"Just the normal incontinence" and other common myths about pregnancy, birth, and beyond

At Southern Pelvic Health, we offer free 15-minute phone consultations for people to determine if pelvic floor physical therapy is the best next step in their health journeys. These consultations are awesome-- they give us a chance to get to know the patient, give the patient a chance to ask any questions, and help us start building a partnership if physical therapy care ends up being their next step. For some, it is. And for others, it's not. Sometimes we refer patients to their physicians or other specialists. Sometimes, we encourage them to wait before coming in for a procedure, surgery, or something else.

Recently, I spoke with a new mom experiencing some difficulties that happened after birth. As we were talking, I asked her if she was having any bladder leakage, or other bladder challenges. She said, "During pregnancy, I had the normal incontinence, and I do leak some now, but nothing unusual." Let that sink in. Why is bladder leakage, ever, looked at as a normal thing? Spoiler alert: It's actually not normal. And guess what? There is something you can do to help it. Even during pregnancy.

So, this inspired me to write a post on some of the common pelvic health myths around having babies.

Myth #1: Bladder leakage is normal during pregnancy or after you've had a baby.

I already spoiled this one. It's actually not. Common, yes. But not normal. During pregnancy, people can be more susceptible to leakage at certain times as the growing uterus changes the angle of the urethra, but the body should still be able to compensate, support the urethra, and avoid leakage. After having a baby, it can be normal to have some leakage in the first few weeks (depending on your birth), but then, it should improve. Continuing to leak after that initial healing period is actually not normal, and there is so much that can be done to improve this!

Myth #2: If someone is experiencing prolapse after having a baby they will eventually need surgery.

I hear this one a lot. Comments from well-meaning providers saying things like, "we'll need to fix that when you're done having kids." So, let's dispell a few myths. First, prolapse is SO common. Some studies have shown that up to 90% of people have some level of prolapse after birth (when checked on examination). This, of course, is going to be a much lower number when you look at people also having symptoms of prolapse. Prolapse is a pressure management problem impacting organ and tissue support. Organs and tissues are supported in the pelvis by fascia, ligaments, connective tissue and muscle. While we can't necessarily change prior tissue damage via rehabilitation efforts, we can optimize muscles to improve the pressure system. And there is evidence that this reduces the stage of prolapse and improves the symptoms too! Additionally, there are other conservative options to help manage prolapse as well. Pessaries are wonderful support devices that can be used, and most people found them to be very helpful when we look at the research.

Myth #3: After having a baby, it's normal for sex to be a little uncomfortable.

Pain is the body's alarm system, produced by the brain to protect us. Pain is meant to evoke action on our part-- to get us to protect the body, do something, to stop the "threat" from occurring. Sexual intimacy is meant to be pleasurable--before and after having a baby. Upon first returning to sex after birth, it can be normal to have a little bit of discomfort, HOWEVER, this should very quickly go away. If it persists, that's a problem, and (you guessed it!), there is SO much we can do to make this better! Why does pain happen after birth? It can be a lot of reasons: scar tissue inhibiting the movement around the vaginal opening, decreased lubrication due to hormonal changes, musculoskeletal restrictions due to injury or dysfunction, and others! Read more on sex after baby here!

Myth #4: Low back or pelvic pain during pregnancy is just part of it.

Let me say it a bit louder for the people in the back: COMMON DOES NOT EQUAL NORMAL. Low back and pelvic girdle pain are indeed common during pregnancy, impacting anywhere from 4-84% (don't you love those huge ranges we get in research) of pregnant individuals. While many cases resolve after birth, some people will continue to experience problems. Also, who wants to struggle with back and pelvic pain for months on end while they are pregnant? Not me, and I'm guessing not you. So, there is a lot that can be done to help this during pregnancy. Not surprising, research is mixed on the effectiveness of various techniques, and honestly, I think that is because treatment really needs to be individualized. Some tout "stabilization exercises" however, some studies have shown that most people with pelvic girdle pain actually have pelvic floor muscle overactivity-- so of course, transverse abdominis and pelvic floor strengthening is going to make them feel worse! Key concept here- if you are pregnant and experiencing back or pelvic pain, go see someone who has specialized training in perinatal and pelvic floor care who can assess YOU (individually-- not making assumptions!) and help make a plan to get you feeling better.

Myth #5: There's nothing you can do about constipation during pregnancy.

Constipation during pregnancy is the worst! We can thank hormonal changes for that. While there's not much we can do to change the hormones (nor would we want to!), we can do everything else to optimize our bowel habits and promote better bowel health. This includes learning the best way to sit on the toilet, proper mechanics for defecation, how to build a stellar bowel routine, and making dietary changes to promote better bowel function.

Myth #6: Do your Kegels, mama!

Surprisingly, this is actually false. While all pregnant individuals were told in the past to do kegel exercises to protect their pelvic floor muscles and optimize their births, we know now that not everyone actually needs pelvic floor strengthening. Remember, a large percentage of people actually struggle with pelvic floor tenderness and overactivity-- especially if they are experiencing back/pelvic pain, or have pre-exisiting pelvic floor disorders. So, the best way to optimize pelvic floor function during pregnancy? Go get an exam, and have a skilled, specialist trained clinician help you get an individualized program for your pelvic floor.

Myth #7: There's nothing you can do to really prepare your body for birth or prevent problems after.

Actually, there is emerging evidence that suggests we can do something to prevent problems like urinary incontinence, and other pelvic floor disorders. A recent Cochrane review (this is basically, the highest level of evidence we have) indicated that a targeted pelvic floor training program early in pregnancy actually decreased the risk of urinary incontinence during and after pregnancy. Exercise during pregnancy has also been shown to be safe and beneficial for the baby. Perineal massage has also been shown to be helpful in improving pelvic floor mobility and reducing perineal trauma during birth (particularly, during the first vaginal birth!). Want more info on preparing for birth? Check out our class on the topic! 

Myth #8: The only way to change your belly problems after having a baby is with surgery.

If you've been following this blog, you've probably read our recent 2-part series on diastasis rectus after birth (If not, check out part 1 & part 2!) Many people experience diastasis rectus during pregnancy and after birth, or may just feel laxity and a loss of support at their belly. Rehabilitation of the abdominal wall can be so hugely beneficial for these people (myself included-- hello cesarean birth x 2!). Surgery can sometimes be an option, but really, this should be used after a person has exhausted conservative options. So, if you're struggling with belly problems after birth, give us a call! Check out our DRA class in the meantime also!

Myth #9: You can jump right back in to whatever exercise you want after having a baby.

I guess technically this one is true. You can do anything you want. But, that doesn't mean it's a good idea. Having a baby can be very impacting to the abdomen and the pelvic floor muscles, and it's best to build back up to desired exercises slowly and methodically. I always say I would much rather someone wait and slowly get back to exercise than to jump into strenuous exercise too quickly. I can't tell you the number of patients I have seen who have had problems like pelvic organ prolapse, or other pelvic floor conditions after resuming really high intensity exercise without adequately preparing their bodies. I don't tell you this to scare you-- believe me, I want you to get back to EVERYTHING. I want you to be a strong mama who can rock exercise EVEN BETTER than you did before your birth. BUT, I think we need to be smart about it, ease into it, and learn how to self-asses our bodies to make sure we do the exercises that are most appropriate for us at the time.

Myth #10: Moms don't need to see a pelvic PT if they don't have problems after birth.

Did you all know the pelvic floor physiotherapy is actually the norm after birth in some European countries? And why shouldn't it be? Birth is transformative and hugely impacting to the body! Why is rehab after an orthopedic surgery nearly required, yet moms are not even offered rehab after cesarean births or operative vaginal births? In my perfect world, I would love to see all parents given the opportunity to seek pelvic health care after birthing a baby. In fact, wanna know a little secret? I'm actually seeing my colleague (Dr. Kate Schenk, who is a rockstar!) for pelvic floor and abdominal wall rehab this week! You may be thinking, didn't you have your baby a year ago, Jessica? Good point my friend. But, like many other moms, I decided to put myself on the back burner for a while...and a while turned into a few months...which then turned into a year. When we celebrated my little Mary Lynn a few weeks ago, I had a moment of, "what am I doing?!" and quickly contacted Kate to make my first appointment! I'll write on my journey later, you can be assured of that. But, don't be me. Put yourself first. I know it's hard (believe me!) but self-care is actually not selfish, it's self-less! (And reading my post on self-care from 3 years ago, I realize that this has clearly always been a struggle for me!) Recently, we actually took a close look at the ways we are caring for our pregnant and postpartum patients, and realized, we can do better! So, we started offering in-home prenatal and postpartum care! I am SO excited about this-- to be able to reach people where they are, reduce their (and their baby's) exposure to...ummm... "germs" in the community, and take away some of the stress of getting childcare to get out of the house!

What else have you heard is "normal" for people during pregnancy and after birth? I know I didn't hit all of the common myths out there! Let me know in the comments, and let's keep the conversation going!

Happy Monday!

~ Jessica