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Pregnancy Incontinence: Why It Happens and What to Do

What is pregnancy incontinence?

Frequent urination is one of the earliest signs of pregnancy. Leaking urine, or incontinence, is also a common symptom during and after pregnancy. About 54.3 percent of pregnant women report negative effects on their quality of life, including travel and emotional areas. Symptoms can increase as the baby grows and last a few weeks after birth.

There are several types of urinary incontinence:

  • stress incontinence: loss of urine due to physical pressure on the bladder
  • urgency incontinence: loss of urine due to an urgent need to urinate, commonly caused by bladder contractions
  • mixed incontinence: a combination of stress and urgency incontinence
  • transient incontinence: temporary loss of urine due to a medication or a temporary condition, such as a urinary tract infection or constipation

Learn more about why you may have incontinence during or after pregnancy, what it means for you and baby, and how you can cope.

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Q&A

Is it urine or amniotic fluid?

  • How can I know if I’m leaking urine or amniotic fluid?
  • Short of going to the hospital to test the fluid, you can check how the fluid leaks. If it’s appearing intermittently and in smaller amounts, it’s probably urine. Most of the time when amniotic fluid leaks, it comes in much larger amounts (often described as a “gush”) and persists continuously. The presence of a white waxy or dark green substance is also indicative of amniotic fluid.

    - Michael Weber, MD
  • Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Causes

What causes pregnancy incontinence?

Your bladder sits right above your pelvic bones and is supported by your pelvic floor. It relaxes and fills with urine throughout the day while the sphincter keeps the organ closed until you can use the bathroom. During pregnancy and childbirth, your pelvic floor muscles are put to the test.

Common causes of pregnancy incontinence include:

Pressure: You may leak when you cough, sneeze, exercise, or laugh. These physical movements put extra pressure on your bladder, which causes stress incontinence. Your baby also puts extra pressure on your bladder as they grow bigger.

Hormones: Changing hormones can affect the lining of your bladder and urethra.

Medical conditions: Some medical causes for incontinence include diabetes, multiple sclerosis, anxiety medications, or a stroke in the past.

Urinary tract infections (UTIs): Between 30 to 40 percent of women who didn’t treat their UTI completely will develop symptoms during pregnancy. Incontinence is a symptom of UTI.

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Treatment

What are the treatment options for pregnancy incontinence?

The first lines of treatment for pregnancy incontinence are lifestyle changes and bladder management. Here are some tips for managing your bladder:

Do Kegels: Kegel exercises to strengthen your pelvic floor. They’re a safe and effective exercise before, during, and after pregnancy. To do a Kegel, focus on the muscles you use to hold in urine. Squeeze them for ten seconds before relaxing. Aim to do five sets of these exercises per day. Learning how to relax your pelvic floor may help during and after labor.

Create a bladder diary: Jot down when you notice the most leaks so you can plan your trips. This is also the first step to bladder retraining. Bladder retraining is about re-teaching your bladder to hold more urine by extending time between trips.

Avoid carbonated or caffeinated drinks: Avoid carbonated drinks, coffee, or tea. These beverages may make you feel like you need to use the bathroom more often. Try drinking more water or decaffeinated drinks.

Avoid drinking at night: Limit your beverages in the evening to avoid frequent trips to the bathroom and leaking at night.

Eat a high-fiber diet: Eat foods that are high in fiber to avoid constipation, which puts added stress on your pelvic floor.

Maintain a healthy weight: Extra weight, especially around your abdomen, increases pressure over your bladder. Losing weight after labor can also help with incontinence after pregnancy.

Read more: Natural remedies for an overactive bladder »

Discuss any big changes with your doctor to make sure you’re doing what’s best for yourself and your baby. While medication and surgery are also options for incontinence, you may want to wait until after your pregnancy.

Tips for preventing UTIs

Do
  • drink plenty of water, up to eight glasses per day
  • urinate before and after having sex
  • wipe from front to back after urination
  • wear cotton fabrics and loose fitting clothes when possible
  • change your underwear each day

Contact your doctor if you think you have a UTI. An untreated UTI can lead to a kidney infection, which may also cause early labor and a low birth weight.

Don't
  • engage in intercourse while you have a UTI
  • drink beverages that irritate the bladder, like fruit juices, caffeine, alcohol, and sugar
  • hold your urine for long periods of time
  • use strong soaps, douches, sprays, or powders
  • wear the same underwear for more than a day

Treatment for a UTI involves antibiotics for three to seven days. This treatment is safe for your baby. Call your doctor if you have side effects, such as a fever, chills, or cramps, after taking your medication.

Risk factors

Are some women more at risk for pregnancy incontinence?

Women who already have an overactive bladder or urgency incontinence will likely have symptoms that continue or worsen during pregnancy.

Other risk factors include:

  • older age
  • being overweight
  • having previous vaginal delivery
  • having previous pelvic surgery
  • smoking, which leads to chronic coughing

Causes after childbirth

Giving birth can contribute to incontinence after pregnancy. During vaginal delivery, muscles and nerves may be injured. A long labor or prolonged pushing can increase the likelihood of damage to nerves as well. The American Congress of Obstetricians and Gynecologists recognizes that cesarean delivery reduces incontinence during the first year. However, the benefits go away two to five years after delivery.

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Diagnosis

How is pregnancy incontinence diagnosed?

Tell your doctor if you’re experiencing incontinence. In some cases, it may be a UTI and you may need antibiotics. If you’re near the end of your pregnancy, you may also confuse leaking urine with leaking amniotic fluid. It’s best to check with your doctor so you know the exact cause.

If signs of labor and infection are cleared, your doctor may perform other tests. A bladder scan using ultrasound can help see if your bladder is emptying the whole way. A bladder stress test allows your doctor to see if you have leaking when you cough or bend down.

If your doctor suspects you have a UTI, they will likely ask for a urine sample for lab testing. This may require you go to your hospital’s lab instead of your usual office. Your doctor may also perform special tests to check if the fluid you’re leaking is from your water breaking.

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Outlook

Does incontinence go away after the baby is born?

Approximately 70% of women will improve enough so they are satisfied with their bladder control.
Dr. May Wakamatsu, director of female pelvic medicine and reconstructive surgery at Massachusetts General Hospital

Some women’s incontinence symptoms go away in the days or weeks after their baby is born. For others, the leaking continues or may get worse. However, incontinence can be managed with first line treatments such as Kegels, bladder retraining, weight loss, and exercise.

Speak with your doctor about your concerns, especially if lifestyle changes don’t work or you’re still experiencing incontinence six or more weeks after delivery. You may want to consider other treatments such as medications and surgery after your pregnancy.

Read more: Female urinary stress incontinence treatments »

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Prevention

How can you prevent pregnancy incontinence?

Takeaway

  1. Doing Kegel exercises before you get pregnant, during pregnancy, and afterward can help keep your pelvic floor muscles strong.
  2. Discuss birthing in a squatting, sitting, side-lying, or standing position with your doctor. This may help prevent damage to your pelvic floor.
  3. Reaching a healthy weight before pregnancy or losing weight after pregnancy may help added stress due to pressure from excess pounds.

Remember: Pregnancy incontinence is a common condition, especially as your belly grows or after your delivery. The good news is that the tips listed above are effective ways to manage incontinence.

Keep reading: Prenatal care: Urinary frequency and urgency »

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