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.
  • Cytoscopy: 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.

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