It is estimated that 63 percent of women with stress incontinence say their symptoms began during or after pregnancy.
Being pregnant brings many health complications. It is known that pregnancy can cause morning sickness, weight transitions and hormonal complications. These problems are so well documented that there are many websites and forums dedicated to helping women with these.
However, a less glamorous and less well-known problem is incontinence during pregnancy. Embarrassing, misunderstood and socially a taboo, many women feel restrained from talking about this. When pregnant women experience this, it can come as surprise. A 2014 study investigated the incidence of incontinence during pregnancy in nulliparous women. It concluded that incontinence is one of the most common disorders during pregnancy that can affect women’s quality of life.
So What Causes Incontinence During Pregnancy?
The most common cause of pregnancy-related urinary incontinence is weak pelvic floor muscles. This interferes with the normal way your urethra relaxes and contracts. Studies in pregnant women with SUI have found significantly decreased pelvic floor strength in incontinent pregnant women in comparison to continent pregnant women. These muscles span the bottom of your pelvis. In pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and the pelvic floor muscles can be overwhelmed by extra stress put on the bladder. When pressure inside the bladder is greater than urethral closure pressure, urine leaks out when there is additional pressure exerted. Stress incontinence can cause leakages to occur when a pregnant woman does exercise or an activity that puts pressure on the bladder such as coughing.
The second main cause of incontinence during pregnancy may come as a surprise. Scientific studies have shown that changes in hormones during pregnancy can also cause stress incontinence. Pregnant women have elevated levels of the hormone relaxin, which is needed to allow expansion as the baby grows. The hormone called relaxin acts to relax the connective tissues during pregnancy and they never quite return to their normal state. Relaxin allows ligaments to soften and stretch during pregnancy, affecting the ligaments supporting the pelvic floor and urethra.
Increased uterine weight is another huge important factor affecting the frequency of leakages during pregnancy. Uterine weight exerts pressure on the bladder and often irritates the bladder. In the later stages of pregnancy, the descent of the fetus can dramatically worsen bladder irritation. Experts over the years have looked into the bladder capacity in each trimester of pregnancy. The available bladder capacity in the first trimester of pregnancy is 410ml. Bladder capacity in the third trimester, however, dramatically reduces to 272ml. This, combined with increased irritability of detrusor muscles, can cause annoyance and cause those embarrassing frequent leaks. The uterine position also plays a significant role in reducing continence. The impacted position of the uterus causes fluid retention as it interferes with the obliteration of the posterior urethrovesical angle. Similarly, gaining excessive physiological weight may also lead to weak pelvic floor muscles. Studies have proven that excess maternal weight gain can impair blood flow and innervations to the bladder and urethra. Researchers Zhu et al discovered that the risk of stress incontinence dramatically increased with increasing prenatal body mass index.
Several studies have also reported a decrease in the total collagen content in women with stress incontinence. Collagen is the main structural protein found in skin and other connective tissues. It helps to heal your gut and digestive lining, preventing leakages. It can also help your stomach to successfully digest foods. However, it has also been proven to assist in preventing urine leaks. Keane et al showed that pregnant women with stress incontinence had much less collagen content in their tissues than continent pregnant women. It is thought that collagen injections are highly successful in treating stress incontinence in pregnant women. In a study of 55 women with this problem, researchers form Kumatoma University in Japan found that injecting collagen protein on both sides of the urethra relieved symptoms in two-thirds of the patients for longer than a year.
Are there any Risk Factors for Developing Stress Incontinence?
The following factors are known to increase your chances of having incontinence whilst pregnant:
-Having a family history of incontinence
-Having a higher body mass index
– Gaining more than the recommended amount of weight during pregnancy
– Being over 35 when pregnant
Experts have also identified that smoking, obesity, pre-pregnancy incontinence and Diabetes are also risk factors.
The Psychological Impact of Pregnancy-Related Incontinence
Incontinence during pregnancy has been proven to cause depression, anxiety and reduced quality of life. A study by Barbara Broome showed that women with stress incontinence are more likely to report a poorer quality of life and reduced self-efficacy. The goals of an individual can be heavily impacted by individual self-efficacy. It is therefore important to pluck up the courage and talk to a Doctor about an ideal treatment method.
How can you treat pregnancy-related stress incontinence?
Pelvic floor muscle exercises are the most common method of treatment for stress incontinence. This is a natural method of strengthening the pelvic floor muscles. You can learn how to do pelvic floor muscle exercises here.
Watching your weight is another key lifestyle change that can help you improve your symptoms of stress incontinence. Women with a higher body mass index have a much higher risk of having severe leakages. Gentle exercise can help you to maintain a healthy weight. You can have a look at our guide to exercising with stress incontinence if you are worried about this.
No matter how tempting it is, do not stop drinking liquids due to incontinence! Dehydration can only further irritate the bladder, which will worsen your symptoms. The ideal liquid for managing incontinence is water. Alcohol, caffeine, acidic and spicy foods are all known to irritate your bladder. If you find water unenjoyable, a very thin lemon slice can improve the taste. To avoid getting constipation, ensure you eat plenty of fibre. The pressure of a hard bowel movement can often contribute to bowel problems, so you should try and avoid this.
If conservative treatments do not work, you can ask your Doctor about your options of bladder surgery for stress incontinence.
Do you want to know more about treating stress incontinence? Read our blog on managing stress incontinence for more information.