Pregnancy incontinence

One of the often unspoken side effects of pregnancy and childbirth is the unexpected - and inconvenient - leaking of urine that can happen to mums when they cough, sneeze or laugh. Incontinence shouldn't be embarrassing as it's extremely common, affecting between 30-50% of new mums.

What is incontinence?

There are several types of incontinence (or bladder weakness) but stress incontinence is the most common form to affect women during and after pregnancy. This is when you leak a little urine when you laugh, sneeze, cough, run, jump or even lift heavy things.

As many as 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 as a result leak before you can get to the bathroom.

Women older than 35 and obese women are at greater risk for pre- and postnatal leaks.

What are the causes of incontinence?

The weight of pregnancy is a major contributor. During the third trimester the uterus rests on the bladder and its supporting ligaments, causing the ligaments and surrounding muscles to stretch.

When those structures become too relaxed they're less effective at supporting the bladder, which in turn can lead to bladder weakness.

Compounding the problem are the hormones that make your tissues and joints more elastic and ready for delivery. These hormones can weaken the muscles that control the release of urine from your bladder and this stops them from working properly.

Constipation, which is common in pregnancy can also put a strain on your pelvic floor.

If you had a vaginal delivery, the stretching that can occur during the birth, can make the problem worse.

Even if you have a caesarean birth you can still experience incontinence as the stretching and weakening of the muscles will have taken place during pregnancy.

How long does it last?

In most cases, women find they are in control again within three to six months, after their body has had a chance to recover.

Is incontinence preventable?

Strengthening your pelvic floor muscles will help to prevent incontinence after your baby has been born.

Your pelvic floor muscles not only support your bladder and other organs in the pelvis, but also control the flow of urine when you wee.

Pelvic floor exercises are important even when you are not pregnant because, like any other muscle group, these muscles will become flaccid if they are not used. If this happens you are much more likely to suffer from incontinence.

To strengthen your pelvic floor muscles draw in the muscles around your back passage, as if you are trying to avoid passing wind, while pulling up the muscles around your vagina as if you were stopping the flow of urine; hold for a few seconds, then repeat eight times – at least three times a day.

How can I avoid having an accident?

Changing your diet may help reduce incontinence. Alcohol, caffeine, foods containing a lot of acid such as grapefruit, and spicy foods can all irritate your bladder.

Avoid getting constipated (by drinking lots of water and eating plenty of fibre) as the pressure of a hard bowel movement can contribute to bladder problems).

Losing weight if you are overweight can also help.

Drink plenty of water. The more concentrated your urine is, the more irritating it is to your bladder. Try to drink enough so that your urine is pale-yellow or clear.

Cross your legs if you feel a sneeze or cough coming on!

Are there any medical solutions?

There are medicines and medical devices that can help when pregnancy is over and incontinence is persistent.

If your GP feels that you need specialist help you may be referred to a continence adviser – a nurse specialising in problems with the urinary system in women.

Alternatively, you may see a physiotherapist who specialises in this area or a specially trained nurse at your GP surgery.

If the problem is severe you may be referred to a Consultant Urogynaecologist for further assessment.