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Diseases & Conditions

Pregnancy Childbirth&Bladder Control

Many women experience urine leakage, which is also called incontinence, during pregnancy or after they have given birth.

The bladder is a round, muscular organ that is located above the pelvic bones. It is supported by the pelvic muscles. A tube called the urethra allows urine to flow out of the bladder. The bladder muscle relaxes as the bladder fills with urine, while the sphincter muscles help to keep the bladder closed until you are ready to urinate.

There are other systems of the body that help to control the bladder. Nerves from the bladder send signals to the brain when the bladder is full, and nerves from the brain signal the bladder when it needs to be emptied. All of these nerves and muscles must work together so the bladder can function normally.

How do pregnancy and childbirth affect bladder control?

During pregnancy, you may leak urine between trips to the bathroom. This type of leakage is called stress incontinence, due to the pressure that the unborn baby exerts on the pelvic floor muscles, the bladder and the urethra. The extra pressure can make you feel the urge to urinate more often. Stress incontinence may be only temporary and often ends within a few weeks after the baby is born.

Pregnancy, the type of delivery and the number of children a woman has are factors that can increase the risk of incontinence. Women who have given birth, whether by vaginal delivery or cesarean section, have much higher rates of stress incontinence than those who never have had a baby.

Loss of bladder control may be caused by pelvic organ prolapse that sometimes occurs after childbirth. The pelvic muscles can stretch and become weaker during pregnancy or vaginal delivery. If the pelvic muscles do not provide adequate support, your bladder may sag or droop. This condition is known as a cystocele. When the bladder sags, it can cause the urethra’s opening to stretch.

Pelvic nerves that regulate bladder function may be injured during a long or difficult vaginal delivery. Delivery with forceps can result in injuries to the pelvic floor and anal sphincter muscles. Prolonged pushing during a vaginal delivery also increases the likelihood of injury to the pelvic nerves and subsequent bladder control problems.

How are bladder control problems diagnosed?

Although most problems with bladder control during or after pregnancy disappear over time, you should visit your doctor if they persist for six weeks or more after you have given birth. It is a good idea to keep a diary to record your trips to the bathroom, how often you experience urine leakage, and when it occurs.

The doctor will perform a physical examination to rule out various medical conditions and see how well your bladder is functioning. Your doctor may order various tests, which might include:

  • Urinalysis -You will be asked to provide a urine sample to be analyzed for possible infections that could cause incontinence.
  • Ultrasound - Images produced by ultrasound waves can show the kidneys, bladder and urethra.
  • Bladder stress test -Your doctor will check for signs of urine leakage when you cough forcefully or bear down.
  • Cytoscopy - A thin tube with a miniature camera at one end is inserted into the urethra so the doctor can examine your bladder and urethra.
  • Urodynamics - A thin tube is inserted into the bladder to fill it with water so the pressure inside the bladder can be measured.

How are bladder control problems treated?

There are several techniques for treating bladder control problems. Practicing 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.

Drinking beverages such as carbonated drinks, coffee and tea might make you feel like you need to urinate more often. Switching to decaffeinated beverages or water can help to prevent urine leakage. Limit your consumption of fluids after dinner to reduce the number of trips to the bathroom during the night. You should consume foods high in fiber to avoid being constipated, since constipation may also result in urine leakage.

Excess body weight can put additional pressure on the bladder. Losing weight after your baby is born can help to relieve some of the pressure.

Keeping a record of the times during the day when you are most likely to experience urine leakage, you may be able to avoid leakage by planning trips to the bathroom ahead of time.

After you have established a regular pattern, you might be able to extend the time between trips to the bathroom. By making yourself hold on longer, you will 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 health care provider.

Cesarean 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 nine 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 health care team if this happens to you.

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 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 increased urinary control.

How do I do Kegel exercises?

Imagine you are trying to hold something in your vagina, stop the flow of urine, or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While doing Kegel 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.

How often should I do Kegel exercises?

Kegel exercises should be done every day. We recommend doing three sets of Kegel exercises a day. 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.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/23/2012…#5745