Postpartum Isolation: When Leakage is a Factor
A recent editorial by Charleston psychologist Risa Mason-Cohen on the topic of postpartum depression1 immediately brought to mind many of its parallels and connections to stress urinary incontinence in women: the myth promoted by society that only a small percentage of women are affected, the suffering in silence by many because women fear being labeled with the diagnosis or even worse believe it is a natural part of having babies and therefore something to accept, and the low level of public health literacy that robs women from realizing how highly treatable and manageable the symptoms are.
In fact, postpartum urinary leakage and even anal incontinence--defined as the loss of control over gas or stool--is quite common and can often be co-mingled with twins. We know that women with multiple births are not only more likely to suffer from postpartum depression than others, they are also more likely to experience problems with incontinence, both urinary and anal. Urinary incontinence affects 30 to 50 percent of childbearing women by age 40. Up to 70 percent of women have some leakage during or after pregnancy and this raises their lifetime risk of experiencing stress urinary incontinence in later years. Anal incontinence affects up to 25 percent of childbearing women and is more likely to occur in women experiencing urinary leakage following childbirth because of common underlying causes. Not only does this impact a woman's sense of balance and return of normalcy following childbirth, these symptoms often directly affect the intimacy with a woman's partner, her sense of femininity and even her self-worth.
Why does this physically happen? In pregnancy and childbirth, support muscles are weakened, pelvic nerve damage can occur particularly after a long or difficult vaginal delivery, connective tissues are routinely stretched and torn, and the perineum can sustain injury especially in the case of an episiotomy.
Much can be done to prepare for pregnancy and delivery to avoid this leakage, only exacerbating postpartum depression. The pelvic floor muscles need to be prepared for delivery, with exercises, perineal massage, weight management and general fitness and tone. But what can be done after delivery? Immediately after vaginal delivery, the prevention of perineal swelling and infection are important with the help of ice packs and proper hygiene. Avoiding constipation is also key. Pelvic floor muscle exercises must be continued to help restore muscle function before it is permanently lost, not only to lessen symptoms of incontinence but to regain sexual vitality and pleasure.
A great book on the subject is by Roger P. Goldberg, MD, MPH, Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth, published by Three Rivers Press, Random House.
Incontinence is not just something that affects our grandmothers. Much of it starts when we are young mothers. Make the connection, not only with postpartum depression but with others. Share this hidden story with those you know who are considering pregnancy, expecting, or recently delivered.
1Mason-Cohen, R. , Postpartum depression relief effort, Charleston Mercury, retrieved on January 28, 2010, from http://www.charlestonmercury.com/articles/2010/01/26/art_and_culture/doc4b5f78c445d60479057597.txt