Guest Blogger- Dustienne Miller
Please welcome guest blogger Dustienne Miller. She is a pelvic floor physical therapist with an advanced board certification in women’s health.
Question: I had a baby. Is it normal to leak now? What’s causing it, my weak core?
Answer: After having a baby, the body has gone through massive structural changes. If you had a C-section, the surgery literally cuts through the abdominal musculature. Even after the delivery, your core continues to go through structural changes as it heals. To prevent urinary incontinence, or leakage, all aspects of the core must be working in coordination.
The core is more than just the abdominals. It includes the diaphragm and vocal cords above and the pelvic floor muscles and connective tissue below. They work together to prevent incontinence. Imagine a can of soda. If you stood on it, it would not burst because the different parts of the can work together to maintain stability and strength.
The core of our body works the same way. The diaphragm and vocal cords are the top and the pelvic floor muscles and connective tissue are the base. The abdominals, most notably the deepest layer in the front (transversus abdominals) and the deep back muscles (multifidi), are the can walls. All aspects of the core, or “canister,” work together to prevent pain in the pelvic girdle and maintain continence. If you lose support from any aspect of the canister, there will be a “leak.” Leaks in the systems can present as urinary/fecal incontinence, prolapse, pelvic pain, diastasis recti, back pain, or hip pain.
Finding optimal standing alignment is critical. For reference, check out this blog post on postural awareness. When the rib cage is aligned over the pelvic girdle, the core can work more efficiently and effectively to prevent and heal pelvic girdle pain and leakage.
Question: Should I do kegals to stop the leaking?
Answer: This is a tricky question. There can be many reasons why leakage is happening. The pelvic floor muscles can be weak, tight, asymmetrical, and/or have difficulty firing due to nerve injuries. These issues with the pelvic floor muscles, along with connective tissue damage like prolapse, can cause urinary urgency and leaking.
If someone has a habitual state of overactivity of the pelvic floor muscles (think chronic jaw clenching), kegals can make the leakage worse.
After perineal tearing during delivery, the connective tissue heals and normal scarring occurs. Abnormal scarring will result in pain at the scar site due to lack of mobility. These tissue restrictions may affect the ability to perform adequate pelvic floor muscle contractions.
To figure out if you have restricted mobility, you can do an at-home assessment by placing your finger into the vaginal canal and seeing if both the right and left sides of the pelvic floor muscles initiate and sustain a contraction. If there is pain or tenderness, there is probably myofascial restriction that should be released.
Remember, it takes much more than kegals to stay dry. Pelvic floor physical therapists evaluate breathing patterns, hip strength, posture, and many other aspects of the musculoskeletal system.
Question: If there is myofascial restriction from a perineal tear during childbirth, is there anything I can do about that?
Answer: Proper evaluation from your medical provider and physical therapist is important. Once you have been medically cleared, you can work at home with dilators and your fingers to release the myofascial restrictions. The tissue of the vulva and surrounding structures scar the same as other parts of the body. Be kind to yourself—the scars (physical and emotional) need to be addressed in a gentle and mindful way. Please write in with more questions. She would be happy to address them here on this blog platform or she can be reached privately at firstname.lastname@example.org.