Millions of women worldwide suffer from incontinence and/or prolapse of the bladder and uterus following childbirth arising from damage to the pelvic muscles which support these structures.
Damage to pelvic muscles because of natural birth?Damage often occurs when women give birth "naturally"; that is, vaginally and without the use of pain medications. New research suggests that the use of epidurals during labor, commonly used to decrease pain, may protect the pelvic muscles from the damage associated with vaginal birth. In the past, epidurals received a bad rap, as they were associated with an increased need for cesarean sections and the use of instruments during delivery, such as forceps. The concept that epidurals not only relieve the pain of childbirth but also protect women from future complications such as incontinence and prolapse, will be welcome news to many women.
What are the pelvic floor muscles, and why do we need them?The pelvic floor is composed of a broad band of muscles, ligaments and tissue. These muscles and tissues stretch from your pubic bone in the front all the way to the base of your spine. These muscles and tissues are very important because they support the bladder, rectum and uterus. These muscles are responsible for giving you full control over your bladder and bowels. In addition, strong pelvic floor muscles make intercourse more enjoyable.
During pregnancy, these muscles must support extra weight and can become weak and strained. Delivering a baby can damage already-weakened muscles when the laboring mother strains to push her baby into the world, further stretching delicate tissues. In some cases, such as a prolonged labor, a very large birth weight baby or the birth of multiples, these muscles may be strained past their limit, resulting in weakness. Weakness of the pelvic floor muscles may result in prolapse of the uterus, bowels or rectum or in incontinence.
Incontinence and prolapse- what are they?Incontinence refers to the involuntary leakage of urine or stool that occurs unexpectedly. Incontinence may involve the loss of small amounts of urine or stool, or may be severe and result in the loss of the entire bladder/bowel contents all at once. Urinary incontinence is more common than bowel incontinence, but both are devastating emotionally for women who suffer from this common problem.
Stress incontinence, a frequent form of incontinence, occurs when a stress placed on the bladder causes urine to leak out. Common stressors include sneezing, coughing, lifting heavy objects, exercising or even laughing. Urge incontinence occurs when a sudden intense need to urinate is felt and urine is lost before the washroom can be reached. Some women suffer from both types of incontinence, which is known as mixed incontinence.
Prolapse occurs when the uterus or bladder sag downwards, putting pressure on the walls of the vagina. Sometimes the uterus sags down into the vagina. The rectum may also prolapse. The term prolapse literally means "to fall out of place". As one might imagine, prolapsing of internal organs may lead to all sorts of problems, including incontinence. Weakened pelvic muscles can contribute to prolapse.
An epidural is essentially a medication delivery system that relieves pain without putting the patient to sleep. Epidurals are inserted into the spine, taped in place and may provide a continuous infusion of pain-relieving medications or periodic doses of the same drugs. When you receive an epidural, you will feel numb from the abdomen down. Many women opt for epidurals for pain relief during labor. It is estimated that more than half the women in the United States receive an epidural during labor, with some figures being quoted as high as 70%.
How does an epidural protect against incontinence and prolapse?A study published in the British Journal of Gynecology found that epidurals may offer protection of the pelvic floor muscles, therefore decreasing the risk of developing incontinence or prolapse later in life as a result of childbirth. What exactly did the study find?
- More than 10% of women studied suffered damage to the pelvic floor muscles during vaginal childbirth
- Women who chose epidural anesthesia suffered less damage to their pelvic floor muscles
- 2/3 of the women studied who were found to have suffered muscle damage did not have an epidural
The researchers involved in the study speculate that, because women who have epidurals lose sensation, they are less likely to push prematurely, push for too long or push too forcefully. It is also possible that paralysis of the pelvic floor muscles that occurs as the result of an epidural protects these muscles from sustaining damage from childbirth.
This is good news for women who desire a pain-free birth. Epidurals enjoyed a bad reputation for a number of years, with some experts stating that women who had an epidural were more likely to require a cesarean section, require the use of forceps, or experience prolonged labor. Epidurals were also associated with the risk of low blood pressure in laboring mothers, risk of spinal headaches and confining the laboring mother to bed following administration of the epidural. Although these complications do sometimes occur, they are not common.
Women who are pro-natural childbirth argue that epidurals are unnecessary, dangerous and are performed too readily, but many a laboring mother has felt a strong desire to kiss the anesthesiologist who bears the pain-relieving medication delivered through the epidural catheter. News that epidurals may prevent incontinence and prolapse may prompt even more women to turn to epidurals in their moment of need.
Incontinence and prolapse are serious complications of childbirth that can greatly decrease quality of life for women who suffer from these conditions. Symptoms do not always present themselves immediately after childbirth, but often appear years after the fact. Women who suffer from these problems may suffer from depression and may isolate themselves due to embarrassment or shame. Although pelvic floor exercises may sometimes be helpful in mild cases, surgery is sometimes necessary; therefore, the fact that epidurals not only provide welcome pain relief during labor but may also prevent misery down the road may be all that is needed to tip many women's minds in favor of epidurals during labor.