Recognizing Your Postreproductive Problem

Ever Since I Had My Baby
by Roger Goldberg, M.D., M.P.H.

At last, a reassuring, straightforward, and practical guide to easing, preventing, and even curing, once and for all, the symptoms of pelvic-floor disorders, including:

• incontinence
• prolapse
• pressure and pain
• sexual difficulties
• bowel troubles

Pelvic-floor disorders are much more common than you might think - millions of women suffer from one or more symptoms of pelvic-floor injury. These problems often stem from the strain placed on the body during pregnancy and childbirth, although symptoms may take years, or decades, to appear - if they don't begin right away. Childbirth can wreak havoc on even the healthiest woman's body, and you may still be feeling the effects long after the birth of your last child.

If you suffer from any of these conditions, you do not need to feel helpless, and you are certainly not alone. Every one of these pelvic disorders is treatable, even curable in many cases. Dr. Roger Goldberg, a respected physician in the emerging field of urogynecology, provides the most up-to-date information on surgical and nonsurgical treatment options. He offers a clear explanation of the pelvic anatomy and why these disorders occur and also describes simple preventive techniques you can use to ease pelvic symptoms and minimize further strain (including the correct way to do Kegel exercises).

Armed with the facts and candid advice contained in Ever Since I Had My Baby, you will be able to discuss your individual symptoms and potential treatments with your doctor confidently and knowledgeably. This book will help you realize the freedom you've been seeking from the emotional and physical burden of symptoms that often go unmentioned, or are overlooked, in women's health care.

Incontinence, Prolapse, Sexual Dysfunction, and Other Commonly Overlooked Conditions

The reason why mothers are more devoted to their children than fathers: it is that they suffer more in giving them birth.

-Aristotle

Why didn't anyone tell me about this problem ten years ago.

-Linda, age forty-one, considering surgery

"What's happened down there?" you've asked yourself, as have so many other women from time immemorial. Ever since that wondrous day you gave birth - for the first time or the fifth - your body has never felt quite the same. Was it embarrassment over the loss of urine you first noticed while lifting your child, laughing with your friends, or making a run to the bathroom? Was it your growing self-consciousness about controlling your bowel movements or gas? Or maybe it was your worry that sex didn't feel the same as it once did, and that your partner's satisfaction might have changed also.

"I feel way too young for this!" you've told yourself while mothering, working, exercising, nurturing relationships, and striving for a full and active life. Yet more and more, you've found that these problems really can't be ignored, because they're making you less active, your life less complete. Never, at this stage in life, had you anticipated such challenges to your sense of control, intimacy, and self-image, conditions that make you feel terribly alone and abnormal. What might the response be if you mentioned these problems to your peers?

More likely than not, their eyes would light up with interest and affirmation. Many of them have these problems, too. What's happened down there for you and many other women are the effects of pregnancy, labor, and delivery - of forceps, episiotomies, and a newborn's head, shoulders, arms, and legs - on your pelvic muscles, nerves, bladder, bowel, and vagina. They are long-term problems of the pelvic floor that modern obstetrics has overlooked in its efforts to make delivery safe and comfortable in the short term. Leaking, bulging, soiling, sexual dissatisfaction - women of past generations rarely complained about these "inevitable costs" of childbirth. After all, what could be done?

A New Chapter

Within the book of women's health, you've turned the first page of a new chapter whose time is overdue. Call it urogynecology, female pelvic medicine, or postreproductive women's health. By any name, it is finally centered on the female conditions that so often follow the most wonderful and dramatic physical event of your lifetime: childbirth. You've learned of the many ways to prevent and treat problems such as heart disease, breast cancer, and osteoporosis. But you've heard little about the countless ways to prevent and treat the physical effects of childbirth. From this chapter forward, you'll hear a great deal.

Along the winding road between childbirth and menopause, scores of women are affected by physical symptoms that often attest to the extraordinary physical demands of pregnancy, labor, and delivery. Some of these postreproductive changes are immediately apparent, affecting the quality of a woman's most vigorous years; other anatomic changes have no repercussions until decades later. Whether these physical transitions are subtle or severe, immediate or delayed, they are more common - and fortunately, more treatable - than you might think. Incontinence, prolapse, and pelvic and sexual problems are no longer the unspoken and inevitable costs of motherhood.

"Mom takes care of everyone, but who takes care of Mom?" The average working mother spends one and a half hours each day shuttling kids around, two hours preparing food and straightening the house, and what often seems like twenty-five hours listening to everybody else's problems! The time has arrived to better understand one of the most important physical events in your life, and learn how to treat the symptoms that are bothering you. Take a Calgon moment and read on. Doctor's orders.

Identifying Your Postreproductive Symptoms = Urinary Incontinence and Loss of Bladder Control

At least one of every three women will suffer significant loss of bladder control, and although incontinence affects many women without kids, up to 65 percent will notice this problem for the first time either during or after childbirth. Millions each year choose surgery for this debilitating condition, and millions more seek nonsurgical treatments; countless others silently endure their symptoms without ever seeking help. A loss of bladder control can make you feel lonely, ashamed, and antisocial, even unemployable. But what many women don't realize is that urinary incontinence, in most cases, boils down to a few common types - all of them treatable. Understanding your problem is your first step to reaching a cure.

Stress Incontinence

Allison

"I don't want to be Florence Henderson in diapers in a few years!"
"Excuse me?" I replied as I continued to jot down some notes on her medical history. It was her first office visit.
"I said, I don't want to become Florence Henderson!"

This was Allison, a thirty-three-year-old advertising executive, upbeat about everything except her four-year history of leaking urine. "Everything's felt different," she said, since the forceps-assisted vaginal delivery of her only child. During the months after delivery, she had begun to notice a few changes, a bit less control. Like a few of her friends, she'd wet her pants a bit when laughing or coughing hard. For security, she began wearing pads all month long. And for two years before coming to my office, she'd been doing occasional Kegel exercises at the recommendation of her internist. She hadn't noticed much improvement since starting with the exercises, although she couldn't swear that she'd been doing them correctly. I turned my chair toward Allison and, serving her up a bit of her own deadpan humor on that cold and rainy day, reassured her that in my medical opinion, her risk of becoming Florence Henderson was very, very small.

Allison's comment resonated in my mind as we continued her office visit, reviewed the testing plan, and discussed her most likely treatment options. Though I wasn't sure Mrs. Henderson ever advertised adult diapers or spoke publicly about incontinence, I understood the message loud and clear. Lurking behind Allison's campy quip was a great deal of anxiety - about youthfulness and aging, about losing control. She was facing a problem that, in her mind, belonged to the "Golden Girls," the Brady Bunch mom - not a young, working city slicker just starting her family life.

Should she worry? Research suggests that even a completely problem-free vaginal childbirth would leave her with a significant risk of incontinence. And though forceps may have been used with good reason, they further increased the likelihood that she would develop bladder problems; she stood at several times the usual risk of severe stress incontinence by age forty, as compared to women with no previous forceps delivery. Furthermore, there is compelling evidence to suggest that her current symptoms would not improve over time but rather would progress to needing treatment. One study concluded that when certain types of urinary incontinence persist three months after delivery, the risk of long-term leakage approaches 94 percent.

The questions arise: how can Allison help herself, at this early stage, to feel better and prevent her problem from getting worse? How can she avoid joining the fifty thousand women undergoing surgery for stress incontinence each year? And how could we have helped her to avoid this scenario in the first place?

Copyright © 2003 by Roger Goldberg, M.D., M.P.H.

About the Author

Roger Goldberg, M.D., M.P.H., practices urogynecology and reconstructive pelvic surgery at the Evanston Continence Center of Northwestern University Medical School. He completed his residency at Harvard Medical School and his master's in public health training at Johns Hopkins University. He lives in Evanston, Illinois.