Fixing the damage
If you suspect a problem after having a baby, discuss it with your OB-GYN within the first couple of months (see "5 Signs of Trouble," below). Your doctor may refer you to a specially trained physical therapist, as mine did. (If she is unable to help you with this, contact the American Physical Therapy Association at apta.org.) Most P.T.s use biofeedback, positioning either an internal probe or electrodes on the perineum—the area between the vagina and anus—to provide visual awareness on a computer screen of your pelvic muscles working. "Because you cannot see the muscles contract and because they do not contract into or against anything, they are harder to isolate than other muscles in the body," explains physical therapist Patti Koehler, co-owner of the West Portland Physical Therapy Clinic in Oregon.
If physical therapy doesn't work, surgery to attach a small "sling" to the pelvic muscles can be performed; this takes 20 to 30 minutes and requires only light sedation and local anesthesia. Prolapse surgery takes one to two hours and requires general anesthesia. However, before considering surgery, doctors suggest waiting until after your baby's first birthday to see how much healing occurs naturally. Success rates are good—there's an 80 percent to 85 percent chance of eliminating "leaking" when you sneeze, for instance, says Walters.
As for me, hearing my doctor say the word "incontinence" was motivation enough to seek help right away. I started working with a physical therapist the following week, and I'm proud to say I'm leak-free, even when I run. And as a marathoner, that's saying a lot.
5 Signs Of Trouble
Signs of a pelvic floor-disorder range from slight to severe. Here are symptoms to look for up to 12 months postpartum, according to Mark Walters, M.D., head of gynecology, urogynecology and reconstructive pelvic surgery at the Cleveland Clinic:
1) Urine leakage when you sneeze, laugh, cough or exercise.
2) Difficulty pushing out a bowel movement or feeling pressure on your perineum when bearing down.
3) Trouble keeping a tampon in.
4) A feeling of looseness in your vagina during intercourse.
5) The sensation that something is dropping down in your vagina during activities or intercourse, especially when you are on top.
For step-by-step instructions on how to do Kegels, go to fitpregnancy.com/kegels.