Do you have questions about postpartum incontinence or bladder weakness? Ask INNOVO’s experts - £200 voucher to be won

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Please note, questions have been answered and the experts are no longer available to answer new questions.

Post-birth incontinence can be difficult to come to terms with both physically and emotionally. Despite many women suffering from it, it’s rarely discussed, which is why [[https://www.myinnovo.com/uk/
INNOVO]] wants to encourage conversation and raise awareness of the issue. INNOVO’S experts, Dr Meg Arroll, a Chartered Psychologist and Behavioural Change Specialist, and Aoife Ni Eochaidh, a Chartered Physiotherapist and Clinical Specialist in Women’s Health & Continence, are here to help answer any questions you might have about bladder weakness.

Here’s some more information about Dr Meg Arroll:

“Chartered Psychologist with The British Psychological Society. Dr Meg started her career in academia, focusing on medically unexplained conditions that leave people feeling lost, neglected and at sea in a world of symptoms, stigma and pain. Dr Meg's interest in bladder conditions stemmed from her own experience of bladder pain and the sheer lack of open discussion on this topic, leading her to publishing What's Up With Your Bladder (Hammersmith Books) in 2018. Dr Meg's aim is to guide people through their journeys, so that they have the confidence to move forward with resilience and psychological flexibility, rather than shame and embarrassment.”

Here’s some more information about Aoife Ni Eochaidh:

“A Chartered Physiotherapist and clinical expert in the field of Women’s Health & Continence, founder of International Pelvic Physiotherapy Management (IPPM). Aoife is a peer nominated Medico Legal Pelvic Physiotherapy Expert, providing services in the UK & Ireland. Passionate about the pelvic floor, Aoife was inspired to work in pelvic floor physiotherapy seeing first hand the awful impact pelvic dysfunctions had on her late Grandmother.”

Would you like to know more about the causes of postpartum incontinence or bladder weakness? Maybe you would like to know how to cope with it and treat it? Have you got questions about how you can strengthen your pelvic floor? Does bladder weakness and experiencing leaks affect your emotional wellbeing, making you feel anxious? Whatever you question, please post them on this thread. Dr Meg Arroll and Aoife Ni Eochaidh will be back on the 12th July to answer a selection of them.

All who share a question on the thread below will be entered into a prize draw where one Mumsnet user will win a £200 voucher for a store of their choice (from a list).

Thanks and good luck!

MNHQ

Insight Terms and Conditions apply

@kos88

What is your opinion on surgery versus physio? I have bladder and bowel prolapse after a forceps delivery but have had good success with exercises regimes I have found online. However i’m still so aware of it and it hasn’t corrected completely. I don’t have leakage but can have urgency and frequent need to wee. Not sure is surgery would be worth it or not. Thanks.

Hello @kos88, thank you for your question! Pelvic Physiotherapy is recommended as a first line treatment for prolapse and frequency and urgency. It depends how bad your prolapse is, as to whether you need surgery. It is never either surgery or pelvic floor physiotherapy, both are needed. Good luck!

• Aoife

@seepingweeping

I was told it was my fault for not doing my pelvic floor muscles when pregnant with dd.

She was 11lb 4 at birth and I had a cesarean.

My bladder has never been the same.

Is there anything I can do to help? I don't lose a lot of pee but when I lean forward when I need the loo, it just starts and I can't stop it.

Dear @seepingweeping, thank you for your question!

It is never too late to do pelvic floor muscle training! No amount of leakage is normal. Your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to help with the leakage, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be as good as needed, and most importantly, the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep you dry might not be fully working correctly.

The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted, supervised, pelvic floor muscle training. You could also use electrical stimulation, such as Innovo but best to be assessed by a pelvic floor physiotherapist first. It is important to keep up the exercises for life, intensively first supervised by your pelvic floor physiotherapist and then at a maintenance dose amount and some women keep up some amount of electrical stimulation too on an on-gong basis.

If you can have an appointment with a pelvic floor physiotherapist or women's health physiotherapist as soon as possible, in person or on-line, this would be best for you if you are interested in trying it. Good luck with it and thank you for posting your great question!

• Aoife

@indigosmother

I gave birth at the end of October last year, but after a completely healthy pregnancy and being in active labour for over two hours, my little girl suddenly stopped recovering from contractions and then died. Then I was left for several hours (apparently to 'process' although there was none of that then, it took months) before being given syntocin to bring back the contractions. Then after pushing for several more hours they ended up using forceps so I had an episiotomy. I was fully dilated for more than eight hours, and they said that leaving it longer could have resulted in permanent damage to my pelvic floor. Now I'm worried that could have happened anyway, as all the exercises I've been doing for months have made little difference - but the pelvic health physio I've spoken to twice (with about four cancelled appointments and the service shut down for months in between, because of covid) said that you can't permanently damage it. I'm confused, especially as I've heard of and seen here many women complaining of what sounds like permanent damage. All I can think about, and the only thing getting me out of bed and eating each day, is trying to have another baby. I'm trying to do what I can to get everything in as good a shape as possible, so delays and confusion around this is just one more thing I'm worrying about.

Hello @indigosmother, thank you for your question. It sounds to me like you are doing a great job with your exercises and I would keep them up.

I really hope you conceive soon, and go on to have a lovely healthy baby. I think you should keep in touch with your pelvic physio too. Thank you for your question and I am so sorry for your loss.

• Aoife

@indigosmother

I gave birth at the end of October last year, but after a completely healthy pregnancy and being in active labour for over two hours, my little girl suddenly stopped recovering from contractions and then died. Then I was left for several hours (apparently to 'process' although there was none of that then, it took months) before being given syntocin to bring back the contractions. Then after pushing for several more hours they ended up using forceps so I had an episiotomy. I was fully dilated for more than eight hours, and they said that leaving it longer could have resulted in permanent damage to my pelvic floor. Now I'm worried that could have happened anyway, as all the exercises I've been doing for months have made little difference - but the pelvic health physio I've spoken to twice (with about four cancelled appointments and the service shut down for months in between, because of covid) said that you can't permanently damage it. I'm confused, especially as I've heard of and seen here many women complaining of what sounds like permanent damage. All I can think about, and the only thing getting me out of bed and eating each day, is trying to have another baby. I'm trying to do what I can to get everything in as good a shape as possible, so delays and confusion around this is just one more thing I'm worrying about.

Hello @indigosmother, first of all I am so incredibly sorry for your loss. It’s ever so very natural to focus now on trying to have another baby but I’m wondering what sort of support you’ve had for your bereavement – there are many charities that offer help including Tommy’s and Sands which offers a free national helpline and a bereavement support app, a UK-wide network of support groups with trained befrienders, an online forum enabling bereaved families to connect with each other and a wide range of bereavement support resources available both online and in print.

This needn’t delay trying to conceive again or improving your pelvic floor health, it may just help to manage some intrusive thoughts and desperation to become pregnant again. I sincerely wish you all the best with trying for another baby, from someone who has also experienced a pregnancy loss.

• Meg

@goldengrove

Is it ever too late to take steps to strengthen pelvic floor muscles?

Hello @goldengrove, thank you for your question! No, it is never too late to take steps to strengthen your pelvic floor muscles.

• Aoife

Is it possible to train my pelvic floor over five years after the birth of my last baby and with daily leakage?

@Wheresthebeach

What can I do post hysterectomy to help with stress incontenance?

Hello @Wheresthebeach, thank you for your question.

You need to be sure that you followed the post op guidelines that you were given after your hysterectomy. If you are still having problems or have developed stress incontinence, you need to be assessed by your pelvic physiotherapist.

Your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to help with the leakage, the strength in the muscles might not be good enough too, the fitness or endurance in the pelvic floor muscles might not be as good as needed, and most importantly, the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it a the right position to keep you dry might not be fully working correctly.

The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted supervised pelvic floor muscle training. You could also use electrical stimulation, such as Innovo, but best to be assessed by a pelvic floor physiotherapist first. Good luck with it and thank you for posting your great question!

• Aoife

@SearchingTheSkies

Can carrying a baby in a sling/carrier make bladder leaks worse?

Hello @SearchingTheSkies and thank you for your question! No, carrying a baby in a sling / carrier will not make bladder leaks worse.

• Aoife

Thanks Aoife! I do have weak pelvic floor muscles. I should go back to my GP about it?

@BraveBraveMouse

I saw the thread title and opened it up to read more and was disappointed MN only seem interested in questions about bladder incontinence.

Is having ongoing faecal incontinence after obstetric anal sphincter injury a taboo? I certainly wish someone had told me more about the risks of this before I agreed to be induced.

Hello @BraveBraveMouse and thank you for you question.

Faecal Incontinence is not as common as bladder incontinence so more women here are affected by bladder incontinence. Faecal incontinence is a taboo topic but thank you for raising it here because if we talk about it more, it will be easier for women to come forward to seek the treatment they need. Thank you for a great question.

• Aoife

@BraveBraveMouse

I saw the thread title and opened it up to read more and was disappointed MN only seem interested in questions about bladder incontinence.

Is having ongoing faecal incontinence after obstetric anal sphincter injury a taboo? I certainly wish someone had told me more about the risks of this before I agreed to be induced.

Hi @BraveBraveMouse, yes faecal incontinence is certainly taboo also and I’d say even more so than urinary incontinence. Anything to do with fluids or bodily substances tends to be taboo in our society but it is getting better! The more we talk about these topics, the less shame and stigma surrounds them so thank you for highlighting it! Your voice will help others to open up and not feel so alone in their experience.

• Meg

@Dentistlakes

Leakage seems to be worse at different points in my cycle. Do hormone levels have an impact on the pelvic floor making the problem worse? I do pelvic floor exercises x3 a day. What other options are there? Are there any measures I can take to prevent leakage during exercise?

Hello @Dentistlakes and thank you for your question!

You are so that right that there are monthly hormonal changes that affect us and our pelvic floor muscles. It can occur once a month, this hormone change can be sudden, and it can be that one night in the month that we don’t sleep very well because of this hormonal shift. If our sleep is disturbed, our gut hormones and our digestion processes are affected too. We can be more sluggish and bloated in our tummies around this time and any sluggishness, constipation or difficulty emptying the bowel can weaken our pelvic floor muscles and put some pressure on our bladders too.

It is important that we keep up our pelvic floor muscle training routine at this time, at a time when we feel most unlike doing it! It is vital to keep up our general exercise also at this time. Electrical stimulation might help you further too - something like Innovo might suit you - it's best to see your pelvic physiotherapist about it though.

There are some fantastic Dieticians that could help with hormone related gut advice too, your pelvic physiotherapist will refer you. I see in my own private practice with my own patients, that birth trauma relating to third degree tear, to mothers that had a forceps delivery or that have pudendal neuropathy (pelvic nerve damage) will be more affected by this hormonal, pre, peri or post-menopausal often monthly worsening of symptoms. Thank you for asking such a great question!

• Aoife

@trevorandsimon

Should women have to put up with bladder weakness after birth as a normal thing that can't be fixed? I really want to run to get fit but I wee myself every time....

Hello @trevorandsimon, thank you for your question. No amount of leakage is normal. A pelvic physiotherapy appointment, in person or on-line will help you. Electrical stimulation might also help you too.

• Aoife

@trevorandsimon

Should women have to put up with bladder weakness after birth as a normal thing that can't be fixed? I really want to run to get fit but I wee myself every time....

Hi @trevorandsimon and thanks for your question.

My answer is no, no one should have to put up with leaks as there are effective treatments for urinary incontinence. Have you tried any form of pelvic floor muscle strengthening yet? It’s best to first be assessed by a pelvic floor physiotherapist but then you may want to look into Innovo which is a non-invasive method that strengthens and re-educates your pelvic floor muscles.

However, you can do pelvic floor exercises on your own too – first you need to find the right muscles. One of the easiest ways to locate your muscles is when you wee. Squeeze the muscles you use to stop your urine; halfway through weeing, stop or slow down the flow. Don't hold your breath or tense your muscles. If you can slow or stop the flow, then these are the muscles you use for the pelvic exercises. Then to begin the exercises:

• Firstly, lay down on a flat surface, e.g. the floor or a bed.
• Squeeze the muscles for 2 seconds, then relax for 2 seconds.
• After 2 seconds, add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 to 15 times a session. Do at least 3 sessions a day.

You can also try the NHS’s Squeezy app.

• Meg

@flamingoshoes

I am 5 years post a forceps delivery. I have been told I have nerve damage that might or might not repair itself. I have double incontinence issues but manage OK with routine and have some feeling that has returned but need to find a toilet pretty quickly which is why a routine works well. I struggle with pelvic floor exercises as I can't feel much. I hate being near running water/taps/fountains/ rivers as it just makes me release whatever is in my bladder- is there anything I can do to stop this? I am no longer under any medical professionals (as of 4 years ago) as they didn't know what to do with me as progress plateaued - is it worth trying again? And if so who would e the best person to see?

Hello @flamingoshoes and thank you for your question.

I am so sorry to hear that you have birth related pelvic floor muscle damage and double incontinence. It would be great if you could get you a little better!

It is important that you keep up your pelvic floor muscle training routine. Electrical stimulation might help you further too, something like Innovo might suit you. It would be best to see your pelvic physiotherapist again about it though. There are some fantastic Dietitians that could help you too. I see in my own private practice with my patients, that birth trauma relating to third degree tears, to mothers that had a forceps delivery or that have pudendal neuropathy (pelvic nerve damage) will be more affected by hormonal (often monthly) worsening of symptoms. Thank you for asking such a great question!

• Aoife

@NormanSicily

What is the best non-surgical way of tackling slight incontinence after birth, and is there ever a point when these exercises have rendered you as good as you are going to be and further exercises will not improve the situation any more?

Hello @NormanSicily, thank you for your question. Yes sometimes results plateau, you could try adding electrical stimulation with the exercises, under the supervision of your pelvic physiotherapist. A device like Innovo might be a good option to try.

• Aoife

@Crossfitgirl

Are pelvic floor exercises enough for treating most straightforward bladder leakage / stress incontinence / weak bladder following birth, or is there merit in using pelvic floor training devices? If so, would they give better results than pelvic floor alone, and do you have any recommendations?

Hello @Crossfitgirl, thank you for your question. A combined approach of pelvic floor muscle training and electrical stimulation is a good option - a device like Innovo might be a good option to try.

• Aoife

@retryy

I am 3 years post partum and still experience some stress incontinence. Is it too late to make a difference with pelvic floor exercises?

Hello @retryy, thank you for your question. No it is not too late , you will be able to make a difference with pelvic floor muscle training.

• Aoife

@Asuwere

Can the pelvic floor muscles always be recovered with pelvic floor exercises or can it be permanently weakened after multiple pregnancies? Is very slight leakage just something to live with?

Hello @Asuwere, thank you for your question, Usually in most cases a full recovery can be achieved even with multiple pregnancies.

• Aoife

@goingpearshaped

Normal pelvic floor exercises seem to do nothing for me, what else can be done? As in what can I do to help myself?

Hello @goingpearshaped, thank you for your question. Yes you could try electrical stimulation, under the supervision of your pelvic physiotherapist but do keep up your pelvic floor exercise too.

• Aiofe

@Sunshinebrunshine

Do we just have to accept that women will have some incontinence after birth? I find it so demoralising as I'm not bad enough but it still affects my life

Hello @Sunshinebrunshine and thanks for your question.

My answer is a very loud ABSOLUTELY NOT!!! The notion that incontinence is ‘normal’ is not supported by the scientific evidence – yes, it is common with 1 in 3 women experiencing it but as we know therapeutic strategies such as pelvic floor strengthening work, it is not something that has to be accepted nor lived with!

If you haven’t yet tried pelvic floor exercises do give them a go or you may prefer a product like Innovo that uses electrical muscle stimulation (EMS) in which studies found 80% of users saw a significant reduction in leaks after 4 weeks, and 87% of users were defined as dry or almost dry after 12 weeks.

If incontinence affects your life at all then it is ‘bad enough’ to seek help and sort it! You can also try the NHS’s Squeezy App which was designed by chartered physiotherapists specialising in both women's and men's pelvic health.

• Meg

@LapinR0se

I’ve had two c sections. I have pretty bad stress incontinence, and have leakage even when I blow my nose. Here in Switzerland “training of the perineum” is covered by insurance post childbirth. I did the whole programme, including a thing where you insert something in your vagina and then play a kind of video game using your pelvic floor muscles. Horrendous. Anyway this achieved nothing. I still leak when I cough, sneeze, jump or blow my nose. Is there anything left to try?

Hello @LapinR0se, thank you for your question.

Yes, you can try other types of electrical stimulation in addition to the pelvic floor muscle training, you could try a device like Innovo or a device with an anal electrode.

• Aoife

My surgeon and indeed the two others ha e I have Seen over the years are very sceptical about the actual benefits of exercises
They say that those that get significant prolapses were always going to get them irrespective of of exercises.

Is this something that is common view amongst consultants?

@junebirthdaygirl

I suffer from the urge to go even when l have just been..over active bladder. I am older and this began in the menopause. I am paranoid about knowing where toilets are and during Lockdown this has becomea bigger issue. I find myself turning down opportunities as l know there will be no toilets nearby and it is very stressful. I have never even had a tiny leak..its the feeling of urgency that is so debilitating. It is taking up too much of my thoughts.

Have you tried oestrogen cream for vaginal atrophy? Miracle cure for me. Given your age menopause is worth a try. Ovedtin for example ask gp

My children and 6 and 8, both births were c section - I still leak when I cough or sneeze. I’m only 39, this can’t be normal?!