Leaking bladder pregnancy

Pregnancy & Bladder Control: Causes, Diagnosis & Treatment

What is incontinence?

Urinary incontinence is the inability to control the passage of urine. If you experience incontinence, you might feel an urgent need to urinate or leak urine between trips to the bathroom. You also might find that you have to make frequent trips to a toilet if you have incontinence. This can happen for many reasons, including pregnancy, childbirth and age.

How does the bladder work?

Your bladder is a round, muscular organ that’s located above the pelvic bone. It’s held in place by the pelvic muscles. A tube called the urethra allows urine to flow out of the bladder. The bladder muscle relaxes as your bladder fill with urine, while the sphincter muscles help to keep the bladder closed until you’re ready to urinate.

Other systems of your body also help to control the bladder. Nerves from the bladder send signals to the brain when the bladder is full and then nerves from the brain signal the bladder when it’s ready to be emptied. All of these nerves and muscles must work together so that your bladder can function normally.

How do pregnancy and childbirth affect bladder control?

During pregnancy, you might leak urine between trips to the bathroom. This is called incontinence. One type of incontinence that can affect pregnant women is stress incontinence. If you’re experiencing stress incontinence, you might leak urine when you:

Cough.
Laugh.
Do physical activity.

Your bladder rests under the uterus. As your growing baby expands, the bladder gets compressed (flattened), making less space for urine. This extra pressure can make you feel the urge to urinate more often than normal. Usually, this is temporary and goes away within a few weeks of your baby’s birth.

However, the risk of experiencing incontinence after pregnancy often depends on your particular pregnancy, the type of delivery and the number of children you have. Women who have given birth — by vaginal delivery or C-section — are at a much higher risk of stress incontinence than women who have never had a baby.

Loss of bladder control can be caused by pelvic organ prolapse (slipping down) that can sometimes happen after childbirth. Your pelvic muscles can stretch and become weaker during pregnancy or a vaginal delivery. If the pelvic muscles do not provide enough support, your bladder might sag or droop. This condition is called cystocele. When the bladder sags, it can cause the urethra’s opening to stretch.

What causes bladder control loss in women after pregnancy and childbirth?

There are several things that can cause you to experience a loss of bladder control after having a baby, including:

Pelvic organ prolapse: If the muscles around your bladder become weak, the organ can actually slip out of position. This condition is called cystocele.
Pelvic nerve damage: The pelvic nerves that control your bladder function can get injured during a long or difficult vaginal delivery.
Injury during delivery: Sometimes, delivery with forceps can result in injuries to the pelvic floor muscles and anal sphincter muscles.
Injury because of prolonged pushing: Prolonged pushing during a vaginal delivery can also increase the likelihood of injury to the pelvic nerves.

Is it common to leak urine during pregnancy?

For many women, urine leakage (incontinence) is a common during pregnancy or after giving birth. As your body changes throughout pregnancy to accommodate a growing baby, the bladder can be placed under pressure. This is normal for many women during pregnancy.

How are bladder control problems during or after pregnancy diagnosed?

Although most problems with bladder control during or after a pregnancy disappear over time, you should talk to your healthcare provider if the problem continues for six weeks or more after birth. It’s a good idea to keep a diary that records your trips to the bathroom. In this diary, you’ll want to make sure to keep track of how often your have urine leakage and when it occurs.

During an appointment, your healthcare provider will perform a physical examination to rule out various medical conditions and see how well your bladder is functioning. Your provider may also order various tests, including:

Urinalysis: During this test, you will be asked to provide a urine sample. This sample will be analyzed for possible infections that could cause incontinence.
Ultrasound: Images produced by ultrasound waves can make sure that your bladder is emptying completely.
Bladder stress test: During this test, your provider will check for signs of urine leakage when you cough forcefully or bear down.
Cystoscopy: This test involves a thin tube with a miniature camera at one end being inserted into your urethra. Your provider will be able to look inside your bladder and urethra during this test.
Urodynamics: A thin tube is inserted into your bladder during this test. Water flows through this tube to fill the bladder, so that the pressure inside the bladder can be measured.

How are bladder control problems treated?

There are several techniques for treating bladder control problems. Kegel exercises may help to improve bladder control and reduce urine leakage. In addition, changing your diet, losing weight, and timing your trips to the bathroom may help.

Some suggestions to help with bladder control problems include:

Switching to decaffeinated beverages or water to help prevent urine leakage. Drinking beverages such as carbonated drinks, coffee and tea might make you feel like you need to urinate more often.
Limiting the amount of fluids you drink after dinner to reduce the number of trips to the bathroom you need to make during the night.
Eating foods that are high in fiber to avoid being constipated, since constipation can also cause urine leakage.
Maintaining a healthy body weight. Extra body weight can put additional pressure on the bladder. Losing weight after your baby is born can help to relieve some of the pressure on your bladder.
Keeping a record of when you experience urine leakage. It’s a good idea to keep track of what times during the day you have urine leakage. If you can see a pattern, you might be able to avoid leakage by planning trips to the bathroom ahead of time.

After you’ve established a regular pattern, you might be able to stretch out the time between trips to the bathroom. By making yourself hold on longer, you’ll strengthen your pelvic muscles and increase control over your bladder.

How can loss of bladder control due to pregnancy or childbirth be prevented?

Labor and vaginal delivery have an impact on the pelvic floor muscles and nerves that affect bladder control, so you should discuss your options with your healthcare provider.

Cesarean sections (C-sections) are associated with a lower risk of incontinence or pelvic prolapse than vaginal deliveries, but they may present other risks. Large babies who weigh more than 9 pounds at birth may increase the risk of nerve damage during delivery.

Exercising pelvic floor muscles with Kegel exercises can help prevent bladder control problems.

Bladder control problems might show up months to years after childbirth. Talk to your healthcare team if this happens to you.

How do I do Kegel exercises?

Kegel exercises, also called pelvic floor exercises, help strengthen the muscles that support the bladder, uterus and bowels. By strengthening these muscles during pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.

Kegel exercises are highly recommended during the postpartum period (after you give birth) to promote the healing of perineal tissues, increase the strength of the pelvic floor muscles and help these muscles return to a healthy state (including better urinary control).

To do Kegel exercises, imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting (tightening) the muscles of the pelvic floor, and are practicing Kegel exercises. While doing these exercises, try not to move your leg, buttock or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises.

Kegel exercises should be done every day. Doing five sets of Kegel exercises a day is recommended. Each time you contract the muscles of the pelvic floor, hold for a slow count of 10 seconds and then relax. Repeat this 15 times for one set of Kegels.

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.

Before your big day arrives, get a preview of the accommodations for new moms at UT Southwestern's Clements University Hospital. From the chef-prepared meals to the roomy, high-tech labor and delivery suites, we want to make sure that you, your baby, and your family have the opportunity to bond in a safe and soothing environment.

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.

What causes urinary incontinence in pregnant women

One of the signs of pregnancy is frequent urination. In process of increase in term the phenomenon is expressed more often, especially at night. Unfortunately, this is often not the only change in the work of the expectant mother's urination organs. Against the background of metamorphoses occurring in the body of a woman, various disorders in the functioning of the kidneys and bladder appear. One of these troubles can be urinary incontinence in pregnant women. The condition causes discomfort but is not a serious health threat. The main symptoms are involuntary excretion of urine in small portions. This usually manifests itself at the moment of tension in the abdominal muscles. If a woman laughs, sneezes or coughs, the laundry suddenly becomes wet. There is no need to be afraid of this, in most cases the condition intensifies in the 2nd or 3rd trimester, but after childbirth the body returns to normal. However, to rule out the presence of serious problems, it is worth consulting with your doctor.

Types of urinary incontinence during pregnancy

Most often, 3 types of urinary incontinence in a pregnant woman appear, and in each case there are characteristic signs.

Stress. It manifests itself with the tension of the abdominal muscles and fluctuations of the diaphragm. That is, it is enough to sneeze, cough or laugh so that a couple of drops of urine appear on the linen. The condition is typical for the first trimester.
Urgent. Symptoms are sudden urge to urinate. They arise so unexpectedly that the expectant mother simply does not have enough time to run to the bathroom. One of the causes of the condition lies in the irritation of the urinary canal. You can also blame the failure of the nervous system and overstretching of the muscles in the pelvis. The condition is typical for the last trimester, but also occurs after childbirth.
Full bladder syndrome. The symptom is the inability to completely empty the bladder. A woman often feels an acute urge to urinate, and after leaving the toilet it seems that urine remains in the ureter. The reason may be hidden in the stretched and therefore sluggish walls of the bladder.

Regardless of the cause of urinary incontinence in a pregnant woman, the condition causes discomfort and stress. This is not a reason to panic, in fact, the situation is not so critical - most often, not the entire volume of urine from the bladder is released, but only a small amount. To calm down in such a difficult period, it is enough to consult a doctor and get an appointment if necessary.

Main causes of urinary incontinence in pregnant women

Given that it is not difficult to find an explanation for urinary incontinence in a pregnant woman, it should not cause much concern. It is only necessary to identify the causes and make sure that this is due to physiology, and not diseases of the genitourinary system. The doctor who leads the pregnancy will help dispel fears.

The main cause is weakened muscles in the pelvic area. Excessive stretching of muscle tissue leads to loss of tone. As a result, the sphincter that holds urine, the walls of the bladder, and other muscles are weakened. This is due to hormonal changes, as well as changes in the size of internal organs. For example, the growing uterus during pregnancy compresses the bladder. As a result, its volume decreases, and urination occurs more often.

Another cause of urinary incontinence in a woman during pregnancy is the impact of a baby's foot on the bladder. This phenomenon does not happen to everyone. Doctors explain its severity by the position and size of the fetus, as well as the physical form of the expectant mother.

The number of previous pregnancies and births is also thought to increase the risk of urinary incontinence. Especially if the pregnancies go one after another, and the woman's muscles simply do not have time to recover.

Other factors associated with urinary incontinence during pregnancy are overweight and a sedentary lifestyle. A protracted birth process provokes a problem already in the postpartum period.

Healthy urinary retention occurs when the following conditions are met:

when the bladder is in a normal position;
immobility of the urethra;
good work of the muscles surrounding the bladder and pelvic floor muscles;
with the functional and anatomical integrity of the urethra and bladder closure apparatus.

What to do to deal with the problem

As mentioned above, urinary incontinence in women during pregnancy is most often associated with physiological changes, so no treatment is required. However, given the responsibility for the health of the baby during this period, you need to consult a doctor and, according to his appointment, take a urine test. This is necessary to exclude or identify urinary infections and diseases associated with them.

If the tests do not show deviations, it remains only to calm down and practice hygiene more often. The doctor will give recommendations on hygiene products - their choice and the frequency of changing underwear. But even without a specialist, we can say that the replacement of pads and panties is carried out as needed. Lingerie should fit the size, and it is better to choose a special cut for expectant mothers so that it does not press anywhere. Decorative details on underwear are not welcome, you should give preference to simple panties made of natural fabric.

If there is a problem, you will often have to wash yourself, go to the toilet on time. Doctors advise you to lean forward slightly when urinating. This will allow the urethra to open completely. At the end, you need to push slightly (without fanaticism) to completely empty the bladder.

Reducing the pressure on the diaphragm can help reduce the risk of urine leakage when sneezing and coughing. To do this, you need to open your mouth, normalizing the pressure.

Examination and treatment

Before dealing with incontinence, it is imperative to establish its cause by contacting a doctor. The doctor, in turn, will prescribe the necessary examination. It usually consists of several stages:

Urodynamic examination. With the help of it, the work of the upper and lower urinary tract is evaluated.
Clinical examination. It includes a routine urine test and urine culture for flora, as well as a study in a gynecological chair - during an external examination, the doctor can assess the mobility of the bladder neck during a cough test or straining, assess the condition of the vaginal mucosa and skin, and also identify a possible genital prolapse.
Ultrasound examination. It is carried out to study the functioning of the renal system, the urethrovesical segment, the condition of the urethra in a pregnant woman with stress urinary incontinence, as well as to confirm the presence or absence of pathologies of the genitals.

In addition to tests and examinations, you will most likely be asked to keep a special diary in which for several days you will record several parameters of urination, such as the amount of urine released per urination, the number of urination per day, all cases of urinary incontinence, the number of used during the day pads and physical activity.

Only after the examination, conclusions are drawn about the methods of treatment, which are often necessary only in extreme cases. If no pathology or inflammatory processes are detected, then most likely no special treatment will be carried out, since after childbirth, incontinence most often goes away on its own or occurs less and less.

If incontinence is due to weakening of the pelvic floor muscles, then the situation can be significantly improved with the help of special exercises. Currently, there are a large number of complexes for intimate gymnastics. One of the most popular was developed by the American gynecologist and MD Arnold Kegel. The simplest and, perhaps, the most effective exercise that can be done several times a day is the repeated tension and relaxation of the "intimate muscles" (slow or intense, without delay).

It is important to know that if you have never strengthened intimate muscles before pregnancy, you need to do this with caution, in no case overdo it.

It is possible that the doctor will prescribe you some herbal preparation that supports the functioning of the bladder and has an antispasmodic, anti-inflammatory and antimicrobial effect.

Treatment with decoctions of herbs (rose hips, sage, dill, lingonberries) may also be recommended. They have not only preventive, but also curative properties.

Pelvic (intimate) muscle training

To reduce the risk of urinary incontinence in a pregnant woman at night and during the day, doctors recommend doing special exercises. These are Kegel exercises that are useful not only for expectant mothers, but for all women, without exception, regardless of age. The bottom line is to alternate tension and relaxation of intimate muscles. It is not difficult to determine the zone for training - during urination, you need to interrupt the process for a couple of minutes. At this moment, those muscles that are involved in gymnastics will just tighten. You need to do exercises before childbirth, during pregnancy and after the baby is born. A simple and understandable set of exercises will reduce the risk of any problems with the urinary system. You can read more about gymnastics in another article.

How to ensure your comfort and peace of mind

So that urinary incontinence in pregnant women in the early, and especially in the later stages (38-39 weeks), does not cause increased discomfort, manufacturers of hygiene products produce special pads. One of the options is German MoliMed urological pads. They are specifically designed to provide comfort during involuntary urination. Features of these pads:

anatomically shaped to prevent urine from leaking out;
absorbent layer that instantly absorbs liquids and odors;
secure fit on underwear;
small thickness so that the pad is not visible under clothing;
safe even for sensitive skin;
the ability to choose a product based on the amount of discharge.

If you need help choosing the right hygiene products, the PAUL HARTMANN Sp. z o.o. hotline will advise you.

How else can you help yourself

Go to the toilet as often as possible during the day. At the same time, you should not reduce your fluid intake. The expectant mother should drink as much as she wants. But you need to try not to drink large amounts of liquid an hour before bedtime.

Many women use disposable pads to avoid trouble. This should be done only when absolutely necessary, since the frequent use of sanitary pads can provoke colpitis, which, in turn, can lead to infection of the membranes, and as a result, a miscarriage or premature birth due to rupture of the membranes.

You can somewhat alleviate the condition with the help of a prenatal bandage. Its regular correct wearing allows you to somewhat ease the load on the bladder, respectively, reduce the number of urges to urinate.

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