By: Jeffrey Ulrich, MD
Babies and bladders have a relationship that expectant mothers typically learn about in their third trimester of pregnancy when running to the restroom becomes the norm. But for most first-time moms, it’s important to know that the effects of that relationship can linger well beyond delivery day.
Childbearing is a leading cause of stress incontinence and overactive bladder in women, and partly why urinary incontinence affects twice as many women as men. For 55% of new mothers, pregnancy-onset incontinence persists a full year after the baby is born, research shows.
And the more children a woman carries, the higher the incidence of OAB and incontinence. For some, the condition can become chronic.
WHY ALL THE STRESS INCONTINENCE? BLAME THE PRESSURE
When the bladder is compressed, such as by the weight of a developing baby, its sphincter muscle is overtaxed and can’t hold back urine as well. Even a sneeze or cough can exert enough added pressure to cause the bladder to leak.
Further, the pressure of the developing fetus can overburden the muscles of the pelvic floor as well, which can contribute to overactive bladder – when the bladder has uncontrollable spasms. This condition can persist after pregnancy.
Other pregnancy-related events that can cause bladder-control issues include:
- Damage to the nerves that control the bladder.
- A shift of the urethra and bladder during pregnancy.
- An episiotomy (a surgical cut of the pelvic floor muscle during delivery).
- A rise in the level of the female hormone progesterone, which relaxes muscles so the baby can expand, but also can loosen pelvic floor muscles.
EXPECT THE PRESSURE, AND BUILD MUSCLES FOR IT
Among the best steps an expectant mother can take to prevent incontinence is to strengthen the pelvic floor muscles early on (even when planning a pregnancy).
These exercises, called Kegels, can be done pretty much anywhere. Simply tighten the vagina muscles and hold them while counting to 10, then release them to the count of 10. Kegels can be performed in sets of 10 in the morning, afternoon, and evening.
If the mother still experiences stress incontinence or OAB, these practices can help:
Bladder training. With this approach, the expectant mother holds off on urinating for a few minutes when the urge to go strikes. With each following trip, she adds a little more time, lengthening the intervals.
Tracking voiding time. The mom-to-be can keep a record of the times she urinates and when she leaks, to establish her incontinence pattern. She then uses this pattern to prepare for trips to the bathroom, avoiding leakage.
TREATMENT OPTIONS IF PREVENTION ISN’T ENOUGH
Sometimes, 1,000 Kegels can only go so far in preventing or improving female incontinence, especially as women enter menopause.
If incontinence or OAB becomes chronic, a physician can suggest a range of approachable treatments. Among the common options:
Some drugs can help suppress the involuntary muscle contractions surrounding the bladder that trigger OAB. Estrogens, antidepressants, and nerve-stimulating drugs also have proven to reduce symptoms.
- Injections – Certain synthetic compounds (polyacrylamide gel) can be effective at improving the function of urethral muscles. Botox, known for cosmetic uses, can improve bladder function as well, by partially paralyzing the bladder muscle enough to reduce overactivity.
- Posterior Tibial Nerve Stimulation (PTNS) – During this ongoing outpatient treatment, the physician stimulates the posterior tibial nerve (near the ankle), which runs up to the sacral nerves that control the bladder and pelvic floor muscles.
- Urethral slings or vaginal tape – This option involves placing supportive mesh tape, or the patient’s own tissue, under the urethra to hold it in position like a sling. This enables the urethra to remain closed during a cough or sudden movement.
- Sacral nerve stimulation – In this procedure, a small pacemaker-like device is implanted through a tiny incision near the tailbone, to regulate and calm the nerves that control the bladder.
UNSURE OF THE BEST TREATMENT FOR YOU? ASK A DOCTOR
Even though millions of women experience urinary incontinence and OAB, to many it is an embarrassing condition. They shouldn’t be afraid to seek care. We talk to patients about incontinence every day (and yes, some of us live with it, too!).
It may be time to call a doctor. When you share your symptoms with us, it helps us manage the condition better, meaning you can help future generations of women, too.