Urinary Incontinence
During and After Pregnancy
Incontinence is the involuntary loss of urine. Although it is quite common for pregnant women to leak urine with a sneeze or laugh, it is not normal. Most pregnant women will hear, “What do you expect, you’re pregnant,” when inquiring about how to manage the leaking. Incontinence, however, can be corrected in most situations without medicine or surgery.
Imagine that the bony pelvis is like a bowl, and the pelvic floor muscles are the vaginal muscles that encompass the whole bottom or floor of the bowl, holding all of the bowl’s contents or the body’s internal organs. These muscles attach from the pubic bone in the front of the pelvis to the tailbone in the back. The pelvic floor muscles are responsible for stopping the flow of urine out of the body when it is necessary to delay urinating. The two most common types of incontinence experienced by pregnant women are stress urinary incontinence and urge incontinence, also known as overactive bladder.
The most common type of incontinence experienced during pregnancy is stress urinary incontinence, or SUI. SUI is a sudden loss of urine most commonly associated with a sneeze, cough, laugh, exercise or a sudden movement. This occurs due to the increased weight of the uterus on the bladder and stress on the pelvic floor muscles. These muscles should automatically tighten, without even thinking about it, in response to an increase in pressure within the abdominal cavity, such as during a sneeze. If the pelvic floor muscles are weakened, these muscles may not be able to counteract this pressure and a small amount of urine may leak out of the body.
During the postpartum months, stress urinary incontinence can persist, but it is also common to experience symptoms of urge incontinence. This can also be known as overactive bladder or OAB. OAB can disrupt and interfere with daily life and social activities. OAB causes sudden strong urges to urinate even if the bladder was just emptied. These uncontrollable urges can lead to leaking when trying to make it to the bathroom on time and wanting to urinate frequently throughout the day and night. Symptoms can include lower abdominal/bladder discomfort and having to urinate greater than eight times during the daytime and more than twice at night. The pelvic floor muscles and nerves are often damaged or weakened during childbirth. This can lead to uncontrollable bladder muscle spasms causing an intense urge to urinate. It is possible to have both types of incontinence at the same time.
Both types of urinary incontinence can be helped by gaining control over the pelvic floor muscles. It is important to learn how to properly activate and relax these muscles. A pelvic floor contraction consists of a lift and squeeze of the vaginal muscles while exhaling and then relaxing or letting the muscle go. This is also known as a kegel or quick flick. The second exercise is for endurance of the muscle and this consists of tightening the pelvic floor muscles for ten seconds while breathing followed by a ten second rest period. Make sure to not lift the pelvis/hips or squeeze legs together to compensate for a weak pelvic floor. Both types of incontinence can be helped by performing pelvic floor exercises. With SUI, if one can anticipate the sneeze, cough or laugh, tighten the pelvic floor muscles just before to stop or minimize the leaking. For OAB, it is helpful to start bladder retraining with a timed schedule of urinating. Gradually lengthen the time period between bathroom visits until there are about two hours between urinating. This may take one to two weeks. Delaying the urge can be accomplished by tightening and relaxing the pelvic floor muscles, applying pressure to the vaginal area or distracting the mind. Limiting the use of bladder irritants, such as coffee or tea, controlling constipation and not limiting fluid intake are also important aspects of managing incontinence.
If experiencing symptoms of incontinence during or after pregnancy, ask your doctor for a referral to a pelvic floor physical therapist. By at least eight weeks postpartum, you should have control over your bowel and bladder. It is important to speak to your doctor or physical therapist about these symptoms because an individualized plan of care will be developed that best suits your needs. A physical therapy evaluation will include a detailed gynecological and orthopedic history and an assessment of the spine, hips and accompanying muscles, especially the pelvic floor muscles. The therapist will provide a specific exercise program and bladder-retraining schedule as needed. It can be quite difficult to tell if the pelvic floor muscles are working correctly on your own. A home exercise program will be given and usually, the patient will be seen once a week. For the most part, great results can be expected in six to eight sessions. Remember you are in control of your bladder, not the other way around.