Pregnancy Incontinence… A Common Problem

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The weight gain, the nausea and the morning sickness…a less known aspect of pregnancy is urinary incontinence also known as pregnancy incontinence. And though embarrassing, HEALTH learns that the good news is that it is usually easy to treat…

Expecting your bundle of joy is an exciting time in any couple’s life. Changes occur day by day with your baby developing and growing and the idea of parenthood starts sinking in and becoming more of a reality. One about-to-be first time mom is Vickie* who is in her third trimester of pregnancy. She says her and her husband were thrilled to learn they were expecting. And while she says advice came from everyone—friends, family and well wishers, no one mentioned the problem of urinary incontinence. She explains, “I was actually shocked the first time it happened to me. I rushed to the doctor and asked her if my water had broken and she looked a little amused. It began in the third trimester and now it’s getting to the point I am weary of drinking too many liquids for fear of not being able to have control. I wish I had been pre-warned…” (*name changed)


Pregnancy Incontinence... A Common Problem

She is far from alone; although urinary incontinence is often thought of as a necessary part of growing older, according to the National Association for Continence, 63 percent of stress-incontinent women say their symptoms began during or after pregnancy. In one study, most of the 500 otherwise healthy participants experienced urinary incontinence at some point from the first through the third trimester. In fact, overall, women experience incontinence two times more often than men due to pregnancy, childbirth, menopause, and the structure of the female urinary tract.

Defined

Female stress incontinence can be described as the involuntary release of urine due to stress placed on the bladder. This stress does not have to involve major activity, and can be something as simple as sneezing, coughing, lifting a heavy object or laughing too hard. Some forms of exercise, such as running, may also cause stress incontinence. This type of incontinence can affect young women as easily as older women. Younger women may feel more distressed when they experience female stress incontinence, simply due to the fact that younger women do not expect to experience incontinence at a young age.

Why It Happens

Incontinence in women usually occurs because of problems with muscles that help to hold or release urine. The body stores urine–water and wastes removed by the kidneys–in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body. During urination, muscles in the wall of the bladder contract, which forces urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.

Why during Pregnancy

What changes during pregnancy and childbirth predispose some women to experiencing female stress incontinence? One is changes in hormones – the surge of hormones during pregnancy, meant to support a healthy pregnancy, and may also cause a relaxation of the structures supporting the bladder. However hormone levels subside again once the baby is born, usually solving the problem. Not surprisingly, the second factor is the weight of the baby – the weight of the growing fetus can put a significant amount of pressure on the bladder, making sneezing or coughing a tricky proposition.

Many women experience mild female stress incontinence during the last trimester of pregnancy. This mild incontinence usually resolves itself once the baby is born and there is no longer extra pressure on the bladder.

And the third factor is childbirth itself. As during childbirth, enormous stress is placed on the bladder, its supporting muscles and ligaments, which actually causes them to become lax. Nerves that innervate the bladder can also be damaged. Factors that predispose to the development of incontinence include birthing a large baby, the use of instruments such as forceps, prolonged labour, multiple births, and episiotomies. Incontinence that results from childbirth may be evident immediately after giving birth or may take years to manifest itself. Occasionally, childbirth may cause organs such as the bladder or uterus to prolapsed, or relax, downwards.

Treatment

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If your medical history does not define the problem, it will at least suggest which tests are needed.

However pregnancy incontinence doesn’t have to make your life miserable when you’re pregnant. One proactive step to take is to schedule your bathroom breaks. When you are pregnant, you will have to urinate much more frequently than before. Being more cognizant of that will help you avoid leakage; aim to urinate every 30 minutes — before you have the urge — and then try to extend the time between this each day. This may mean scheduling bathroom breaks into your day so you don’t get caught with a bladder that’s too full when you can’t get to a restroom.

Also Kegel exercises help to strengthen the pelvic floor and help you avoid leakage, but you need to practice in order to do them properly. The exercise starts by stopping the flow of urine the next time you urinate. Simply contract the same muscles you would to stop the flow of urine, hold the contraction for a count of 10, and then release. The American Congress of Obstetricians and Gynecologists suggests doing Kegel exercises 10 to 20 times in a row two or three times a day. In a review of studies, researchers found that women who practiced pelvic floor muscle training when they were pregnant with their first baby prevented leakage later in pregnancy and after giving birth. Kegel exercises also helped women who had persistent incontinence problems after giving birth. Keep in mind that it takes about four to eight weeks of doing them regularly before you’ll see results.

Also watch the weight gain as studies show that women who weigh more when they get pregnant or who gain an excessive amount of weight during pregnancy are more likely to experience urinary incontinence. Basically those extra kilos put extra pressure on your bladder during pregnancy.

Medications

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen , are believed to cause muscles involved in urination to function normally. Some of these medications can produce harmful side effects if used for long periods. Talk to your doctor about the risks and benefits of long-term use of medications.

Surgery

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.

Other Tips To Avoid Pregnancy Incontinence:

  • Try to avoid constipation duringpregnancy, so that your full bowels don’t put added pressure on your bladder.
  • Keep drinking at least eight glasses of fluids every day as cutting back on fluids can make you susceptible to dehydration and urinary tract infection.
  • Avoid coffee, citrus, tomatoes,and soft drinks which can irritate your bladder and make it harder to control those leaks.
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