If you have followed my practice at all, whether it be on Facebook, Instagram or Twitter, you have likely read about the care French women receive after childbirth. I am specifically referring to the model of postpartum care for moms (or mums) focusing on pelvic floor health. In France, women are seen by a pelvic physio (pelvic Physical Therapist) approximately 6 weeks following delivery and receive 10-12 sessions with the physio for "perineal re-education." Sound a bit odd? Well, it may, but it may not once you know the affects of pregnancy and labor/delivery on the pelvic floor. According to a study by researchers at the California HMO Kaiser Permanente, approximately 1 in 3 women suffer from a pelvic floor disorder (this includes urinary incontinence, fecal incontinence, and prolapse), and roughly 80 percent of those women are mothers.
It doesn't seem out of place to expect some type of typical care following a vaginal delivery or cesarean delivery (a major surgical operation), right? I mean, we don't expect our athletes to incur an injury, wait 6 weeks to heal and then return to previous level of function with no skilled or specialized professional rehabilitation. "Well, professional athletes are training for a very specific sport with high physical demands and it is their job..." one may rebuttal. And my response...Well, moms are returning to (let's be honest...often continuing with) everyday functions that stress the core and pelvic floor and require good function to prevent compensations or overuse that could cause additional injuries. And..some women, in the US, don't even get a full 6 weeks to assist with some of that recovery before it is back to "life pre-delivery."
So...when the 6 weeks is up, what rehab do women get to make sure that the pelvic floor is healthy and ready to take on current or future demands? Holding up (and in) vital organs, toileting, lifting/carrying, sex, return to exercise.... Most are left to research on their own navigating through loads of online information, advise from family and friends and exercise programs that may or may not be helping them with an effective recovery. This can be daunting for many women. I have had women tell me it is daunting, confusing and frustrating. There is a plethora of click-bait links to postpartum advice and programs, some of which lack a strong foundation of the multiple facets of core and pelvic floor rehab following childbirth. It does not have to be daunting and impossible, but there is also no a quick fix.
Every woman in the US should be seen by a pelvic Physical Therapist after childbirth. The more this is discussed, and the more those who have benefited from pelvic PT speak about it, the more awareness there will be. So what can a pelvic PT help you with? Here are just a few things.
- pain management during pregnancy
- labor positioning
- prevention or treatment of adhesions of c-section scars and perineal tears
- diastasis recti
- pelvic floor tightness or laxity
- pelvic floor dysfunction
- urinary (pee) or fecal (poo) incontinence
- tailbone (coccyx) pain
- pubic symphysis pain and dysfunction
- sacroiliac (SI) joing pain and dysfunction
- stretching to relieve muscle discomfort during postpartum
- painful intercourse
You have probably done it yourself.... or seen it in the workplace or during an outing with friends. You know, the delaying of urination (peeing) until you can barely walk correctly to get to the bathroom. Is this "holding" harmful? It definitely could be.
Although each person's body is different, there is a common consensus and knowledge about the risks of frequently holding urination.
Increased Risk of Bladder Infection- The capacity of an average bladder allows for 15 ounces of urine retention. Holding urine in the bladder for long amounts of time increases the chance that bacteria may attach to the bladder lining and potentially multiply, resulting in a bladder infection. That infection could also make its way to the kidneys and cause other problems.
Decreasing the brain-body connection- When the bladder is full, it sends signals to the brain; the brain then signals to the body it is time to get to the bathroom. Holding urine and delaying those signals can lead to an alteration in the brain-bladder connection. This could result in decreasing the effectiveness of that connection and result in the body not knowing when it is time to go.
So What Do You Do? The issue with "holding it" is real. Many are limited by his/her work environment; teachers, for example, often delay bathroom breaks the most out of many professionals. The problems that can occur from the delay is real though also. Keep these suggestions in mind next time you cross your legs to hold it for "just a little longer...."
1) Void (pee) Regularly- Pretty straight forward advice, right? But, many people just don't do it or don't plan ahead for the day to allow for regular bathroom breaks, especially during times of travel and work. On average, voiding should occur every 3-4 hours. Don't force yourself to urinate; just go when you sense that you need to. Plan ahead and advocate for your ability to use the restroom in reasonable intervals.
2) Drink Water Regularly- Limiting consumption of water in hopes to decrease the need to use the restroom is not the best approach. Our bodies are designed to consume water and flush out regularly. You should drink when you are thirsty and your urine color should be a light yellow-clear. If your urine is a medium to dark yellow, that is your sign that you are not drinking enough.
The Better Bladder Book by Wendy Cohan, RN
Holding Your Pee: Health Risks from Ignoring Nature's Call. The Huffington Post Canada. 02/27/2012
Robyn Wilhelm, PT, DPT Private Practice Owner in Mesa, Arizona specializing in pelvic floor and women's health physical therapy. Connect with Dr. Wilhelm on her practice website http://www.wilhelmpt.com.
Dr. Robyn Wilhelm, PT, DPT specializes in women's health and pelvic PT. An Ohio native, she enjoys Buckeye football and misses the Fall season. Dr. Robyn enjoys her life in Arizona and spending time with her husband, two kids and Chocolate Lab George.