Bladder Control After C-Section or Episiotomy Scar?

Just when I think I’ve learned everything about LBL, a conversation comes up that surprises me. My recent “Aha!” came while talking with the Director of Therapy Services, Kristen Maike, PT, at McClarin Oakland Hospital, in Pontiac, Michigan. You may remember Kristen. She’s a pelvic floor physical therapist who shared ways to strengthen your pelvic floor on the Woman-to-Woman podcast series.

If you’ve ever had an episiotomy or C-Section – even if it was many years ago – this post if for you. We women know that after childbirth, we need time to recover, especially if delivery involved a surgical procedure. What you may not know, is that during the healing process, both C-section and episiotomy scars can sometimes lead to bladder leakage.

A C-section scar can attach to the front wall of your bladder, causing urge incontinence (that strong urge to go). “As everything shrinks back down after the birth, the scar begins tugging on the bladder making it feel like you have to pee,” said Kristen.

An episiotomy scar can make the pelvic floor inefficient and weak. Kristen explained, “During an episiotomy, the doctor cuts through the fibers of the pelvic floor muscles. When they stitch it back up you can end up having areas that won’t contract as well because of the disrupted muscle fibers.” Not all women who get an episiotomy or C-section end up leaking. But when scars attach to the bladder or disrupt full motion, your odds go way up.

Many of Kristen’s patients come to see her because of bladder leakage issues resulting from an episiotomy or C-section. The great news, is that most of these women see improvements — or completely stop leaking — by receiving pelvic floor physical therapy…even years after giving birth. One of her patients' is a lovely 50-year-old woman who had an overactive bladder for three years. Even though she was taking medication to treat it, she found herself getting out of bed five to six times every night to run to the bathroom. Kristen noticed her patient had a 30-year-old C-section scar. “After about three weeks of treatments to pull the scar up and away from the bladder, she started getting six hours of sleep, and maintained that. She used to get an hour and a half at most,” said Kristen. Kristen recommends that you feel your scar. “If it’s thick and it doesn’t move, it’s attached itself to the tissue around the bladder. A pelvic floor physical therapist can get underneath it to stretch and mobilize the tissue under and around the scar.” she said. It’s a non- surgical and non-invasive way to get relief. There are things you can do to manage light bladder leakage — before, during, and long after you’ve given birth.

Here are a few tips from Kristen:

BEFORE GIVING BIRTH Get familiar with your pelvic floor area and learn to strengthen it. “Most women don’t realize they have a pelvic floor. Half, if not more, of my patients think they’re doing Kegel exercises correctly, but they’re not. Many are doing the exact opposite,” said Kristen. It’s worth checking with your doctor or a pelvic floor physical therapist. Kristen says there are many ways to ensure you’re doing Kegel exercises correctly — from using a biofeedback machine to gauge the strength of your Kegel contractions, to simply using your finger to feel for the squeeze.

DURING THE DELIVERY During a normal vaginal delivery you do a lot of pushing. But to have the baby come out, the pelvic floor muscles need to relax. When you’re able to relax the muscles, it’s easier for them to stretch. Otherwise you’ll either tear, or the doctor will choose to cut. If you’re able to relax those muscles, you give yourself a good chance of avoiding an episiotomy. Though, it’s not a guarantee. Every woman’s body is different, and there are other factors, too - like the size of your baby for example.

AFTER GIVING BIRTH After you’ve had your baby and your doctor has cleared you for all activities, it’s time to make sure you can engage your pelvic floor. This can be done with exercises like Kegels , yoga, walking, or Pilates. “If you continue to leak, feel pain, or feel a strong urge to go, talk with your physician. The sooner you get it addressed, the easier it will be for you,” Kristen said. She suggests you ask questions and let your doctor know what you want by saying, “I’ve been reading about physical therapy for leaking and I’d like to be able to see a pelvic floor physical therapist. Will you write me a prescription to see one?” If you continue to leak when you cough, laugh or sneeze, a physical therapist will check to see if your pelvic floor is too weak or too tight. Your pelvic floor needs to have a range of motion. To get an understanding of why this happens, try this: Hold your wrist straight in front of you and make a tight fist. Notice how easy that was. Try again, only this time bend your wrist towards you first, and then try to make a fist. Did you notice it’s not as strong and it’s harder to do? “That’s because the muscles were already shortened. This is what happens with your pelvic floor when it's too tight. You cannot get the power you need when you need it,” said Kristen. Tight muscles can happen for a variety of reasons. For example, some women get into a pattern of constantly pulling up and holding in those muscles for fear of leaking. When they feel a big sneeze coming on, they don’t have enough power and motion in those muscles to stop the urine from coming out, and they leak. The only way to really know if your muscles are tight is with a pelvic exam. “In France, pelvic floor physical therapy is offered to all women before and after delivery. In the U.S., many women don’t even know it’s available to them,” Kristen said. It’s important to take charge of your health care and talk with your doctor. One of the biggest pleasures Kristen gets is helping women improve their quality of life. When I asked her what she wants women to know about seeing a pelvic floor physical therapist, she said, “There’s no award for suffering. There are many options for you to address light bladder leakage. We’re all nice and we all do our best to make you feel comfortable with us.”

How about you? Have you talked with a medical professional about LBL and how your episiotomy or C-section scar could be affecting it?


-- Edited by MarilynSuttle at Jun 10, 2014 10:43 AM PDT



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