A mother tells EVELINE GAN how wetting herself became an everyday affair after delivering her third baby.
When Faith Tan peed on herself and wet the entire floor shortly after the birth of her daughter, she brushed off the incident as a one-time embarrassment. After all, she had a hard time pushing her third baby out. “I didn’t take it seriously, so I left the hospital without telling my doctor about it,” says the 40-year-old administrator. She delivered three kids – now aged 13, 12 and one – by vaginal birth. But that was not a once-off.
Faith never quite regained control of her bladder. Wetting herself at least five to six times each day became the new norm. Within a week of delivering, adult diapers had become her postpartum essential. Not even the thickest and most absorbent maternity pads could keep up with her massive urine leakage. “In a sitting position, I was fine. But when I stood up, everything simply flowed out. It was very embarrassing because my new helper and the kids saw what happened,” says Faith.
On a regular day, she had to change her adult diapers at least twice. To avoid wetting herself so frequently, Faith made a toilet trip every half an hour. She also tried restricting her water intake. “The problem worsened every time I drank something. But it was impossible to stop myself from drinking water because I was constantly thirsty from breastfeeding,” she adds. She would also leak urine whenever she laughed or coughed.
TRIPLE WHAMMY
Along with the awful realisation that she could no longer control her bladder, Faith also developed urinary tract infection and severe piles, both at the same time. The latter landed her in the emergency department two weeks after childbirth, while the infection probably came about because she was in adult diapers all day, she shares. “The pain from the piles was terrible, but I didn’t want to be admitted because that would affect my breastfeeding,” she recalls. “Thankfully, the doctors gave me medication and I was able to avoid being hospitalised.”
By the third week, an exhausted Faith felt postnatal blues creep up on her. “Imagine going through all those three conditions within a month during your confinement. I didn’t rest at all, and felt so down and lost because I didn’t know what to do,” she says. In a desperate bid to solve her leaky conundrum, she booked an appointment to see her gynae, who recommended strengthening her pelvic muscles with Kegel exercises (see The Leak that Doesn’t Stop on page 42).
Apparently, what she was going through was “pretty normal” for a thirdtime mum, according to her doctor. Those words, however, were hardly reassuring to Faith. “I was so scared. How long would it take for me to regain control of my bladder again?” she says. Until then, she had never done such exercises. Neither had she adhered to traditional confinement practices when she had her first two kids.
2 ways to prevent it
Dr Christopher Chong, an obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital, shows you how to avoid urinary incontinence.
Do not strain the pelvic floor after delivery. This includes no heavy lifting, housework or exercising within the confinement period of four to six weeks.
Do your pelvic floor exercises – also known as Kegels – during pregnancy, after delivery and forever after.Do the exercises as often as you can, and regularly. How do you know if you’re doing your Kegels correctly? Imagine that you are about to move your bowels, but you cannot find a toilet. What would you do? Squeeze your anus to prevent the faeces from coming out.
This action helps you squeeze your pelvic floor muscles, Dr Chong shares. Another way to fi gure out if you are squeezing the right muscles is to use the muscles needed to stop urine fl ow half way when urinating, he adds. The examples above illustrate which muscles to use when doing your Kegels. Don’t do pelvic floor exercises while passing urine or motion.
’’In a sitting position, I was fine. But when I stood up, everything simply flowed out...’’”
“My second child was born premature at 28 weeks, so I didn’t have the chance to do a proper confinement. Now that I’m an older mum, I had planned to rest well. But I ended up having all these issues!” she says. The incident spurred her to take better care of herself. She did Kegels every day without fail, and took traditional herbs said to help strengthen her pelvic area. She also learnt to sit back and let other people help care for her newborn. “
I think my husband felt really bad for me and tried to be more hands-on with the baby. For example, he and the helper would take turns to carry the baby so that I did not put extra pressure on my bladder. I’d only hold the baby when I was seated,” Faith says. True to her gynae’s words, her urinary incontinence tapered off by the time her little one was two months old. Having seen results for herself, Faith is now an advocate of pelvic floor exercises for women. “
If I had strengthened my lax pelvic muscles before my third kid, my urinary incontinence might not have been so bad,” she says. “My advice is not to wait until you have had your second or third baby to do pelvic floor exercises. Do them right now.”
The leak that doesn’t stop
THE DOC SAYS
You should also take Grandma’s confinement advice when she tells you not to lift heavy things, exercise or do housework. “If a mum has to carry heavy loads, over-exert herself, or put continuous stress on the pelvic fl oor after delivery [such as chronic constipation], the wound – especially from a normal vaginal delivery – will not heal well. This can increase her risk of stress incontinence and pelvic organ prolapse,” Dr Chong adds. Pelvic organ prolapse occurs when the womb, bladder or bowel drops into the vagina. Half of women with stress incontinence will have this, Dr Chong notes. About 95 per cent of mothers who leak urine three months postpartum will continue to do so five years after the delivery. Pelvic floor exercises may help nip 60 per cent of mild stress incontinence cases, according to Dr Chong. But if that doesn’t work, surgery is your next best bet. He says: “Any urine leakage is not normal. Seek professional help early.”
WHAT IS IT?
Urinary incontinence occurs when you leak urine involuntarily when you cough, sneeze, run, jump or carry heavy things. This is known as stress incontinence, which is one of the most common types of urinary incontinence affecting women, says Dr Christopher Chong from Gleneagles Hospital.
WHO GETS IT?
Around 13.5 per cent of women in Singapore suffer from the condition, and more than a third of them above the age of 50 have it, based on a local survey by Dr Chong. The effects can range from a minor leak (of just a few drops) to a substantial amount of urine, as in Faith’s experience.
VAGINAL VERSUS C-SECTION DELIVERIES
If you had a vaginal delivery, you are more likely to have urinary incontinence a year after delivering your baby, compared to a mum who had a C-section, according to a study published in Obstetrics and Gynaecology in March 2014. This may be due to torn tissues, or tissues that do not heal well after being stretched by Baby’s head coming through the vagina, Dr Chong explains. That said, even mums who undergo a C-section can get it. During pregnancy, the enlarged womb would have caused the pelvic floor muscles – which support the bladder, womb and rectum – to overstretch.
“If the woman did not do protective pelvic floor exercise during and after pregnancy, the risk of stress incontinence will be even higher,” he warns.
