Control issues

I recently shared a laugh with a close friend as we discussed a new fitness class that’s hot in our area. It’s a fast-paced cardio dance class with upbeat music and instructors who look like they leapt off the pages of a Lululemon catalog. The moves are fun and effective … but there’s a lot of jumping involved (plyometrics, burpees, that kind of thing). For us moms, all that bouncing can mean increased opportunities to dampen our pants in public. As my friend and I joked about wearing black and standing by the exit closest to the lavatory, I had a couple of thoughts: (1) I know we’re not the only moms dealing with this shiz. (2) On the other hand, I have fitter-than-me mom friends who seem to have no problem jump-squatting, jumping-jacking and double-rope-jumping from here until eternity. What’s the secret of their triumph over incontinence?

Why we leak

Loss of bladder control has everything to do with the pelvic floor muscles—the same group of muscles that work overtime to support the expanding uterus during pregnancy, only to be completely abused when it’s time for delivery.

These muscles will stretch and strain—and maybe tear—during childbirth, leading to issues of incontinence that can begin immediately and/or wreak havoc in decades to come. When pelvic floor muscles are weak, the bladder tends to leak with every forceful movement. (Think jumping on a trampoline, working out or even sneezing.)

With age and successive pregnancies, pelvic floor muscles grow increasingly weaker unless something is done to counteract their depletion. In some cases, women eventually suffer organ prolapse, where the bladder falls from its normal position down into the vagina, causing more problems and possibly requiring surgery.

What we can do about it

Good news: We do not have to resign ourselves to buying panty liners in bulk for the next 50 years! While some cases involve vaginal tearing or organ prolapse severe enough to require surgery (ask your OB to refer you to a urologist if you think you might fall into this category), most of us can take control of our pelvic floors independently, with simple everyday practices.

Kegels are the most basic strengthening exercises for the pelvic floor. Named for the gynecologist who began to prescribe them in the 1940s, Kegel exercises are the repeated contracting and relaxing of the pelvic floor muscles. Kegels are safe to practice any time; they should be made a habit during pregnancy and reintroduced soon after delivery (even before you leave the hospital.)

To do Kegels, pay attention to the muscles in play when you go to the bathroom. The same muscles you use to stop and start the flow of urine are those we’re working with here. When you begin, you might only be able to tighten the pelvic floor muscles for a couple seconds at a time, but practice several sets every day, and your endurance will build up so that you’re gradually holding stronger and longer before releasing.

Although Kegels are a great start, “Simply doing Kegels may not be enough,” says Lia G. Andrews, DAOM, LAc, author of The Postpartum Recovery Program. Welcome to the world of vaginal weight-lifting. (Who knew, right?) Andrews recommends strength training with jade eggs (a traditional Daoist method) or modern vaginal weights, starting about four to six weeks after giving birth, when the vaginal area has healed.

A jade egg or weight is inserted into the vagina like a tampon with a removal cord hanging down; you then use your pelvic floor muscles to clench and lift the weight, giving you more resistance than you would have with Kegels alone. Depending upon the tools you use, you’ll be working toward lifting heavier weights or clenching smaller objects. No one will see these fitness results, but you stand to benefit in more ways than one—pelvic floor exercises are said to increase sexual pleasure and deliver stronger orgasms, too.

Overall health for better control

“It’s important to understand that your pelvic floor muscles don’t stand alone,” stresses Michelle Ishio, CPT, postpregnancy rehab specialist. “Your diaphragm, abdominal muscles and back muscles contribute to the integrity of your pelvic floor muscles.”

Ishio’s rehabilitation methods include, first, maintaining good neutral posture. When the pelvis is pushed back too far (like when you’re wearing high heels) or jutted forward (like when you have a baby on your hip), you’re impeding pelvic floor recovery. Second, Ishio coaches, “Always contract your pelvic floor and abdominal muscles (at the same time) whenever you have short bouts of exertion. Doing this will help retrain your muscle reaction to exertion.” Your pelvic and abdominal muscles will improve hand in hand. After recovering from childbirth, you will likely be eager to hit the gym, rework your overall shape and fit back into your old clothes. Lifting weights and performing high-impact moves will put stress on your pelvic floor; fortunately, when you act on Ishio’s advice and push back with pelvic muscle contraction, you can train your body to react healthfully to this stress rather than allowing leakage.

Nutrition plays a part, too. Overweight women are more likely to have issues with incontinence and prolapse because of the extra weight their pelvic floor muscles must bear. Maintaining a healthy weight will remove some of this stress. As your postpartum hormones come back into balance and you work to recover muscle strength, make diet choices that will support your efforts. Anti-inflammatory foods and lean proteins will help you on your way.