Jogging usually cleared her head, but tonight, as Priska threaded through the streets of her neighborhood, the 30-year-old couldn't shake thoughts of her near-miss a few days ago.
Since she'd given birth to her first child, Sam, it seemed like she couldn't venture far from a bathroom without risking a leak or an accident. She'd barely held it long enough to make it into the park restroom the other night.
She had Googled "causes of frequent urination" immediately afterward on her phone.
Confusing Postpartum Symptoms
Dr. Google was more confusing than helpful. The consensus in her new parents' group was that her body was still healing from having Sam. Several admitted to postpartum problems with dribbles and leaks. Do your Kegels, they'd advised.
Priska's delivery had been more difficult than she'd expected. Six weeks of natural childbirth classes still hadn't prepared her for 19 hours of intense labor. But in the end, she had delivered a big, healthy baby and had so much to be thankful for.
A few days later, when Priska stood suddenly at her desk, she felt something drop in her vagina. At least, that's how it felt. Horrified, she realized she had wet her pants. Pushing back feelings of discomfort, she reached for her phone.
"It's time to get to the bottom of this," she thought as she tapped out her OB/GYN's number.
Diagnosing Causes of Frequent Urination
The OB/GYN who delivered Sam was on vacation, so Priska saw another doctor in the medical group. Priska described her recent mishap at her desk, the jogging emergency and the newer sensation of bulkiness and discomfort that felt like it was coming from her vagina.
One of the first questions the gynecologist asked was whether Priska had undergone a hysterectomy. The procedure, the doctor explained, can cause pelvic floor issues and increase the risk of urinary incontinence and pelvic organ prolapse, a condition Priska had never heard of. Priska explained that she just had her first child a few months ago and that she didn't see a hysterectomy in her future any time soon.
When the doctor asked about the delivery, Priska revealed that having Sam had been more challenging than expected. She'd pushed for a long time, and in the end, her OB/GYN had needed to use forceps to guide Sam's head out of the birth canal.
The gynecologist explained that pelvic floor problems can occur when arduous labor stretches and weakens the pelvic floor muscles. She reassured Priska that if the problem was a weak pelvic floor, the issue was common and treatable.
Priska said she had heard about the problem from her mother and aunts.
"I've already started doing my Kegels, so that'll fix it, right?" Priska asked. The gynecologist, however, said she'd like to rule out a few other conditions first.
Ruling Out Common Postpartum Issues
When asked about postpartum care, Priska acknowledged she'd been forced to miss her postpartum checkup due to a last-minute crisis at work.
She was surprised when the doctor asked if she had any fecal incontinence or problems emptying her bowels. The gynecologist explained that problems with bowel movements and fecal incontinence can also be a sign of pelvic floor dysfunction.
The doctor went on to ask Priska other questions, such as whether she had a history of urinary tract infections, interstitial cystitis or irritable bowel syndrome. But Priska had been fairly problem-free — until now.
The pelvic exam was different from those Priska had had before. The gynecologist carefully used her hands to test how well Priska could control her pelvic muscles. She told Priska she was looking for spasms, knots or signs of a weak pelvic floor.
The gynecologist discussed the possibility of prolapse and rectocele. She said pregnancy and childbirth may weaken the supportive tissues holding the pelvic organs and the wall separating the rectum and vagina, but said she felt no signs of that in the pelvic exam.
Even so, she told Priska her pelvic floor was weaker than it should be and recommended an ultrasound for insights into the health of the muscles there.
Opting for 3D Translabial Ultrasound
In between appointments, Priska found that Kegels weren't helping. Jogging had become so fraught with leaks and even full-blown accidents that she had resorted to wearing pads full time. She hated the bulky feel in her running tights.
Ten days after her initial consult, with a go-ahead from her insurance, Priska visited a urogynecologist for a 3D translabial ultrasound. Priska was familiar with ultrasound technology, having had many ultrasound exams while she was pregnant with Sam, but she had never heard of a translabial option. While initially a bit intimidated, Priska was reassured by her doctor that the imaging study would be quick and painless. Her doctor went on to explain how the special ultrasound was being used more and more to understand the link between childbirth and pelvic floor disorders.
In the exam room, a technician placed a cushion under Priska's buttocks and asked her to recline in a frog-like position. She gently placed the probe on Priska's genitals, and toward the end of the exam asked Priska to clench her pelvic muscles.
The ultrasound revealed levator ani trauma, likely related to Priska's lengthy bout of pushing and instrument-aided delivery, her doctor surmised. She reassured Priska that the tear was common in vaginal childbirth, and it would most likely go away naturally within 12 months.
Still, because the injury put Priska at greater risk of developing prolapse, the doctor said she'd like to keep an eye on her and suggested a series of new pelvic floor muscle exercises in the meantime.
Priska was relieved. That night, after lacing up her running shoes, she placed a fresh pad in her tights. The box of pads was half empty. She felt hopeful this box might be her last.
