PREGNANCY INCONTINENCE

WHAT ARE THE TYPES OF PREGNANCY INCONTINENCE?

Any incontinence experienced during pregnancy is more than likely stress incontinence (SI) and involves the loss of urine brought about by increased pressure on the bladder. When that happens, your bladder sphincter doesn’t function well enough to hold in urine.

Occasionally, pregnancy incontinence is attributed to an overactive bladder (OAB), which involves more frequent urination than normal because the bladder has uncontrollable spasms. Additionally, the muscles surrounding the urethra can also be affected. Ordinarily, these muscles prevent urine from leaving your body but are overridden if the bladder has a strong contraction.

WHAT CAUSES PREGNANCY INCONTINENCE?

Your bladder sphincter is the muscular valve that lies at the bottom of the bladder working to control the flow of urine. When you’re pregnant, pressure from your expanding uterus can overwhelm your bladder, the bladder sphincter and your pelvic floor. Consequently, urine leaks from your bladder when additional pressure is applied from little things like a cough or a sneeze.

Incontinence problems can continue after the birth of your baby because childbirth can weaken your pelvic floor muscles resulting in an overactive bladder.

Sometimes other factors can contribute to bladder control problems, these might include:

• Damage to the nerves controlling your bladder
• The urethra and bladder may have moved during pregnancy
• An episiotomy (a small cut made in the pelvic floor muscle) during delivery to allow your baby to come out more easily

Additionally, there may also be specific things about the birth that can make a woman more likely to have bladder and bowel problems. These might include having:

• Your first baby
• A large baby
• A long labour (particularly the second stage of labour)
• A difficult vaginal delivery, where your baby is helped out by a vacuum cap or forceps

What if I have a caesarean birth?

Having a caesarean birth may reduce the risk of severe bladder control problems for the first baby, but there may be little benefit after the third caesarean.

Read more about how to identify if you have pregnancy incontinence

HOW IS PREGNANCY INCONTINENCE TREATED?

There are a couple of techniques effective in treating incontinence during and after pregnancy. These behaviour techniques known as timed voiding and bladder training are recommended as an initial treatment and can be done in the home without any serious side effects.

Timed voiding involves keeping a diary to record the times you urinate and when you leak urine. You should soon notice a pattern of leakage and be able to avoid it by going to the toilet at or before these times.

In bladder training, you gradually increase the intervals at which you go to the toilet by waiting a little longer each time you go. Start by planning to go to the bathroom once an hour. After a while, change the schedule to every 90 minutes, then two hours and continue to increase the time until you’re up to around three or four hours between visits.

Other methods include postponing a visit to the bathroom for 15 minutes with the first urge. You do this for two weeks and then increase the time to 30 minutes and so on; using a pessary (a device to block the urethra or to strengthen the pelvic muscles); using drugs to either control muscle spasms in the bladder or strengthen the muscles in the urethra or to relax an overactive bladder.

If you are unsure, please talk to your doctor about the best option to manage your symptoms.

WHAT HAPPENS AFTER PREGNANCY (POSTPARTUM)?

When you give birth, you can overstretch and injure the nerves, ligaments, and pelvic floor muscles that normally work together to support your bladder, keep your urethra closed and prevent urine leakage. When they stop working properly, you’ll usually suffer from stress incontinence.

Stress incontinence is a common complaint amongst pregnant women, with some finding that it is still a problem well after they’ve had their baby.

Women who opt for vaginal births are more likely to have the problem than women who deliver by caesarean section (although some women have had stress incontinence after a caesarean delivery).

Other factors affecting postpartum incontinence can include:

• Obesity — Women who are obese are about four times as likely to have stress incontinence.
• Smoking — Women who smoke are at greater risk.
• Genetics — Recent research suggests that genetic predisposition may also play a role.
• Multiple births — Urinary incontinence is also higher for mothers who have had many children.