Medical Conditions - Urinary Incontinence during and after pregnancy

During pregnancy, many women experience at least some degree of urinary incontinence, which is the involuntary loss of urine. The incontinence may be mild and occasional for some women and more severe for others. Incontinence can continue after pregnancy and may not be present right after childbirth.

The kind of incontinence experienced during pregnancy is usually stress incontinence. Stress incontinence is the loss of urine caused by increased pressure on the bladder. In stress incontinence, the bladder sphincter does not function well enough to hold in urine.

Urinary incontinence during pregnancy can also be the result of an overactive bladder. Women who have an overactive bladder need to urinate more than usual because their bladders have uncontrollable spasms. In addition, the muscles surrounding the urethra -- the tube through which urine passes from the bladder -- can be affected. These muscles are meant to prevent urine from leaving the body, but they may be "overridden" if the bladder has a strong contraction.

The bladder sphincter is a muscular valve that lies at the bottom of the bladder. It works to control the flow of urine. In pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and in the pelvic floor can be overwhelmed by the extra stress or pressure on the bladder. Urine may leak out of the bladder when there is additional pressure exerted -- for example, when a pregnant woman coughs or sneezes.

After pregnancy, incontinence problems may continue because pregnancy and childbirth weaken the pelvic floor muscles. Damage to the nerves that control the bladder may also contribute to incontinence.

Behavioural methods such as timed voiding and bladder training can be helpful in treating urinary incontinence during and after pregnancy. These techniques are often used first and can be done at home. The changes in habits that behavioural methods involve do not have serious side effects.

To practice timed voiding, you use a chart or diary to record the times that you urinate and when you leak urine. This will give you an idea of your leakage "patterns" so that you can avoid leaking in the future by going to the bathroom at those times.

In bladder training, you "stretch out" the intervals at which you go to the bathroom by waiting a little longer before you go. For instance, to start, you can plan to go to the bathroom once an hour. You follow this pattern for a period of time. Then you change the schedule to going to the bathroom every 90 minutes. Eventually you change it to every two hours and continue to lengthen the time until you are up to three or four hours between bathroom visits.

Another method is to try to postpone a visit to the bathroom for 15 minutes with the first urge. Do this for two weeks and then increase the amount of time to 30 minutes and so on.

In certain cases, devices can be used to block the urethra or to strengthen the pelvic muscles. In addition, medications also can be helpful in controlling muscle spasms in the bladder or strengthening the muscles in the urethra. Some drugs can help to relax an overactive bladder.

Pelvic Floor or Kegel exercises are another method that can be used to help control urinary incontinence. These exercises help tighten and strengthen the muscles in the pelvic floor. Strengthening the pelvic floor muscles can improve the function of the urethra and rectal sphincter.

For expert advice/information on incontinence please contact the Australian Continence Foundation (1800 33 00 66) for a list of pelvic floor or Women’s Health physiotherapists.

Study by Australian College of GP’s Western Australia.

This longitudinal study was undertaken to determine the prevalence of stress incontinence amongst women during pregnancy, early post partum (six weeks), and the late post partum period (six months), and identify determinants of the disappearance or persistence of stress incontinence after childbirth. Also considered were the obstetric variables predictive of an onset of urinary stress incontinence post partum. The research team utilised a self-administered questionnaire and State-based Midwife Notification data with women recruited from public and private maternity hospitals, and private obstetricians and GPs, in Perth and Melbourne.

Urinary incontinence in pregnancy was reported by 79% of 736 women participating in the study at 36 weeks gestation, with most experiencing stress incontinence. Mixed incontinence, i.e. symptoms of both urge and stress incontinence, were present in 40% of participants. Of the 432 women who remained in the study at six months post delivery, the level of stress incontinence had reduced to 21%.

If you would like a copy of this report please contact continence@health.gov.au

Reference

Royal Australian College of General Practitioners WA Research Unit (2003). Stress Incontinence in Pregnancy. Final Report prepared for the Australian Government Department of Health and Ageing.