You sneeze, and—oops. A friend makes you laugh, and—oops. You run after your rambunctious dog, and—oops.
Experiencing occasional incontinence is one of those post-pregnancy side effects that takes women by surprise. Many women just accept it (and try to avoid triggering it), but you don’t have to. Richmond urogynecologist Dr. Tovia M. Smith, of Virginia Women’s Center shares common misconceptions around incontinence and treatment options.
I can’t talk to my doctor about postpartum incontinence—it’s so embarrassing!
Many women are embarrassed about incontinence, or they don’t know who to turn to, Dr. Smith says. That’s why “here at Virginia Women’s Center, we really make a point to ask about it.”
Incontinence is one of those post-pregnancy side effects that takes many women by surprise. It’s totally common and even expected, Dr. Smith reassures her patients. “Many women don’t seek care because they aren’t that bothered by it,” she says, and that’s OK. At the same time, if postpartum incontinence is affecting your quality of life, it’s time to talk to your doctor.
Incontinence will go away on its own in a few months—right?
After childbirth, your body needs time to recover and function normally. If you’re not nursing, your period may return around the third month postpartum. If you are nursing, you may not get your period for several months.
Having regular periods means “your body’s back to its new normal, hormonally speaking,” Dr. Smith explains, and that means episodes of incontinence should decrease: “The majority of women do improve, to the point where it’s no longer a major quality-of-life issue.” But if you’re still leaking six to 12 months postpartum (and not nursing), it may be time to seek advice from your doctor.
If I’d had a C-section, I wouldn’t have problems with incontinence now.
Having a C-section does not necessarily prevent it, Dr. Smith says. While prolonged pushing, having a large baby and having a forceps delivery are associated with an increased risk, postpartum incontinence is caused by many factors.
Number one is hormones. During pregnancy, progesterone levels are elevated, which relaxes muscles such as the esophagus (leading to reflux) and the urethral sphincters, which control the flow of urine from the bladder. “I call it the loosey-goosey hormone,” Dr. Smith says.
Another factor is pregnancy-related trauma to the nerves and muscles that run through the pelvic floor to and around the urethra. The weight of carrying a baby for nine months, plus the trauma of childbirth, can damage nerves and tear the pelvic muscles. “I don’t know when I have to pee anymore,” women tell Dr. Smith. Others say that they can’t really feel themselves squeezing when trying to stop the urine stream.
Other causes are simply environmental. New moms may be drinking a lot of water if they’re nursing, but they’re so busy caring for their newborn that they often forget to go to the bathroom.
Incontinence is a problem for me, but there’s nothing I can do about it.
When postpartum incontinence is persistent and affecting a woman’s quality of life, there are several treatment options. The first is Kegel exercises, which aren’t as simple as women think they are! Dr. Smith recommends working with a physical therapist on muscle training to strengthen the pelvic floor with the help of biofeedback to “really make that brain to pelvic connection.”
Another option is a pessary, a small vaginal device that increases the resistance in the urethra. Dr. Smith shows women how to put it in place and take it out. A pessary is completely removable and reversible.
When incontinence persists, Dr. Smith asks two questions: “Is this bothersome enough to you to take a surgical step? And are you done with childbearing?” If the answer to both is yes, she may recommend a urethral sling, which lifts the urethra and exerts pressure to help control the flow of urine.
For many women, the biggest relief they feel is simply knowing they’re not alone in dealing with postpartum incontinence. The first step toward a solution is making an appointment by calling 804.288.4084.
Dr. Smith is as passionate about giving women time and space to discuss their symptoms as she is educating women on their conditions and treatment options. With all treatments, she aims to help women of any age regain an improved quality of life.
As a urogynecologist, Dr. Smith uses non-surgical approaches as well as advanced technologies, such as minimally invasive surgery and the daVinci® Surgical System, to reconstruct the pelvic floor for women who suffer from pelvic organ prolapse, urinary incontinence and fecal incontinence. In addition, she is skilled in repairing fistulas and complications from third and fourth-degree tears following vaginal childbirth.
Dr. Smith earned her bachelor’s degree from Yale University, where she played varsity field hockey as an All-American for the Bulldogs. She earned her medical degree from the University of Virginia, where she was elected to the Gold Humanism Honor Society for compassion in medicine. Dr. Smith trained in obstetrics and gynecology at the University of Virginia. She then pursued a specialty fellowship in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) at the University of Michigan in Ann Arbor, an ACGME Accredited program.