There are several theories for why this occurs. During vaginal delivery, as the baby passes through the birth canal (vagina), there is a tremendous amount of stretching of the surrounding muscle, nerves and connective tissue. All together these structures make up an area of the pelvis called the pelvic floor.
The pelvic floor plays a crucial role in urinary continence. Sometimes the stretching can be so significant that these structures can be torn or damaged. Studies have shown that most women will heal and recover from a vaginal delivery. Those women who do not recover may note symptoms of urinary incontinence, vaginal laxity (prolapse) or fecal incontinence.
Urinary incontinence can be caused by a urethra that lacks support due to tearing of supporting connective tissue during birth. Sometimes strengthening the kegel muscles around the urethra may be enough to make up for the weakened connective tissue. However, in some women even strong kegel muscles may not be able to compensate for a sagging urethra that lacks adequate connective tissue support. Hundreds of kegels a day may not keep the leaking away in this situation.
Often women are told to do kegels but they not instructed in the appropriate technique. If you think that the kegels are not helping with urinary leakage, it is important to ask yourself a few questions.
First, are you doing the kegel exercises correctly? If you do them incorrectly (i.e., if you bear down rather than kegel correctly) you may cause more damage to what you are trying to fix. If you are unsure, ask your provider to assess your kegel ability or ask to be referred to a specialist who can assess you and teach the appropriate technique. Second, have you given the kegel exercises an appropriate amount of time and effort? A good regimen should be tried for three months before you give up.
If you have done your kegels religiously and still note no improvement in the urinary incontinence symptoms, then it is time to speak to your provider about other treatment options. If the leakage is due to a loss of connective tissue support for the urethra that the kegels cannot overcome, you may be a candidate for a minimally invasive sling procedure. An evaluation by a provider experienced in dealing with urinary incontinence will help you find the right answer.