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Incontinence is any leakage of urine, that results in
life-style alterations, emotional changes, or feelings of discomfort. Because of
anatomical and physiological changes occurring during pregnancy, incontinence can
become a problem during and after childbirth.
1. The uterus enlarges to accommodate the growth of the baby putting pressure
on the bladder.
2. Supporting structures in the pelvis relax during pregnancy to allow for
increased growth of the uterus and to allow the pelvis to expand for vaginal
delivery. Therefore, these structures cannot support the bladder as
effectively.
3. Constipation can be a problem particularly in the last trimester of the
pregnancy due to the crowded conditions in the pelvis and change in the way the
lower bowel contracts. Constipation causes increased irritation of the bladder
which can cause bladder leaking.
4. Relaxation of the ligaments and fascia structure may continue for several
months after delivery. These structures in the lower pelvis, bladder, uterus,
and bowel usually return to the pre-pregnancy state gradually over several
months.
Recommendations for exercise the pelvic muscles during pregnancy include:
(These are from a series of exercises for treating many different types of
incontinences. The exercises included here are the ones which are appropriate
for pregnancy.
Level One Exercise: Relaxed Awareness of the Pelvic Muscles- This essential
first step of exercise begins with awareness of breathing rhythm, and separates
the pelvic muscle action from the other muscles of the pelvis. Practice this
exercise for short periods 2 to 3 times a day, until it feels easy to tighten
the pelvic muscles while keeping the buttocks and stomach muscles quiet and
maintaining your normal breathing rhythm.
Sit in a comfortable supported position, concentrate of
the the feel of the support of the chair or bed from your head to
you feet. Feel the support and relax into it, letting go into the support more and
more through you head and neck, shoulders and back arms, and hands: let you hips
and legs sink into the support, let you ankles and get relax and release into
the bed or the chair. Then, begin to focus on breathing. Notice its natural rhythm.
Level Two Exercise: Assisted Pelvic Muscle tightening using the Obturator
Internus and Adductor Muscles. -These muscles provide optimum support for the
internal organs of bowel, uterus, and bladder with increased tone of the pelvic
diaphragm and Obturator Internus muscles. Five to seven minutes of practice twice
a day is recommended. There are 3 levels of this exercise and they are to be
done progressively.
A. Do these exercises 2-3 times a day for 3-5 minutes. If the muscles
become tired do the exercise for less time. For this exercise, you will need a toilet
paper roll or a soft ball 7-9". Place the ball or roll just above your knees.
Then, roll your knees against the ball while lifting you pelvic muscles up and
in, tightening around the anal vaginal, and urethral openings. Hold for a count
of 10. Remember to maintain your breathing throughout the exercise and tighten
just the muscles of the inner thighs and hammock of pelvic muscles.
B. This level of exercises assists the pelvic diaphragm/ lavatory anal
muscles by using the Obturator Internus muscle. Repeat this exercise 2-3 times
a day for 3-5 minutes. When it is easy progress to the C level of this exercise.
Secure an elastic band around the legs just above the knees. Now roll your
knees out against the elastic band while you lift the pelvic muscles up and in,
tightening the anal, urethral, and vaginal areas. Hold this position and slowly
count to 10. Then relax the muscle while maintaining your breathing.
C. Adductor and Obturator muscles will now be combined into one. This will
then become the only exercise for level two. Roll your knees in against the soft
ball while pulling up and in the pelvis muscles holding for a count of ten. Then
relax for a count of ten. Then relax for a count of 10. Repeat this exercise 5
times. Now roll your knees out against the elastic band while pulling band while
pulling in with the pelvic muscles and hold for a count of 10. Repeat this
exercise 5 times.
Level Four Exercise; Quick Contractions of the
Urogenital Diaphragm- This exercise provides speed and strength. Tighten the
pelvic muscles, lifting up and in, without tightening any other muscles.
Maintain slow, low breathing as you do this. Pull up and in with the pelvic
muscles and hold for a count of 5 to begin with. Then relax for a count of 10.
You will start with a count of 5 because the pelvic muscles get tired
faster when they are contracting alone. Repeat the exercise 4 to 5 times and
gradually increase to 10 repetitions as you become stronger.
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