Postpartum Urinary Incontinence by ProQuest

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									                                                                                                     Perinatal Wellness


                                                                            Postpartum
                                                      Urinary Incontinence
By Heather Jeffcoat, DPT

      There is a typical history I encounter in my practice—            Sample Kegel Progression
“I’ve had two kids and now whenever I laugh or sneeze, I                Week 1: Hold 1 second (“Quick Flick”). Perform 2 sets of 5,
experience urine leakage”. But it’s normal, right? I always                       3 times per day.
tell my clients that the problem may have arisen because of             Week 2: Increase to 2 sets of 10, 2 times per day.
childbirth, and maybe all of their friends giggle about this            Week 3: Increase to 2 sets of 15, 1 time per day.
unfortunate consequence of having a beautiful and perfect               Week 4: Continue with Week 3 routine, add 3 second holds
baby. But it is not NORMAL—there is something you can do                          (“Long Holds”), 2 sets of 5.
(other than surgery or medication) to get your pelvic floor                   Continue to increase 3 second holds per Week 2 & 3 pro-
muscle function back to normal. And it’s more than doing                tocol. Once, up to 2 sets of 15, increase hold times to 5 seconds
just “Kegels”.                                                          and reduce repetitions to 2 sets of 5 again. Continue to gradu-
      I’ve had many women tell me over the years, “I do                 ally increase repetitions. Your client’s goal will be to perform
“Kegels”, but they don’t work”. A study published in The                “Long Holds” for 10 seconds, at least 2 sets of 10 daily.
American Journal of Obstetrics and Gynecology (Bump, et al
                                                                            There are additional exercises that assist with reducing
1991) looked at the performance of Kegel exercises after brief
                                                                        symptoms of incontinence. These exercises work by utiliz-
verbal instruction. The results showed that 51% of women
                                                                        ing muscles that have a synergistic effect to the pelvic floor
were performing a Kegel incorrectly at this level of teaching.
                                                                        muscles (Carriere, 2006).
Worse yet, 25% of women were performing them in such a
way that could actually worsen their incontinence. This study           Pillow Squeeze with Pelvic Curl
highlights the principal that if an exercise is not performed                Instruct your client to lie as pictured in (A) with a pillow
properly, it will not work and has the potential to worsen the          or ball between her knees. Have her take a deep breathe in,
problem.                                                                then exhale as she imprints her spine into the floor followed
      The first item to consider is, does your client perform a         by elevating her hips as pictured in (B). Cue her to inhale to
Kegel properly? This is an essential first step in reducing or          prepare then exhale as she reverses this movement back to
eliminating incontinence. Here is a helpful trick your clients          the start position.
can try at home: Take a mirror to visualize the perineal area.
                                                                                                              A
When performing a Kegel, they should only see the anus
and vaginal opening lift and cl
								
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