Is it normal to pee on yourself when pregnant

Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy | Women's Health | Your Pregnancy Matters

Instructions on how to locate pelvic muscles and exercises to strengthen them can help prevent incontinence during and after pregnancy.

Friends and family describe stress urinary incontinence (SUI) to pregnant women as if it’s just a fact of life: "After you have a baby, you won't be able to cough, sneeze, or exercise without peeing a little."

SUI is the most common type of urinary incontinence associated with pregnancy. More than a third of pregnant women experience involuntary urine leakage during the second and third trimesters, and a third leak during the first three months after delivery.

But you don’t have to just live with urinary incontinence. There are steps you can take to prevent and reduce leakage before, during, and after pregnancy. Interventions can include lifestyle modifications and strengthening your pelvic floor muscles through Kegel exercises.

Unfortunately, not all health care providers make such recommendations. Or they might suggest performing Kegels, but they don't show patients how to do them correctly. There's a lot going on in the pelvic region during pregnancy, and many women don't know how to locate or engage their pelvic floor muscles.

UT Southwestern has one of the largest Female Pelvic Medicine and Reconstructive Surgery divisions in the country. We help patients at all stages of life with strategies and therapies to prevent or treat urinary incontinence.

The first step in prevention is education.

Why does urinary incontinence occur with pregnancy?

Pregnancy and childbirth can cause incontinence in several ways:

Your growing baby takes up a lot of room. As the uterus expands, it puts increased pressure on the bladder, urethra, and pelvic floor muscles. This can lead to leakage.
Changing progesterone levels during pregnancy can weaken the pelvic floor. Increases in this hormone loosen up your ligaments and joints so the belly can expand and so you can deliver. But it can also loosen ligaments in the pelvis that help you hold in urine.
Childbirth, particularly vaginal delivery, can stretch and weaken the pelvic floor muscles. This can lead to pelvic organ prolapse, in which your bladder, uterus, or rectum droops into the vaginal canal. Prolapse can be associated with urinary incontinence.
Vaginal delivery also can result in pelvic muscle and nerve injury, which can result in bladder control problems.

If you experience urinary incontinence during pregnancy, you are at higher risk of having a persistent problem after birth. Tell your health care provider about urinary incontinence symptoms as soon as you notice them during pregnancy or at your first postnatal visit.

More than 80% of postpartum women who experience SUI symptoms during pregnancy may continue to experience stress incontinence without treatment.

Related reading: Body after birth: Treating post-pregnancy problems

Where are the pelvic floor muscles?

During initial exam, I often use a clock visual to help women know where their pelvic floor muscles can be palpated. If you lie on your back, imagine the top of the opening of your vagina is 12 o’clock and the bottom of the opening is 6 o’clock.

The pelvic floor muscles are easiest to palpate at the 5 o’clock and 7 o’clock positions– about even with where your legs meet your hips and approximately 3 to 4 centimeters above the vaginal opening.

These are the same muscles you contract when you try to stop the flow of urine midstream or if you were to tighten your vagina around a tampon. And these are the muscles you contract to do Kegel exercises. These pelvic floor muscle exercises were named after Dr. Arnold Kegel, who described them in the 1940s to help patients strengthen their pelvic floor muscles to treat urinary incontinence.

The proper way to Kegel

Verbal or written instructions alone don't necessarily help patients know whether they're doing Kegel exercises properly.

When we see patients for urinary incontinence, we provide education and instruction. We often recommend one to six sessions of supervised Kegel exercises with a female pelvic medicine and reconstructive surgery doctor, a pelvic floor physical therapist, or another provider who has expertise in pelvic floor disorders. While physical therapy or other medical visits usually are not covered by insurance for preventive purposes, they usually are once a problem develops.

In these appointments, your provider will describe how to locate and engage the pelvic floor muscles. The provider will gently press on the pelvic floor muscles with a gloved exam finger inside your vagina and ask you to squeeze the muscles. The muscles will be identified as described. Make sure you’re not squeezing your stomach, legs, or gluteal muscles at the same time, and don’t hold your breath.

Some patients benefit from holding a mirror between the legs to visualize the external anatomy during the exercise. When done properly, you should see the area between your vagina and anus lift toward your upper body.

Doing Kegel exercises regularly is key to strengthening the pelvic floor. We recommend women do 10 repetitions, holding each squeeze for 5 to 10 seconds, three times each day.

You can do the exercises while lying down, sitting, or standing. Many patients find it easier to remember to do Kegels if the exercises become part of a daily routine. Maybe do a set while lying in bed right after you wake up, another as you eat lunch, and another at bedtime.

Most women see less frequent urine leakage within a few weeks or months after maintaining a Kegel exercise routine.

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Lifestyle changes to reduce urinary incontinence

Along with Kegel exercises, there are a few other noninvasive methods to eliminate or reduce the risk of urinary incontinence:

Lose weight. Excess body weight puts pressure on the bladder. Even a 10% reduction in weight can significantly help with urinary incontinence. Work with your doctor to manage your weight gain during pregnancy, and after the birth of your little one, returning to your pre-pregnancy weight will help relieve the pressure on your bladder and pelvic floor.
Quit smoking. Smoking has been shown to increase the risk of urinary incontinence as it leads to bladder irritation and chronic coughing.
Make dietary changes. Some foods and beverages can make incontinence worse. These include caffeine, alcohol, and spicy and acidic foods. This is especially important if you experience urinary frequency and urgency and have trouble making it to the bathroom once you have the urge to urinate. Constipation can worsen symptoms of urine leakage. Stool in the rectum can put pressure on the bladder, urethra, and pelvic floor, so include plenty of higher-fiber foods and fluids in your daily diet.

Other treatments for urinary incontinence

Your doctor may recommend alternative treatment options, such as:

Electrical stimulation: This therapy can help rehabilitate weak pelvic floor muscles and can be done in conjunction with Kegel exercises.
Medications: Certain drugs can be used to treat urgency urinary incontinence (UUI) that does not respond to diet and behavioral modification, such as timed voiding to avoid overfilling of the bladder. UUI is associated with a sudden, intense urge to urinate followed by involuntary loss of urine. It is often associated with urinary frequency and urgency. Medications to treat UUI allow the bladder to fill up with more urine before giving the body a signal that it needs to use the bathroom.
Pessary: This is a plastic insert that supports the vaginal walls. It can be removed, replaced, and cleaned at home.
Surgical procedures: There are several surgical procedures that can be performed for the treatment of stress urinary incontinence that does not respond to the conservative measures described above. One of the most common and effective surgeries involves placing a synthetic mesh sling between the vagina and the middle portion of the urethra. This supports the urethra like a hammock and helps control urine leakage during activities such as coughing, sneezing, laughing, exercise. Other effective surgeries for SUI that do not involve mesh include the Burch colposuspension and the traditional pubovaginal sling with graft material procured from the patient’s own body. Urethral bulking injection is an office procedure that may provide relieve of symptoms in patients who have contraindications for surgery.

If you are experiencing urinary incontinence during or after pregnancy, know that you’re not alone. Talk with your doctor – we can help you get back to exercising, laughing, and sneezing without worrying about a accidental urine leakage.

To visit with an incontinence expert, call 214-645-8300 or request an appointment online.

How to Manage Pregnancy Incontinence

Incontinence is common during pregnancy, but it can be managed with the right habits. Find out how to keep incontinence in check when you're expecting.

By Marie SuszynskiMedically Reviewed by Rosalyn Carson-DeWitt, MD

Reviewed: September 14, 2015

Medically Reviewed

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Urinary incontinence affects some 10-13 million Americans — and the condition is twice as common in women. Women are more likely to have bladder control issues, largely because of the changes the body experiences during pregnancy and childbirth. According to the National Association for Continence, 63 percent of stress-incontinent women say their symptoms began during or after pregnancy. In one study, most of the 500 otherwise healthy participants experienced urinary incontinence at some point from the first through the third trimester.

“I would say virtually all pregnant women experience some type of incontinence,” says Anthony Atala, MD, a spokesman for the American Urological Association and director of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

But incontinence problems don’t have to rule your life during pregnancy.

Why Pregnancy Incontinence Occurs

First, understand the urination process. You’re able to urinate when the muscles around your urethra relax, which allows urine to flow from your bladder out of your body. When you’re finished urinating, the muscles around your urethra contract, holding off any urine flow until you’re ready to empty your bladder again.

Pregnancy can interfere with the normal way your urethra relaxes and contracts. Hormone changes during pregnancy and added pressure on the bladder from your uterus can cause stress incontinence, Dr. Atala says. When you have stress incontinence, you may urinate when you sneeze, cough, or laugh. Walking, running, or exercising can also cause leakage.

Researchers have also discovered that women who have a family history of incontinence, have a higher body mass index, gain more than the recommended amount of weight during pregnancy, and are over 35 when they get pregnant also have a higher risk of experiencing incontinence.

How to Avoid Pregnancy Incontinence

Urinary incontinence doesn’t have to make your life miserable when you’re pregnant. Here’s what to do to avoid leakage:

Schedule your bathroom breaks. There’s no way around it: When you’re pregnant, you’re going to have to excuse yourself to use the lady’s room more often. Being more cognizant of that will help you avoid leakage. Atala suggests planning to use the bathroom at least every two hours. That may mean scheduling bathroom breaks into your day so you don’t get caught with a bladder that’s too full when you can’t get to a restroom.

Practice Kegels. Kegel exercises help to strengthen the pelvic floor and help you avoid leakage, but you need to practice in order to do them properly, Atala says. If you’ve never done a Kegel before, start by stopping the flow of urine the next time you urinate. The contraction of those muscles is how you do a Kegel, and you can do Kegel exercises any time throughout the day, whether your bladder is full or empty.

Simply contract the same muscles you would to stop the flow of urine, hold the contraction for a count of 10, and then release. The American Congress of Obstetricians and Gynecologists suggests doing Kegel exercises 10 to 20 times in a row two or three times a day.

Kegel exercises really do help with incontinence. In a review of studies, researchers found that women who practiced pelvic floor muscle training when they were pregnant with their first baby prevented leakage later in pregnancy and after giving birth. Kegel exercises also helped women who had persistent incontinence problems after giving birth. Keep in mind that it takes about four to eight weeks of doing them regularly before you’ll see results, Atala says.

Watch the weight gain. Studies show that women who weigh more when they get pregnant or who gain an excessive amount of weight during pregnancy are more likely to experience urinary incontinence.

Incontinence: Will It Continue After Pregnancy?

Pregnancy and having a vaginal delivery can stretch the muscles that support the pelvis, making them weaker. As a result, you may leak urine or have trouble urinating even after you’ve given birth.

In a recent study of pregnant women, researchers found that 62 percent had incontinence during the pregnancy. And 50 percent continued to have problems with leaking urine after childbirth. Women who didn’t have problems with incontinence during pregnancy had a lower risk of postpartum incontinence compared to women who experienced incontinence at any point during their pregnancy.

An Unspoken Epidemic?

Unfortunately, many women with incontinence don’t tell their doctors. Some experts suggest this may be because women don't consider just a few drops of leakage anything to worry about, or they may feel embarrassed to discuss incontinence with their doctor.

But no amount of urinary incontinence needs to be tolerated. If urinary incontinence becomes a problem during your pregnancy or doesn’t go away after pregnancy, be sure to tell your doctor so you can be treated for it. In the meantime, take comfort in knowing that there are strategies to minimize the risk of those embarrassing and uncomfortable leaks from occurring in the first place.

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Frequent urination during pregnancy - Juno

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Frequent urination during pregnancy

We offer you to understand the issue in more detail - you will find out how normal frequent urination in women during pregnancy when appears and what to do.

Contents of article

When is considered frequent

Urges are frequent if they occur more than 9 times a day. Usually only a small amount of urine is passed at a time. Pregnant women may have about 20 visits to the toilet per day, while the daily amount of urine can also increase to 2 liters.

Is it an early sign of pregnancy?

HCG slightly increases the volume of urine excreted, so frequent urination begins already in the first weeks of pregnancy. The symptom does not 100% indicate the onset of fertilization - it should be considered in conjunction with other manifestations - primarily with a positive test.

However, keep in mind that with an increase in the daily volume of urine at a very early date, a false negative result is possible. Also, the symptom is less pronounced in ectopic pregnancy due to lower hCG levels, so an examination is required in any case.

If you began to frequent the toilet and there is a delay, then pregnancy is very likely.

Physiological causes of frequent urination in pregnant women

In healthy women, this phenomenon is associated with the body getting used to carrying a baby, as well as with other physiological reasons.

In the first half of pregnancy

The main causes of frequent urination during early pregnancy:

Increased progesterone production. This hormone relaxes muscle tissue, helping to maintain pregnancy. As a result, urine is retained worse, the urge to void becomes more frequent due to the reduced tone of the bladder.
Increased blood supply in the pelvis. Due to the proximity of the bladder to the uterus, its increased sensitivity occurs - filling receptors react more strongly.
Active work of the kidneys. During the bearing of a child, the renal blood flow increases 1.5 times for the constant renewal of amniotic fluid and the timely removal of metabolic products. Accordingly, more urine begins to be produced.

Physiological increase in urination does not cause pain and discomfort, itching and burning. In the presence of negative symptoms, you need to consult a doctor to rule out pathologies.

Second half of pregnancy

The main reason for frequent urge to urinate in the second and third trimester is the increased pressure of the uterus on the bladder. However, diseases can also be the cause:

Infections. Changes in the pelvis in pregnant women and a decrease in protective forces increase the risk of developing urethritis, cystitis, pyelonephritis. Such pathologies are accompanied not only by frequent urination, but also by pain, discomfort in the area of inflammation, and a burning sensation. The woman's health is deteriorating;
Gestational diabetes. An increase in blood glucose in violation of carbohydrate metabolism. The amount of urine separated increases significantly.

Other pathologies include neoplasms in the small pelvis, endocrine and neurological disorders.

Pain with frequent urination in pregnant women - is it normal or not?

Painful urination is not normal. Unpleasant sensations indicate the development of a pathological process. Pain and discomfort are a sign of urinary tract irritation. Cystitis is very likely if a woman has severely reduced immunity or has chronic diseases of the pelvic organs. Sometimes it can be accompanied by a temperature and requires a mandatory visit to the doctor.

Calls at night

Pregnant women often complain about how tired they are at night "hiking". The situation is explained by the fact that the work of the kidneys depends on the position of the body. In the later stages, the female body is prone to fluid retention and edema, especially when in an upright position. When the expectant mother lies down, the renal blood flow and the outflow of fluid from the tissues increase. As a result, the kidneys excrete more urine.

What is the duration of frequent urination during pregnancy?

The phenomenon begins already from the first days of pregnancy and is especially pronounced up to about 12 weeks. Later, the number of emptyings gradually decreases, because by 4-5 months the body adapts to new conditions. The diaphragm rises, creating more space for the growing uterus and "unloading" the pelvic organs.

Frequent urination during pregnancy in the second trimester may indicate the addition of an infection or the development of inflammation, but it is also possible as a manifestation of the individual characteristics of the body.

In the third trimester, the opposite phenomenon is possible - fluid retention. However, the closer the birth, the more often the urge to urinate becomes. In the last month of gestation, the uterus descends and puts pressure on the organs of the urinary system.

How likely is a miscarriage in the absence of frequent urination?

A woman does not always immediately find out about a missed pregnancy. Fetal movements are not felt in the early stages, so pregnant women "listen" to other signs. In the first weeks, the abrupt cessation of toxicosis and frequent urge to urinate are alarming. These symptoms can indeed indicate the death or developmental delay of the fetus, as well as an ectopic pregnancy, but not always. Toward the end of the first trimester, the kidneys excrete less urine, in some this has been observed since 9‒10 weeks.

Tips for dealing with frequent urination during pregnancy

In the absence of pathologies, the discomfort caused by physiological frequent urination can be reduced as follows:

Stay hydrated. Drink enough, but don't overdo it. Give preference to water over sugary drinks like coffee.
Eat rationally. Eliminate diuretic foods (citrus fruits, spicy foods), as well as things that cause constipation.
Exercise. Strengthen your pelvic muscles by training your vaginal and anus sphincters.
Get more rest. Sleep during the day is very useful, especially in the later stages - after being in a horizontal position, the bladder empties faster, as a result, the load on the kidneys during night rest is reduced.
Maintain immunity. Avoid hypothermia, take vitamin complexes as prescribed by the doctor.
Empty your bladder as much as possible. Do not hold back the urge and try to make sure that all the urine comes out completely. In this regard, it is easier to urinate in the shower.

Control your condition. If other symptoms (pain, fever, burning sensation) appear in addition to frequent urination, tell your doctor immediately.

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