Hey, Everyone, thanks for this episode of moms talks with Christa. I'm so excited for this episode because we have not yet talked about this on the podcast. So we have Samantha Spencer here today, she's talking about postpartum incontinence. So we are going to just dive right in and answer all your questions. This is something that affects about 1/3 of moms and their postpartum stages so, we're just going to dive right in. Thanks for coming today, Samantha.

Samantha: I'm so glad to be here. Thanks for having me.

Christa: Absolutely. So I'm sure our audience has a lot of questions about what this is and what they can do. But let's just start, can you just tell us a little bit about you and what you do, and we'll kind of go from there.

Samantha: So my name is Samantha Spencer. I'm a licensed physical therapist, and I specialize in pelvic health, and specifically prenatal and postpartum care. I was a personal trainer for many years and I ended up with this group, this ongoing group of pregnant women. And when they all came back after birth, they all had such different concerns and issues and pain and all these other things that were going on that was clear I needed to learn a little bit more about. So, I went back to PT school. And even before I graduated, I specialized in pelvic health and I worked with a big hospital for a while and saw lots of different things. And now I work for myself and I treat mostly prenatal and postpartum recovery. And I think the biggest thing, one of the biggest reasons I'm so excited that you're talking about this is that I see a lot of moms who are much later after birth. I've seen many moms who have like eight year olds who are like, Oh, I just don't run, I just don't like chase my kid in the yard because I'm peeing on myself and things like that and I think there's just this cultural acceptance of it where we think that it's normal, or it's just the way that it needs to be after birth and it really is not the case, there's so much we can do. So it's good to be getting the word out there.

Christa: So for those of those that are listening, what is like the definition of postpartum incontinence and what kind of, I guess goes along with it?

Samantha: Incontinence is when you pee for a week and that can be urinary incontinence, it could also be fecal incontinence, and there's about up to 10% of women have some degree of fecal incontinence after birth which you can imagine is a is a heavy burden to carry, right? you're embarrassed and trying to figure it out and it's not talked about. So just know you're not alone, there is help out there. And it makes sense, right? Even no matter what type of a birth you've had, you've had a pregnancy and there's a baby sitting on your bladder and on all your structures and your muscles for however many months so. So it's um, it's really common with any type of birth, where you might have a little leakage after you deliver or at the end of your pregnancy. So there are a couple different kinds of postpartum incontinence so it's hard to put a blanket over it but if we're talking about specifically urinary incontinence, because that is really the most common type versus fecal incontinence, it's going to happen when there's a muscular or a pressure imbalance somehow and this is stress incontinence. So this is when the muscles are maybe weak, or they're so tight, that they can't do their job, and then pressure comes down from above. So that means as the pressure comes down, urine will leak through, right? either because those muscles are weak, or they're so tight, right? So some degree of imbalance there causes some leakage. Usually, it's some combination of both those things, which I think is where we go wrong with telling women to just do your cables, right? So it's not just about like strength and strength and strength and tighten, tighten, tighten, right, you can also be a little bit too tight. And or you can have muscles that are functioning, alright, but then you have such an intense pressure coming down from above that your body just doesn't know how to coordinate and manage and then you cause leakage there too. So it's definitely a bigger picture than just your pelvic floor muscles, right? It's about that balance of like pressure going down strength coming up and the coordination where they go together. There's also a different kind of incontinence called urge urinary incontinence which is where the bladder actually gets irritated and spasms, and you have to feel like you have to go and then you can't control it and you just leak, right? So that's another type of incontinence and that's also super common. I actually see that more after a Syrian birth but you know, it's all over the postpartum world and that is a little bit easier to remedy because there are some real reasons why that might be happening that are kind of easy to take care of?

Christa: You also kind of talked about the difference between, like stress, urgency and mixed urinary incontinence. So, what are kind of the differences between these? And are there different ways to address these kinds?

Samantha: Yes, absolutely. So, stress is the biggest. I mean, I think that's the biggest one that we usually hear about which is what we kind of described just recently with the pressure, the imbalance of the muscle and the pressure coming down. What a lot of women hear is either Oh, that's just your fate, you've had some babies, you're just going to leak when you laugh, or cough or sneeze or jump, right? Like, oh, can't go on a trampoline, those types of things that stress incontinence and a lot of providers and culturally we hear just do your cables, right? So that is absolutely one thing you can do. You can strengthen the pelvic floor. And if you want to do that, you want to make sure you're really focusing on the both the contract and the relax. So as you breathe, your pelvic floor actually moves with your diaphragm. So as you inhale, your diaphragm drops down to make space for your lungs. So, if you want to try this, the inhale, diaphragm drops down to make space for our lungs. And actually, the pelvic floor also releases just a little bit to make space for all that pressure moving, moving down. So your body's like this piston, it's like a canister. So you inhale, everything sort of releases to open up and expand a little bit like a balloon, and then you exhale, and you empty all of that air, and you empty all that pressure, it all comes back up and out. So I love that sort of basic strategy for starting with a pelvic floor training program because you really make sure you're covering all your bases. If I haven't seen someone's pelvic floor, right, but they tell me they've been leaking and oh, I've tried cables, and they're not working, I might say, well, let's take a week or two and just practice this with the breath to make sure you're really releasing fully as well. Inhale, let everything go. Exhale, gently pick it up, you don't have to like squeeze in tense and grip your jaw just lift up that pelvic floor ever so slightly. So that can really help kind of move things in the right direction and then we build on that into all the activities that you want to do so that you can do them without leaking. So if you're having leaking, let's say you have leakage, when you call for sneeze, right? that's an exhale, right, that's a big amount of pressure going down. So I would probably want to queue your pelvic floor to try to do a little pre contraction, call it the neck, just like just kick it on before you cough or sneeze and that's really easier said than done, it takes a lot of practice. But if you're practicing in that more serene kind of environment, then you'll be better able to pick it up when you need to. And if it's something like jumping, we would back it up and start with jumping on the ground before we move to the trampoline, for instance, or like jumping slowly before getting out your jump rope and I would really ask that you be like you start with just some slow, easy jumps but working on breathing, right? release that tension at your abdominals so that your pelvic floor can come in and support the way that it needs to. So, there's a lot of looking at the whole body when we're looking at stress incontinence, and what else might be going on. If you're listening and you are having leakage, I would start with that breathing and moving and just notice what you're doing during those activities, do you find that you're just gripping your abs or you know, otherwise squeezing pressure downward? It's like if you're squeezing a balloon, all that pressure is going to go down and that's going to put pressure on your bladder and your pelvic floor too. So just notice, are you are you really able to like exhale and recruit those muscles before you do that activity that is causing your leakage? And if not, that's a good thing to practice. So that's stress incontinence. And like I said, it's a full body picture. pelvic floor strength definitely can help but it's certainly not the only issue and I think that's why a lot of moms don't come in to see a PT sooner is because they're like, oh well, people just told me that if I do my cables, it'll get better and maybe I haven't been doing them enough. Or maybe they're, I guess they're just not working for me, I don't know what else can be done. So just know that there's a lot that can be done, we can look at your alignment and your posture. If you're crunched forward, there's less room for all that pressure, there's more pressure going down, just by nature of your alignment there, too. So definitely a lot of things to think about with that.

Christa: Whether someone has like a certain level of incontinence that after they give birth is that based on the kind of birth they have? Or is it based on if they worked out before? Or if they were more active before, there are different things that you guys can tell ahead of time to be like, you might have trouble with this afterbirth, maybe try this now, or is there? Or is it kind of just it just kind of happens? And there's not really a way to prevent it? Or make it not as severe?

Samantha: That's a great question. There's research that shows that if you're doing pelvic floor muscle exercise, so cables, for instance, and coordinating all those pieces before pregnancy and an early pregnancy, then you are slightly less likely to have incontinence later in pregnancy. So that's a good thing, you can start doing that, and just paying attention to all of this early on and that will help you down the road, both during pregnancy and postpartum. There are some other markers and some other risk factors, were just some about anatomy and certain, you know, markers that we can see, that can indicate you might be more likely to have incontinence and sometimes you can't prevent it. Sometimes it's just the way your body is built, and you've got a heavy baby in there and you can't you're doing your best. However, if you're having incontinence during pregnancy, you are more likely to have incontinence after birth, as well. There's also a mixed bag of research on this topic, but up some articles show that up to 50% of women don't do pelvic floor contract, relax exercises correctly, up to 50%. So we might be like cackling away thinking that we're doing the right thing and actually we're really putting pressure downward or maybe not squeezing and lifting in the way that those muscles are built for. So you know if I am biased, because I'm a pelvic PT but I am definitely of the opinion that we don't really have any other training on this in our lives. As a normal person, we don't like learn about it, we don't really have an opportunity to go over it with someone to make sure we're doing it well. Some awesome OBS and midwives will cover this but in general, that's not what they're looking for. So, I think everybody should get in touch with a postpartum or pelvic PT and just check in especially if they're having incontinence just to make sure you're on the right track really, even before pregnancy or early in pregnancy, just to make sure you're doing what you can the right way. And so I think I kind of cut you off before we were talking about difference between stress and urgency and then mixed urinary incontinence. So, for those different ones, how would that kind of differ between them? We've talked about stress incontinence a lot because it's the most common thing you'll see in postpartum because obviously, babies go through there or there's a surgery that affects that area. So, but urge urinary incontinence, this is one that I love to treat because it's compared to some other things, it's almost easy, right? With urge urinary incontinence, the bladder gets irritated and starts to squeeze, right? So like, have you ever felt like you had to just pee so bad, but you just went like 20 minutes ago? And you're like, I don't know, I just have to go right now or like sometimes there's a trigger, like running water, or walking into the grocery store, or like pulling into your driveway and you're just like, just every day, every time, why do I have to pee so bad? I just peed when I left work and now I have to go again. That is sort of a mixture of your nervous system and your bladder muscle getting all worked up. And there's some other reasons why that might happen to like anxiety and bladder irritants, so certain foods and beverages can irritate the bladder lining. So, what do we do about that? Well, one of the things we can do, the first thing we do is calm down the lining of the bladder. So, if you're drinking a lot of caffeine, or carbonation, and yes, that includes plain seltzer, those are bladder irritants. There's also like a mile-long list of bladder irritants that are potential irritating factors but the big ones are caffeine and carbonation and artificial sweeteners. So like sodas, and then also citrus, and sometimes milk and tomato products can be irritating. And then like anything else you can think of really, but most people are going to find that one of those is the irritating factor if they're having this. So we cut down on those irritating factors, we sandwich those drinks with water, like I'm never going to take coffee away from you but I will ask you to have some water before and after so that your bladder is a little bit diluted in your bladder, your bladder isn't so pissed off that you have all this caffeine in there. And that way you can, you're still going to have to pee a lot. But it won't be like you're leaking on your way to the bathroom, hopefully, right. So that's one thing we do is calm down the actual physical structure. The other piece of this is big time, calming down that nervous system like cueing the bladder that it's not time to go. So if you have an urge, and you real and you're like, I just went or like you know, if this is a regular thing for you, you probably want to work on it in a safe environment, like when you're at home, not in the grocery store necessarily. Don't want you leaking in the grocery store, you want to sit down if you can. That's counterintuitive because you want to run to the bathroom but by putting sitting down, you're actually putting pressure on your perennial and putting pressure on the pelvic floor, which then sends a little signal to the bladder that says it's not time to go right now so this urge comes in waves. So, your bladder is going to spasm, spasm, spasm, spasm, and then eventually it's going to fade and come back down the other side so all we really need to do is get over that peak, if you're trying to walk to the bathroom, when it's at its peak, you might not make it. But if you can wait till the other side, then you can really assess and be like, Do I really have to go? Yes, and then walk to the bathroom without leaking. So, stop what you're doing, sit down if you can, and let's take some deep breaths. So you're really kind of taking back control, your body's trying to get all ramped up, and like spasm some more and find the bathroom and get there real quick and get your pants off and sit down like it all has to happen so fast and we just have to throw a wrench in that pathway and give your body the opportunity to just like sit tight, relax those muscles, create a little space for your bladder, let everything calm down, let it calm, let it pass, it takes like a minute or two sometimes so it's not instant. You just need to breathe through it and then you can walk to the bathroom. This is something that when I tell people to try it, they look at me like I have three heads like they're, like upset that they like even talk to me about it and but then they try it and a lot of the time people get better, within days, like you can take control of this reflex. It's basically a reflex and let your body kind of settle and then you have more control. Over time as you practice this more and more. You can really defer an urge like I've been working on this, I used to pee all the time, just all the time and so for a couple of years, I've been like really, really working on this. Now I can go like four or five hours if I want to because I just let it pass. I like implement all my strategies.

Christa: So when you mentioned like anxiety tied to having to go all the time, like I have definitely had that issue.

Samantha: That's the kind of troubleshooting that can be so helpful to talk to someone about. But yeah, the bladder can hold up to two cups of fluid. So if you're going a lot, and you're just dribbling a little bit, or you just have like short streams, that's probably an urgency thing. Yeah, but if you're going a lot, and you're really going a lot, you might be drinking too much.

Christa: How do you tell the difference between, Okay, this is urgency, or, I really do have to go or like, okay, it's just like a mental thing, I'm just thinking I have to go, do they kind of have to get used to their own kind of routine with that so they know, like, Okay, I'm not going to just hold my bladder and then like, feel sick to my stomach or something like how? is there like an indicator? how they can know is it kind of just learning your body and what works for you?

Samantha: It's definitely learning your body, that's one thing, it's generally recommended to just drink to satisfy your thirst. So if you're breastfeeding and you're trying to really support your body and support your supply, even then you still want to just drink to thirst, if chugging more water will not necessarily increase your supply so that's one thing to consider. And then regarding voiding, one of the things you can do is to really watch the clock on with one eye and listen to your body with the other eye. Sometimes it's helpful if this is something you're really struggling with, and you really want to dial in, it can be helpful to take a little food, or a little food and drink journal, just for like two days, and just write down sort of approximately how much water you're drinking and then and what other fluids you're taking in and then when you're going to the bathroom and your urgency at those times. So that way, you can more clearly see like, Oh, I chug 50 ounces at 10am every day, and then I have to pee at 11 every day that's probably why or like I drink four cups of coffee and he and then so you can see some trends and patterns that way and that really can help. Normal range is going at least two or three hours at a time between urinating, but again, all these other reasons could kind of front load it or backload it like I've really, I'm not going to give my coffee up. I love it. So I do pee a little bit more often in the morning, because I'm drinking all this extra fluid and there's caffeine in it. So if you're struggling with it, or, or just like feeling a little bit lost, I might start with a with a little diary just on a notepad, like just write down what you're drinking and how often you're going to the bathroom and see what you notice and then you could also try those urge deferral strategies like sit down, breathe, relax, see if it passes, and then you can go.

Christa: So, when is the time that someone should you know, seek a medical professional, talk to you about pelvic floor therapist, and just or go through therapy with it? You know, next steps?

Samantha: Definitely. Good question. And I think I think this is a tricky one, right? Especially because, you know, people like me will say everybody needs pelvic PT, everybody. Right? Why not? Right? Just go in for a checkup but when you're pregnant, and when you're early postpartum, there are so many other things that are going on, maybe there was something that happened at your birth or with your baby early after delivery. Maybe you're working on nursing or figuring out sleep and all those things. So I get it. I mean, we're not all going to go at six weeks postpartum but I would say, if incontinence is impacting your life, or your activity in any way, or limiting what you're doing, I would see a professional, I would at least go see your OBY or your care provider but you would probably also benefit from looking around at a pelvic PT. The other thing is, it just frustrates me when moms are told to give it time, or just do your cables because like, yeah, some people are going to do fine with it with time. But then, as we continue to age, these issues don't just go away, no. And when we hit menopause, we lose estrogen and those tissues get a little bit less elastic and a little less robust. So, if you're just going along with it, and you're like, struggling but you're fine, then you hit menopause. It could all come crashing down so what, not. Now is the perfect time to get a little bit of training and round it out on this. But I would say yeah, as soon as you're noticing that you're changing your lifestyle or your, if it's bothering you in any way, that's the time.

Christa: So, where can everyone find you and get more information on other like resources you have and things you offer?

Samantha: Well, you can find me at Strong Beyond Birth, on social media, and postpartum PT.com And you can find some of the articles I've written and some more resources at aeroflowbreastpumps.com. They have some awesome tools, they have some postpartum compression garments that can kind of support the whole body and help with some of these incontinence issues really early on, and they're covered by insurance. So, it's worth going to their website and checking out what your coverage looks like and great blog over there two great resources from a lot of health professionals.

Christa: Awesome. And we'll put those links in all your contact and everything and the descriptions which everyone can check that out. So, that was awesome. Yeah, thank you so much for coming on. And like I said, this was the first time we've talked about this, but it's clear how important it is to talk about. And so, moms out there listening, definitely go check out Samantha. Check out her resources because this is definitely something you know, if you're it's an issue that you're dealing with right now. It's definitely something that you can fix and you can be you know, addressed. So, thank you so much for coming on.

Samantha: Thank you, Christa. So this has been really fun grateful for you and I loved your podcast.

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