Your Guide to Urinary Incontinence After Childbirth
Urinary incontinence often starts during pregnancy but can linger long after. Fortunately, Kegels aren't the only solution.
Urinary incontinence is incredibly prevalent among new moms, affecting at least 7 million women in the U.S. "Even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50 percent of women," says Roger Goldberg, M.D., director of urogynecology research at the University of Chicago NorthShore University HealthSystem and author of Ever Since I Had My Baby (Random House). New moms who delivered vaginally are more likely to have urinary incontinence one year postpartum, compared to women who had C-sections, says a new study published in Obstetrics & Gynecology.
Most cases resolve in the first year after birth. However, five years after delivery, one-third to one-half of women report some degree of spritzing; 10 percent to 20 percent of women report having leakage that they consider "socially bothersome." Here’s everything you need to know about urinary incontinence, including a variety of treatment methods to help you stay dry.
Types of Urinary Incontinence
Incontinence comes in two varieties: stress and urge. If you leak when you forcefully laugh, sneeze, cough, run, jump or lift weights, you have stress incontinence. "It's really common in the third trimester because of the pressure of the uterus on the bladder," says Sangeeta Mahajan, M.D., division chief of female pelvic medicine and reconstructive surgery at University Hospital's Case Medical Center Department of Ob-Gyn in Cleveland. Compounding the problem are the hormones that make your tissues and joints more elastic for delivery: They also reduce bladder support, allowing urine to leak.
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About two-thirds of women with stress incontinence also experience urge incontinence, which is caused by an overactive bladder. You get the sudden urge to go, even though your bladder may be nearly empty, and leak before you can get to the bathroom.
Urinary Incontinence Causes
The bladder is like a balloon, with a stubby knob at the end called the urethra. Normally, the bladder relaxes to accommodate urine as it fills. The fuller it gets, the more the sphincter muscle around the urethra squeezes to keep the urine contained, explains Margaret Roberts, MD, PhD, director of the neurophysiology lab at Schwab Rehabilitation Hospital in Chicago. During delivery, the ligaments and muscles that support the bladder and urethra are stretched. In addition, there is a change in some of the enzymes and hormones that make ligaments elastic. Because the muscles and ligaments are weakened, urine may leak out, especially when a woman coughs, laughs, exercises, sneezes, or lifts something. These are all activities that physically stress the bladder, hence the name stress incontinence.
Women older than 35 and obese women are at greater risk for prenatal leakage of both varieties. After childbirth, the biggest risk factor for stress incontinence is having had a vaginal delivery, especially one involving forceps or other interventions that can injure pelvic nerves and muscles. A Norwegian study of 12,000 women found that among women who did not leak during pregnancy, 20 percent did so six months after a vaginal delivery, compared with 8 percent who had elective Cesarean sections. Among prenatal leakers, half who delivered vaginally were spritzing six months later, compared with 23 percent of those who had a C-section.
Urinary Incontinence Treatment
Though it might be tempting to schedule a C-section to lower your odds of urinary incontinence, experts advise against this. For one thing, susceptibility is to some degree genetic, and a substantial number of women who choose C-sections end up leaking anyway.
What's more, research shows, two decades after giving birth, women who delivered via C-section are no better off, leakage-wise, than women who delivered vaginally. "Things tend to equalize due to wear and tear and gravity," Goldberg explains. Besides, C-sections pose their own risks, to both mom and baby.
Here are some urinary incontinence treatment options:
These increase the strength and elasticity of your pelvic floor muscles. Here's a primer: Lie down, knees bent and legs parted. Tighten the muscles around your vagina and urethra as if you're trying to prevent urine or gas from leaking out. Place one hand on your lower abdomen and make sure you're not pushing or contracting your abdominal muscles. (If you're pushing down on your abdominal muscles or squeezing your thighs or buttocks, you're not doing the Kegels correctly.)
While breathing, tighten your vaginal muscles. Think of the pelvic floor as an elevator: Contract muscles in stages, rising to successive levels slowly, in intervals of five to ten seconds. Aim to accomplish sets of ten, three to four times a day, every other day.
If you're leaking while pregnant, Kegel exercises may not be enough to stop the spritz; experts believe that the weight of the uterus combined with pregnancy hormones make for an overpowering combo. But it still pays to start getting your pelvic-floor muscles in shape: Research suggests that after delivery, Kegel exercises, if done properly, can help minimize both stress and urge incontinence. "You can Kegel immediately, right in your hospital bed," says Missy Lavender, founder of the Women's Health Foundation, a nonprofit group that educates women about pelvic health.
(Note: If this approaches doesn't work, your doctor may conduct further testing to identify the problem. While stress incontinence is the most likely scenario in postpartum women, there are other possible causes, such as nerve damage, loss of muscular support, sphincter muscle problems, or injury to the bladder.)
Electrical Stimulation Therapy
In this technique, a gentle electric current is used to make the muscles in the pelvic floor contract like a Kegel, says Dr. Roberts.
The NeoControl is a comfortable chair that produces highly focused, pulsating magnetic fields. The pelvic floor muscles contract and relax with each pulse, strengthening in the process. The procedure requires going to the doctor's office twice a week for eight weeks for a 20-minute session. More than 20,000 women throughout the U.S. have used the chair, with impressive success rates.
If your leakage is persistent, you can be fitted for a pessary, a small silicone ring that acts as a "speed bump" for the urethra; you place it inside the vagina in the morning and remove it at night. Some women use a pessary only when they jog or play tennis.
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"Bladder Sling" Surgery
This surgery, which has a 90 percent success rate for stress incontinence, may be the best option for frequent leakage as long as you aren't planning any future pregnancies. In a quick, minimally invasive procedure, the surgeon inserts a U- shaped, mesh sling that permanently supports the urethra. What kind of treatment you seek depends on whether your activities are disrupted. Consider surgery, Mahajan says, "if you have to wear a pad every day or if you can't live the way you want to. Don't let your bladder rule your life."
Stitches are placed on both sides of the urethra through a horizontal skin incision on the bikini line. The stitches are then attached to a strong ligament that lies on the pubic bone, thus resupporting the bladder or lifting it back up into a normal position.
These can bulk up and strengthen the tissue around the urethra. (This procedure is not ideal for young, active women, because the collagen eventually dissolves – the results aren't permanent.)
Lifestyle changes can also help new moms regain bladder control.
Ease up on caffeine, alcohol, carbonated beverages, and spicy foods – they can irritate your bladder and make it contract more easily, says Dr. Roberts.
Stop smoking. Nicotine acts directly on the muscles of the bladder, causing it to spasm. Women who smoke also often have a chronic cough, which brings about more episodes of urine loss if you're incontinent.
Lose excess weight. Extra weight puts constant pressure on your pelvic floor muscles.