What happens with pregnancy and childbirth?

During pregnancy and childbirth, the pelvic floor muscles (which normally support the bladder and urethra), can stretch out so much that they no longer function properly to prevent urine from leaking out of the bladder. Sometimes, delivering the baby can also affect the nerves at the bladder neck and urethra, which leads to poor urinary sphincter function and leakage. We refer to this type of leakage as stress incontinence.

In many women, stress incontinence improves in the few months after childbirth. Pelvic floor physical therapy can dramatically improve the muscle function so it returns back to normal. There are various devices which can be used at home so that the benefit of the exercises is not lost when you cannot continue seeing the therapist. Some use biofeedback to let you know you are doing the exercises correctly, and others use gentle electrical stimulation to contract the pelvic floor muscles for you. Dr. Kumar can show you various devices in the office and help select what will be most beneficial for you.

What if pelvic floor physical therapy and kegel exercises are not effective?

If your stress incontinence does not improve within six months to a year, or you continue to leak with exercise, it is very important to be evaluated by a urologist or a urogynecologist. Depending on your exam, you may be a good candidate for an office treatment. Office treatments include:

• Bulkamid – a water-based gel that is injected on the inside of the urethra, allowing the urethral walls to form a tighter seal which prevents urine from leaking out.  This is an office procedure without recovery time like surgery. A repeat injection may be necessary anywhere between 1-3 years.
• Sling Surgery – This is a surgical treatment for stress incontinence, involving placement of a small mesh strip under the vaginal wall, to restore the support of the urethra. It is the most definitive treatment, allowing most women to be completely dry even with very vigorous cough or exercise.

What other postpartum issues does Dr. Kumar see?

In addition to stress incontinence, postpartum women may suffer from overactive bladder, recurrent urinary infections, or painful intercourse. After pregnancy, estrogen levels drop, causing symptoms that are similar to what menopausal women go through. Sometimes, having an episiotomy scar can also be painful. Dr. Kumar will take the time to listen to your issues, as well as perform a thorough history and physical exam so she can design the right plan for you.