More than fifty percent of pregnant women report negative effects on their quality of life for a variety of different reasons. Negative symptoms of pregnancy can worsen as the baby grows and last a few weeks after birth.
Commonly known symptoms of pregnancy include a high body temperature, weight gain, nausea and mood swings. A weak bladder, however, is a symptom of pregnancy that is less frequently spoken of. A poll of 1,900 women, conducted by Netmums for the Chartered Society of Physiotherapy and the Royal College of Midwives (RCM), revealed one out of three women developed urinary incontinence during pregnancy. Incontinence can have an enormous impact on the quality of an individual’s life, resulting in many women avoiding activities they once enjoyed due to fear of leakages.
Why do pregnant women develop incontinence?
The bladder sphincter is a muscular valve that lies at the bottom of the bladder, controlling the flow of urine. During pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and in the pelvic floor can be overwhelmed by the extra stress or pressure on the bladder. Urine leaks out of the bladder when there is additional pressure exerted on the bladder. 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 are less effective at supporting the bladder, which can also lead to bladder weakness. The muscles surrounding the urethra, the tube through which urine passes from the bladder, can be affected. These muscles are supposed to prevent urine from leaving the body, however, may be “overridden” if the bladder has a strong contraction.
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. The consequence of this can be frequent involuntary leakages and weak bladder control.
How can you treat incontinence during pregnancy?
Pelvic floor muscles span the bottom of your pelvis, supporting the uterus and helping to control the bladder and bowel. Exercising the pelvic floor can, therefore, be greatly effective in improving incontinence during pregnancy. NICE guidelines even recommend women complete regular pelvic floor exercises in their first and subsequent pregnancies to reduce the risk of the condition developing.
Physiotherapists advise daily repetitions of pelvic floor muscle exercises. If you do contact a physiotherapist, they can:
> Teach you how to exercise your pelvic floor muscles correctly
> Advise you on your lifestyle habits, such as diet, exercise, and fluid intake, which will help you manage the problem
> Monitor your progress and modify the exercises accordingly
Physiotherapists work in the NHS, for charities and in the workplace through occupational health schemes.
You can use the Chartered Society of Physiotherapy website to find a physiotherapist local to you here.
Tracking patterns of urination can also help women determine when they urinate and when they leak, often leading to greater understanding of their condition. Timing urination to just before times of common leakage can help keep accidents from happening. Methods such as postponing the time of urination from 15 minutes then to 30 minutes following the first urge to urinate can help train the bladder to retain urine. To practise timed voiding, you can use a chart to record the times that you urinate and when you leak urine. This will give you an idea of your leakage “patterns” so that you can avoid leaking in the future by going to the toilet at those times. Eventually, you can continue to lengthen the times in between urination so your bladder becomes used to retaining urine for longer periods of time.
When should you consider surgery?
For some women, symptoms of incontinence do not respond to conservative treatment during pregnancy. When you’ve tried conservative measures and urinary incontinence continues to disrupt your life, surgery might be an option. Although surgery is more invasive and has a higher risk of complications than do many other therapies, it can also provide a long-term solution in severe cases.
The surgical options available to you depend on the type of urinary incontinence you have. Most surgical procedures to treat incontinence fall into two main categories: sling procedures and bladder neck suspension procedures.
If you have a sling procedure, a surgeon uses strips of synthetic mesh, your own tissue, or sometimes animal or donor tissue to create “hammock” under the tube that carries urine from the bladder. The sling supports the urethra and helps keep it closed so you do not leak urine. The sling procedure that is best for you depends on your situation. If you do use surgery as a final option, discussing the benefits of each type of procedure with your doctor can help you make the right choice.