About Incontinence - Contributing Factors - Pregnancy and Childbirth
Medical Reviewer: Beth Shelly PT, DPT, BCIA-PMDB
It’s pretty common knowledge that pregnant women urinate more often due to the extra weight on their bladder, but a surprising fact some people don’t know is that many women experience urinary incontinence during pregnancy. Often that incontinence will worsen after delivery. Usually symptoms will dissipate after giving birth, but for some women the urinary incontinence continues.
Why?
There are several reasons why pregnancy and childbirth can cause incontinence. While a vaginal delivery can cause incontinence (straining on the pelvic floor during labor, complications due to episiotomies, and damage and tearing due to forceps or a large baby), some studies also find that simply carrying the weight of pregnancy can cause incontinence. There is also a hormonal shift during pregnancy and during and after childbirth that may contribute to incontinence.
Prevention
It is important for a pregnant woman to discuss the affects of pregnancy and birthing on her pelvic floor with her health care provider. Your provider can help you weigh the risks and benefits of different birthing choices, and teach you exercises that may help prevent incontinence. Some possible preventative measures to discuss with your provider include:
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Pelvic floor exercises: Several studies have looked at whether doing pelvic floor exercises during pregnancy can reduce the chance and severity of incontinence both during and after pregnancy. The studies have conflicting results (some say it helps, some say it doesn't make a difference), but most experts agree that doing pelvic floor exercises doesn't hurt anything, and since it may indeed help to prevent incontinence, they are usually recommended.
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Avoiding routine episiotomies: An episiotomy is a small cut made to the perineum to open up the vagina and reduce the small spontaneous tears that can happen as the baby crowns. Originally it was thought that one larger cut that can then be sewn closed was better than the smaller tears. The National Institutes of Health now recommends, for the sake of preventing incontinence, that routine episiotomies no longer be performed.
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Choice of assisted vaginal delivery: Sometimes when delivery is difficult, the health care provider may turn to an instrument such as forceps or a vacuum extractor to assist with the delivery. Before your birth, discuss the pros and cons of these different devices should the need arise to use one during delivery.
Treatment and Management
While consumed with caring for a newborn, taking the time to seek treatment for incontinence may be the last thing a new mom wants to do, but it is a very necessary and important step for several reasons. First, while the pregnancy and/or labor and delivery probably contributed to the incontinence, only a qualified health professional can tell you that for sure, and it's important for your own health to rule out any other conditions that may be the cause. Second, sometimes early intervention can make a difference with incontinence - for example, treating pelvic organ prolapse before it gets worse. Third, incontinence can easily start off as something "small and insignificant" and gradually grow worse until you look back and realize that it's affected your quality of life for quite some time. Some treatment and management options to discuss with your health professional are available HERE.
For More Info
The type of incontinence that is often associated with pregnancy and childbirth is stress urinary incontinence. For more information, please read about stress urinary incontinence.
Beth Shelly is a Doctor of Physical Therapy practicing in the Quad Cities of Illinois and Iowa. She has practiced for over 20 years, specializing in women's and men's health. She currently practices in Moline, Illinois and is available for private instruction, mentoring and lectures.
Beth has been widely recognized in her field and is the 2007 recipient of the Elizabeth Noble award for leadership and dedication from the Section on Women’s Health of the American Physical Therapy Association.
Page last modified 25 July 2009