There is a lot more to pooing and weeing than I ever thought. I think it's what a lot of women learn when pregnant or afterwards due to the effects on their poor old pelvic floors. Last time I was at my obstetricians I mentioned that while I had a nasty head cold (at about 19 weeks) I'd often had a bit of a wee leak when I'd sneezed or coughed.
I also hesitatingly added that I'd done this, but only very very occasionally over the five or so years before becoming pregnant. It was always very minor. But the pregancy/head cold incidents were a tad more of an inconvenience.
I'd wondered if it was due to my long term diabetes with dodgy control. I blamed pretty much everything on this. I thought it was worth mentioning it to her as pelvic floor exercises seemed to feature quite a bit in antenatal classes, yoga classes and on the web.
She said it was pretty early in the pregnancy to get Urinary Stress Incontinence (it often happens late in pregnancy when the uterus really pushes on the bladder) and referred me to a physiotherapist who specialised in the area.
I think she felt that my pelvic floor muscles might have been a bit weak or somehow dodgy. She mentioned that pregnancy could make the condition worse and that the birth process contributed to it, however emphasising that caesarean births only reduced the likelihood of pelvic floor problems by 10 percent.
She asked me to find out if my mother had had any problems with urinary incontinence after giving birth and said even though prolapse wasn't too common, it did happen and I guess seeing the physio and strengthening the pelvic floor etc was something I needed to prioritise.
My mother, who's had five children, some natural some caesar, said no, she'd had no problems with it.
So off I toddled to the wee and poo physio....
Now this woman was amazing. She gave me some handouts with all the bits and pieces inside a woman's body named and she enthusiastically highlighted the important bits as she gave me the drill.
The short of it was, I needed to keep my transverse abdominal muscles as strong as possible and "brace" during the day whenever I could to protect my pelvic floor muscles. This meant pulling in the lower abdominal muscles and pelvic floor area before... getting out of bed, standing up, sitting down, coughing, sneezing, pushing a trolley, picking something up etc. Doing pelvic floor exercices was also recommended, but when I said I was hopeless at it she said just do this bracing then throughout the day and just pull in your transverse abdominals whenever you can. Better than setting aside a few times a day just to do pelvic floors. This sounded much more doable to me.
She asked me all about my pooing and weeing behaviour and gave me specific techniques for doing each. I have to say that aside from the general sit down and make sure it goes into the toilet bowl aspects, I hadn't thought much about it! It was all about sitting forward and leaning forward on the loo, which is apparently what blokes do while women lean backwards and put pressure on their pelvic floors. There's a whole bunch of other stuff too. Hmmm.
Anyway I asked her all sorts of questions based on paranoia about diabetes damage I might have incurred in my nether regions. I suspected I had mild gastroparesis although my doctor was not totally convinced. But I felt that the nerves to my stomach and bowel had been affected to a some extent by a protracted period of dangerously high sugar levels in my early twenties that caused abdominal pain, no appetite and a really disturbed digestive system for a while back then, around the time of my 21st birthday. I'd been wondering lately whether changes might have occured in my birth and pelvic floor area (as they had in other parts of my body - eyes, kidneys, skin, connective tissue in my shoulders and fingers and breasts) that might impact on my ability to have a smooth natural delivery of my baby.
She said maybe. In contrast to all the active birth classes and most of the info and discussions I'd found on the web, she was a caesar advocate. "I'm biased you know, I've got prolapse myself and all I see are women who have major problems because of vaginal deliveries." She said caesars weren't perfect either and could affect the bladder for instance, but overall were much gentler on the pelvic floor than trying to push a baby out through it. She highly recommended caesars but suggested I talk to my obstetrician who was much more balanced!
She looked at my pelvic floor from the outside. Yep. Me up on the table with no knickers. Squeezing releasing. Squeezing releasing. While she observed and graded me as "moderate" strength. She said she thought everything was looking fine but saod she never gave "good" or "excellent" ratings to anyone!
So I left armed with my anatomical illustrations, my guidelines for pooing and weeing, my instructions for bracing and squeezing and my orders to pick up some metamucil and have it every day. (Keeping yourself really regular bowel-wise, she stressed, was extremely important, especially close to the birth, no matter what type of birth you were going to have. Two babies and lots of discussions with mum friends later, revealled that everyone, second time around, was on a major mission to make sure they weren't constipated at the time of the birth as pooing post birth is a feat unto itself! :-)
I was also to keep a record of my weeing and fluid consumption for a 24 hour period (to test my bladder function, which can apparently be affected by diabetes over the long term) and was also to keep a record of my pooing behaviour over a number of days.
It was yet another fascinating new world I had entered and the first time I had ever had such an "intimate" and "revealing" conversation with a medical professional in my life.
Back to see her in one month...
Now, ....BRACE!Posted by M.A. at June 25, 2003 06:43 AM