Stress Incontinence

Stress incontinence, or being unable to control your bladder properly is a rather embarrassing part of pregnancy. Stress incontinence is caused when the pelvic floor muscles are weakened, meaning that urine leaks when your bladder is under pressure or if you cough, sneeze or laugh. During the third trimester of pregnancy more than 50% of women will experience some stress incontinence.

How the bladder works

The bladder is located behind the pubic bone in the pelvis at the lowest point of the abdomen. Storage of urine in the bladder is supported by the pelvic floor muscles. These help to keep the bladder closed until you go to the toilet. When your bladder is full, the brain is told that you need to empty your bladder. The brain then tells your pelvic floor muscles to relax, allowing urine to be pushed through the urethra and out of the body. The two main muscles involved are the sphincter, a circular muscle that surrounds the urethra, and the detrusor which is the bladder wall muscle. The detrusor allows the bladder to expand when the muscle is relaxed.

Causes of stress incontinence during pregnancy

Throughout pregnancy, the pelvic floor muscles are often weakened and over-stretched, meaning that the muscles cannot always contain the contents of the bladder and urine can be leaked. For most women, this leakage is a tiny amount, however, for some there can be a greater amount of leakage.

Hormones also have an impact on your pelvic floor muscles. The hormones released during pregnancy allow your muscles to stretch much easier to allow your body to prepare for delivery.

Women who have had more children, especially children delivered vaginally, usually have a higher chance of suffering with stress incontinence.

Is it always stress incontinence that causes leaks?

Not always. It's important to make sure that it is only urine that is leaking; a quick sniff to check that it does smell of ammonia will confirm this. If the liquid does not smell of urine then do contact your doctor as it may be a small leak of amniotic fluid.

If you notice any burning or pain when you urinate, or of your urine appears differently coloured than usual, then speak to your doctor as these can be symptoms of urinary tract infections (UTIs) which can also cause incontinence.

Minimising the impact of stress incontinence

Use a sanitary or incontinence pad to prevent leaks from reaching your clothes. If you do feel the need to cough, laugh or sneeze then try tightening your pelvic muscles before you do. If this does not make any difference, then try crossing your legs the next time you need to cough, laugh or sneeze.

Stress incontinence during and after delivery

Vaginal deliveries can contribute more to the problem of stress incontinence than C-sections. Some experts have also suggested that the use of forceps may cause stress incontinence after birth.

For some women, stress incontinence can also continue long after pregnancy as the muscles have been severly overstretched during delivery.

What can reduce stress incontinence?

• Continue to drink plenty of water as if you reduce your water intake too much then you could become dehydrated.
• Try re-training your bladder by going to the toilet every 30 minutes or so, even if you don't feel the need to go. Then try to extend the length of time between toilet visits.
• Keep an eye on your weight as any extra weight will put extra pressure on the bladder.
• You should encourage regular bowel movements with fibre or laxatives as constipation can make the incontinence worse.
• Do avoid caffeine, alcohol, spicy foods and citrus as all of these can either irritate or over-stimulate the bladder.
• Be careful of exercise such as running during and after pregnancy as this puts extra pressure on the bladder; try brisk walking or cycling instead.

The importance of pelvic floor (Kegel) exercises

Pelvic floor, or Kegel exercises are important to strengthen your muscles. These should be done throughout your pregnancy as well as afterwards. Not only can they help with stress incontinence during pregnancy but they also help you to avoid tears during delivery. These exercises can enhance your sex life and help you to minimise incontinence problems as you age.

To perform pelvic floor exercises you could be sitting comfortably on a chair, in the car or even at your desk. Firstly, try imagining that you are passing urine then stopping the flow. You will feel the set of muscles working to stop this. Try and hold these muscles for five seconds or so and repeat at least five times. Repeat the exercises but only hold the muscles for one to two seconds, then repeat these reps of fast and slow holds for 5-10 minutes, 2-3 times a day. Try not to do this exercise on the toilet while you are actually urinating, as this can increase the risk of urine infections.

To perform the second type of pelvic floor excersises, imagine stopping yourself from breaking wind. As you do this you should only be moving the muscles around your rectum. Your legs or buttocks should not move.

Pelvic floor exercises are also able to minimise some of the swelling caused by bruising or stitches after delivery; ideally you should continue with these exercises as soon after delivery as you are able.

Other treatments for stress incontinence

Treatment of stress incontinence will often depend on the severity of your symptoms and how much of an impact it is having on your daily life.

There is a variety of pelvic toners available including weighted cones, which work by causing the pelvic floor muscles to contract around it. This strengthens the muscles. The weight is then adjusted to further strengthen the muscles. Other toners work with electrical impulses to stimulate the pelvic floor muscles.

There are medications available for those who usually have mild to moderate stress incontinence. These medications can help improve symptoms or may block bladder contractions.

If the incontinence continues long term, then there are surgical options available to correct the problem, including the use of vaginal slings or anterior vaginal repair.

It's important that you don't just accept that stress incontinence is part of having your baby and put up with it. Exercises and bladder re-training can help to significantly reduce the symptoms of stress incontinence. Your midwife will also be able to provide practical advice and guide you with your pelvic floor exercises. If your incontinence does continue after pregnancy then speak to your health visitor. Different treatments may be required to minimise the impact of the stress incontinence in long term cases.