What Is Postpartum Urinary Incontinence
Postpartum urinary incontinence is involuntary leaking of urine that can occur after pregnancy and childbirth.
You may experience this loss of bladder control while laughing, sneezing, coughing or performing a strenuous activity, and it’s very common after giving birth. In fact, it’s estimated that about half of adult women may experience postpartum urinary incontinence.
Some women experience urinary leakage associated with urgency that gotta go sensation. Others actually experience both types of leakage.
Behind Postpregnancy Problems With Oab
During your pregnancy, you may have developed some minor issues with incontinence, which makes sense given that your growing baby placed more pressure on your urinary tract, namely on your bladder and on your bladder sphincter.
In many cases, these incontinence problems resolve themselves shortly after childbirth, but many women are left with ongoing OAB, which may be caused by:
- A weakened pelvic floor
To put some numbers to the problem, at least 40% of women in the United States have OAB, mainly due to pregnancy and menopause.
When Should Women See A Doctor About Postpartum Incontinence
Women should talk to their doctor or a female pelvic health specialist six weeks after delivery if they had incontinence before, during or after pregnancy. Regular, unintended urine leakage may mean a woman has another medical condition. The loss of bladder control should be treated sooner rather than later, or it can become a long-term problem.
Episiotomy considerations
We have a postpartum pelvic floor program uniquely designed to help women who experienced third- and fourth-degree anal sphincter lacerations during delivery. Women will meet with our pelvic floor physical therapists and begin therapy treatment 6-8 weeks post-delivery.
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Pelvic Floor Safe Exercise
Pelvic floor safe exercise is vital for new mums seeking to get back into shape. After pregnancy and childbirth women are at increased of pelvic floor injury with inappropriate exercises that overload the pelvic floor because their pelvic floor muscles are often weak and not working to support the pelvic organs as well as prior to pregnancy.
Pelvic floor safe exercises for new mums involve low impact general fitness exercises , appropriate core abdominal exercises and pelvic floor safe strength training exercises. New mums, particularly those with prolapse problems will benefit from avoiding high impact exercises, intense core abdominal exercises and heavy weight-loaded strength routines to avoid worsening of their prolapse.
What Causes Bladder Control Loss In Women After Pregnancy And Childbirth
There are several things that can cause you to experience a loss of bladder control after having a baby, including:
- Pelvic organ prolapse: If the muscles around your bladder become weak, the organ can actually slip out of position. This condition is called cystocele.
- Pelvic nerve damage: The pelvic nerves that control your bladder function can get injured during a long or difficult vaginal delivery.
- Injury during delivery: Sometimes, delivery with forceps can result in injuries to the pelvic floor muscles and anal sphincter muscles.
- Injury because of prolonged pushing: Prolonged pushing during a vaginal delivery can also increase the likelihood of injury to the pelvic nerves.
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Is It Normal To Experience Problems After Childbirth
It is very common for women to experience some birth trauma, physically affecting the pelvic floor and vagina. The vast majority of women recover completely and have no ongoing problems in the long-term, though we would always recommend that women continue to do their pelvic floor exercises to help to prevent problems later in life, such as incontinence or prolapse.
A small minority of women experience ongoing problems after childbirth including pain, scarring, or heaviness in the vagina, which may be uncomfortable. This can also affect sexual function and cause great distress, which should not be ignored.
Not all women require a surgical solution to their pelvic floor problem. Our care is tailored to your individual symptoms and expectations. We also take into account any plans for future children when deciding what treatment to recommend.
The Proper Way To Kegel
Verbal or written instructions alone don’t necessarily help patients know whether they’re doing Kegel exercises properly.
When we see patients for urinary incontinence, we provide education and instruction. We often recommend one to six sessions of supervised Kegel exercises with a female pelvic medicine and reconstructive surgery doctor, a pelvic floor physical therapist, or another provider who has expertise in pelvic floor disorders. While physical therapy or other medical visits usually are not covered by insurance for preventive purposes, they usually are once a problem develops.
In these appointments, your provider will describe how to locate and engage the pelvic floor muscles. The provider will gently press on the pelvic floor muscles with a gloved exam finger inside your vagina and ask you to squeeze the muscles. The muscles will be identified as described. Make sure youre not squeezing your stomach, legs, or gluteal muscles at the same time, and dont hold your breath.
Some patients benefit from holding a mirror between the legs to visualize the external anatomy during the exercise. When done properly, you should see the area between your vagina and anus lift toward your upper body.
Doing Kegel exercises regularly is key to strengthening the pelvic floor. We recommend women do 10 repetitions, holding each squeeze for 5 to 10 seconds, three times each day.
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Changes To The Appearance Of The Labia
The labia minora are the flaps of skin which are found on either side of the opening of the vagina. After childbirth, the labia may be traumatised. As a result, one of the labia may appear scarred or reduced in size, when compared to the other. Labial enlargement can also occur after childbirth which may be present on one or both sides.
Enlargement of the labia may cause stress and discomfort. The increase in size may mean they are more likely to catch on clothing, make wearing certain types of underwear uncomfortable, make sex painful, or cause discomfort when sitting down. Additionally, the appearance of enlarged or damaged labia may affect a womans self-confidence or sexual libido, causing intimacy issues.
If the appearance or feeling of your labia is causing you problems, you might wish to consider labiaplasty, which is a surgery used to reduce the size of the labia minora. This can be done for several reasons, including the size and shape causing discomfort, or simply because a woman does not like its appearance. Many health professionals discourage labiaplasty for purely cosmetic reasons and as such, it is a major decision which one should consider very carefully.
How Do You Use A Pessary
Pessaries can be a great option for urinary incontinence if youre looking for a quick and simple fix.
First, your doctor should perform a physical exam to identify the severity of your postpartum urinary incontinence.
This is because some pessaries may only provide temporary relief while others work better for more significant leakage.
Your doctor will probably fit you for a pessary by having you place one hand on your lower abdomen and feeling your pelvic floor muscles contract. This is so they know where to place the device within the vagina.
Next, theyll pull down your underwear and insert a speculum into the vagina so that they can get a better view of the vaginal walls.
Afterward, theyll slowly peel your skin away from your bladder and insert a pessary into the vagina. They should also use a ring to secure it against the wall of the vagina.
In most cases, this is a quick, non-invasive procedure that can be repeated as needed to help you maintain your normal activities. These should only be worn during the first six weeks after childbirth while you recover, and should not be left in for more than 12 hours at a time.
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What To Expect After Childbirth
Expect your nurses to be very interested in when youre ready to pee and how much urine you pass when you do use the bathroom. They want to feel like your bodys basic functions are returning to normal before they release you.
Again this is similar to any surgery they want you to pee, or they want to hear youve got gas or you tummys rumbling, that your appetite is returning etc.
Your nurses or doctors will want you to pee within 6 to 8 hours of delivery and after youll go, theyll want to see how much urine youve passed. They may also measure the bladder for distension .
If you do not manage to urinate within the designated timeframe, your healthcare providers may use a catheter to drain your bladder. Theyll be on the lookout for signs of a urinary tract infection as this is sometimes the reason new mothers cannot pee postpartum.
Even if you manage to pee and are cleared for release, continue to pay attention to urination and any unusual sensations as your body heals. You should feel that you are making a sure return to normally. If youre only able to pee small amounts, if theres pain or a burning sensation or if you experience a fever, make sure to book an appointment to see your doctor.
Similarly, if you feel you cant control leakages and are experiencing incontinence, chat with your doctor.
Avoid Excess Caffeine Intake
The effects of caffeine on the bladder are twofold. Caffeine irritates the muscles of the bladder, which can cause muscle spasms that increase the frequency and urgency of urination. Caffeine is also a mild diuretic, which means that it increases the amount of water released in urine.
It may be worth avoiding beverages that are high in caffeine, such as coffee, energy drinks, or green teas. Instead, opt for beverages that are decaffeinated or contain no caffeine, such as water or herbal teas.
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Can Episiotomy Lead To Anal Incontinence
Just before the delivery of the baby’s head, an incision may be made by the doctor in the skin and, sometimes, also in the muscle at the bottom portion of the vagina to allow more room for the baby to deliver. This incision, called episiotomy, is supposed to avoid incidental tearing of the vagina or rectum as the baby delivers. Episiotomy is a recent practice, devised in order to substitute a straight, clean, easy-to-repair surgical incision for the jagged tear that might otherwise occur. Cutting this incision is also intended to shorten labor by giving the baby’s head more room so delivery might be easier and faster. It was thought that faster delivery would decrease the risk of injury to the mother’s bladder, and would be gentler for the baby’s head. However, studies show no evidence that these assumptions are true.
The Following Conditions May Also Add To Postpartum Bladder Control Problems
- Damage to the nerves that control the bladder, rectum and pelvic floor muscles.
- Movement of the urethra and bladder from their usual position.
- Having an episiotomy or experiencing a tear in the pelvic floor muscle during delivery.
- Undergoing an assisted vaginal delivery with either forceps or a vacuum, which can damage the pelvic floor and anal sphincter, leading to urinary or fecal incontinence.
Incontinence is common in new moms but can also develop in the months and years after childbirth some women dont experience problems until their 40s. Whenever postpartum incontinence issues begin to develop, women should consider making an appointment with a female pelvic health specialist. We offer many treatment options that can improve the mothers quality of life.
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If Stress Incontinence Is Bothering You Start With Your Obstetrician
Your doctor will want to get a handle on the details of your urinary problems and how theyre affecting your life. Shell most likely perform a pelvic exam, test your urine to rule out infection and ask you about symptoms that might signal other pelvic floor disorders, said Dr. Megan Schimpf, M.D., an obstetrician-gynecologist specializing in female pelvic medicine and reconstructive surgery at Michigan Medicine.
Doctors may recommend that you keep a voiding diary, or an everything in, everything out record of your liquid intake and when and how often you empty your bladder. If you are peeing three times a day, you may need to do it more often to avoid leakage, Dr. Lukacz said. And you can cut down on excess liquid consumption and on caffeinated, alcoholic or carbonated drinks to see if that helps. Because obesity is a strong risk factor, keeping weight in check can help, too.
Your doctor may also prescribe Kegel exercises to strengthen your pelvic floor muscles. Some women can activate those muscles and see improvement on their own, but the exercises have to be done correctly to see improvement, said Dr. Handa, who often recommends a supervised exercise program with a physical therapist or nurse practitioner trained in pelvic health.
Take A Virtual Tour Of Our Labor & Delivery Suites
Before your big day arrives, get a preview of the accommodations for new moms at UT Southwestern’s Clements University Hospital. From the chef-prepared meals to the roomy, high-tech labor and delivery suites, we want to make sure that you, your baby, and your family have the opportunity to bond in a safe and soothing environment.
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Medical Treatment Is Also An Option
If lifestyle changes dont work, your doctor may prescribe medication to make sure that the muscles around your bladder are contracting properly.
Surgery might even be necessary if lifestyle changes and medications dont seem to help.
This is definitely an option that you dont want to consider though.
When you have very weak bladder control, surgery can help to make sure that the muscles around your bladder are contracting properly. It also helps to make sure that there isnt any damage to your bladder or urethra which could lead to incontinence issues later on down the road.
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What Role Does Forceps Delivery Play In Incontinence
Forceps increases the risk of injury to the nerves and muscles of the pelvis. Forceps are the spoon-shaped metal instruments that are sometimes inserted into the mother’s vagina and placed around the baby’s head at the time of delivery. These instruments are usually used after a long or difficult labor to help deliver a baby. As the doctor pulls on the forceps, they push away the muscles and soft tissues in the pelvis, allowing more room for the baby to come out. The forceps also help the doctor to pull the baby out, especially if there is a tight fit. However, because the instruments are made of metal and take up space of their own, they increase the risk of stretching and tearing the vagina and supporting tissues of the pelvis. They also put more force against the nerves that run inside the pelvis. As a result, more harm can be done to the tissues, possibly resulting in long-term damage and eventual incontinence.
Because there is a risk of complications with forceps to mother or baby, they should probably not be used to deliver a baby unless there is a rapid drop in the baby’s heartbeat, severe bleeding or other emergency that dictates a quick delivery.
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Pregnancy Childbirth And Incontinence
When you go through pregnancy and childbirth, several things can lead to incontinence problems, including:
- Weakening of the pelvic floor muscles
- Damage to nerves controlling your bladder
- Movement of your bladder and urethra during pregnancy
You also experience specific hormonal changes that prepare your body for childbirth. These changes, which are important because they increase the elasticity of your joints and tissues, also reduce bladder support.
For many women, urinary incontinence issues resolve within a year of childbirth. However, 30-50% report still having unwanted urinary leakage five years after delivery.
Types Of Pregnancy Incontinence
The two main types of urinary incontinence in pregnant women are stress and urge incontinence .
Stress incontinence is the most common form of pregnancy incontinence and includes involuntary urine leakage that result from a weakened pelvic floor. Your pelvic floor is the system of muscles, ligaments and tissue that supports your bladder, uterus and anus. When it is weakened, the bladder will give way when increased pressure â or stress â is applied to it, leading to a sprinkle of urine escaping the bladder.
Urge incontinence is a result of nerve or tissue damage to the bladder that results in frequent, sudden and intense urges to urinate. During pregnancy, weight from the uterus can press on the nerves leading to the bladder, causing it to spasm and sending you running to the bathroom.
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Why Does Your Bladder Get Weak
There are many reasons why someone has a weak bladder. Here are some of the most common causes:
- Pregnancy This is the most common cause of having a weak bladder for women that are not able to control their bladders at all during pregnancy, especially during the last months.
- Childbirth Giving birth is also another common cause of women not being able to control their bladders after they gave birth. During childbirth, you can seriously injure your bladder and it will never be the same again.
- Age When you get older, you lose muscle tone. For women, this is more common after they have children. After childbirth, your muscles are stretched out and you lose tone.
- Diseases When people get diseases that affect their nervous systems or abdominal organs, it can cause them to not be able to control their bladders. This is especially true if the person has had a stroke or a spinal cord injury.
- Nerve damage Sometimes, people can lose the nerve that makes them able to control their bladders after they have had surgery on their prostate. This is pretty common for older men.