What Happens During Labor

During labor, as the baby’s head comes down into the pelvis, the muscles that line the inside are pressed against. This leads to muscles and nerves in the pelvis being especially affected. Unless delivery occurs quickly, the baby’s head is continuously pressed against the pelvic muscles for an hour on end. This prolonged delivery can result in damaged pelvic nerves that carry the signals from the brain to the muscles that hold the rectum and bladder in place. Over time and with age, the normal supporting tissues of the bladder, uterus, and rectum weaken, adding to the effect of childbirth injury.

Recent studies show the chances of incontinence and prolapse are lower if during childbirth, the natural force of uterine contractions to push the baby down the canal, rather than the mother pushing as hard as she can. Also, studies show if voluntary pushing can be limited to one hour, there is a significantly lower chance of injury to the nerves and muscles of the pelvis.

Damage From Childbirth

To keep it short and simple, chances are low for women to develop incontinence during labor and delivery. For the majority, any damage done from childbirth repairs itself over time as the tissues go through the healing process. Almost half of women who deliver vaginally show almost immediate pelvic nerve and muscle recovery. While 60% will have a complete resolution within two months. Of course, those numbers do not fit every woman, and those who’s tissues do not recover 100% have a higher likelihood of incontinence and pelvic prolapse developing later in life.

Can Childbirth Weaken the Bladder?

During labor and delivery, the muscles and tissues supporting the uterus, bladder, and rectum in their place have the chance of being stretched, strained, or even tore. Even the nerves are susceptible to being stretched and injured, which leads to the muscles not working properly. Of course, every woman is different so some women may have no damage from labor and delivery, while other women have some damage to the muscles, tissues, and nerves.

Pelvic relaxation, prolapse, may occur from injury during delivery and the weakened support of the bladder, rectum or uterus. Pelvic relaxation occurs when the muscles and supporting tissues above the vagina, holding the bladder, drop down into the vagina. Prolapse can also cause the urethra, the tube that is used to urinate, to drop. The drop from the normal position of the bladder and urethra combined with the weakened nerve signals may affect the bladder’s function. This can result in urine leakage.

Do Kegel Exercises During Pregnancy Prevent Incontinence?

Practicing Kegel exercises daily can help strengthen the pelvic muscles. Practicing Kegel exercises while pregnant has been shown to decrease incontinence, not only during pregnancy but right after delivery as well.

Can Childbirth Weaken the Rectum?

Childbirth is natural but can be intensive on the body. Just as with the bladder, the tissues supporting the rectum in place under the vagina has the chance of being torn during labor and delivery, causing the rectum to bulge up into the vagina. It is normal for women to experience some degree of prolapse after delivery, but these changes heal and resolve themselves within a few months in most women. Of course, if the issues are severe and not resolving themselves than some repair might need to be completed.

Can Childbirth Lead to Anal Incontinence?

Bowel movements are controlled by the muscles that are directly below the vagina and encircle the rectum. These muscles are faced with extensive forces and pressure during the final phases of labor. Just as with the bladder, anal incontinence can occur due to injury during these last phases. Studies show that more than a third of women who deliver vaginally have some damage to the anal muscles. Similar to urinary incontinence, chances are more likely of experiencing anal incontinence for a woman following a vaginal delivery than following a cesarean section. In fact, recent studies show over a third of women who deliver vaginally might have slight damage to these anal muscles. While most women recover quickly, it is possible for the anal nerves and muscles to close entirely. In that case, involuntary loss of glass or stool could be a possibility.

Can Anything be Done to Prevent Incontinence That Results from Childbirth?

There are pro-active decisions a woman can make that can help decrease the likelihood of a pelvic injury during labor and delivery.

As stated before, allowing the natural conceptions of the uterus to push the baby down the birth canal, without excessive pushing has shown to decrease the risk of injury. While it is common for a woman to think she must “push, push, push,” that may not be the best advice. To decrease the risk of incontinence, the doctor and mother should stay patient until it is time to start pushing to deliver the baby’s head.

Choosing to deliver via cesarean section may be the right choice for the mother if the woman is delivering a large baby, has small pelvic bones, or if the baby’s head is in the wrong position. If women experience prolonged labor, a cesarean section might be the best option for the baby and to help avoid damage to the mother.

Open communication with women and their doctors is important for labor and delivery, and agreements as to the reasonable choices if difficult labor is encountered should be discussed prior to the day of delivery. Every woman is different and that is why it is vital for these conversations to take place with the doctors.