Pregnancy and Bladder Control

What is incontinence during pregnancy?

Urinary incontinence happens when you have trouble controlling your bladder. If you experience incontinence, you might feel an urgent need to pee, or you may leak urine (pee) between trips to the bathroom. You may also find yourself making more frequent trips to the toilet. Bladder control problems happen for many reasons, including pregnancy and childbirth.

The good news is that incontinence during pregnancy is usually temporary. Things usually return to normal a few months after your baby’s born or the pregnancy ends.

What is the most common type of incontinence in pregnancy?

Stress urinary incontinence (SUI) is the most common type during pregnancy. With SUI, you dribble or pee when you:

• Cough.
• Sneeze.
• Laugh.
• Engage in physical activities (even as simple as walking).

You may also experience urge urinary incontinence (UUI). With UUI, the muscles in your bladder squeeze without your control, causing you to feel the sudden, uncontrollable urge to pee. It can make you run to the toilet, only to find you dribbled before making it in time.

Is it common to leak pee during pregnancy?

It is. Approximately 40% to over half of people experience bladder control problems during pregnancy. It’s most common in the third trimester, when the fetus is heaviest and placing the most pressure on your bladder, but incontinence can happen at any stage.

It’s also common to experience incontinence after pregnancy. Childbirth — vaginal deliveries, in particular — can cause or worsen bladder control problems.

What are the signs of pregnancy incontinence?

Most of us have experienced an unintended dribble at some point. During pregnancy, these “accidents” can become more common. You may notice changes as early as your first trimester. The likelihood of losing bladder control increases as your pregnancy progresses.

Signs and symptoms include:

• Dribbling when you cough, sneeze, laugh or exercise.
• Feeling a sudden urge to pee and being unable to “hold it.”
• Having to take more frequent trips to the toilet.
• Leaking or dribbling in between bathroom trips.

What causes bladder control loss in pregnancy and after childbirth?

During pregnancy, your body goes through changes that are ideal for allowing a fetus to grow — but not so good for bladder control.

Your uterus is located behind your bladder. A growing fetus inside your uterus can pressure or squish your bladder so it holds less pee. Also, hormone changes during pregnancy cause the pelvic floor muscles that hold your bladder in place to loosen and weaken. An increase in progesterone causes these muscles to become more flexible. Flexibility allows your body to adapt to a developing fetus and (when the time comes) deliver a baby.

But weak pelvic floor muscles also make it harder to “hold it” when the urge hits.

Childbirth (and vaginal deliveries in particular) can also lead to bladder control problems. Causes include:

• 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 injure your pelvic floor and anal sphincter muscles.
• Injury because of prolonged pushing: Pushing for a long time during a vaginal delivery can also increase the likelihood of injury to your pelvic nerves.
• Pelvic organ prolapse (POP): Your pelvic muscles can become so weak during pregnancy or vaginal delivery that they can no longer support your organs. For example, your bladder may sag or droop (cystocele). A sagging bladder can lead to incontinence issues.

Risk factors for incontinence during pregnancy

If you have bladder control problems before pregnancy, they’ll likely continue or worsen during pregnancy. Having conditions that affect your bladder, like repeat urinary tract infections (UTIs), can also lead to bladder control trouble. Other risk factors include:

• Obesity or overweight. Having overweight (BMI or body mass index > 25) or obesity (BMI > 30) increases your risk of UI. Some studies suggest that obesity can more than double your risk. Losing weight can sometimes reverse incontinence issues. Work with your provider to reach a weight that’s healthy for you.
• Age. Some studies suggest that people older than 30 during their first delivery have higher rates of SUI than people younger than 30.
• Vaginal deliveries. Delivering your baby vaginally (as opposed to a C-section) is more likely to cause incontinence issues after pregnancy. They’re also more likely to increase your risk of POP.
• Episiotomies. An episiotomy is a procedure where a provider makes a small incision (cut) in the tissue beneath your vaginal opening so it’s easier for a baby to exit. While medical professionals once thought that this procedure helped make for easier deliveries and reduced risks (like UI), it’s since been shown to weaken your pelvic floor muscles.
• Large babies. Babies who weigh more than 9 pounds at birth may increase the risk of nerve damage during delivery.
• Diet and lifestyle. Certain foods and drinks can irritate your bladder, increasing your risk of UUI. Drinking caffeinated beverages (especially coffee), alcohol and carbonated beverages can cause your bladder to contract, making you feel the sudden urge to pee. Spicy or acidic foods can also irritate your bladder. Although the evidence is mixed, some studies suggest that smoking increases your risk of urinary incontinence.

How are bladder control problems during or after pregnancy diagnosed?

Urinary incontinence during pregnancy is so common that many people don’t bother telling their providers. But you should alert your provider if you’re having bladder control issues. Your provider can recommend strategies to help you better manage things. Usually, normal bladder function returns after pregnancy.

If you’re still having issues six weeks or more after your pregnancy’s ended, you should check with your provider to see what’s going on. They’ll perform a physical exam and order tests to check your bladder function and rule out various medical conditions. Tests may include:

• Bladder stress test (to check for signs of leakage when you cough forcefully or bear down).
• Cystoscopy.
• Pad test (to see how much pee a pad has absorbed at a set time).
• Ultrasound of your bladder.
• Urinalysis.
• Urodynamic testing.

How are bladder control problems during pregnancy treated?

You can do several things to improve your bladder control during pregnancy. For example, doing Kegel exercises can strengthen the pelvic floor muscles that support your bladder, giving you more bladder control.

Other lifestyle changes can help, too. You can:

• Switch to decaffeinated beverages or water. Also, steer clear of foods that are spicy or heavily acidic.
• Limit your fluid intake after dinner. This can reduce your bathroom trips when you’re trying to sleep.
• Eat high-fiber foods. Fiber can reduce your risk ofconstipation during pregnancy. Straining to poop can also take a toll on your bladder and lead to leakage.
• Maintain a healthy body weight. Losing weight can ease some of the pressure on your bladder. While losing weight may be challenging during pregnancy, aiming for a weight that’s healthy for you throughout your life can reduce your risk of experiencing incontinence.
• Try bladder training (alongside Kegels).Keep tabs on when you pee and when you leak. Plan for bathroom breaks before the “leak” times. Try to gradually extend the time in between bathroom breaks so you’re training your pelvic muscles to get better at holding your pee.

In the meantime, you may need to wear pads or leak-proof incontinence underwear. It can feel embarrassing to need the extra help. Remember, though, that many other pregnant people are experiencing the same thing (and many before you have been here, too).

How do I do Kegel exercises?

Kegel exercises can help you better control the muscles you’ll use during childbirth. They can also help promote tissue healing after pregnancy. Still, check with a provider to ensure it’s safe. If you’ve had a tear or another injury during childbirth, you may need to wait to heal before attempting Kegels.

To do Kegel exercises, squeeze the muscles you’d use if you were trying to stop the flow of pee or trying not to pass gas. Try not to move your leg, butt or stomach muscles. Hold for a slow count of 10 seconds. Then, relax. Repeat the squeeze and release pattern 15 times for one set of Kegels. Then, do four more sets for a total of five sets.

Do your Kegel exercises daily.

Can pregnancy-related loss of bladder control be prevented?

There isn’t a foolproof way to prevent incontinence. But you can make lifestyle changes (like regularly performing Kegels) that make it more manageable.

How long does incontinence last?

Most people regain their normal bladder control three to six months after the baby’s born or the pregnancy ends.

But your risk of experiencing incontinence after pregnancy often depends on your particular experience, including the type of delivery (vaginal or C-section) and other risk factors like your weight.

Sometimes, incontinence that improves after pregnancy returns several years later. It’s important to keep in mind that factors other than pregnancy also increase your risk of incontinence, including pelvic floor muscles that weaken with age.

How do I take care of myself?

For most people, the dribbling isn’t a major problem insomuch as it’s an embarrassing annoyance. Wearing a pad is often enough to manage the leakage. Still, your provider needs to know about symptoms you’re experiencing. There are steps you can take to improve your bladder control.

When should I see my provider?

Schedule a visit with your healthcare provider if the problem continues for six weeks or more after your pregnancy. Also, see your provider at any point if incontinence interferes with your quality of life. If you’re skipping social events because you’re worried about your bladder or if you’ve become more self-conscious — it’s time to reach out for help.

Am I leaking urine or discharge?

Color, smell and texture all provide clues about whether you’re leaking pee or vaginal discharge. Healthy pee should be watery, clear or pale yellow. It may have a slight ammonia smell or no smell at all. On the other hand, vaginal discharge may be a range of colors, including clear, white, dark yellow, brown, green or gray. It may have a distinct fishy smell if you have an infection. Chunky or foamy discharge may also be a sign of an infection.

Use your senses to determine whether you’re leaking pee or have another issue. And if there’s any question, see your provider. Infections during pregnancy can pose risks both to you and the fetus.

How do I know if I'm peeing myself or leaking amniotic fluid?

Amniotic fluid cushions the fetus in your uterus and leaks from your body when your water breaks. It may gush, but sometimes it may feel like you’re peeing. If you’re unsure if what’s leaking is amniotic fluid or pee, check the color and smell in your underwear. Amniotic fluid is thin, odorless and clear. Or it may be straw-colored or tinged with brown or green. If you’re getting a whiff of ammonia, you’re leaking pee. If you smell something fishy or unpleasant, you may have an infection.

It’s best not to take chances. Contact your healthcare provider if you’re unsure about the fluids you’re leaking.

A note from Cleveland Clinic

While changes in your body during pregnancy may make controlling your bladder harder, you have more power to manage incontinence than you might think. If you’re pregnant and dribbling or leaking pee, it’s worth mentioning to your provider. They can guide you on lifestyle changes that can help. Watching what you eat can help. Daily Kegel exercises and planning bathroom breaks can also help. Don’t accept discomfort as your new reality or allow bladder control problems to keep you from doing the things you enjoy.