The silent struggle: Incontinence during and after pregnancy
What does pregnancy and postpartum incontinence involve and are you at risk?
Expecting a child is one of the most exciting phases of life and many women start planning for their new arrival as soon as they find out they’re pregnant. As the pregnancy progresses and specialist appointments increase, a health professional might bring up the topic of urinary incontinence – a not-so-often-talked-about but relatively common consequence of pregnancy and childbirth.
There are different types of incontinence, the main two being ‘urge incontinence’ and ‘stress incontinence’. Urge incontinence is the sudden need to urinate; stress incontinence is the uncontrolled leaking of urine during activities such as coughing, laughing and anything that pushes down on the bladder. Typically, stress incontinence is more commonly connected to pregnancy and childbirth.
Why does incontinence happen?
Different scientific studies report that anywhere between 18% to 60% of pregnant women will experience stress incontinence.
“There are a number of factors that put you at higher risk,” urologist Dr Dominic Lee from the Urological Society of Australia and New Zealand explains.
“If you’re older when you conceive incontinence is more probable, there is also a higher risk if you’re overweight.”
“Labour, too, can affect the post-partum outcome; for example, if a woman has an assisted delivery – i.e. forceps are used – the chance of incontinence after childbirth (postpartum) is increased.”
Some studies have shown that a caesarean delivery can decrease the odds of postpartum incontinence compared to a vaginal birth for a woman’s first birth. However, there are risks associated with caesarean delivery that outweigh this benefit when both mum and baby are healthy, including a longer recovery time for the mother.
“When a woman delivers a second child it’s hard to say whether a caesarean section decreases incontinence odds. By the third pregnancy, regardless if a woman has a vaginal birth or a caesarean section, the outcome is the same when we talk about postpartum incontinence,” Dr Lee explains.
Pregnancy and postpartum incontinence is less likely if you start your pregnancy at a healthy body weight, gain weight following the recommended guidelines and eat healthily, and keep active during your pregnancy.
Strong pelvic floor muscles can also reduce your risk of incontinence, so the Continence Foundation of Australia encourages all pregnant and planning-to-become-pregnant women to educate themselves about training these muscles.
“Pelvic floor muscle function is very important for maintaining continence, as well as sexual response and preventing prolapse,” says Fiona Rogers, a women’s health physiotherapist.
“Pelvic floor muscles respond to regular exercise just like other muscles, so in order for them to perform their job women need keep their muscles strong and flexible.”
Dr Lee recommends that all pregnant women attend antenatal classes to learn how to properly perform pelvic floor exercises, and emphasises that it’s essential you continue to practice the exercises throughout pregnancy and beyond.
After birth, you can register for an online course with The Pelvic Expert, which includes nutrition advice as well as pelvic floor exercises.
The reality is that even if you eat a healthy diet, exercise often and regularly practice your pelvic floor exercises, you might still find yourself with stress incontinence (or urge incontinence, or both) in the later stages of pregnancy and post birth.
Dr Lee explains that in most cases, pregnancy-associated incontinence will go away 3 to 6 months after childbirth as you recover and your muscles regain their strength.
For some women, however, incontinence will continue. If it happens to you, see your GP for a referral to a specialist urologist or gynaecologist, as corrective surgery may be an option*.
“Urinary incontinence is common,” says Rogers, but you can do something about it. “Don’t be embarrassed to ask for help sooner rather than later.”
*There’s been increasing concern about the adverse effects experienced by a number of Australian women who’ve received transvaginal mesh implants, a treatment for pelvic organ prolapse (a common cause of postpartum incontinence).
This surgery is currently being investigated by The Australian Commission on Safety and Quality in Health Care. Talk to your doctor if you have any concerns about a procedure you’ve had, or if you’re considering having the surgery.
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