Urinary incontinence in pregnancy

Urinary incontinence is the technical name for the involuntary loss of urine.¹ You may have heard terms, like ‘bladder leakage’ or ‘a weak bladder.’ While these are not medical terms, they refer to the same condition. Urinary incontinence can be mild – just a few drops, or severe – a large volume of urine leakage or a complete loss of a full bladder. 

There are different types of urinary incontinence, defined by the cause or trigger of urine leakage. The most common types include:¹

• Stress urinary incontinence: involuntary urine loss that occurs with coughing or sneezing, physical activity or exertion

• Urgency urinary incontinence: involuntary urine loss that occurs with the urge to urinate 

• Mixed urinary incontinence: involuntary urine loss that occurs with the urge to urinate AND with physical activity, coughing or sneezing; a combination of symptoms of stress and urgency urinary incontinence; usually labeled ‘stress-dominant’ or ‘urge-dominant’ mixed urinary incontinence, depending on symptoms.¹ 

Urinary incontinence is a common condition during pregnancy, with stress incontinence being the most frequent complaint. Studies indicate a wide range of 21% up to 71% of pregnant moms reporting some degree of urine leakage.² Rates of urinary incontinence increase as pregnancy progresses, with more women reporting urine leakage in the 3rd trimester than in the 2nd trimester, and even less in the 1st trimester.^3,4 Rates of incontinence are also lower for those who are pregnant for the first time. If this is your second, third, fourth (or more!) pregnancy, then you may be more likely to experience incontinence than your first-timer counterparts.⁵ 

Why the increased risk of urinary incontinence during pregnancy? 

There are a few factors that contribute to pregnancy-related incontinence. First, during pregnancy, the pelvic floor and the pelvic organs descend or drop lower than their usual pre-pregnancy position.⁶ The increasing size and weight of the uterus places pressure on the bladder. Together, these changes may cause bladder irritation and/or make it more difficult to control the bladder when it is full.² This explains why rates of incontinence increase from the 1st to the 3rd trimester. 

Second, high levels of the pregnancy hormone progesterone cause relaxation of the smooth muscles in the body (all the muscles we don’t have voluntary control over). This is important to maintain the pregnancy because it prevents premature uterine contractions. But, it can also decrease the muscle tone in the bladder and urethra, making it more difficult to hold urine.² This may explain why some women experience incontinence early in their pregnancy.  

Third, another hormone called relaxin may play a role in pregnancy-related incontinence. This hormone relaxes (as its name implies) the body’s connective tissues, which allows the pelvis to widen, in order to support the increased size and weight of the uterus and ultimately, to deliver the baby. Researchers believe this hormone also plays a role in urinary incontinence during pregnancy.² 

What other factors increase risk of urinary incontinence during pregnancy?

If you experienced any urinary incontinence before pregnancy, you are more likely to continue to have this condition during your pregnancy and may be at risk for worsening of your symptoms.² This is true for first-time pregnant moms and for those who have had one or more prior deliveries. A history of childhood incontinence or bedwetting is also associated with pregnancy related urinary incontinence.^2,7 A few other important risk factors are smoking and increased body weight.³ This is one of many reasons to take steps to quit smoking and to work with your health care provider to achieve a healthy weight gain during your pregnancy. 

What can be done to prevent or treat urinary incontinence during pregnancy?

It is important to recognize that urinary incontinence is a treatable condition. While it is a common complaint during pregnancy, moderate to severe symptoms of urine leakage are not normal and will not always go away after delivery. Pelvic floor muscle exercises, or Kegels, are effective in preventing new onset urinary incontinence during pregnancy.^4,8 If you have developed incontinence during your pregnancy, pelvic floor muscle exercises may help to reduce the severity of your symptoms.^4,8 When pelvic floor muscle exercise is combined with aerobic exercise (aka cardio), it’s even more effective in prevention and treatment of pregnancy-related incontinence.⁴ You may also speak with your health care provider or search your area for a physical therapist who specializes in treating women’s and pelvic health conditions. 

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Sources

1. Haylen BT, De Ridder D, Freeman RM, et al. An International Urogynecological Association / International Continence Society Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn. 2010;29:4-20. doi:10.1007/s00192-009-0976-9
2. Abdullah B, Ayub SH, Mohd Zahid AZ, Noorneza AR, Isa MR, Ng PY. Urinary incontinence in primigravida: The neglected pregnancy predicament. Eur J Obstet Gynecol Reprod Biol. 2016;198:110-115. doi:10.1016/j.ejogrb.2016.01.006
3. Liang CC, Chang SD, Lin SJ, Lin YJ. Lower urinary tract symptoms in primiparous women before and during pregnancy. Arch Gynecol Obstet. 2012;285(5):1205-1210. doi:10.1007/s00404-011-2124-2
4. Davenport MH, Nagpal TS, Mottola MF, et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1397-1404. doi:10.1136/bjsports-2018-099780
5. Balik G, Güven ESG, Tekin YB, et al. Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy. LUTS Low Urin Tract Symptoms. 2016;8(2):120-124. doi:10.1111/luts.12082
6. Wijmaa J, Potters AEW, Wolf BTHM de, Tinga DJ, Aarnoudseb JG. Anatomical and functional changes in the lower urinary tract during pregnancy. Br J Obstet Gynaecol. 2001;108(7):726-732. doi:10.1067/mob.2001.114501
7. Daly D, Clarke M, Begley C. Urinary incontinence in nulliparous women before and during pregnancy: prevalence , incidence , and associated risk factors. 2018;29:353-362. doi:10.1007/s00192-009-1011-x
8. Woodley S, Boyle R, Cody J, Mørkved S, Hay-Smith E. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in pregnant women and women who have recently given birth. Cochrane Database Syst Rev. 2017;(12). doi:10.1002/14651858.CD007471.pub3.www.cochranelibrary.com