C-sections and the pelvic floor - help!

[izzzie]

Hello
This is a question for mums who've had c-sections. To what extent did you find it protected your pelvic floor and reduced incontinence?(urinary and faecal)
I am 21 weeks pregnant with my first baby and the more I read the more worried I am getting about the prospect of incontinence.
I already have a very weak bladder (i am working on it with kegels and retraining) and I want to do everything possible to avoid things getting worse after childbirth. (I don't leak but i need the loo 10-15 times a day; three to five times a night)
I saw an obs who said that it isn't actually childbirth, but carrying the baby in pregnancy, that damages the pelvic floor, but from what i've read since, i'm not sure this is totally true.
I am a really keen runner and since four months into the pregnancy I haven't been able to run because it makes me feel like i need the toilet. The thought that I might have to give up running after childbirth, and suffer long term incontinence after birth makes me feel totally anxious and depressed.
any advice anyone? Although I would rather have a natural childbirth, I would be prepared to pay for an elective c-section privately if people think it would help preserve my poor old pelvic floor.
Thank you...

I think that maybe it's a mixture of both - I certainly leaked more after a natural birth (2nd child) and didn't really suffer at all after CS with 1st DC. However, perhaps if I had done all the exercises after CS, I wouldn't have had the probs in 2nd natural birth.
I do think my 2nd carried a lot lower and I had lots more trouble with leaking before his birth, compared to DD who carried very high up under my ribs.
They should give you exercises relating to the section afterwards and perhaps even do a class whilst in hospital (they did for me only I felt too crap to go to it!)
If you're fit through running anyway, you might be fine after a normal birth and I certainly wouldn't a section instead of a natural if at all possible. But if there's a medical reason why you feel you may suffer incontinence afterwards, then perhaps a CS would be the way to go - although the risks generally are greater.

I've heard some people say it is pregnancy more than childbirth which damages the pelvic floor, but my anecdotal experience is that childbirth certainly plays some part. I've had 2 c-sections and my pelvic floor feels exactly the same as it did before my first pregnancy, but some friends who've had natural births have had incontinence problems afterwards.

You need proper medical advice on this though - c-sections aren't for everyone, and there are cons as well as pros.

I have had a c/s and have no problems with my pelvic floor even though I was leeking during pregnancy and generally have, like you, always had a weak bladder. I know people say that it's the pregnancy but surely pushing the baby out must somehow damage the pelvic floor.

I think speak to a consultant about this who will give an honest answer. Good Luck !

forgot to add, I agree with TuttiFrutti, I too have friends who have had vaginal births and now have terrible problems even if they didn't have horrendous tears, one is, like you a keen runner, and 18 months after delivery can't really run without leaking and 'feeling that things are about to fall out' (her words, sorry if TMI). I have one other friend who has had a c/s and she like me seems fine. Again, that's just anecdotal evidence so do speak to a consultant.

Hi - I had a c-section three weeks ago for medical reasons. While in hospital I was seen twice by a physio who advised me that it is the pregnancy not the method of delivery that affects the pelvic floor. I still have to do all the exercises and will be assessed again at the six week check up. I was also advised not to do any running until six months after the pregnancy.

I had a c section, and pooped myself afterwards, mind you that's probably because I was sore and couldn't get up the stairs quick enough!!!!

i had a cs and have no probs with pelvic floor. i was being induced for days and days though so probably was fairly well tested, or is it the pushing that does it? BUT i was pretty fit beforehand, despite being somewhat fat this must be in your favour for natural birth (fit not fat).

and can risking your pelvic floor in labour really be worth the cutting through stomach muscles for cs trade off? i wouldn't.

more anecdotal evidence here - I have had 2 x cs and my pelvic floor is tip-top. I also have a friend who has problems and she had a difficult ventouse delivery

thanks everyone - it seems like there's no guarantees, however you give birth! i'm just going to keep doing the kegels and keep up general exercise (apparently that's quite important, as it improves your overall strength etc) and hope for the best!
anyone else who reads this post, please keep adding your experiences, it's really helpful to read the anecdotes.
I don't want to be an incontinent old lady at 32 if i can possibly avoid it!!

Hi

Just to add my experiences, I have had two sections and two vaginal births ( one ventouse) and have no problems, I am able to trampoline and run etc , I have always been able to 'hold on' and before babies used to go all day without weeing!! . I do intermittent pelvic floor exercises whenever I remember, usually when I read this type of post .

In my experience I would not opt for an elective section but that is just a personal opinion.

good luck

Pregnancy does do some damage, but most of the damage is done in natural delivery. I'm all for a woman's right to choose a section if she wants to. But, I don't think I'd make that choice solely on the possibility of agravating an existing problem of weak bladder.

Though, perhaps I'm not the person to talk to since I don't suffer from the problem. Maybe people who have become incontinent as a result of natural delivery would have a different view.

This question unfortunately is quite political in the sense that there is overwhelming evidence that an elective cesarean does protect you from urinary incontinence but the whole maternal choice cesarean topic is a very controversial issue, not always for the right reasons. Everyone agrees it protects you from fecal incontinence. As far as it protecting you from urinary incontinence, there's no question that it does help protect you from that but it is also true that being pregnant adds to the possibility of urinary incontinence in the future. Effectively, what that means is that being pregnant raises your risk of this but giving birth vaginally will raise the risk even more and possibley result in a worse case of urinary incontinence.

There needs to be a clear distinction in the type of cesarean section tho b/c cesarean after a trial of labour will not protect you from this problem, only an elective cesarean for your first child will protect you from this sort of problem. I have, after much research long before I got pregnant, decided to opt for an elective cesarean birth (for my first baby) for these reasons and a number of others, none of which has anything to do with any fear of pain of childbirth (as some people wrongly assume that is a motivation for all people who choose this sort of birth mode) since that is not something I fear. I read a number of wonderful books that helped clear my head on these topics and I can highly recommend them to you so that you can make your own decision. They are, 1) Ever Since I Had My Baby: Understanding, Treating, and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth, by Roger P. Goldberg, 2) Pelvic Health & Childbirth: What Every Woman Needs to Know by Magnus Murphy and Carol L. Wasson, 3) Just Take It Out! : The Ethics and Economics of Cesarean Section and Hysterectomy by D. Campbell Walters. I hope this helps answer your question.

Women who have had c-sections can be just as much at risk of incontinence as women who have vaginal deliveries. Sorry but the latest research shows this...and I mean urinary incontinence. By the time you have had 3 babies, by either method the risk of incontinence is the same. Being pregnant is v bad for your pelvic floor, relaxin and heavy babies put a lot of pressure on your urethra. Faecal incontinence is a different issue, often due to rectal trauma at a long delivery with instrumental delivery.
I am severely incontinent from my first brutal long instrumental delivery, should have had a c-section but didn't happen. I am having a c-section this summer, urinary incontinence won't get worse but my faecal incontinence could become vvv bad if I had a normal birth, so not risking it.
My advice, DO PELVIC FLOOR EXERCISES, straight after birth and get someone professional to train you otherwise you will recruit the wrong muscles. Do Pilates. I did antenatal yoga, what a waste of money and very unrealistic about what happens to your body in labour. Opening up like a lotus....er no, having a large episitomy and lots of interventions, thats what did it for me!
Good luck!