Five Minutes a Day Can Combat Urinary Incontinence

Urinary incontinence and poor bladder control is something that affects many women and unfortunately is not frequently talked about. There are many things that can contribute to urinary incontinence such as diet, surgical history, and pelvic floor strength. The pelvic floor is considered the group of muscles that forms a hammock within the pelvic and is very important when managing bathroom habits. Stress incontinence is a term used for incontinence when doing things such as sneezing, coughing, or jumping caused by poor pelvic floor strength. Child birth and menopause can both affect the integrity of these muscles and limit them from functioning efficiently.

The term “Kegel” is a well-known word for an exercise that strengthens the pelvic floor. Although this exercise is well known and attempted, a Kegel exercise if often done incorrectly. The problem is common and it’s that many people compensate and use muscles such as their abdominals, glutes, and hip adductors when performing a Kegel. This can exacerbate the problem because people do not isolate the pelvic floor muscles, and the results are poor effectiveness of the exercise and not true strengthening.

The Proper Kegel:

Goal: Gently tighten and lift the pelvic floor without using other muscles

1. Keep glutes and abdomen relaxed
2. Tighten the muscles as if you were trying to stop the flow of urine
3. Imagine a string pulling those same muscles up towards your belly button

The endurance of these muscles is also an important factor for proper bladder control. It is recommended once you have properly tightened the Kegel, you hold it for five-10 seconds and perform a minimum of thirty a day to improve muscle strength. Simply, five minutes of exercise can greatly improve your strength and quality of life.

Physical therapy can significantly help train people to do a Kegel correctly and help manage urinary stress incontinence. At Therapeutic Associates, we can do a non-invasive evaluation and teach you how to do a proper Kegel by using our Real Time Ultrasound machine that shows you which muscles you are using while attempting the Kegels. Visually seeing how these important muscles are functioning help correct bad habits and strengthen the proper muscles. Combined with other techniques we can help combat urinary incontinence and allow you to get active without worrying about where the next rest room is.

Being wheeled to the Operating Room in my hospital bed felt a little bit surreal and like I was sitting in a chariot with all the hospital staff around me. I had been unhooked from the pitocin and to my surprise, I had no more contractions from that point on (not sure if thats normal for when the pitocin is stopped or not). We passed the nurse's station and I waved and smiled at them. I don't even think I was nervous. I felt completely normal sitting up on a comfy bed just rolling down the hall towards the OR.

We passed through a set of doors into a big steril room which acts like a waiting room for the OR. There were two OR's connected to this room and I could see though the windows into the other room that they were cleaning up and someone was getting ready to leave. They wheeled me into the empty OR and parked my hospital bed next to a hard, narrow table. The table I would give birth to my twins on. I transferred myself awkwardly onto the OR table and they slid a wedge under my back that kept me slightly propped up.

Around this time, my doctor and husband both arrived in scrubs. In a somewhat annoyed voice, my doctor instructed someone to clear all the people out of the hall who were lingering. Thank you, since there are windows that look straight at my open legs. The nurses had me put my feet in the stirrups and my doctor took his place in the middle. 

All along the wall facing me, staring straight at my open legs, were a bunch of nurses and an anesthesiologist (I was told there were 14 additional people to myself, husband and doctor). They seemed to be casually chatting amongst themselves waiting for the babies to be born. Some had their arms crossed looking bored others a bit more engaged in the scene about to unfold. 

My doctor checked my cervix to be certain I was fully dilated and he said in the most straight forward, calm but no nonsense voice, "OK, go ahead and push the first baby out."

Excuse me...? Push the first baby out...? I just peered at him very confused; maybe he was joking I thought, and stammered, "But I'm not having any contractions."

Again he repeated, "That's OK, go ahead and push the first baby out." 

It took me a second to wrap my head around what he was saying. I think I expected to be coached through some contractions and how to push them out like they did in my previous birth. That wasn't something I wanted, quite the contrary but I was still expecting it. I glanced around nervously and did a timid trial push. 

I was annoyed that the stirrups were unstable and the wedge under my back kept shifting and sliding back. It was just set under me, not secured by anything. I think that 99% of the OR births are C Section's and in those, the lower half of the mother is completely limp and in the occasional vaginal twin birth, the mom has an epidural so her legs are also relaxed. My legs however were fully functioning and my ability to push felt inhibited by the lack of stirrup stability.

I cannot emphasize enough how strange it was to be laying there feeling completely normal and trying to push out a baby. It felt almost embarrassing and awkward to be trying different pushes with all those people staring at me. In my first birth, that pushing phase was so intenseband it was so natural to be pushing. It was something I couldn't even control, that primal fetal ejection reflex that I had experienced in just those two contractions earlier. 

Each time I tried a new push, I pushed a little stronger but they started out pretty timid. Then after four small, experimental pushes, my doctor said, "You just moved the baby about an inch." I had found The Push. I still felt awkward and unsure each time I pushed but now I knew what to do.  

Each time I pushed, I would inhale a deep breath and briefly hold it at the top for several seconds as I started to push and then I gently exhaled, continuing to push through the full exhale. I'd take a few normal breaths and then repeat. It wasn't something I even thought about, it just felt the most natural way to achieve an effective push. I didn't really realize what I was doing until after the birth until one of the nurses commented in awe, "You just breathed those babies out!"

It only took a few minutes of this pushing until I felt an intense stretching and burning feeling. The ring of fire. I never felt that ring of fire in my first birth. I think the pressure was so great and I was working so hard, I never noticed it. However, this birth was utterly painless until this point (with the brief exception of my two contractions earlier). I glanced around the room a little franticly exclaimed, "It burns! It really, really burrrrrrrnnnnns!" For me, vocalizing what I was feeling helped me manage the pain and process the experience.

The burning gave me a little bit of a mental block that made me not want to push anymore. I had to give myself a few seconds to mentally talk myself though it. It was a mild, uncomfortable overstretched feeling when I wasn't pushing and a really intense, about-to-rip burning when I was actively pushing. 

I vaguely remember my husband at my right side whispering encouraging words in my ear and kissing my forehead between pushes. I'm very thankful for his love and presence but honestly, I wasn't even paying attention to him. I squeezed my eyes closed to deal with the impending pain and gave one last big push. The feeling of the baby coming out was like a pressurized pop when the head finally came out and then the limp, little body quickly slid out behind it. The speed at which the baby's body exited was a bit unnerving. It was too quick; so quick it was almost uncomfortable.

My doctor held up the baby and my husband announced the sex of the baby. *Per Matt's very insistent request, no one gets to know which baby came first. He is convinced that there will be sibling rivalry about who is older and no amount of persuasion on my part can sway him so I will no be disclosing which baby was which.* I reached out and took the baby from my doctor and placed them on my chest, clinging to their slimy little body.

I don't remember what happened next but I know what my doctor told me he would do once Baby A was out. He manually put pressure on my belly with his hand to guid Baby B down and make sure that they stayed head down and didn't get caught up at the top of the uterus. At some point in this process, Baby A, the first baby was taken from me to be weighted and examined. I was instructed to push the second baby out and that baby, Baby B was born five minutes after Baby A.

I announced the sex of the second baby as my doctor held them up for me. We didn't know the sexes until the birth but I had a gut feeling that we were having a boy and a girl. I even guessed right who was who and it felt more like a confirmation rather than a reveal. 

I was put back on a high dose of pitocin as soon as Baby B was born to prevent me from postpartum hemorrhaging and to help me deliver the placentas. The delivery of the placentas is also a blur but I know that they were both delivered after both twins which was something I had to Google during my pregnancy. I didn't know if the placentas were delivered immediately following the twin who they belonged to or if they were both delivered at the end. Turns out both babies come first then both placentas. 

Once both placentas were delivered, my doctor went in and did three manual sweeps of my uterus with his hand to remove any remaining pieces. He did this because Atlas, my boy twin's placenta was completely degraded (this is why he was so small and why we induced at 37 weeks instead of waiting one more week to 38). It came out in pieces and he wanted to make sure all of it was removed. This was by far the most painful part of their birth. I arched my upper back, pushed my head back into the bed, winced, squeezed my husband's hand and took ragged breaths through the whole procedure.

This procedure was not a new experience. After Sterling, my first son's birth, this same doctor had to reach in and dig out clots with his hand and I remember it being excruciatingly painful that time too. There's something about a hand and arm going in (rather than something exiting) and then digging around that just feels so disturbing and is downright painful. After the third sweep, I pleaded with him to be done. 

I started to hemorrhage unexpectedly and was given another medication to stop it  along with aggressive uterine massage since I was already on pitocin and which was not effectively stopping it. The hemorrhaging was stopped and my doc finished stitching up the small perineal tear that I'd suffered during the birth. 

I am surprised that I tore with such small babies. 5 pounds, 8 ounces and 4 pounds, 14 ounces but I think it was because they came so quick. Normally, the pushing takes much longer and the body has a chance to stretch. I just popped these guys out in a matter of minutes.

I ended up hemorrhaging two more times back in my labor and delivery room. The second round of hemorrhaging started while I was attempting to breastfeed them for the first time. I started to feel absolutely awful and the babies were taken from me and I was given an oral medication and then a shot when the oral med did not effectively stop the bleeding. There was only one more medication after the three I had already been given that can be used to stop the bleeding.

I was also given pain medication during this intense time. I was unable to stop shaking and my entire body was tense from the pain. My breathing was labored as I tried to cope with everything my body was going through. I remember consenting to the pain medication but because of the state of mind I was in, I wasn't able to fully comprehend what I was agreeing to. I wasn't ready to surrender to pain meds just yet. I wanted to wait and see if I could ride it out without painkillers but I remember her asking and I said yes because I had to answer something and I honestly just could not think.

I received pain meds AFTER Sterling's birth after my postpartum hemorrhage too. I probably would have eventually caved and asked for them but I had intended to try to do it without. It's so strange to me how I'm such a bad ass at the labor and delivery part of birth but then both times, I've completely crumbled afterwards. Maybe I'm like a sprinter trying to run a long distance race and I just burn myself out before its over?

My post delivery experience is something that I'm still working though now. The emotions surrounding my tendency to hemorrhage are very turbulent. Both births I nearly bled to death. The first time it was completely unexpected. With the twins, my doctor and I had a very detailed plan in place to prevent it because I was high risk for it and even with that very specific plan, I still struggled.

During my rough recovery, my babies were with the NICU teams in my Labor and Delivery room that I was back in after leaving the OR but before being transferred to the Maternal Recovery floor. The twins each ended up getting one feeding of formula which breaks my heart but I didn't come prepared with donor milk and they had dangerously low blood sugars. I was later able to obtain donor milk from a close friend who was nursing her six month old twins and she pumped me a few bags for while I was in the hospital and waiting for my milk to come in. 

Pictured above is Olympia on the left and Atlas on the right. 

This is the story of my twins' birth. It's important to respect every mother's unique birth experience and embrace them as they are. I have shared mine because it's a story dear to my heart and in the hopes that other mothers can learn something from it. I have read, watched and listened to hundreds of birth stories since becoming pregnant the first time and that is something that helped me feel prepared and empowered for my own two births. I think that childbirth is utterly fascinating and though at some points painful, I very much enjoy it both times.

This is the story of how my twins made their way earthside at exactly 37 weeks gestation. I desperately wanted to go into labor naturally but for medical reasons I will describe later, it was the safest option to induce and get them out. I was scheduled at 7:00  am on a Thursday morning, December 7th 2017.

When I showed up in Triage at 7:00 am to check in, I was surprised to have to wait in the waiting room for about a half hour. It wasn't really a big deal, I guess the nurses were prepping my room, but it was just something I hadn't expected. I also wasn't expecting to go straight to a Labor and Delivery room. When you go into labor naturally and show up in Triage with contractions, they keep you there in a room for a bit and monitor you for 20 minutes, take a urine sample and if you're far enough along, they take you to a L&D suite. 

I asked Matt to take one last bump photo once we got to the room.  It's still hard to believe that there were two babies in my belly in those photos!

I was started on 2 milliunites/minute of Pitocin around 8 am. The plan was to bump it up by 2 every half hour until I had consistent contractions and then I was hoping to be able to come off the pitocin and continue progressing on my own. Luckily, I was 4-5 cm dilated when I came in which was a great start. If I had not been dilated at all, the plan had been to start with a prostoglandin gel to help soften my cervix first with the hope that it would also set me into labor. If no contractions started with just the gel then I would start on pitocin 4 hours after it was was applied.

I expected to start having some contractions almost immediatly after the pitocin drip was started since I was already so dilated and my body is generally pretty sensitive to medications. I had also been fighting preterm labor since 24 weeks pregnant all the way through 35 weeks, so if I was having contractions then, shouldn't my body be easily encouraged to start having them again now that it was time?

My first labor went so quick and naturally, I did all my early labor standing and walking around which helps to speed things along by applying pressure to the cervix via gravity and movement. I knew that even with this induced labor, I wanted to be up and active as much as possible because I did not want to be there though the wee hours of the next morning trying to get these babies out. I wasn't messing around, I was here to have them so I was serious about getting this show on the road!

My doula and the L&D nurse assured me it is totally normal not to start having contractions right away; that it's all about finding that perfect dose for the mom that sets her into steady contractions. Each time we increased the dose, I thought hopefully,  is this going to be my dose? 

Around 10 am, my OB came in to visit me and see how things were going. He offered to break my water to help get things going but I declined. I wasn't ready for that just yet, I was still holding out that things would pick up soon with just the pitocin. I was also hoping that my water would break naturally when it was time because I know that often times after the water breaks, contractions are insanely intense. I needed time to wrap my head around getting my water artificially broken and to prepare for the intensity of labor that quite possibly would ensue. He said that he would come back on his lunch to check on me and see if I was ready to have it broken then.

In the mean time, I was going to do some yoga and try to bounce these babies out on the exercise ball. I set up my yoga mat right next to my bed since standing on the hard floor hurt my feet and I was required to be hooked up to monitors to keep an eye on the babies. I asked for a portable monitor but they said they could not monitor twins with the portable ones so I had to stay hooked up. I had four lines going; the pitocin drip, a cord for each baby and one to measure my (nonexistent) contractions. We kept loosing the baby's heart rates on monitors because they were moving around so the nurse had to basically hold them on my belly the whole time.

I was pretty bored and discouraged that noting was happening. Each time the pitocin dose was increased, I was so hopeful and then discouraged when nothing happened. My husband ran to the Coop which is just down the street from the hospital, to get us all some food. I ordered a fresh juice that was mostly kale and beets with some apple. It was something light that would give me good nutrients and blood sugar but nothing solid that I might *ahhem*......poop out later. 

My doula, the nurse and I chatted to try to pass the time. I lucked out with the nurse I got; she was super pro natural births and had her doula training and happened to know a lot of the same holistic practitioners that my doula and I know. It made for a really supportive environment for me and interesting conversation since there was not other action to keep us occupied.

My doula rubbed some clarry sage on my belly to try and further stimulate my uterus to perk up and start contracting. By now I was getting a little tired of just standing, squatting, rocking and bouncing to try and get things going so as we crept into the afternoon hours, I decided to take a little break and rest up a bit since it was looking like it might end up being a long night. 

I sat on the bed and my doula gave me a divine hand massage which was so relaxing and amazing. I felt a little sleepy so I decided to lay back and get some rest while things were still slow. I was wondering if my OB was coming back since it was getting a bit late for lunch but I also knew that his office often runs behind because he really takes his time with each patient and makes sure all their needs are met. I was able to doze off for an hour or so.

My OB finally came back around 2:30 pm and I told him I was ready to have my water broken. He checked my cervix and said that I was a 5 but easily stretched to a 6 and he broke baby A's sac of water. For some reason I thought it would hurt a little but it didn't. They put a bunch of towels under me and the only way I knew it had been broken was that that there was a small warm gush of fluid and then it just kept trickling. The nurses told me to hang out on the bed for a while and let it mostly empty.

Matt left to grab some coffee and about a half hour later, I had to pee so I asked to get up. I was defiantly a little scared that once I stood up and the baby's head was pressing directly against my cervix that the contractions would kick in full blast. I got up, went to the bathroom in my suite and came back out. I decided to stay standing for a bit and try to get things going once again.

I told the nurse and my doula that I thought maybe I had to poo but I wasn't sure. They both studied me suspiciously and asked questions like, "Are you having contractions?" "Is it like you have to push?" "Is it pressure thats constant or does it come and go?" They were so worried. I just kept telling them, "I don't know. I mean I feel fine. Not having any contractions. I think its constant pressure but its really subtle. I just think I might just have to go to the bathroom.... I mean I hope that I do because I'd rather go now than later when I'm pushing..."

I decided to go back into the bathroom and try to go. I could tell that they both wanted to come in with me but I wanted some privacy so I promised I'd call if I needed anything. I sat there on the toilet praying, please let me poop now, please I just want to go so I'll feel more confident moving forward with this labor.... it's super common and totally normal to poop during labor, especially when pushing, but I really didn't want to if I could avoid it. I wanted to keep some sliver of privacy and dignity though pretty much all modestly goes out the window during childbirth.

I felt a familiar uncomfortable sensation that I remembered from my first labor as I sat there on the toilet. It wasn't as intense as I remembered it, but I also started to feel pretty emotional. I thought I was just feeling uncomfortable and frustrated because I really wanted to poop and get it over with but I wasn't even sure if I actually had to go. I was feeling nervous about the impending labor and the lack of progress so far. I was just flooded with emotions as I sat in the bathroom alone.

I spent about 5-10 minutes in there and I did finally poop a little which made me feel a little more confident so I decided to head back out into the room. I was met with two faces full of anticipation, I laughed and said "I'm fine guys. But I do think I might be getting close to transition because I'm feeling a little emotional." My doula looked at the nurse and warned her again that I don't show pain or my labor progress. She told her I'm a tough read based on my first labor (she is my good friend and the same doula that we hired for Sterling's birth). At this point, Matt came back into the room from his coffee run and  he headed into the bathroom.

Out of no where, I suddenly had a massive, painful contraction. It came on so fast and so hard I cried out and almost crumbled to the ground. My doula rushed to me and placed a gentle hand on me until it passed. I whined in a scared voice just because labor had escalated so quickly without warning, "I'm pushing..." There was almost no rest time before I had another big contraction. This time I grabbed ahold of my poor doula (who is almost half my size) by the shoulders and almost tackled her to the floor.... Matt came busting out of the bathroom and in a booming, concerned voice, "Whats going on?"

I remember a sudden flurry of activity in the room. The nurse was on her phone franticly calling my doctor and the other nurse assigned to my delivery who hadn't been in the room much (which was fine by me because I didn't like her energy). They wheeled the bed over to me and had me get in. I took off the hospital gown I had been wearing and they placed a sheet over my lap so I just sat there in my sports bra and the sheet. Matt was handed a pair of scrubs to change into and I was whisked away to the Operating Room. All twin deliveries in Idaho are required to happen in the OR even if they are vaginal so women get transferred right before the pushing starts.

​To be continued....