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Pregnancy and incontinence

Expert: Associate Professor Pauline Chiarelli

Associate Professor Pauline Chiarelli was a founding member of the Continence Foundation of Australia and first Australian Physiotherapist member of the International Continence Society and lays claim to being the first Australian Physiotherapist Continence Adviser. She is a Research Associate with Australian Longitudinal Women’s Health, immediate past Scientific Editor of the Australian and New Zealand Continence Journal and a member of the steering committee of the Australian National Continence Management Program.

As well as her PhD, Pauline has a Master’s degree in Medical Science in Health Promotion: a degree that has proven effective in her continence promotion efforts to “dry up Australia”. Her  Master Thesis was “Incontinence During Pregnancy: Prevalence and Opportunities for Continence Promotion” while her PhD thesis explored “Female Urinary Incontinence in Australia: Prevalence and Prevention in Postpartum Women”.

For the last eight years Pauline has convened the Bachelor of Physiotherapy Undergraduate program at the University of Newcastle NSW Australia.

Watch the video

The following video answers the question about why a woman has an increased risk of leaking urine (urinary incontinence) after childbirth. A useful resource for your patient to find out how to prevent this from happening, how to treat the condition and where to get help.

The purpose of this video is to provide information to viewers about pelvic floor exercises, good bladder and bowel habits and where to go for help, in a simple and easy to understand manner. 

Video produced by the Continence Foundation of Australia in association with Jean Hailes for Women's Health.

Click here to download the Protect your pelvic floor and stay in control pamphlet

Q&A with Assoc. Prof. Pauline Chiarelli

Q: What’s your opinion of the abdominal hypopressive technique? Would you use in conjunction with pelvic floor muscle contraction?

Emerging evidence does not support that this technique adds anything to a well-designed protocol related to the management of pelvic organ prolapse.

See: Resende APM, Stüpp L, Bernardes BT, Oliveira E, Castro RA, Girão MJBC, et al. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourology and Urodynamics. 2012;31(1):121-5.

Apart from this I think the exercise technique is extremely complex and complicated to teach and from a continence promotion (i.e. Health promotion) point of view it is a well-known fact that we should always keep the message as simple as possible.

As a long-time proponent of pelvic floor muscle exercises I find this specific exercise incredibly difficult to achieve and unless I had a highly educated patients I really believe they would have difficulty understanding instructions. It is really important to understand the relationship between motivation to exercise an exercise outcomes. If you want to encourage women to adopt lifetime/lifestyle practices, then the simpler the practice the easier to adopt over the longer term.

 

Q: What impact do different connective tissue types have on the pelvic floor?

The pelvic floor muscles are attached to the pelvic side walls by connective tissue.

The pelvic organs themselves are suspended within the pelvic basin by connective tissue.

For this reason adequate connective tissue is required to hold the pelvic organs in their correct place within the pelvis. If collagen tissues are defective they are subjected to stresses and strains during pregnancy and birth leading to poor support of the pelvic organs and eventual pelvic organ prolapse.

This is one of the reasons there is quite a strong genetic relationship between pelvic organ prolapse collagen type and connective tissue/integrity.

 

Q: An 11 year old girl has been diagnosed with a prolapse which I am told is very rare. She has frequency and wets if she tries to hold on. She has been advised to go and see a pelvic floor physiotherapist but her paediatrician does not agree. What do you suggest?

This little girl sounds as though she may have a quite a rare connective tissue disorder called Ehlers-Danlos syndrome. This is a genetic condition related to extremely poor collagen and connective tissues. To my way of thinking I feel this young girl needs to see a pelvic floor physiotherapist – not only because there is evidence that pelvic floor muscle exercises may help to her pelvic organ prolapse or if it is in the early stages, but because she is in dire need of effective wide ranging preventive strategies related to pelvic floor muscle function over the longer time term.

A pelvic floor physiotherapist will be able to talk to the mother of this girl to ensure minimisation of the impact of activities of daily living and life stages for this young girl.