Reducing the incidence of incontinence
The pelvic floor muscles (PFMs) are the layer of muscles that support the pelvic organs and play an important role in continence. Weakened PFMs will not fully support the internal organs, which can lead to difficulties controlling the release of urine, faeces or flatus and can cause prolapse to occur. Pregnancy and vaginal delivery are a recognised cause of PFM weakness; however, it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred for more specialist treatment. We describe an initiative to support midwives with these tasks.
Many women develop problems associated with pelvic floor dysfunction, which often stem from the peripartum period. Those at most risk include: women of an older maternal age, those with a high body mass index (BMI), women who have heavier babies, women have had four or more normal births, and women who have had a forceps birth (Glazener et al, 2009). It has also been shown that birth by caesarean section is not protective for incontinence in the longer term (Press et al, 2007).
Pelvic floor dysfunction can cause urinary incontinence, anal incontinence, and pelvic organ prolapse; all of which can have a significant impact on a woman's quality of life. In 2013–2014, a parenting website on behalf of the Chartered Society of Physiotherapy (CSP, unpublished), carried out a survey of 1900 mothers and found that over 80% had experienced urinary leakage at some point with 49% continuing to leak at 6 months.
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