Stacey’s Story

Stacey came to see one of our Physio’s at WMHP for help with her bladder control. She was feeling very embarrassed, and was avoiding catching up with friends or going to Mothers Group because she was scared of having an accident. She was feeling very overwhelmed about being a new parent
Her problem started after she gave birth to her daughter Mia 12 weeks earlier.  Mia was a very large baby, weighing 4.2kg, and was delivered with forceps after a long pushing stage. 
At her first appointment, Stacey described leaking urine when she coughed, sneezed or walked with Mia in the pram. She also couldn’t hold on, often leaking on the way to the toilet.  She was wearing 1-2 continence pads each day.  
She was very constipated, only opening her bowels once per week with lots of straining. Being so busy with Mia her diet consisted of ‘mainly toast’, and minimal fruit and vegetable intake. Stacey was ‘trying to drink lots’ to help with breastfeeding.  
She was also bothered by a ‘heavy’ feeling vaginally when she had been on her feet all day. She had tried to have sex a few times, but said ‘it doesn’t feel like it used to’. 
Stacey’s husband worked very long hours, with lots of travel for work, and she had no family in Melbourne. Mia was a ‘terrible sleeper’, and would only settle in the pram, so Stacey was walking for up to 4-5 hours each day.  
Stacey’s goal was to feel confident to socialise and not worry about her bladder. 

What We Found              

When Stacey’s Physio did a vaginal examination, her pelvic floor muscles were very weak. Stacey was only able to get a slight flicker of a pelvic floor muscle contraction, and could only hold this for 1-2 seconds. She also had a mild prolapse of her bladder, and reduced vaginal sensation, which indicated there had been some injury to the pelvic nerves during Mia’s birth. 
Stacey was asked to fill in a bladder diary, which showed that she was drinking so much that her bladder volumes were bigger than normal.   This indicated that Stacey was overstretching her bladder, which can be harmful. 
Stacey was diagnosed with Stress Urinary Incontinence and Urgency Urinary Incontinence, caused by:
  • Weakness of the pelvic floor muscles 
  • Nerve injury during delivery 
  • High fluid intake.
Trauma to the pelvic floor muscles and nerves is common after vaginal delivery, especially in babies >4kg, delivery with forceps, and a long pushing stage.  In Stacey's case, constipation and excessive walking were also contributing to her symptoms.

What We Did

Stacey was started on a pelvic floor muscle training program including the addition of neuromuscular electrical stimulation (NMES) with a vaginal sensor. NMES is a great adjunct to exercises, helping to build muscle strength in women who have injured the pelvic floor muscles and nerves during childbirth.  
We also advised Stacey to: 
  • Reduce her fluid intake
  • Make dietary changes to soften her bowel motion
  • Empty her bowels without straining and  how to do this
Stacey was started on a bladder retraining program, with instructions to respond in a timely fashion to bladder urges, and also taught how to control bladder urges so she doesn’t leak on the way to the toilet.
Stacey’s Physio also discussed the importance of reducing her walking and having more rest, to give her pelvic tissues some “anti-gravity time”.  Stacey was encouraged to talk to her husband about sharing the load, and to speak to her GP and Maternal & Child health nurse to help with settling strategies for Mia.

What Happened

2 weeks after reducing her fluid intake, changing her bladder habits, reducing constipation and having more rest, Stacey's incontinence had reduced by around 25%. Following 12 weeks of NMES and a pelvic floor muscle training program, Stacey could generate a weak pelvic floor muscle contraction and could hold it for 8 seconds.  
Following 6 months of treatment, Stacey had no vaginal heaviness or bladder urgency, and only required a liner for occasional leaks when she had a cold with lots of coughing or sneezing.
After 8 months of treatment, with  commitment to her pelvic floor exercise program, Stacey was pad free and only had a very occasional leak with multiple star jumps!  She was loving motherhood, enjoying being able to play at the park with Mia and exercise with confidence, and was feeling excited and confident to start trying for a sibling for Mia.
November 2018