If you are a woman of a certain age and childbearing status and you have to ask yourself that question, than the answer is undoubtedly….Yes.  Yes you did.  Yes, you did just pee.  Sorry.

It happens to the best of us, it has happened to me.  Why?  (Why God, Why?).  Is it because I had a C-section, or is it because I birthed an 8 pound 4 ounce baby out of my vagina?  Maybe I am lacking integrity, perineal integrity that is. In a nutshell perineal integrity means the “intactness” of the perineum (the area from the anus to the vaginal opening).   Perineal integrity includes not only intactness, which can be disrupted by episiotomies and lacerations, but also pelvic floor strength.  This can be influenced by age, pregnancies, nutritional status, weight, etc. I know I am lacking the other type of integrity regarding morals and ethics.  Example:  I once did not pay for two cases of beer at Costco because the cashier did not notice them at the bottom of my cart.  Did I fess up?  Hell no.  I ran out to my car and felt not one ounce of guilt.  But karma is cruel, and now,  I pee when I sneeze.

There are varying opinions on what causes stress incontinence in women.  For me, it  only happened during pregnancy and for a few weeks after delivery.  Oddly enough, it happened more after my C-section than after my vaginal delivery with a second degree tear.  The other factor for nurses is the dreaded “Nurses Bladder,” (or Infrequent Voiders Syndrome.  Seriously, it has a real name).  Those in the know, know, that this condition is unique to us nurses who do not go on any sort of a break for hours on end.  (My personal best was 12 hours with no potty break.  So proud).  This can lead to bladder over distension, urinary incontinence, and urinary tract infections.  So nurses, take two seconds and go pee for crying out loud.  Don’t be a hero like me, who steals from Costco and pees when she sneezes…….. sometimes.

For those who work in OB you may hear patients fear that they will lose pelvic floor strength and possibly develop urinary incontinence if they deliver their baby vaginally.  We have heard of celebrities choosing to have a C-Section to maintain their “perineal integrity”, and not have to go through the trials of labor.  They choose not to deliver vaginally for fear of having vaginal tearing, over stretching of perineal muscles, and losing perineal sensations.  Could this be true?  Are you more at risk for losing perineal integrity and subsuquent urinary incontinece from having a vaginal delivery?  I always thought the answer was no.  Mostly this was anecdotal, considering I delivered both by C-section and VBAC, and had more perineal issues with the C-Section.

Thank God there are women out there who are much smarter, and definitely have more integrity than I.  The good folks over at Science and Sensibility helped me out to unravel the mystery of whether vaginal deliveries really do cause more urinary incontinence than a C-Section.  According to Amy Romano, MSN, CNM, and author Henci Goer, a C-Section delivery does not guarantee you any more perineal integrity and lack of urinary incontinence than a vaginal delivery would.

Henci and Amy have written a book, Obstetric Myths Versus Research Realities, 2nd edition (to be published by University of Michigan Press), that looks at the research and answers the myth of C-Sections preserving perineal integrity and urinary continence, among a vast array of other interesting OB topics.  They have found that the issues of urinary incontinence may be more complex and multifactorial than is commonly thought.  C-Sections may have a small protection against mild urinary incontinence, but not much protection against moderate to sever urinary incontinence.  This is pretty much what I thought from the years of working in OB and with my own experience.  If you want to see all the extensive research and juicy details regarding this topic, you will have to wait until the book comes out.  Henci and Amy were kind enough to give me some snippets of the book.  It is very interesting!

There is hope for us nurses and lay people who pee when we sneeze, laugh  or read Dooce .  It requires diet, rest, and exercise which I will address in a subsequent post.  Do your Kegels ladies!

RR