Pregnancy can put extra strain on the bladder and bowels.
It is common knowledge that pregnant women urinate more often. This is partly due to the extra weight on their bladder, but many do not know that women can experience urinary incontinence during their pregnancy. For some, urinary incontinence continues or worsens after delivery of the baby, but for most, symptoms will go away after giving birth or shortly after the birth.
There are several reasons why pregnancy and childbirth can cause urinary incontinence. A vaginal delivery can cause incontinence due to a weakened pelvic floor from straining during labor, complications due to episiotomies, the number of pregnancies, and damage and tearing due to forceps or a large baby. Some studies also find that simply the extra weight of pregnancy can cause urinary incontinence as the pelvic muscles become quite supple during the pregnancy. There is also a hormonal shift during pregnancy, and during and after childbirth, which may contribute to urinary incontinence. Age and body mass index (BMI) can also contribute to urinary incontinence during pregnancy.
Some women may develop bowel incontinence after the birth of their baby. Bowel incontinence after delivery may be due to injury from episiotomies, injury to the pelvic floor muscles or muscles of the anus during a vaginal delivery, or nerve injury to the anal sphincter muscle during a vaginal delivery.
Pregnant women should discuss the affects of pregnancy and birthing on her pelvic floor with her healthcare provider. The provider can help weigh the risks and benefits of different birthing choices, and teach exercises that may help prevent incontinence.
Some possible preventative measures to discuss with your healthcare provider include:
Pelvic Floor Exercises
Many 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 help to prevent incontinence, they are usually recommended. Your healthcare provider should provide guidelines on how to perform these exercises. If you have problems locating your pelvic floor muscles, a specialized physical therapist will be able to help you perform these exercises properly.
Weight Gain During Pregnancy
Gradual and moderate weight gain during pregnancy is normal. However, an unhealthy weight gain or a high BMI before pregnancy begins puts a woman at a higher risk for developing urinary incontinence during pregnancy. Discuss with your healthcare professional what your planned weight gain should be during pregnancy. Obesity after delivery also contributes to urinary incontinence. If you are having trouble controlling your weight, ask for assistance and dietary guidance from your healthcare provider. Also, ask for exercise guidelines for your pregnancy, as exercise may help you with your weight gain. Get your healthcare provider’s guidance on what types of exercise would be best for you during your pregnancy, when you may do these exercises during your pregnancy, and how much exercise should be healthy for you and your pregnancy.
Ask your healthcare provider about walking and other forms of exercise during pregnancy.
Avoid 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, which can then be sewn closed, was better than the smaller tears. The National Institutes of Health now recommends that routine episiotomies no longer be performed as episiotomy does not prevent urinary incontinence.
Choice of Assisted Vaginal Delivery
Sometimes when delivery is difficult, the healthcare provider may turn to an instrument such as forceps or a vacuum extractor to assist with the delivery. Before your baby’s birth, discuss the pros and cons of these different devices should the need arise to use one during delivery.
Caesarean vs. Vaginal Delivery
Vaginal delivery does appear to be the most important predisposing factor for all pelvic floor disorders (urinary incontinence, bowel incontinence and pelvic organ prolapse). However, current evidence to support this comes from observational studies and not randomized controlled trials, which would compare different modes of delivery and the number of deliveries. If the mode of delivery is of great concern to you, please discuss this with your obstetrician.
Avoid Constipation
During and after pregnancy, keep your bowels working regularly. Drink plenty of fluids and make sure you are eating enough fiber. If you have problems with constipation, please discuss this with your healthcare provider.
Do Not Smoke
Smoking always irritates the bladder and can cause a chronic cough, which can trigger stress urinary incontinence.
While consumed with caring for a newborn, taking the time to seek treatment for incontinence may be the last thing a new mother wants to do. However, it is an important step for several reasons. First, it is important for your health to rule out any other conditions that may be the cause of incontinence. Second, early intervention can make a difference with incontinence. Research shows the success of post partum pelvic floor muscle exercises provided by a skilled medical professional (usually a specially trained physical therapist or nurse) in decreasing urinary incontinence. Incontinence may start as something “small and insignificant” but can gradually worsen until you look back and realize that it has affected your quality of life for some time. Ask your medical professional for a referral to a skill pelvic rehabilitation specialist if urinary leakage persists after delivery.
The type of urinary incontinence that is most often associated with pregnancy and childbirth is stress urinary incontinence. For more information, please read our section on stress urinary incontinence.
Medical Reviewer: Beth Shelly PT, DPT, WCS, BCB PMD
Dr. Beth Shelly
Dr. Shelly is a Doctor of Physical Therapy and has been practicing in the Quad Cities of Illinois and Iowa for over 25 years, specializing in women’s and men’s health. She has board certifications in Pelvic Muscle Dysfunction Biofeedback and as a Women’s Health Specialist. She has authored nine professional chapters and multiple articles in the field of women’s health. She has taught over 100 three-day CEU courses mostly on Pelvic PT / gynecology / urology and has sat on several national and international boards. She speaks internationally and currently is working to develop distance-learning methods for pelvic physical therapy. She has an active blog reviewing Pelvic PT literature and a monthly distance journal club. She has a private practice treating outpatients with various pelvic floor and obstetric dysfunctions in Moline, Illinois. She offers individual phone mentoring and private on site courses. She 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.