Incontinence After Childbirth
Incontinence after childbirth at a glance
- During pregnancy and after childbirth, many women experience at least some degree of involuntary urination, called urinary incontinence.
- Some women also experience bowel (fecal) incontinence, which is involuntary loss of fecal matter.
- Postpartum incontinence is caused by the increased weight of the uterus weakening the pelvic floor muscles and hormones produced in pregnancy that make tissues and joints more elastic for giving birth.
- Women with a higher body mass index (BMI) during and after pregnancy have a higher chance of incontinence after childbirth.
- Women who delivered their child via cesarean section have 50% less risk of developing incontinence after childbirth.
- Treating incontinence depends on individual circumstances, but can include strengthening exercises, medicines, bladder training, a pessary or surgical treatments in some cases.
What is postpartum incontinence?
During and immediately following pregnancy, as many as 4 in 10 women experience urinary incontinence, or the involuntary loss of urine. The most common type of incontinence experienced is stress incontinence caused by pressure on the bladder sphincter, the muscular valve at the bottom of the bladder that controls urine flow during a laugh, cough, sneeze or other activity that adds stress to the bladder.
Giving birth is extremely tough on the body and can change a woman’s urinary control abilities. During pregnancy, the body produces special hormones that make tissues and joints more elastic for delivery – these same hormones can even cause a pregnant woman’s feet to grow up to one size during pregnancy. That, combined with the weight of the expanding uterus, weakens the strength of a woman’s pelvic floor muscles and causes urine to leak.
The following conditions may also add to postpartum bladder control problems
- Damage to the nerves that control the bladder and rectum.
- Movement of the urethra and bladder during pregnancy.
- An episiotomy, a small 3-4 cm cut made in the pelvic floor muscle during delivery of a baby. The degrees of episiotomy range from first to fourth and are categorized by the severity of the tear. Women with third- and fourth-degree episiotomies are at a higher risk for urinary and fecal incontinence.
Incontinence is common in new moms but can also develop in the months and years after childbirth – some women don’t experience problems until their 40s. Whenever postpartum incontinence issues begin to develop, women should consider making an appointment with a female pelvic health specialist. There are many treatment options that can improve the mother’s quality of life.
Sorry diamonds, Kegels are a girl’s best friend
Doing regular Kegel exercises will strengthen the pelvic floor muscles and can help to prevent urinary incontinence after childbirth. We have many resources all about Kegels including how to do them and how often, exercise tips and more.
Risk factors for incontinence after childbirth
Women are more likely to have incontinence if they also had leakage problems during pregnancy, particularly in the first or second trimester. Women who also had long deliveries or needed forceps during labor are also more likely to experience urinary leakage.
According to the National Institutes of Health, women who had cesarean sections were 50% less likely to develop stress urinary incontinence compared with women who had spontaneous vaginal birth (vaginal birth without the use of forceps or other devices to help the baby out of the vaginal canal).
If it is safe for both mother and baby during labor, letting the contractions naturally pull the baby down through the birth canal with the mother pushing for less than one hour can help prevent more permanent damage to the nerves that help control urinary and fecal processes.
Age also has an effect on urinary incontinence, but not so directly in younger women giving birth. As women age and enter into menopause, the bladder muscles lose some strength. Lower levels of estrogen in pre- and post-menopausal women may also aid in weakening the urethra, the duct that carries urine from the bladder outside the body.
Women with a high BMI or who retain pregnancy weight gain after the birth of their child or children are more likely to experience incontinence and pelvic organ prolapse (POP). Postpartum weight loss decreases the risk of urinary incontinence, even if other risk factors such as age and/or type of delivery method exist.
When should you see a doctor about postpartum incontinence?
Talk to your doctor or a female pelvic health specialist if you still have bladder problems six weeks after delivery. Regular, unintended urine leakage may mean that you have another medical condition. The loss of bladder control should be treated sooner rather than later, or it can become a long-term problem.
Episiotomy considerations: Women with third- and fourth-degree anal sphincter lacerations during delivery, which may be spontaneous or due to episiotomy, can be referred to our pelvic floor physical therapists and begin therapy treatment 6-8 weeks post-delivery.
Postpartum incontinence treatments
The good news in regard to incontinence after childbirth is that there are many treatment options, ranging from dietary changes and bladder training to injections and surgery. Some treatment options are listed below.
- Diet and exercise. Food and drinks such as coffee, citrus, spicy foods and soda can all irritate the bladder. Cutting back on or eliminating these foods may help improve incontinence symptoms. Keeping weight within a healthy BMI range, and/or focusing on losing pregnancy weight, can also help with bladder control.
- Special exercises. Kegels strengthen the pelvic floor, giving more control over urinary urges. Exercises in pelvic floor physical therapy can also help build muscle strength and memory.
- Bladder training. The bladder is a muscle that should be regularly strengthened. Scheduling urination times and then gradually increasing the amount of time in between urination can increase bladder strength.
- Evaluating lifestyle factors. Excessive coughing due to smoking or being overweight can put unnecessary strain on the pelvic floor muscles. Certain drugs such as antidepressants and antihistamines can also have an impact on urinary incontinence.
- Pessary. A pessary is a device inserted into the vagina to provide support for vaginal tissues, in turn, aiding in bladder incontinence.
- Injection treatments. Injections of bulking agents, like collagen, into the tissue surrounding the urethra can help keep the urethra closed. Botox injections can also aid in urinary incontinence relief by relaxing the muscles and increasing the bladder’s storage capacity.
- Nerve stimulators. A neurotransmitter used in InterStim therapy can be implanted under the skin in the buttocks area. The device then sends electrical impulses to the sacral nerve, which improves bladder control.
- Surgical treatments. A variety of surgical treatment options can lift the bladder or urethra back into their proper place.