Urinary Incontinence during Pregnancy

Not spoken about very often, one of the side effects of pregnancy and childbirth is the leaking of urine much to the dismay of expectant mothers. Urinary incontinence or leaking of urine at unexpected times can affect mothers when they experience a cough, laugh or sneeze. But it is certainly not something to be embarrassed about as it affects 30%-50% of new mothers and is extremely common.

What is Pregnancy Incontinence?

Soon after you conceived you find that you experience difficulty with bladder control during pregnancy. Don’t panic or be embarrassed! It is only going to get worse during the last trimester when your growing baby exerts pressure on your bladder. Bladder incontinence in pregnancy can be annoying and frustrating, yet it is quite common. You urinate when the muscles around your urethra relax, allowing the urine to flow, and after urination the muscles contract, holding the urine flow until you are ready to empty your bladder again. The fluctuation of hormones during pregnancy and the pressure exerted by the uterus on the bladder interferes with the normal way the urethra relaxes and contracts. This leads to stress, and you may urinate when you exercise, laugh, walk, run or even cough.

What Types of Incontinence are Experienced During and After Pregnancy?

There are several types of incontinence experienced during and after pregnancy:

• Stress Incontinence – Stress incontinence in pregnancy, the most common during pregnancy, is the loss of urine owing to increased physical pressure on the bladder. The bladder sphincter, a muscular valve which controls the flow of urine is stressed owing to pressure on the bladder by the uterus during pregnancy. Urine leaks out of the bladder when additional pressure is exerted especially when a woman coughs, sneezes or laughs.
• Urgency Incontinence – Women with an overactive bladder also have urinary incontinence during pregnancy. Their bladders have uncontrollable spasms which affect the urethra preventing it from controlling urine due to strong contractions. This kind of incontinence can be experienced after childbirth as the pelvic muscles weaken owing to an episiotomy or long labour.
• Mixed Incontinence – Urgency incontinence along with stress
• Transient Incontinence – A medication that you take could cause temporary loss of urine

What are the Causes of Pregnancy Incontinence?

The bladder rests right above the pelvic bones supported by the pelvic floor. The bladder relaxes and fills with urine through the day with the sphincter keeping it closed until you can use the washroom. During pregnancy and childbirth, the pelvic muscles are put through a lot of tests due to several causes.

1. Weight

Weight is a major contributor to stress related incontinence. By the third trimester, the uterus is resting on the bladder and its supporting ligaments causing them and the surrounding muscles to stretch. Any physical movement puts extra pressure on the bladder causing stress incontinence.

2. Hormones

Pregnancy is nothing but a frenzy of fluctuating hormones. These changes affect the bladder lining and the urethra. The hormones make your tissues and joints more elastic to prepare for delivery, in turn, weakening the muscles that control the bladder from releasing urine.

3. Constipation

Pregnancy more often than not is characterized by constipation which puts a strain on the pelvic floor causing incontinence.

4. Medical history

Women who suffer from diabetes, multiple sclerosis, or have had a stroke in the past could also suffer from incontinence.

5. Urinary Tract Infections (UTI)

More than 40% of women do not treat their UTI’s completely, and it is one of the major symptoms of incontinence.

Post-childbirth, especially during vaginal delivery, prolonged pushing could damage the nerves. This contributes to incontinence during pregnancy.

Which Pregnant Women are Most at the Risk of Experience Urinary Incontinence?

Some women are at an added risk of suffering from incontinence during pregnancy

• Conceived at an older age
• Over-weight or obesity
• Have had a vaginal delivery before
• Have had a pelvic surgery
• Smoking as it could lead to a chronic cough

How is the Diagnosis Done?

When you reach the final weeks of pregnancy, leaking urine may be confused with leaking amniotic fluid. A doctor is the best person to ascertain the cause. If there are no signs of labour or infection, a doctor may perform other tests. A doctor may conduct a bladder stress test to see if you leak when coughing or exert pressure on the body. A bladder scan using ultrasound also helps to determine if the bladder is emptying itself completely. There could also be chances that you may be suffering from UTI which needs to be treated.

Treatment for Urinary Incontinence in Pregnancy

Lifestyle changes and bladder management are the effective first lines of treatment for pregnancy incontinence. Some useful tips:

1. Do the Kegels:

Aim to do five sets of Kegel exercises to strengthen your pelvic floor. The best part is these exercises help your pelvis during and after labour too.

2. Bladder training:

To practice timed voiding, use a chart and record your urinating times and intervals. Start with retraining your bladder. Start with visiting the toilet every hour for a certain period of time. Then change the schedule by increasing the duration. Eventually, you can change it to a comfortable time limit to empty your bladder.

3. Cut down on caffeine or carbonated drinks:

Caffeine and fizzy drink may make you want to visit the toilet often. Drink more water or decaffeinated drinks instead.

4. Reduce liquid intake at night:

Limit the number of beverages in the evening to avoid frequent trips to the bathroom or leaking at night.

5. Eat a fibre rich diet:

A fibre rich diet reduces constipation thereby reducing stress on your pelvic floor.

6. Control your weight:

Extra weight around your abdomen increases pressure on the bladder. Try to control your increase weight by doing exercises and leading an active lifestyle.

7. Medications and devices:

Sometimes, doctors suggest the use of devices to block the urethra and block the pelvic muscles. Doctors also prescribe medication to muscle spasms in the bladder or an overactive bladder.

Kegel Exercises to Control Urinary Incontinence

Kegel exercises are a proven technique to control urinary incontinence during pregnancy. The exercises help to tighten and strengthen the muscles in the pelvic floor region. Strong pelvic floor muscles improve the function of the urethra and the bladder sphincter which controls the flow of urine.

To locate your Kegel muscles, start by sitting on the toilet and urinating. Stop urinating mid-stream, and the muscles that you use to stop the flow of urine are the Kegel muscles. Alternatively, insert a finger into the vagina and try to get the muscles to tighten around your finger.

How to perform the exercises:

• Relax the muscles in your abdomen, thighs and glutes
• Tighten the pelvic floor muscles
• Count 10 until you hold the muscles
• Count 10 after you relax the pelvic floor muscles

It is recommended to do these exercises 10 times in the morning, afternoon and night. These can be done anywhere – at your desk, in the car while driving or even on your sofa.

Prevention

There is no definitive way to prevent urinary urgency in pregnancy. However, there are few exercises that can help gain some control over the pelvic muscles to control urine discharge. Regular Kegel exercises help to train the bladder and control flow of urine. Try to strengthen your pelvic floor muscles which are not only important when you are pregnant but even otherwise. Pelvic floor muscles sag if not used regularly so it is helpful if you practice exercises that will strengthen the muscles.

When to Consult a Doctor

Consult a doctor if you experience urinary incontinence during early pregnancy. This is to rule out any possibility of urinary infection that could lead to further problems. Urinary incontinence will definitely set in during the later stages of pregnancy and last for a few weeks after delivery too. However, if you suffer from incontinence for six weeks after delivery, be sure to get checked.

Most women dismiss a few drops of leakage of urine as nothing to worry about or shy away from discussing incontinence with the doctor. If you find that incontinence is hindering your daily routine during or after pregnancy, seek immediate help from the doctor. In the meanwhile, practice suggested techniques to minimize risk and embarrassing encounters owing to incontinence and unexpected leaks.