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Bladder Bounce Back

Oct13

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Photo by helgasms!
Nobody tells you about peeing, postpartum. The leaking. The “bladder control issues.” The straight-up, unsexy, embarrassing incontinence.
It’s in all the PREGNANCY books — first it’s the hormones ratcheting up the urgency, then it’s an expanding uterus pressing on your bladder, and finally it’s a full-term baby’s head and judo chops. All things that would lead you to believe that everything goes back to normal after you have the baby.
I had some problems, particularly during my first pregnancy. Chronic urinary tract infections, an already-jumpy bladder, a job that often interfered with regular bathroom breaks, and a very large baby. Laughing or sneezing soon became an exercise in terror. But I was prepared for that. I crossed my legs and did my Kegels. The symptoms vanished after the birth, just like I assumed they would.
My second pregnancy was a breeze, in that regard, and with a scheduled c-section on the calendar I never really gave much thought to the state of my pelvic floor. I’d be fine, just like the first time.
HA. HAAAAAA. Lordy, I’m doing Kegels right now.
So there are varying degrees of awfulness here: there’s the occasional leaking when you sneeze or laugh, which is annoying but generally tolerable. Then there’s the crazy urgency, making every time you have to pee a race to the bathroom and oh God your belt your zipper your pants hurry. And for some women we’re talking honest-to-God zero-control adult-diaper-level incontinence.
If you had problems during your pregnancy, you are MUCH more likely to suffer after the birth, as well. Same goes if you’re overweight or a smoker. Vaginal births (and forceps, and bigger babies) also up your chances, though a c-section is no guarantee, particularly if you labored and pushed for awhile before getting the surgery. And then there’s me, who had more problems after a labor-free scheduled c-section. Sometimes it’s just the stress of pregnancy itself, and nothing to do with the birth.
So what should you do, if it happens to you? First, relax. It’s normal. It’s not permanent. It will get better. It might take awhile, but it will get better. Even if you’re dealing with the worst-case scenario, where you can’t stand up and walk across the room without peeing yourself, it doesn’t mean it’s an obstetric fistula and surgery or a life doomed to Depends.
The problem will USUALLY be at its worst during the first two weeks postpartum, while your uterus is still contracting back to its normal size and position off your bladder. Everything I’ve read about postpartum incontinence (that I had to SEEK OUT SPECIFICALLY, because it sure as hell wasn’t in any of those new baby books), mentions a range of “three to six months” before you regain “complete” control. (To which I snort dismissively at, because while I didn’t have any super severe problems, I’m a full year postpartum and still wouldn’t consider my bladder to be in its original factory-new condition.)
THINGS THAT HELP:
1) Kegels. Yeah. Those things. I vaguely remember having trouble doing Kegels right away — too much pain, feeling generally kind of obliterated DOWN THERE — so do your best and start small, just like ramping up any kind of exercise routine. (Teh Innernet says 30 a day is ideal. If you can do five at first, I declare you Pelvic Floor Champion.)
2) Empty your bladder every 30 minutes, rain or shine, urge or no urge. Then gradually increase the time between bathroom trips each day. (This is pretty much how I potty-trained my 2.5 year old, by the way. The more you know!)
3) Pads. Big ones. Look, you’re wearing those ginormous pads anyway, at first. Ask for extras from the hospital.
4) Colace. Again, something you’ll be taking post-birth anyway, but constipation puts even more pressure on your bladder.
5) Crossing your legs and clenching, pre-sneeze or laugh. It’s stupid but it works.
THINGS THAT DON’T HELP:
1) Alcohol, caffeine, soda, citrus, acidic foods.
2) Urinary tract infections. If you think you have one (i.e., there’s burning in addition to the urgency), get it treated ASAP. Drink cranberry juice or take those cranberry tablets.
3) Dehydration. Don’t do the “I’ll drink less/pee less” thing. Not only is dehydration just a terrible postpartum idea in general, you’re actually just upping your chances of a UTI.
And finally, yes: there is a surgical procedure to correct stress incontinence. If months go by and you are still having problems despite daily Kegels and test negative for UTIs, then talk to your doctor or midwife. Don’t let them tell you it’s “normal” if you believe you’re struggling with something that’s out of the realm of “normal.” You can also contact a physical therapist, as incontinence is actually something that many of them can treat. (Think post-injury or illness — it’s so very common.)
Ah, the indignities of motherhood. You have to laugh about this stuff…just make sure you cross your legs first.

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About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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23 Responses to “Bladder Bounce Back”

  1. anon Oct 13 at 1:19 pm Reply Reply

    Going anonymous here, I’m in week 5 postpartum and thought, “Hey! My bladder is doing great, no problems so far, no worries!”
    …. until I sat down to nurse yesterday and mysteriously and unexpectedly just… peed myself. Boo. Back to doing Kegels.

  2. Della Oct 13 at 3:02 pm Reply Reply

    Don’t remember with kid #1, but with kid #2, I had almost complete incontinence for the duration of my hospital stay, and my muscles were so sore and essentially paralyzed by the stress that I literally was unable to clench the muscles that you use for a kegel (the ones you use to stop the flow of urine).
    However, (a) thankfully, I had those HUGE hospital pads in anyway due to lochia/postpartum bleeding, and (b) it pretty much resolved within those three days. I may have had a little leaking during stressful situations (ie had to pee anyway and laughed, or coughed) for about another 2 weeks, but I’m pretty much cool now (1 month out). So yep, pretty much what Amy said. I’m living proof.
    A lot of parenthetical statements there, but I want to assure you that if you’re reading this before you give birth and freakingout, don’t worry. It’s like the pooping while pushing thing. It pretty much happens to everybody, and it’s probably not going to be a big deal (because it’s likely to resolve itself)
    Having said that… do kegels anyway, fo sho.

  3. Olivia Oct 13 at 3:22 pm Reply Reply

    Weirdly, my bladder seems stronger 6 months after having a c-section than ever before in my life. I’ve always had to take very frequent bathroom breaks, and by the end of pregnancy I was practically living in there. Now I feel “normal” compared to my friends.

  4. Joy Oct 13 at 3:22 pm Reply Reply

    I’m five months postpartum and peed myself sneezing yesterday. That was… unexpected. Made the mistake of telling my husband, who then laughed so hard he almost peed himself. It would have been so poetic if only he had.

  5. Caitlin Oct 13 at 4:01 pm Reply Reply

    wow – there’s a whole lot of non-commenting going on here! clearly a subject that no one wants to fess up to!

  6. melissa Oct 13 at 4:39 pm Reply Reply

    So, uh, I am 20 weeks pregnant. Every single time I puke (yes, still doing that), I pee as if i just chugged a gallon of water. Even if I just peed. (I have felt my mouth water ominously, peed in a hurry and then thrown up and it still doesn’t help.) This never, ever happened to me before I was pregnant. Is it being pregnant? Will, uh, exercise help?

  7. geek anachronism Oct 13 at 6:25 pm Reply Reply

    I thought I was doing great until my gall bladder REALLY started having issues – I’d vomit so forcefully I’d pee everywhere. That happened on occasion while I was pregnant, but only if I needed to pee as well. Now, I can be empty and STILL pee myself if I throw up. Sneezing, coughing, laughing? No problem.
    I still remember the nurse and my mother abandoning me while I was in the middle of changing the baby the day after the birth. After ten minutes standing there wondering when they’d come back with clean nappies and desperately needing to pee, I decided to put the dirty nappy back on her, pick her up and put her in the cot. BIG mistake. I peed EVERYWHERE because post-partum pee? Gallons of it. Then the nurse had the nerve to GLARE at me when she finally made it back (with no nappies).

  8. Elizabeth Oct 13 at 7:42 pm Reply Reply

    Oh my gosh, I’m so glad that you wrote this. I pushed a 9 pounder out about 9 months ago…and things still aren’t back to normal. It’s not bad, just, well, not normal. I thought I had read somewhere that giving birth can mess up things for awhile, but it’s really good to see that confirmed.

  9. Kimberly Oct 13 at 11:18 pm Reply Reply

    So is this the appropriate place to talk about the, ahem, other type of incontinence? Or is that just a special hell reserved for those of us with third and fourth degree tears?
    NOBODY TOLD ME ABOUT THAT.

  10. Kirsten Oct 14 at 5:57 am Reply Reply

    Umm. I am am 3 years and 1 month postpartum, and I still have to cross my legs when I sneeze. It also happens when I cough or laugh occasionally. I try to laugh it off, but that might make me pee more!

  11. France Oct 14 at 8:42 am Reply Reply

    I’m not sure whether this exists in the US, but in France (and many other European countries), there is a special type of physiotherapy (called “rededucation perineale”, you figure it out) which many women go through post-partum, specifically to deal with this issue (also, not to rub it in, but the first ten sessions are reimbursed by the national healthcare system).
    Perhaps this is something to look into, at least if problems persist?

  12. Cindy Oct 14 at 11:21 am Reply Reply

    Incontinence STINKS!!! With my first, I had vag. birth – the first night, I woke up at 3 am with the slight feeling of having to pee. I stood up and BAM – completely full bladder pouring right onto the floor. If I had my own room, it would have been ok, but the hospital was packed and I was sharing with 5 other women – one of which decided that 3 am was the perfect time to shower and brush her teeth. As I stood there peeing myself, crying, humiliated, she was very sympathetic and brought me towels, but then made a joke at the WRONG moment – “should have done your kegels”. I wanted to beat her over the head, but instead I cried and said “but I did do them”.
    My second birth was c-section of twins. The girls are now 16 months old and I still pee myself occasionally. I am not talking a little drip (which does happen with laughing or coughing sometimes), I am talking full on OMG, get me to the bathroom, oh no, cross the legs I am not going to make it, shoot – I didn’t make it. I do kegels ALL THE TIME, but there are still those instances, very rare instances, but they happen none the less, where nothing I do will keep it in. Why didn’t someone tell me this sticks around FOREVER? I warn everyone I know who is pregnant just so they don’t get surprised.

  13. Beth Oct 14 at 11:55 am Reply Reply

    Long time lurker, but I had to jump in on this post to add to France. Indeed, there are physical therapists who specialize in pelvic floor physical therapy, which your insurance will cover if your OB/GYN or urologist will write you a prescription for it. (It’s counted just like ‘normal’ PT, like rehabbing a shoulder or knee injury.)
    I don’t have kids, but do have 2 linked conditions (interstitial cystitis / pelvic floor dysfunction) and PT for this has really helped. My PT sees a lot of women who need to rehab their pelvic floor after birth or pregnancy.

  14. Lori Oct 14 at 1:00 pm Reply Reply

    Ok I’ll fess up. Am 9 years(!!!!!) post and still pee myself on a regular basis. Nice. Welcome to old age

  15. anon. Oct 15 at 1:07 am Reply Reply

    Also going anonymous….My 9.5 lb daughter was born 41 hours after my water broke, and although I had no tearing (miracle!), when I got out of bed after sleeping a couple hours….whoosh! As Joy said, that was unexpected, although at the time I had no idea that I had peed myself because WTF?!…I couldn’t have possibly peed myself, right? I figred out pretty quickly that I had little bladder control if it got to full so peeing regularly whether I felt the urge to or not was part of my routine.
    I was also surprised ~4 weeks postpartum that I had a rectocele when I noticed this…fleshy protrusion from my girl parts. The interwebs informed me (and later, my OB) that could contribute to uncontrolable flatulance and worse, but didn’t realize that I had more than uncontrolable flatulence until an unfortunate incident a few weeks later. Luckily I was at home because I might have thrown myself in front of a bus so I could die in a horrible traffic accident rather than from embarassment. Seven months postpartum, both are waaaay better, but I still pee frequently to avoid leakage, and head to the bathroom at the slightest pooping urge.
    The peeing thing I was somewhat aware of (although not the full on incontinence), but the bowel thing…not. at. all. Luckily my baby is adorable.

  16. G Oct 15 at 2:04 pm Reply Reply

    Thank you for posting about this! Why didn’t ANYONE tell me about this when I was pregnant? That was the largest surprise after having my 9lb daughter six months ago. I seriously thought something was wrong with me because I just couldn’t control it- and I had no problems with control the day before giving birth(when I was at 40+ weeks)! The doctor kind of just shrugged and said “It’ll go away eventually.” Um..Thanx?
    It does/has gotten much better- but I’m still reminding myself to do Kegels.

  17. Suzanne Oct 15 at 9:09 pm Reply Reply

    I’m 6 months postpartum and finally stopped peeing a little every time I sneeze. I’ve never been very good at Kegals (is that the muscle? wait, am I doing it? did I stop yet?) but I do practice stopping and starting the flow when I pee. It really strengthened the muscles. Once I could stop it completely the, uh, leakage issues went away.
    I bet some doctor is going to get on here and tell me I’m causing bladder cancer/liver disease/brain tumors by doing that, but at least I don’t have to check my seat for a wet spot every time I sneeze.

  18. Laura Oct 19 at 3:35 pm Reply Reply

    KIMBERLY: So is this the appropriate place to talk about the, ahem, other type of incontinence? Or is that just a special hell reserved for those of us with third and fourth degree tears?
    NOBODY TOLD ME ABOUT THAT.
    No joke sister. The peeing thing was only an issue for about the first 6-8 months when I worked out but the other type still plagues me 2.25 years later. OMG it is a nightmare.

  19. Trisha Oct 20 at 10:47 am Reply Reply

    My mom has had both types of incontinence, and she only had me. It SUCKS. I am 31 weeks and talked to my OB about it today. She says it’s less related to baby’s or your size, and more about your skin itself. There’s no way to tell for sure until after giving birth. She also said that surgery can help but should only be performed after you’re dine with childbearing. I will look into it more and post whatever I find out.

  20. Jessica Nov 11 at 7:26 pm Reply Reply

    It’s so great to see women discussing this! Bladder weakness is more common in women than migraines and hay fever, but it is a taboo topic nonetheless.
    I work with a brand called TENA (www.tena.us), the worldwide leader in the management of bladder protection, and along with Harris Interactive we recently conducted “Bladder Talk,” a survey of 780 women over age 35 in North America and found that half of the women (51 percent) surveyed feel that bladder weakness has a strong impact on their daily life but forty three percent have never done anything about their symptoms! Some interesting findings include: More than a third (37 percent) say that they would live differently without bladder weakness. One fifth (20 percent) say they think constantly about their problem and it almost controls their lives. More than a quarter (28 percent) have planned trips around bathroom locations and almost one fifth (18 percent) have changed the way they dress.
    Please keep the dialogue open so can overcome the stigma associated with bladder weakness like we have with social stigmas around menopause, infertility and PMS. Women don’t have to be ashamed, and they don’t have to suffer silently. Diet, pelvic fitness exercises, and lifestyle changes can greatly improve control over the condition.

  21. Anonymous Nov 17 at 5:18 pm Reply Reply

    OMG, reading this post and comments is the only thing that makes me want to go outside tomorrow! I had my son ALMOST A YEAR AGO, and haven’t had a ton of regular leaking issues. Of course until today, when I FREAKIN’ PEED MYSELF walking down the street pushing the stroller! WTF, I didn’t really even have to pee that badly, and suddenly here I am 5 minutes from my house, crouching. So I do what any normal mom would do, push the stroller between the street and moi and pretend to tie my shoe, then mess with the little guy’s sippy cup… At least I can laugh now at the horror! Nothing has been “normal” down there since the birth – thanks for the heads-up, world. And I’m cursing myself for not being diligent about the kegels. Oh well, at least the street was deserted (at least it is in my mind). Keep up the courage, ladies.

  22. Daisy Oct 29 at 3:49 am Reply Reply

    Gyahhh. I can’t even… My heart goes out to you guys. I’ve been doing kegels, no lie, since I was a preteen. I saw a show on TV about it and ever since, every day pretty much. I was so diligent during pregnancy and after. I had NO problems during my pregnancy, even with a giant, head down baby who constantly pressed my bladder. I had a crazy birth where his head was stuck on my hip, and I had to push 3 hours, wasn’t allowed to be upright so I ended up sorta half up half lying… anyway, lots of stitches, almost 9lb baby, etc etc.
    Things were totally fine til… 6 months postpartum. Two months later, still no good. What the heck, lol. I had a regression I guess. I’ve still been doing kegels but now for the first time in my life, I’m leaking small amounts of urine. I have to change constantly. I feel like a potty training toddler. It’s awful. Small amounts, but still. I am paranoid about odour. I don’t have a UTI. I exercise moderately. I eat well. I’m not remotely overweight. But here I am running to the bathroom. My actual bladder is super strong and can hold a lot, but it’s like a random event. The muscles are really weak and I can barely feel kegels now. Embarrassing. I am afraid to work out around other people or do yoga or bend down some days. Wish I knew what to do. I’m going to try to see a women’s doctor soon…

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