Many women experience at least some degree of urinary incontinence after childbirth; it isn’t anything to be ashamed of, and it may be decreased with certain treatments and exercises.
Postpartum urinary incontinence is the involuntary leaking of urine that new mothers may experience. It is estimated that approximately one-third of postpartum women will experience some form of urinary incontinence. It is an often-overlooked condition, with many women assuming it is a normal part of having a baby.
Who is at risk for this form of bladder leakage?
Vaginal delivery appears to be the biggest risk factor in the development of postpartum urinary incontinence. The National Institutes of Health states that women who have a vaginal delivery are 50% more likely to have postpartum incontinence than those who deliver by C-section. Women who had bladder leakage during pregnancy are also more likely to experience urinary incontinence after delivery.
Other risk factors include delivering a large baby, a prolonged pushing phase, pre-pregnancy obesity and excessive weight gain during pregnancy. Decreased pelvic floor muscle strength due to the stretching of muscles during delivery can add to the problem as well.
Stress incontinence and overactive bladder (urge incontinence)
Stress incontinence is the most common type of urinary incontinence in postpartum. This is involuntary leakage when pressure is exerted on the bladder such as with coughing, sneezing and laughing. The extra pressure on the bladder sphincter pushes the urine through the muscular valve.
Urge incontinence (urgency incontinence) is another common form of postpartum urinary incontinence and is defined by the loss of urine following a sudden urge to urinate. This is also referred to as an overactive bladder. In the average bladder, the muscle remains relaxed while the bladder gradually fills up. With urgency incontinence, the muscle contracts too early and causes the urge to urinate, sometimes allowing for bladder leakage.
When should women see an expert about postpartum urinary incontinence?
During their six-week postpartum checkup if they experienced incontinence before, during or after pregnancy. If a woman has regular, unintended urine leakage, it may mean she has another medical condition.
Treating urinary incontinence with Kegels, pessaries & a healthy lifestyle
The good news is, there is treatment for postpartum urinary incontinence, and most women find their symptoms improve over the course of 6-12 months. In order to get started on corrective action, it is important for you to let your healthcare provider know if you are having any difficulties with emptying your bladder, starting your urine stream or if you are experiencing any kind of urinary incontinence.
Your Kegel exercise tuneup
At your six-week postpartum visit, your provider will assess your pelvic floor by checking the strength of your Kegel exercise, which is the squeezing of your pelvic floor muscles. You will also be evaluated for bladder prolapse. If we determine that your Kegel is weak, we may recommend a pelvic floor exercise regimen as part of your daily routine.
- Start by squeezing your pelvic floor muscles as tightly as possible for 1-2 seconds then completely relaxing them (it’s like starting to urinate but stopping, with your abdomen, thighs and buttocks relaxed).
- Do this for 10 repetitions.
- Then squeeze your pelvic floor muscles as tightly as possible, hold for 5-10 seconds (not easy) and then completely relax them.
- Do this for 10 repetitions.
- The combination of fast and slow contractions strengthens muscle fibers more effectively than quick contractions alone.
Do this regimen morning and night. If you see no improvement over six weeks, let your healthcare provider know, as a referral to physical therapy for pelvic floor rehabilitation may be warranted.
Marsha Merry, WHNP-BC
Marsha is a board-certified women’s health nurse practitioner (WHNP-BC) with more than 30 years of experience in gynecologic care, menopausal management, urinary incontinence and chronic pelvic pain.
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Pessary, timed voiding and other solutions
We may recommend a pessary, which is a vaginal support device, if we find you have prolapse. Prolapse is a common condition in which the bladder, uterus and/or bowel protrudes into the vagina. We can fit you for a pessary in the office and will teach you how to remove and insert the device yourself.
Other treatments include practicing timed voidings. Don’t wait until your bladder is over full before heading to the bathroom. Void every 2-3 hours while awake.
Constipation can affect how the bladder stores and empties urine. Normal bowel function can be maintained by drinking an adequate amount of fluids and consuming foods high in fiber. Exercise can also help move stool through the intestine.
Avoid foods and beverages that are bladder irritants. These include caffeine, carbonated beverages, very acidic and very spicy foods. These foods can cause an increase in the sense of urgency and more trips to the bathroom. Cigarettes are also a bladder irritant and smoking should be avoided.
Be proactive to prevent postpartum urinary incontinence
There are several ways to decrease the likelihood of postpartum incontinence before pregnancy.
- Performing pre-pregnancy Kegel exercises on a regular basis can ensure maximum pelvic floor strength. You can ask your provider to assess your Kegel before becoming pregnant.
- Try to go into pregnancy at a normal weight and don’t gain more than the recommended amount of weight. You can also do Kegels while you are pregnant.
- Ask for smoking cessation resources if you are a smoker.
I want every woman to know that no amount of urinary incontinence needs to be tolerated. With multiple treatment options available, postpartum urinary incontinence does not need to be a part of daily life after giving birth.