Did I Just Pee?
Posted by realityrounds on July 20, 2009
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
pinky said
I think the jury is still out on wether vag delivery causes incontinence later. I know that I had 2 9lb babies and I cross my legs when I laugh too hard.
realityrounds said
Is it the delivery method or the pressure on the pelvis of those 9 pound babies? I know large tears and episiotomies can effect pelvic floor strength, (and being a nurse,,,sigh). I was reading an US Weekly (I’m addicted), on how Christian Aguilara wanted a C-Section because she was afraid of vaginal tearing and the complications that may come with it. Hmmm.
pinky said
Might have been the huge mediolateral episiotomy with the first baby? Not sure. Could be I just have poor bladder control.
Takingheart said
“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.”
HA HA! I think I just peed reading that!
realityrounds said
Oopsie!
thefeministshopper said
I VBAC’d a nearly 10 lb baby, after having an 8 lb’er cut out of me, and I have to say I had WAYYYYYYYY more problems with incontinence after my cesarean. It was horrible. There was something about the way they piled all my organs back in there that cause me to have such severe stomach issues that I had debilitating, bleeding, infected hemorrhoids for a full YEAR after that birth. There were days where I could barely walk. I was starting to consider surgery to get them fixed. Then I got pregnant again, VBAC’d that baby (with a 2nd degree tear no less) and all my plumbing was magically put back in it’s right place. I haven’t head a hemorrhoid since. Go figure!
So there’s a second piece of anecdotal evidence.
Erinn said
It’s funny you tell that story the same day a coworker recounted to me how she had menstruation issues for several years (during which she was subjected to a D&C four times – FOUR!); but after she had her first baby, she never had any period-related problems again.
Akiko said
I thought that most urinary incontinence from child bearing was due to nerve damage. The weight of the child can push on those nerves and damage them. Usually it is temporary. It can happen during delivery (most likley) as the baby pushes past the bundle of nerves from the coccyx to the bladder. Another cause for incontinence is damage to the coccyx. If you have ever fallen on your tailbone you will probably have issues later. My sister suffered for years after a fall at the skating rink as a child. Lucky for her she found the right doctor to treat it and is normal now. So take heart. Holding your pee will not result in incontinence but it can damage your kidneys if the infection is bad enough.
realityrounds said
Dear Word Press,
Why is this:
“Possibly related posts: (automatically generated)
* Telling it like it is about Christian television”
a related post?
Tom said
I can’t believe that you didn’t also refer to the perineum in the more common name … the “taint”.
Just a show of hands, how many people call it the “taint”?
realityrounds said
Oh Tom.
Amy Romano said
I’ve been meaning to write to say that I really enjoyed this post and of course appreciated the hat-tip! One of the things that’s difficult to convey to women (and, for that matter, health professionals) is that we have no idea what kind of pelvic floor strength and function we’d see if we offered women optimal care in birth. So much of what affects the likelihood of perineal injury and/or pelvic floor weakness likely has to do with modifiable aspects of labor management – purple pushing, lithotomy or McRoberts (knees to ears) positioning, episiotomy, vacuum/forceps, fundal pressure, etc. When we see research comparing c-sections and vaginal birth, authors rarely if ever describe second stage management practices, so we cannot account for these.
I won’t listen to anyone tell me c-sections are better for the pelvic floor unless and until they also talk to me about changing the way we care for women in vaginal birth!
realityrounds said
Thanks Amy!
Agree 100% with your last sentence.
mamamia said
Say it ‘taint so Joe, eh Tom. Never heard of a taint(?) ’til I read Tom’s comment. It’s like crossing one’s fingers and wishing, only I cross my legs when I sneeze and wish I don’t piss myself. Another lovely gift given to us women, periods-pregnancy-leaking milk and leaking pee.
A Cracking Grand Rounds! // Emergiblog said
[...] of reflexes, Reality Rounds asks that rhetorical question, Did I Just Pee? And yes, she actually did! Find out why and what she has discovered about perineal integrity along [...]
Calli Arcale said
I read of a study a while back (sorry, I have no reference, but if somebody knows where to look that stuff up, it’d be awesome if they’d find it) which looked at urinary incontinence in elderly women. In particular, they looked at nuns, who, being virgins, had obviously never been pregnant at all. The interesting thing was that they had the same rate of urinary incontinence as the general population.
Perhaps the number one risk factor may simply be a matched set of X chromosomes.