The long-awaited plus sign shows itself on your pregnancy test; you share the exciting news with your family and friends and analyze every little change your body makes in the following weeks.
Pregnancy is an incredible time of transformation for a woman’s body, with more than 90 percent of women reporting they experience symptoms by the first eight weeks. While some symptoms may be welcome (like missed periods and food cravings), others are more challenging to manage, like nausea, fatigue, and bladder leakage.
Women should not hesitate to ask questions or share concerns with their providers about pregnancy symptoms. Seeking guidance and professional support is especially important when a topic is confusing or varies significantly from woman to woman, like urinary incontinence, incontinence after pregnancy, and incontinence treatment and prevention recommendations.
It is not uncommon to have questions about the risks of incontinence during or after pregnancy. However, it is important to first understand the types of urinary incontinence, which include:
- Stress: Loss of urine due to physical pressure on the bladder
- Urgency: Loss of urine due to an urgent need to urinate (commonly caused by bladder contractions)
- Mixed: A combination of stress and urgency incontinence
- Transient: Loss of urine due to medication or a temporary condition such as a urinary tract infection or constipation
What is Pregnancy Incontinence?
During the early stages of pregnancy, blood flow to the kidneys can increase by 35 to 60 percent. This extra blood flow can make the kidneys produce up to 25 percent more urine soon after conception. Increased urine production is at its height at 9 to 16 weeks of pregnancy and tapers down from there.
Do you leak some urine every time you cough, sneeze, exercise, or laugh? You aren’t alone. A growing uterus places pressure on the bladder and may result in the need to pass urine frequently and, at times, incontinence. As babies grow during pregnancy, they push down on your bladder, urethra, and pelvic floor muscles. This pressure can weaken the pelvic floor muscles and lead to involuntary loss of urine (incontinence) or problems passing urine. Changing hormones can also affect the lining of your bladder and urethra. The good news is most bladder leakage or control problems go away after childbirth when the muscles have had time to heal.
It is important to note that it is not recommended to restrict fluids during this time. You and your baby must stay hydrated by drinking at least six to eight glasses of fluids each day to maintain a healthy pregnancy. Drinking less than the recommended amount may result in dehydration. If the need to go to the bathroom keeps you up at night, try drinking more fluids during the day and cutting back a few hours before bed.
What are the Risk Factors for Pregnancy Incontinence?
When you’re pregnant, pelvic floor muscles work overtime. That said, most women carrying a child are at risk for some form of pregnancy incontinence. Women who have had an overactive bladder or urgency incontinence before pregnancy will most likely have symptoms that continue or worsen during pregnancy.
Other risk factors include:
- Advanced maternal age
- Being overweight
- Previous vaginal delivery
- Previous pelvic surgery
- Smoking, which leads to chronic coughing
- Neurological diseases
- Diabetes
What Causes Urinary Incontinence After Pregnancy?
It may surprise you that it doesn’t matter what type of delivery you have (vaginal or cesarean section) - women who have given birth have much higher rates of stress incontinence than those who have never had a baby.
Giving birth can contribute to incontinence after pregnancy. The American College of Obstetricians and Gynecologists has found that cesarean delivery reduces incontinence during the first year, but benefits diminish two to five years after delivery.
Normal labor and vaginal delivery can weaken the pelvic floor muscles and damage the nerves that control the bladder. A long labor and prolonged pushing can increase the likelihood of immediate pelvic floor muscle weakness following delivery. Additionally, a uterus shrinks in the weeks following delivery, and as it sits directly on the bladder, compression can make it more challenging to control urine flow.
Loss of bladder control is also caused by pelvic organ prolapse (slipping down) that can occur after childbirth. In this case, the pelvic muscles stretch and weaken during pregnancy and vaginal delivery. If the muscles do not provide enough support, the bladder may move down or sag, causing mobility of the urethra, and leading to incontinence with increased abdominal pressure.
How Long Does Incontinence Last After Giving Birth?
Ready for some good news?
Most women’s incontinence symptoms go away in the days or weeks after their baby is born. Bladder leakage resulting from labor and delivery tends to diminish after the muscles have had time to heal. For some women, leaking may continue to worsen. If this is the case, incontinence can be managed with certain pelvic floor exercises such as Kegels and other methods, including pelvic floor physical therapy, bladder retraining, weight loss, and more.
If you have concerns following the delivery of your baby and lifestyle changes haven’t worked to improve incontinence issues six or more weeks after delivery, speak with your doctor about treatments and medications available to help.
It’s important to understand that it can take three to six months, or longer for some women, to regain complete bladder control. Be patient and learn the steps you can take to make the process go faster.
How do I Prevent Incontinence After Pregnancy?
Pregnancy incontinence is a normal occurrence following the delivery of a baby; however, there are some ways you can help prevent it or improve bladder control.
- Take your time while using the toilet. When urine flows at its own speed, you aren’t using your pelvic floor to push it out.
- Treat urinary tract infections (UTIs) promptly. UTIs irritate the bladder lining, and it’s important to seek treatment immediately if you have symptoms.
- Document when you have bladder leakage issues. This documentation will help plan bathroom trips and provide information to your doctor.
- Maintain a healthy weight. Excess weight can put added strain on the muscles of the pelvic floor.
- Don’t smoke. Chronic coughing from smoking weakens the pelvic floor and contributes to incontinence.
- Do pelvic floor muscle or Kegel exercises. They are safe and effective before, during, and after pregnancy.
- Avoid carbonated and caffeinated drinks such as soda, coffee, or tea. These beverages can make you feel like you must use the bathroom more often.
- Talk to a trusted obstetrician about your concerns and seek diagnosis or treatment advice.
What are Some Pregnancy Incontinence Treatments?
The first course of action should incorporate lifestyle changes and bladder management when considering treatment options for pregnancy incontinence. If these steps don’t improve your symptoms, your doctor may recommend other treatment options depending on what type of incontinence you are experiencing. These options may include the following:
- Control of pelvic floor muscles- Kegel exercises, pelvic floor physical therapy.
- Elimination of bladder irritant food and beverages.
- A Pessary is inserted into the vagina to support the urethra, preventing urine leakage.
- A urethral surgical sling involves placing a sling around the urethra to lift it back into a normal position.
- Bladder support “tampons” that support the urethra from leaks.
- Medications to help overactive bladder.
- Bladder retraining tactics for urgency incontinence.
Exercises for Incontinence After Childbirth
Women can do several simple exercises in the comfort of their homes to strengthen pelvic floor muscles and improve bladder control. Consider these incontinence exercises after childbirth.
Kegel Exercises
Kegels (key-ghels) is an easy exercise that can be done anywhere without needing to work up a sweat. If you’re unfamiliar with this exercise, begin by identifying your pelvic floor muscles. This can be done by pretending your tightening your vagina around a tampon or by pretending you’re trying to avoid passing gas.
Once you’ve identified those muscles, you can add kegel sessions to your daily schedule. Kegels can be done lying down or sitting down and should only focus on tightening your pelvic floor muscles, not your abdomen, thighs, or buttock.
Step 1: Contract your pelvic floor muscles for 3-5 seconds.
Step 2: Relax your muscles for another 3-5 seconds.
Step 3: Repeat.
Depending on your level of urinary incontinence after childbirth, the amount of recommended sets of Kegels a day will vary. For starters, try doing multiple sets of kegels three times a day. Quick tip! One patient mentioned she always does Kegel exercises when she’s stopped at a red light!
Bridging Exercise
This exercise may be more familiar to most women as it is a common yoga pose. Along with strengthening your pelvic muscles, it’s also good for hip mobility and strengthening your glutes.
Step 1: Lay down a blanket or yoga mat for comfort.
Step 2: Lay flat on your back with your knees bent and feet firmly on the floor hip-width apart; arms should be resting by your sides.
Step 3: Draw in your pelvic floor muscles and abdominals and lift your buttocks in the air.
Step 4: Hold this position using your abdominals, leg muscles, and glutes for three slow breaths, be mindful not to use your neck and shoulders.
Step 5: Lower down slowly. Repeat ten times or to your comfort level.
Bird-Dog Exercise
Position yourself on an exercise mat or cushioned surface on all fours, with your knees hip-width apart and hands firmly on the ground. Tighten your abdominal muscles.
Step 1: Extend one arm forward and, at the same time, extend your opposite leg, trying to create a straight line from your extended hand to the extended foot. Keep your hips squared to the ground.
Step 2: Hold for a few seconds, then return to your hands and knees. Keep your abs engaged throughout exercise, and work to minimize any extra motion in your hips during the weight shift.
Step 3: Switch to the other side.
Aim to complete five reps on each side or ten reps total. Add additional sets of ten exercises for a maximum of three sets of ten. As a variation, you can do a set of ten bird dogs on one side, then switch to the other side.
Knee Fold Exercise
Knee folds are another great exercise to help with incontinence after pregnancy. These begin with the same movements as the bridge exercise mentioned above.
Step 1: Lay down a blanket or yoga mat for comfort.
Step 2: Lay flat on your back with your knees bent and feet firmly on the floor hip-width apart; arms should be resting by your sides.
Step 3: Engage your abdominal and pelvic floor muscles.
Step 4: Slowly lift one leg at the hip and bring the knee joint straight above the hip joint, creating a 90-degree angle from the knee to your ankle.
Step 5: Slowly bring the knee back down.
Step 6: Repeat steps, alternating between legs, and complete ten on each side.
Are you looking for a little extra challenge? After bringing up the first knee, keep it there as you bring up the second knee. Hold both while engaging your core.
How Do I Find the Right Doctor?
There are many important aspects to finding the right medical provider. The most critical element is to ask about the doctor’s viewpoint on the most important concerns. You can never fully predict what pregnancy, labor, delivery, and life will bring. However, you can learn about your doctor’s approach to care and how their team will respond in situations pertaining to your health.
At Moreland OB-GYN, we specialize in women’s health care and always prioritize the needs of our patients. Do you have a question you’d like answered? Our team is a trusted source for information - connect with us here.
