Urinary incontinence (UI), also known as “leaking,” is a health condition that affects up to 60% of adult women in the U.S., and is more common with increasing age. About one third of women develop urinary incontinence during their first pregnancy. UI is defined as the involuntary loss of urine, and has several subtypes based on the physical actions or feelings that accompany the loss of urine.
Stress Urinary Incontinence
Stress Urinary Incontinence is when urine loss happens during physical exertion or activity, including sneezing or coughing, and is the most common type of UI. This type of UI happens during pregnancy because increased uterine weight and size create more downward pressure on the bladder. It is best addressed by following a program of pelvic floor muscle exercises (kegels). These can be done on your own at home, but often, a few visits with a pelvic floor physical therapist is most beneficial. They will help you identify which exercises might be most helpful to you and how to do them correctly. Pelvic floor physical therapists see patients both during and following pregnancy. A pessary, which is a silicone dish that sits in the vagina (you can’t feel it!), can be fitted by your provider or a urogynecologist and can also help with stress incontinence in pregnancy.
Urgency Urinary Incontinence
Urgency Urinary Incontinence is less common than Stress Urinary Incontinence, affecting 7-18% of women during pregnancy, and involves the involuntary loss of urine associated with an urge to pee, or a sudden need to pass urine. If you are experiencing Urgency UI, discuss it with your healthcare provider. This is particularly important if symptoms develop suddenly or are accompanied by vaginal irritation or increased vaginal discharge, since it may be related to a vaginal or urinary tract infection.
The pelvic floor muscles stretch immensely during vaginal birth, which can lead them to be strained or injured after birth. The most common side effect is urinary incontinence. Urinary incontinence after birth should improve within a few weeks. If you’re still experiencing UI six weeks after birth, talk to your healthcare provider.
Tips?
Pelvic floor muscle exercises, commonly referred to as kegels or kegel exercises, are universally recommended in pregnancy to help improve the function of the pelvic floor muscles. These exercises are also helpful as a treatment for urinary incontinence symptoms during pregnancy.
Lifestyle changes for UI during pregnancy
There are many reasons not to smoke during pregnancy, but one of them is to reduce the risk of urinary incontinence. Cigarette smoking has been associated with stress incontinence, urgency incontinence and leakage of urine during sex. Smoking contributes to urinary incontinence by irritating the bladder, and also because it leads to chronic coughing, which can make urine leaking worse.
Certain dietary changes can also help. You should already have cut out alcohol and cut down on caffeine, but try cutting down on spicy or acidic foods too. If you’re experiencing constipation, this can also worsen urinary incontinence, by putting increased pressure on the bladder.
When pelvic floor strengthening and lifestyle changes aren’t working, there are still more options, including medications to improve bladder control, electrical stimulation to strengthen the pelvic floor, and pessaries that are inserted in the vagina to support the bladder.
If none of these options work, there are also certain surgical procedures that your provider can explain. You can also make an appointment to see a urogynecologist. Urogynecologists specialize in pelvic floor dysfunction, including urinary incontinence.
This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic.
Sources
- Minassian, V. A., Stewart, W. F., & Wood, G. C. (2008). Urinary incontinence in women: Variation in prevalence estimates and risk factors. Obstetrics and Gynecology, 111(2), 324–331. https://doi.org/10.1097/01.AOG.0000267220.48987.17; 5. Melville, J., Katon, W., Delaney, K.
- Newton, K. (2005, March 14). Urinary incontinence in US women: a population-based study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15767530 165(5):537-42
- Solans-Domènech M1, Sánchez E, Espuña-Pons M; Pelvic Floor Research Group (Grup de Recerca del Sòl Pelvià; GRESP). (2010 Mar). Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol., 115(3):618-28. doi: 10.1097/AOG.0b013e3181d04dff.
- Haylen BT, de Ridder D, Freeman RM, et al. (Spring 2012). An International Urogynecological Association(IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. J Assn Chartered Physiotherapists in Women’s Health. 110, 33-57.
- Fitzgerald MP, Graziano’s. (2007) Anatomic and Functional Changes of the Lower Urinary Tract During Pregnancy. Urol Clin N Am 34,7–12.
- Balik G, Güven ES, Tekin YB, Şentürk Ş, Kağitci M, Üstüner I, Mete Ural Ü, Şahin FK. (2016 May). Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy. Low Urine Tract Symptoms. 8(2):120-4. doi: 10.1111/luts.12082. Epub 2014 Dec 11
- Bump RC, McClish DM. (1994 Feb) Cigarette smoking and pure genuine stress incontinence of urine: a comparison of risk factors and determinants between smokers and nonsmokers. Am J Obstet Gynecol. 170(2):579-82.
- Marlene Cortone, M.D.. “Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy.” UT Southwestern Medical Center. UT Southwestern Medical Center. May 19, 2020.
- Marlene Corton, M.D. “Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy.” The University of Texas Southwestern Medical Center. May 19, 2020. https://utswmed.org/medblog/leakage-incontinence-during-after-pregnancy/.
- Mayo Clinic Staff. “Pessary types.” Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/multimedia/pessary-use/img-20006056.
- “Pregnancy and Bladder Control.” Cleveland Clinic. Cleveland Clinic June 11, 2020. https://my.clevelandclinic.org/health/articles/16094-pregnancy-and-bladder-control.
- Amy Rosenman, MD. “Childbirth & Incontinence.” UCLA Health. Center for Women’s Pelvic Health at UCLA. https://www.uclahealth.org/womens-pelvic-health/childbirth-incontinence
