% have symptoms. A lot of the time it doesn’t do any harm, and a woman may not notice it.
Women with any of these problems have more than one option for treatment. There are multiple at-home solutions that are often effective, Dr. Rogo-Gupta said.
Steps women can take at home to stop or minimize their symptoms include:
- Avoid or reduce beverages that irritate your bladder or bowel. These irritants include caffeine drinks (coffee, some soft drinks) and alcohol (including wine).
- Don’t smoke.
- Learn to squeeze your vaginal muscles tight, if you feel a sneeze coming on, to avoid leaking. “Squeeze before you sneeze,” Dr. Rogo-Gupta said.
- Lose weight, if you are overweight. Among people who are overweight, losing about 8% of their weight can have a meaningful impact on urinary and bowel leaks, Dr. Rogo-Gupta said.
- Use a tampon-like device, available at some stores, that block urinary flow. Alternatively, some stores also sell underwear that absorbs urine.
- Learn to do Kegel exercises with your vaginal muscles.
One of the best known, and most effective, at-home options is to do Kegel exercises. Kegels can be very effective treatment, helping 75% to 80% of women who do them correctly with guided instruction, Dr. Rogo-Gupta said. While some women learn to do the exercises fairly easily, others find them tricky. She offered these tips:
- When you start to urinate (on the toilet), try stopping the urine midstream. If you can do this, you have found the muscles to squeeze for Kegel exercises. Don’t try to stop your pee more than a few times, because it’s not good to train your body to stop urinating, Dr. Rogo-Gupta said.
- Once you find these muscles to squeeze (when you’re not urinating), you’re ready to do Kegels. Take a deep breath, tighten the muscles for 3 seconds, then relax for 3 seconds. Do 10 times per set, and work up to 3 to 5 sets per day.
- Women can do Kegels in all kinds of situations without others noticing. Some do it during a commute, during commercial breaks on TV, or during meals.
If a woman does Kegel exercises regularly for 12 weeks and still sees no improvement, it’s time to check in with a doctor, Dr. Rogo-Gupta said.
For many women, the next step is physical therapy. It’s a good idea to ask your doctor about seeing a physical therapist trained in pelvic floor health.
Physical therapists can check to see if you’re doing Kegel exercises correctly. They can also recommend a good device to help you do the exercises, Dr. Rogo-Gupta said.
Physical therapists can also assess your posture, core position, lower back, and hips, as well as any lower back pain or sciatica. All these conditions can be considered to identify the best treatment.
Other nonsurgial options
Beyond physical therapy, there are other nonsurgical options:
- Vaginal dish: This is a device that can be inserted to lift organs and plug the weak area in the pelvic floor muscle bowl.
- Acupuncture: This can work as well as medicine used to treat incontinence.
- Bladder Botox: Botox injections can work to improve or even cure urinary leaks.
- Implanted acupuncture or “bladder pacemaker:” This can be extremely effective in the right individuals, and provide years of relief, Dr. Rogo-Gupta said.
If necessary, surgery is also an option. There are multiple kinds of surgeries that are done to reconstruct vaginal supports. The best choice depends on the individual.
Better within a year
In the first 6 months after delivery, about 1 in 5 women have urine leaks. Up to half of women have a weak pelvic floor, a quarter have gas leaks, and 1% leak stool.
Many times, pelvic floor problems improve or resolve within a year of childbirth. Women can improve their chances by following the at-home options and avoiding heavy lifting.
“Have a little bit of patience,” Dr. Rogo-Gupta said. If a woman is still uncomfortable after a year, she should see a doctor or physical therapist trained specifically in pelvic health problems.
Dr. Rogo-Gupta thinks the rewards of giving birth outweigh the risks. Knowing all the risks hasn’t stopped her, for one, from having delivered 2 children herself. “They’re so cute, we do it anyway,” she said.
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