Postpartum Bladder Health: How Physical Therapy Can Help

Physical therapy can treat postpartum bladder problems, such as urinary incontinence, by restoring pelvic floor muscle function after pregnancy and childbirth. Between 30 to 40% of women experience some degree of urinary incontinence postpartum, often silently suffering through stress incontinence in which urine may leak without your control when pressure is applied to the bladder when laughing, coughing, or exercising. Through Kegel exercises, pelvic floor muscle training, manual therapy, and bladder retraining with a skilled physical therapist, women can find relief from postpartum bladder issues.

Postpartum Bladder Health

Urinary incontinence involves undesired leakage of urine that occurs during the day or night. With urinary incontinence, individuals have trouble either starting the urine stream or holding urine; urinary incontinence often involves dysfunction or weakening of the pelvic floor muscles. The pelvic floor muscles form a hammock-like structure, running from the pelvic bone to the tailbone, that supports the internal organs, controls the urethral sphincter muscles, and stabilizes the pelvic bones. The sphincter muscles regulate involuntary and voluntary control of urine flow from the bladder.

There are two types of urinary incontinence: urge incontinence and stress incontinence. With urge incontinence, it is common to need to urinate often with the feeling coming on quickly and strongly. The bladder muscles contract before the bladder is actually full and the muscle contractions can cause you to accidentally urinate even though the bladder isn’t completely full and doesn’t need to be emptied. Urge incontinence can result from urinary tract infections, diabetes, pelvic organ prolapse, or conditions that affect the nervous system like a stroke, multiple sclerosis, or Parkinson’s.

Stress incontinence is the most common form of postpartum incontinence. Stress incontinence happens when pressure is applied to the bladder, such as when laughing, coughing, sneezing, lifting, or exercising. The pressure on the bladder causes urine to leak out without your control. Pelvic floor muscles surround the urethra and help to keep it closed when pressure is applied to the bladder. However, when the pelvic floor muscles are weakened, they are unable to control the urethra when pressure is placed on the bladder.

Approximately 30-40% of women experience some degree of urinary incontinence during pregnancy and after childbirth. Pregnancy and childbirth can change a woman’s pelvic floor and urinary control abilities. During pregnancy, hormonal changes increase the laxity of the pelvic floor muscles and the weight of the growing uterus places increased pressure on the pelvic floor. Childbirth, particularly a vaginal birth, can cause weakening and tearing of the pelvic floor muscles and can affect bladder control and continence after birth. In fact, women who deliver vaginally have a 50% greater chance of developing postpartum incontinence than those who deliver via c-section.

Physical Therapy for Postpartum Incontinence

Physical therapy can treat postpartum incontinence by restoring pelvic muscle function after pregnancy and childbirth. The physical therapist initially conducts a thorough evaluation, discussing symptoms and assessing the muscles of the pelvis, hip, and low back as well as the strength, coordination, and flexibility of the pelvic floor muscles.

A research review of nearly 100 randomized controlled trials assessing urinary incontinence in women revealed that pelvic floor muscle training combined with bladder training resolved urinary incontinence in women with significantly increased continence rates at 3 months and 12 months follow-up.

Physical therapy treatment for postpartum incontinence can include:

•  Kegel exercises: repeated tightening and releasing of the pelvic floor muscles that can be performed standing, sitting, or lying down. Kegel exercises help to build coordination and endurance in the pelvic floor muscles through contracting and quickly relaxing the muscles, enhancing the muscles’ holding ability.

• Muscle strengthening and re-education: specific strengthening exercises of the hip, pelvic, and core muscles to provide additional support for proper bladder function.

• Manual therapy: soft tissue internal and external mobilization techniques to relax tense muscles and improve function.

• Bladder retraining: self-regulation of bladder continence, gradually retraining the bladder so that visits to the bathroom extend to 2.5 to 3 hours between visits.

• Patient education on lifestyle factors: relaxation techniques and diet changes, such as reducing caffeine intake and limiting spicy and citrus foods that can irritate the bladder.

Mangiarelli Rehabilitation physical therapists, Jen Story and Patti Ciferno, explain and demonstrate how physical therapy can address postpartum incontinence, focusing on how Kegel exercises can strengthen the pelvic floor to improve bladder control.