Pregnancy incontinence or urinary incontinence is the inability to control bowel or bladder function during pregnancy (1) (2). Sometimes women experience urine leakage in small amounts during childbirth (3). In a cross-sectional study conducted with 750 pregnant women, 300 experienced urinary incontinence (4).
Read more about the causes, diagnosis, treatment, and prevention of pregnancy incontinence.
Type Of Incontinence Experienced During And After Pregnancy
The most common urinary incontinence experienced during and after pregnancy is stress urinary incontinence. Women may leak urine while laughing, coughing, sneezing, or doing physical activity (2).
- During pregnancy, stress urinary incontinence occurs because the growing baby in the uterus compresses the bladder resting under it. This causes extra pressure in the bladder, causing urine leakage more often (2). A cross-sectional study on pregnant women demonstrated that more women experienced urinary incontinence in the third trimester than in the first trimester (5).
- After childbirth, stress urinary incontinence occurs because of stretching and weakening of the pelvic floor muscles (muscles that support the bladder, uterus, and bowels). When the body prepares for birth, and the baby moves down, progesterone levels change, causing the pelvic floor muscles to stretch (6). This means the muscles that control the bladder become weak, leading to incontinence (7).
Causes Of Pregnancy Incontinence
Apart from the growing uterus size during pregnancy and the hormonal effect during childbirth, pregnancy incontinence may also occur for the following reasons (2).
- Pelvic organ prolapse: Childbirth, especially vaginal birth, may weaken the pelvic floor muscles, leading to pelvic organ prolapse. The bladder, uterus, and rectum slip down into the vaginal canal, leading to urinary incontinence (6).
- Pelvic nerve damage: Long and difficult vaginal delivery may damage the pelvic nerves, thus affecting bladder function.
- Injury during forceps delivery: In some cases, forceps delivery causes an injury to the pelvic floor and anal sphincter muscles.
- Prolonged pushing during vaginal delivery may injure the pelvic nerves, causing incontinence.
Risk Factors For Incontinence During Pregnancy
- Previously weakened pelvic floor muscles
- Constipation because it puts pressure on the pelvic floor
- Urinary tract infection
- Neurological or musculoskeletal conditions, such as arthritis, dementia, and stroke
- Health conditions, such as diabetes, obesity, and heart disease
- Pregnancy with multiples
- Sedentary lifestyle
- Having a large baby
- More than one pregnancy (9)
Diagnosis Of Pregnancy Incontinence
Your doctor will take you through a physical examination to check your bladder’s function and exclude other medical conditions. You will also be asked questions related to (10)
- Frequency of emptying your bladder
- Frequency of urine leakage
- Amount of urine leaked
- Other symptoms
The diagnostic tests include (2):
- Urinalysis, where the urine sample is examined for possible infections causing incontinence.
- Ultrasound imaging helps in examining whether the bladder is emptying completely or not.
- A bladder stress test to check for signs of urine leakage while coughing.
- Cystoscopy involves the insertion of a thin endoscope with a miniature camera in the urethra. It helps examine the inside of the bladder.
- Urodynamics to measure the pressure inside the bladder. During this test, water is filled in the bladder through a thin tube inserted in it.
Treatment And Prevention Of Pregnancy Incontinence
Pregnancy incontinence is usually not treated with medicines. However, some preferable treatment options include the following:
- Heal the perineal tissue
- Strengthen pelvic floor muscles
- Ensure better urinary control
To perform Kegel exercises (7)
- Breathe in and out
- Contract the pelvic floor muscles and pull them up and in as if to control the urine flow
- Breathe normally and squeeze and hold for ten seconds
- Then, relax and repeat the process
- Do three sets of ten exercises each, every day
2. Create a bladder diary: A bladder diary is useful in effectively tracking your urinary incontinence. Recording the frequency of urination and tracking the amount, time, and frequency of urine leakage will enable you to understand the severity of the condition and get ready to the bathroom before experiencing the leakage (2).
3. Avoid carbonated or caffeinated drinks because they increase the urge to urinate. Instead, drink water and decaffeinated beverages to enhance your bladder capacity (11).
4. Avoid drinking large amounts of fluid after dinner to reduce urination at night (2).
5. Eat a high-fiber diet to avoid constipation because the additional pressure created by this condition may increase the risk of urinary incontinence (2).
6. Being overweight can increase the pressure on the bladder and worsen incontinence. Therefore, maintaining a healthy weight after delivery may improve bladder control (2).
7. Quit smoking: Smoking increases the risk of chronic cough and irritates the bladder, so quit smoking to improve your urinary incontinence (6).
8. Include regular exercise for at least 30 minutes a day.
9. Avoid exercises involving lifting heavy weights, contact sports, excessive twisting, bouncing, holding breath, curving the back, and standing on one leg for a long time.
10. Do not delay going to the toilet when you are urged to do so.
11. Get treated for urinary tract infection if you have the condition.
Medications and surgery to treat urinary incontinence are required only in some cases. However, it is good to consult a healthcare provider about it (7).
Signs To See A Doctor
You should consult your doctor if you experience (12)
- Pain or burning sensation during urination
- Lower backache that does not get better with rest
- Any fluid leakage from the vagina
- Unusual or smelly vaginal discharge
Frequently Asked Questions
1. Does incontinence go away after the baby is born?
In most women, incontinence goes away in three to six months after childbirth; however, in some women, the stretching and tear of the pelvic muscles do not heal completely. In such cases, it is advisable to consult your healthcare provider. It also helps if you regularly continue practicing Kegel exercises to bring your pelvic floor back to normal (1).
2. How do I know if I am leaking amniotic fluid or urine?
When the amniotic sac breaks before labor, the amniotic fluid leaks. This leakage or the discharge may seem like a constant trickle or a sudden gush of fluid. This fluid is clear and odorless. However, when urine leaks from the bladder, it is generally little and has a distinct urine smell and yellowish color (13).
Pregnancy incontinence might seem uncomfortable but is a common condition. It is easy to manage with exercises and lifestyle changes in most cases. However, if your symptoms are concerning, it is good to discuss them with a healthcare provider.
- Incontinence during pregnancy.
- Pregnancy and Bladder Control.
- Pregnancy and childbirth.
- Ayten Dinç; (2018); Prevalence of Urinary Incontinence During Pregnancy and Associated Risk Factors.
- Eva Martínez Franco et al.; (2014); Urinary incontinence during pregnancy. Is there a difference between first and third trimester?
- Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy.
- Bladder weakness after birth.
- Aruna Nigam et al.; (2016); Prevalence and risk factors for urinary incontinence in pregnant women during late third trimester.
- Childbirth & Incontinence.
- Urinary incontinence.
- 10 truths: leaking urine in pregnancy and after birth.
- Urinary incontinence in pregnancy.
- Signs of Labor.