Grainne’s experience of urinary incontinence and back pain

Grainne is a 36 year old, mother of two. Her daughter is 4 and her son is just 3 months old. Grainne came to me with her main complaint of leaking a small amount of urine on coughing, laughing and activities such as running up the stairs. Grainne was disappointed that these symptoms had not gone away yet following the birth of her baby boy, and she was finding it quite upsetting. Grainne’s goal was to stop the leaking, and, in time, return to running. Prior to her last pregnancy Grainne was running 5-7 kilometres, 3 times per week.

On further discussion Grainne revealed she was also feeling stiff and sore in her thoracic (mid-back) area. This pain was increased with prolonged breastfeeding.

The physical examination revealed Grainne’s pelvic floor was not working efficiently. Grainne had trigger points (tight areas) in her pelvic floor muscles, which were not allowing her pelvic floor to release fully. To work properly, our pelvic floor must be able to both contract and release.

When I assessed her posture, Grainne displayed slightly forward rounded shoulders and a forward head position. She also had tightness and trigger points in her neck and shoulder muscles. I also noted Grainne had a 3cm DRAM (Diastasis of the Rectus Abdominus Muscle) which is a separation down the middle of the abdomen, also very common with pregnancy.

Grainne was suffering from stress incontinence, a very common form of leaking. Pregnancy, labour and child birth are common risk factors for developing such an issue. However I could provide Grainne with a lot of reassurance as there is excellent research evidence to support physiotherapy as a successful treatment for stress incontinence. The research suggests that the best practice is a thorough pelvic floor assessment and treatment, along with lower abdominal exercises, postural re-education, correct breathing advice, and an effective, individualised exercise program. Grainne’s mid back pain is also a very common issue in pregnancy and post-natally. This can be as a result of postural changes during pregnancy, along with the new requirements that come with having a new baby such as breastfeeding, lifting and carrying the baby.

Grainne’s physiotherapy treatment included:

• Manual therapy, to release the tight areas of her pelvic floor
• Correct breathing techniques
• Education on correct pelvic floor exercise technique
• Postural Advice
• Manual therapy to release her tight mid back
• Advice on best breastfeeding posture
• A comprehensive, individualised home exercise program

– pelvic floor exercise program

– Increase thoracic mobility exercises

– Breathing exercises

– lower abdominal muscle strength work

– completing a bladder diary

As she progressed through treatment, Grainne joined my post natal clinical Pilates class and we made a plan for her return to running.

After 4 treatment sessions Grainne’s leaking had stopped completely. Her posture was improving and she was feeling stronger and more able for the increased demands of her growing baby. Through manual therapy, postural awareness, clinical Pilates and home exercises her thoracic pain had resolved completely. To prevent recurrence, Grainne remained aware of her posture, especially when looking after her baby or lifting her toddler. Her exercise program and clinical Pilates classes had also helped to bring her DRAM from 3cm to 1cm.

The time frame as to when a lady returns to running after having a baby is a very specific and individualised issue. She needs to be symptom free and ready for the task. We worked together with a graded exercise plan which got Grainne back to her full running schedule.